DELIRIUM TREMENS.
The patient must be removed to a partially darkened, noiseless room, with good window fastenings and as little furniture as possible in it. For male patients the female nurse should always have the aid of a reliable male to assist her, and where trained male nurses are procurable their services should always he preferred to females. Often the patient's sur roundings are such that removal to a properly regulated hospital, where suitable provision for such cases is provided, is the only course open to the physician to recommend in violent cases. Though the great majority of the subjects of an attack of delirium tremens betray no evidence of suicidal or homicidal tendencies, the writer has encountered many instances of the contrary during a prolonged residence in hospital, where such cases were common. He has witnessed and experienced several hair-breadth escapes from their violence, whilst they were labouring under the delusion that the nurse or attendants were the hated objects which the hallucina tion of their disordered vision had conjured up. When the very first symptoms of the disease shows Itself the patient must be regarded as insane, and should never for one moment be left alone. Much will depend upon the tact of the nurse, who may be able by humouring the patient to keep him quiet and at rest in bed. Violent and repeated struggles nay be caused by an indiscreet and quick-tempered nurse, and may have a serious influence upon the patient's chances of recovery in bad cases.
Forcible restraint will not be often called for, and the nurse should be made to understand that it is much easier to keep a patient upon his back in bed by gentle persuasion and mild restraint than to allow him to once get up and initiate a struggle, when considerable force will be necessary to get him again into bed. Where this method fails with a restless patient a sheet may be so tied across the bed or tucked in that his movements will be considerably hampered. The straight-jacket—rightly regarded by every physician with disfavour—must in rare cases be employed; and the writer has seen it induce rest and calm, without which the patient's struggles could not have been subdued, and death from exhaustion would inevitably have supervened. Such cases arc, however, rare, and are no
justification for the coarse or cruel abuse which sometimes may be noticed at the hands of untrained nurses or attendants. Visitors should be ex cluded, only one relative being allowed to have access to the sick room.
Food should be administered with regularity, and it should be of the most sustaining and stimulating kind. Solid food, owing to the state of the digestive organs, cannot be taken. Strong soups, beef tea, beef essences, and beef jellies, with an unlimited supply of milk, should form the diet of a patient during the acute stage of the disease. Feeding by the nasal tube and per rectum may be demanded in rare instances.
Such nursing arrangements will safely carry a large majority of patients through their attack, without any narcotics or hypnotics; upon the third night or fourth morning the patient, exhausted and wearied by his restless movements, falls into a natural slumber of variable duration, from which he generally awakes comparatively well and free from all hallucina tions.
Many eases, nevertheless, will demand some further therapeutic measures, and few instances will occur in which some of the distressing symptoms may not he removed or modified by judicious administra tion of medicine.
Alcohol.—The first question which the physician must decide is the one of alcoholic stimulants, and, as mentioned under Alcoholism, the popular prejudice is strongly against the withdrawal of the patient's favourite beverage. In many instances it will be found that he has already ceased drinking just before or soon after the first symptoms of the affection have declared themselves. The distaste for alcohol is often the first symptom of the disease. The physician may be certain that in the great bulk of cases alcohol will do no good, and in very many, especially in young sub jects in their first attack, its administration will do harm.