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

Date:
1854
Catalogue details

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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    accustomed to treat this affection with large closes of opium, will be able, on reflection, to explain his want of success, and the occurrence of casualties. In fact, when recovery takes place after a long sleep forced on by a large opiate, it is simply from the wonderful conservative power of nature resisting the evil influence of the agent, just as some will recover from a severe apoplexy or a palsy. The practice is one of the utmost hazard. If death were the certain alternative in delii'ium tremens should sleep not be early obtained—for it it is said that the patient must sleep or die,—there might be some reason in attempting to force on the sleep by opiates. This, however, is certainly not the case, and consequently such interference is not only uncalled for but most improper, when there is danger to be apprehended from the practice. Sleep occurs as the natural, the favourable crisis, or rather termination of the disease; and it is not to be viewed as a part of the affection, or in the same light as we are accustomed to regard a critical sweat or other discharge. It is the result and the proof of an improved condition of the brain and nervous system,—a salu- tary relaxation succeeding a state of dangerous tension. It will take place in the mild but genuine forms of the affection at the proper period, which, as I have already remarked, is on the second or third day, when the paroxysm has run its course, when the pe- culiar erythism, the nervous irritability, is brought to an end, and a condition of exhausted nervous power now truly produced. That sleep may likewise ensue in severe examples of the disease, although no opiate of any kind is given, the cases at the close of the present paper will prove ; and while convinced that the plan of ti'eatment now to be recommended will be found the most efficacious, I have no hesitation in saying that in a larger pro- portion of instances, sleep would take place spontaneously at an earlier period, and the subsequent condition of the patient be much more sound and safe, by doing nothing at all, than by the use of opiates. I have seen very decided cases of the disease recover well when a mere placebo was given with a view to keep up the ap- pearance to friends of something being done, and prevent them from using as remedies things which would be hui'tful. Dr Ware of Boston, in an excellent memoir on delirium tremens,^ strongly advocates from experience the do-nothing plan of treatment. Among other things, he says of opium :— ' Quoted in the British and Foreign Medical Review, vol. xxiii. p. 603.