Twenty-five cases of alcoholic delirium in which trional was used with advan tage. Conclusions: 1. Delirium was con trolled with greater rapidity and safety by trional than by other hypnotics. 2. In the majority of cases a marked stimulant effect was observed. possibly on account of the methylie and ethylic elements which enter into the composi tion of the drug. 3. On account of the low temperature noted in all eases, tri onal must posses antipyretic proper ties, thereby simulating its allies of the phenol group. 4. It was always well borne by the stomach, and in one case was rapidly absorbed when administered per rectum. 5. No unpleasant after effects observed. Bellamy (N. Y. Med. Jour., July 21, '94).
Trional of great value in insomnbi. Morphine or opium retards the action of trional. C. 11. Springer (Med. and Surg. Reporter, Sept. 22, '94).
A very hot bath gradually cooled anti trional, 20 grains, in water containing 10 minims of tincture of capsieum recom mended. If in thirty minutes there is no abatement, 10 more grains of trional are given. Forced feeding: milk, eggs, soups. etc. Bellamy (N. Y. Med. .four.. vol. Ix. p. 72, '94).
In all cases of acute mania, or delirium tremens. the use of hyoscyamine. or the alkaloid hyoseyine bydrobromate. in large doses is recommended. I. A. Mar shall (\led. Brief. Jan.. 'OS).
A harmless remedy that will produce sleep in a few minutes. even when the patient is suffering with the wildest de lirium. is opumorphine. Just enough is injected subcutaneously to produce light nausea. but not enough to cause vomit ing. One-thirtieth grain is the average quantity required, but individual is ceptibility greatly varies. In a few min utes after administering the remedy perspiration appears and the patient voluntarily lies down, when a sound and restful sleep immediately follows. This sleep lasts at least an hour or two, and, if other sedatives are previously given, it will last six or eight hours. It is of special value in all forms of mania, regardless of the cause. It may also be given in full emetic doses in many cases of alcoholism with marked benefit. It seems to frequently act as almost a spe cific in relieving the alcoholic craving. Charles J. Douglass (N. V. Med. Jour., Oct. 2S, *99).
In delirium tremens the patient should be put to sleep with apomorphine, which can be done in a few minutes without danger and without emesis. He should not be restrained by physical force, and allowed alcohol in some form. He should be nourished with milk, eggnog, or some other liquid and easily assimilable food.
C. J. Douglass (N. Y. Med. Jour., Nov. 17, 1900).
Opium, if given, should be adminis tered cautiously, in the form of mor phine, hypodermically. If, after three or four doses, the patient is still restless, no more is to be given.
If fever is present, cold douche, bath, or preferably the wet pack may be tried. If the pulse becomes too rapid and weak cinnamon, with very small closes of digi talis in aromatic spirits of ammonia, should be given. Digitalis in large doses is dangerous. (Osier, Delpeuch, Kerr.) Cold baths in febrile delirium tremens at 1S° C., or tempered according to in dividual eases, induce rapid resolution of symptoms. The infection and auto intoxication are directly antagonized. Well-marked cardiovascular disease is a contra-indication. Salvant (These de Paris, 1901).
The patient should he carefully fed, milk and concentrated broths being especially useful. If necessary, nutrient enemata are to be administered.
If the delirium occurs during an acute malady or following an injury, two in dications must be attended to:— 1. Sustain the patient's strength by frequent assimilable nourishment.
2. Obtain sleep. For this purpose opium may be given at the outset in one full close, or laudanum may be given by the rectum.
Chloral may be given in doses of 2 to 3 drachms unless some cardiac or pul monary complication or depression ren ders its use dangerous.
If the delirium appears without ap parent cause, during chronic alcoholism or following recent excesses, the adminis tration of alcohol as a remedy may be come necessary. If the fever be not too high, the delirium too violent, and if the strength of the patient be preserved, it may be withheld; but, if the patient be adynamic, recourse must be had to alco hol, as well as to other diffusible stimu lants: caffeine, subcutaneous injections of ether, or draughts of ammonium acetate. Any form of narcotics should be avoided in these eases. (Delpeuch.) Several eases of delirium and cerebral excitement (sometimes followed by loss of consciousness) witnessed in inebriates, after a full dose of caffeine. The ad ministration of this remedy is therefore contra-indicated. In any event it should always be prescribed with caution, be ginning with small doses, with instruc tions to discontinue the medicine on the appearance of the slightest agitation. Czarkowsky (Amer. Medico-Surg. Bull., July, '93).