Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.

Mansell-Moullin, C. W. (Charles William), 1851-1940

Date:: 1893

Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$even l)ettcr, if the patient can be induced to swallow it; hut often he will take nothing at all, or only such things as, from their extreme pungency or acidity, will stimulate a corrupted apj^etite. l>romide of potash is sometimes given in very large doses, but without much avail : chloral is decidedly dangerous, as it tends to increase the vascular depres- sion ; opium, or, better, morphia injected hyi)odermically, deserves more reliance. One-third of a grain given in the alternoon, before the symptoms attain their full severity, and followed by a second similar dose in the evening, is often effectual ; but care must first be taken to examine some of the urine. If the opiate does not succeed, and the sleeplessness still persists, the head may be shaved, and cold water (half-a-dozen jugfuls) jjourcd over it; or chloroform may be cautiously tried, the patient being kept under its influence for twenty minutes or half an hour. If these measures fail, if the patient will not eat and cannot sleep, and particularly if from the condition of his kidneys it is not advisable to administer opium, there is no alternative but to give stimulants. If the pulse is a running one, and they are not given, the patient will almost certainly die. In the vast majority of cases there is no doubt it is better to cut them off at once (though it is quite possible it makes the patient worse for the time), but I have seen many instances in which I am sure the free use of stimulants saved life. The best is bottled stout, of the heaviest and sleepiest description, and it should be given freely, without stint, until either the pulse changes its character or the patient falls asleep. The bowels should be opened as soon as possible; the liver is almost always congested, and it may become necessary to administer nutrient enemata. Quinine and bitter tonics, or alkalies, with carbonate of ammonia, may be advisable for the gastritis and to improve the appetite ; tincture of capsicum is said to be of especial use; but large doses of digitalis are too dangerous. [The use of beef tea is usually followed after a time by great relief, and where there is extreme weakness it may be combined with brandy or sherry. Of such a mixture the dose will vary from a few drops every ten or fifteen minutes to a tea- cupful every two hours.] In many surgical cases restraint of some kind is absolutely necessary, but w^herever it is possible, anything of the nature of a strait-waistcoat should be avoided. Of itself it is sufficient to induce delirium and a severe degree of fever. Patients who are suffering from delirium tremens are for the most part very easily controlled, so long as the attendant is firm ; and it is only in cases of extreme violence, or when there is a fracture which it is absolutely essential to keep quiet, that any tight restraining appliance is advisable. TRAUMATIC DELIRIUM. Traumatic delirium, in the strict sense of that term—excluding, that is to say, the delirium due to pyrexia, that which occasionally follows an anaesthetic, delirium tremens, and those forms which are caused by the absorption of poisonous alka- loids—is decidedly rare. Sometimes, however, a kind of delirium attributable to nothing else is met with, especially in old people ; although, as it is more usual after fractures, it is possible that the symptoms are due, in a measure, to fat-embolism. The delirium is not like that of delirium tremens; it has not the same rest- less, busy character, and the hallucinations are not of the same di.sgusting descrip- tion. The patient is often exceedingly supicious, imagining that every one is wishing to injure him ; but when left to himself he remains quiet, watching every- thing perhaps, and his movements are not tremulous. The tongue is often furred and white, but it can be protruded without fibrillar contractions; food is taken readily \ and though the patient's sleep may be disturbed, there is not the same distressing insomnia. Usually the symptoms subside of themselves in the course of a day or two, w-ith a moderate supply of stimulants; but it sometimes happens that, they persist, and the mental disturbance is permanent.$