On the pathology of delirium tremens, and its treatment without stimulants or opiates / by Alexander Peddie.

Date:
1854
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Licence: Public Domain Mark

Credit: On the pathology of delirium tremens, and its treatment without stimulants or opiates / by Alexander Peddie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    fused, and the pupils not contracted vmless considerable doses of opium have been administered, or very decided arachnitic symp- toms have supervened; skin warm and moist, often perspiring copiously; tongue sometimes loaded but generally pale and moist, occasionally remarkably clean ; appetite small, but the patient will often take whatever is presented to him ; thirst by no means urgent, and seldom or never any craving for spirituous liquors ; urine scanty and high coloured, and in some cases which I have tested, contain- ing a large quantity of albumen, which, however, disappears imme- diately after the paroxysm is over;^ alvine evacuations bilious and offensive; and the pulse usually ranges from 90 to 120, generally soft, but of various degrees of fulness and smallness, according to the strength of the patient and the stage of the affection. The pre- cursory symptoms are by no means peculiar or pathognomonic, but common to many febrile affections implicating the sensorium in the way of sleepless and restless nights, with, perhaps, more of a hurried and agitated manner than usual for some days previously. The paroxysm, which is distinguished by the phenomena above de- scribed—occurring with remarkable uniformity, independently of age and constitution,^—usually runs its course, if uncomplicated and pro- ^ Probably albumen is always present. In the thirtieth volume of the Transactions of the Medico-Chirurgical Society of London, Dr Bence Jones has endeavoured to prove, from three cases of this disease, compared with three of phrenitis, that the phosphates are found in mucli smaller proportion in the urine of the former than in the latter, and that tlius a new diagnostic mark is presented of tlie nervous and non-inflammatory nature of delirium tremens. His observations, however, are not sufficiently numerous to be conclusive, and there are many probable sources of error. In the only two instances (Cases VII. and IX.), in which I have examined the urine, there were present in the one a great many, and in the other a considerable number of beautiful phos- phatic stellee ; and I have no doiibt that these will often be found in abund- ance in the most genuine cases of the affection. * The age at which delirium tremens most commonly occurs, seems to be between 35 and 50 ; the constitution is the irritable, excitable, and somewhat weakly ; and what is interesting, it is very uncommon in tlie female, although from what cause I cannot explain, for the number afi^ected does not bear any relative proportion to the number of dram-drinkers. I have seen several cases of the delirium ebriosum, but no instance of delirium tremens in the female sex. Rayer observed the disease in 7 women out of l76 cases ; Bang in 10 out of 456 cases; and Dr Hoegh-Guldberg of Copenhagen {Commentatio de Delirio Tremente), in 1 out of 173 cases. Dr Gibson of Glasgow, however, informs me that out of 57 cases treated in the prison of that city during 10 years, 8 were females.