212 THE TREATMENT OF DISEASES. 



In favourable cases, a critical sleep comes on about the beginning of the third or 

 fourth day, and the patient slumbers heavily for twelve hours or more. From this 

 he awakes fearfully weak, but free from delirium. Such is the rule ; but, unfor- 

 tunately, after many hours' profound sleep the patient sometimes awakes as delirious 

 as ever, or in a state of complete prostration, which may terminate in death. The 

 occurrence of sleep marks the commencement of convalescence only when, 011 awaking, 

 the intellect is clear, the delusions and hallucinations have disappeared, and the pulse 

 is reduced in frequency. The stage of convalescence once established, every tiling 

 progresses favourably. But, unfortunately, in many cases there is no sleep at all ;. 

 the wakefulness continues, and the case becomes critical. 



Let us now discuss the treatment of delirium tremens. The patient should be at 

 once put to bed in a quiet, darkened room the less furniture the better and every- 

 thing should be avoided that could in any way excite his imagination. Friends and 

 relatives often annoy him by their presence, and it is as well that they should be 

 replaced by a good automatic attendant who will not talk. In cases in which the 

 patient is both violent and of considerable strength, two trained nurses, with 

 experience in the treatment of lunatics, should be in constant attendance. It is. 

 always most desirable to avoid the use of the straight-jacket, or even of bandages,, 

 for the purpose of restraint ; and this may usually be done by a little tact and 

 management. 



It is of vital importance that the patient should be well supported by the 

 frequent administration of food. He will not take mutton-chops, or anything of that 

 kind, and it is useless trying to induce him to do so ; but you may get him to 

 swallow the whites of a dozen eggs with a little lemon-juice in it, or he may take 

 whey of milk with lemon-juice, and, perhaps, just a dash of wine or brandy to 

 flavour it. It is desirable that plenty of milk should be taken, or soup, or strong, 

 hot broth with bread in it. The addition of plenty of Cayenne pepper to the soup 

 or broth often proves beneficial to still the nervous excitement. The necessity for 

 the administration of some nutriment is imperative ; and if the stomach be at first 

 too irritable, or the loss of appetite too complete, to allow of food being taken in the 

 usual way, it must be given in the form of an injection. Even more depends on 

 dietetic than on medicinal treatment. In young people no hesitation need be felt 

 in completely cutting off stimulants, but in those who are old and feeble a small 

 quantity of wine or brandy must be allowed. 



It is a good thing to get the bowels open ; two or three watery motions do good, 

 but excessive purgation must of course be avoided. Three or four table-spoonfuls of 

 the white mixture (Pr. 25) will generally be found to answer as well as anything. 



With many people it is the custom to give very large doses of opium in delirium 

 tremens, with the view of producing sleep ; but the practice is by no means a safe 

 one. If there is much restlessness at night there is no objection to the administra- 

 tion of two grains of opium in the form of two five-grain compound soap pills 

 or thirty drops of laudanum in water. A hypodermic injection of morphia is pre- 

 ferable to giving opium by the mouth, as it does not interfere with the stomach. 



Chloral is a most valuable agent in the treatment of delirium tremens. In 

 ordinary cases it will suffice to give two tea-spoonfuls of the syrup of chloral at bed- 



