Though the physician should act firmly in insisting upon this complete withdrawal, he will be wise to postpone it for a short time if he has good reason to suspect that symptoms of delirium tremens are about to im mediately declare themselves.
Exception should be made in those very much debilitated from disease, especially in those suffering from heart affections, and in the aged. If the pulse should exhibit marked signs of weakness and irregularity, if there has been prolonged insomnia, or if the history of the patient shows clearly that he has for years been taking alcohol in moderate doses daily before his recent excess, then small regulated doses of alcohol should be administered to him at stated intervals, the dose to be proportional to his habits. Generally speaking, 12 oz. of whiskey should be rarely per mitted during the 24 hours, and 6 oz. for all cases may be said to he a fair allowance during the first few days, though the patient may have been in the habit of taking much larger quantities.
If there is much gastric irritability Champagne may be given, hut all other wines should he forbidden. Good whiskey alone being selected as the stimulant, the rule should be laid down that it must be taken by the patient mixed with his soup or milk by a reliable nurse.
In the great majority of instances, however, the physician when called to treat a case of chronic alcoholic poisoning will be safe in fearlessly acting as he would in any other case of poisoning—by immediately stopping the administration of the poison. Much can he done with the assistance of a firm nurse, who should administer liquid nourishment every 15 or 3o minutes.
The following may be given with benefit to allay the craving for alcohol, and to some extent it takes its place: R. Tinct. Cinchonce Liquor. Strychnince Hyd. 5j. Tinct. Cafisici SPt. Ammon. :Iromat. ad ;,iv.
Fiat mistura. Sig.—" A large teaspoonful in half a tumblerful of effervescing potash water every hour." Or the following may be tried :—Ext. Cocx Liq., r oz.; Tinct. Card. Co., 2 oz.; Tinct. Cinnamom., i oz.—one teaspoonful every hour in water.
Or the following :—Tinct. Jaborandi, 3 drs.; Tinct. Chiratx, 2 oz.;
Aqule ad io oz.—one dessertspoonful every quarter of an hour.
Attention has of late years been directed to the value of Strychnine and Nux Vomica in the treatment of alcoholism and delirium tremens. The author first pointed out in 1882 the striking effects of alcohol in Strychnine poisoning, and published a case where recovery followed after the failure of the recognised remedies. He is satisfied that strychnine is a remedy of great value, acting as an antagonist to alcohol, and he finds that it affords the best results of all drug treatments in diminishing the craving for alcohol and preventing the depression following its with drawal. In all cases it should be pushed, and though relapses occur as a rule, the physician can depend upon it in helping the patient till moral influences have time to operate in his reform. The drug may be given hypodermically gr.), while smaller doses are administered by the mouth. Many permanently successful results follow the methodic injection of Strychnine along with Atropine in regulated doses for a couple of weeks, but this treatment can only be properly carried out in combination with restraint in a fully equipped sanatorium under the personal supervision of a skilled physician. Many so-called " Alcohol Cures " contain Strych nine, some contain Brucine, Gold Salts, and Atropine, but the majority contain large percentages of Alcohol.
Coca leaves and Quassia chips may be chewed during the intervals between food and medicine.
Alexander Lambert, in the treatment of over i,000 cases with 8o per cent. successes, begins with smart mercurial purgation, and gradually diminishing doses of alcohol. He uses a mixture consisting of Tinctunt Belladonme (15 per cent.), 2 oz.; Fl. Extract. Xanthoxyli, r oz.; Fl. Extract. I lyoscyami, r oz. Of this, 6 drops arc given every hour for six hours, afterwards increased by 2 drops every six hours until 16 drops arc taken hourly (lay and night till symptoms of belladonna action appear. Vigorous Catharsis is repeated at intervals of ro, 18 and 24 hours, as the principle of the treatment is the rapid elimination of the poison.