On the treatment of delirium tremens, being an appendix to and essay on this disease / formerly published.

Ware, John, 1795-1864

Date:: [1838]

Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of delirium tremens, being an appendix to and essay on this disease / formerly published. Source: Wellcome Collection.

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even admitting it as possible that the great proportion of fatal cases occurring where opium was used, was accidental, it certainly, I think, will not be contended that the favorable termination of the cases not treated by opium, was also owing to accident. And it will certainly follow that opium, if not absolutely injurious to these patients, is at least useless, and that our success in this disease will be sufficiently satisfactory without it. The examination which has been made of these cases has led me to the notice of some other circumstances relating to the history and treatment of delirium tremens, which it may be worth while to record. And first, it appears that a case of this disease is not often fatal unless some other affection is present, which is in itself dangerous, and liable, even without its complication with delirium tremens, to prove fatal. Of the 11 fatal cases above recorded, 7 or 8 were of this character. It is not, however, always in our power to be certain of the existence of such a combination, since the effect of the delirium is to absorb or over-shadow whatever other affection may co-exist, and thus to obscure its symptoms and prevent us from recognizing its presence. It may have been possible, therefore, that in the other fatal cases where no such combi¬ nation was apparent, it may have existed. But it is still worthy of remark that of the fatal cases occurring among patients who were presumed to be free from any such combination, two, if not three, were of those who were subjected to the full opium practice. 2. In three of the fatal cases death took place after the patient had slept. We have been taught to rely on the occurrence of sleep as a pretty certain indication of a favorable termination. It would appear, however, that to this indication there are many exceptions. Neither is the occurrence of sleep in favorable cases always followed by a termination of the paroxysm. Eight patients slept more or less during the continuance of the disease ; awaking to exhibit all the symptoms which had pre¬ viously existed. 3. Convulsions have been considered an unfavorable symptom in delirium tremens ; but of 9 patients in whom they occurred, only two were among the fatal cases. 1 will not assert positively that all the instances in which they took place were noted, yet I do not think they were often omitted. Especially it is probable that they were not overlooked in the fatal cases. Hence, if there be any error, it is one which would diminish rather than increase the ratio of mortality among the cases presenting this symptom. 4. General bloodletting has been usually regarded as inadmissible in the treatment of delirium tremens, and is, by some, thought highly injurious. Thirteen patients were bled from the arm, at some period in the course of their disease. Of these only two died, and these were both affected by peripneumony. This would seem, at least, to show that bleeding is not a dangerous remedy, since the cases in which it was employed were principally those in which there was a combination of some acute disease with the delirium ; in which class of cases, as already observed, very much greater danger exists than in those in which the delirium is uncombined. Boston, April, 1838.