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Delirium Tremens and Dipsomania

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Delirium Tremens.--Del i ri um is a symptom in many diseases; but delirium tremens arises directly from poisoning by alcoholic drinks. It very often occurs, not during the drinking-bout, but after it, sometimes many days after the person has begun entirely to abstain.

The symptoms begin with loss of appetite, sickness, constipation of the bowels, and sleep lessness or irregular sleep, disturbed with fright ful dreams. Then the tendency to delirium begins to appear in restlessness, suspicion, and tendency to quarrel ; the patient is under great dread of something, and extreme tremulousness of his muscles is present. When the delirium is established he is still full of fear and suspicion, searching under the bed and behind curtains for concealed persons; lie is talkative and in coherent, but can readily recover himself and talk for a little sensibly, soon yielding again to the delirium. He has hallucinations of sight, smell, and hearing, tries to grasp at things he sees floating or lying before him, or to strike at the insects, animals, or imps that swarm on and round him, mocking and leering at him. The delirium may become maniacal, and he may at tack his attendants in his excitement. He may have had no rest for nights, mid may have been without food for days. There is generally thirst, but no appetite.

Favourable cases tend to yield of themselves in three or four days, convalescence beginning by a good sleep of many hours. But instead of this favourable result the delirium may go on, and the person become weak, the temperature rise, and convulsions, going on to coma, may end in death.

Treatment.—Place the patient where he can be kept quiet, in a darkened room, free from noise or excitement, and carefully watched. The patient in delirium tremens is sometimes so outrageous and dangerous as to require to be tied down in bed or restrained in other ways; hence the need of watching. He should have small quantities of nourishing food often, milk, beef-tea, eggs, &c. His bowels should be regu lated by saline medicines. Sleep should be pro cured, and for that purpose 15 grains hydrate of chloral may be given in one dose, to be fol lowed by another dose of 15 grains within an hour, but only if the first has failed to give sleep. Without medical advice no further dose should be given till four or six hours later, when, if necessary, other 15 grains may be given. But it must be remembered that chloral requires caution in its use, so many accidents have arisen in its administration. If chloral cannot be got laudanum may be given ; 20 drops for the first dose, a second dose of half the strength in an hour if required, and further doses of 10 drops every two hours, if necessary, for six or eight hours. The patient should be strictly kept from all stimulants. After sleep has been

obtained and recovery is begun give quinine and iron tonics.

Dipsomania is a condition to which drunk ards are liable, in which there is intense crav ing for drink, not easy for the victims to resist. It comes on in paroxysms, which may last for days or even weeks, and the paroxysms may recur at long intervals.

Treatment.—The sufferer is not to be re garded merely as a victim to cravings which he cannot resist, and for which he is, therefore, unaccountable. They can be resisted, and are, besides, the direct consequences of his own habits. lie should, therefore, be put into con ditions as favourable as possible for his aid. He should have good and nourishing but light diet, no highly-seasoned dishes. His bowels should be carefully regulated with saline medi cines. Change of air and change of society will do much for him; and this will be aided by an active occupation. Some effort should be taken to keep temptation out of his way. Some medicines are recommended as a substitute for his accustomed stimulant. The following has often proved useful:— Tincture of Gentian, } of each 1 ounce, Tincture of Ginger, Tincture of Cayenne, of an ounce.

Syrup flavoured with Tincture 11 ounce.

of Orange,..

Water, 1 ounce. Mix.

Give a tea-spoonful in half a wine-glassful of water when required. Tincture of the red cin chona bark has been much lauded in America for such cases. It is ordered in tea-spoonful (loses, and to each dose 6 drops of tincture of nnx vomica may be added.

In the writer's experience there are only three methods which give any promise of success in the treatment of chronic inebriety. The first consists in placing the person in charge of someone who will exercise a constant supervision. This is a method that is very irk some to the patient and very expensive. The second consists in consigning the patient for a time--six, twelve, eighteen months, or longer— to an institution, public or private, where the patient is kept, and where drink.is not to be had. If the patient is long enough in resi dence, the long-continued abstinence from alco hol permits the re-establishment of nerve tone and nerve control. But not many people can afford thus to go away from home and business for a year or more. The third method is the adoption of one or other of the " Drink cures," of which the "Keeley cure" is the type. The essence of this consists in the injection, under the skin, thrice daily, of a drug whose nature is not stated, and the administration of a tonic by the mouth six times a day. The usual length of treatment is three weeks. This treat ment may be carried out without the patient's business arrangements, &c., being upset; all that is necessary is that he present himself at the stated limits daily for the injections.