The principles and practice of modern surgery / by Robert Druitt.
- Robert Druitt
- Date:
- 1848
Licence: Public Domain Mark
Credit: The principles and practice of modern surgery / by Robert Druitt. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
35/586 page 29
![sleepless, irritable in his temper, answers questions in a snappish, or peevish, or incoherent manner; is often anxious to call himself perfectly well; and as the malady increases, he becomes restless, impatient, and talkative; wishes, perhaps, to get out of bed, and attempts to injure his attendants, and soon becomes most furiously maniacal. In some cases, however, the delirium is of a milder cast; the patient is haunted with extravagant ideas and spectral illusions ; or fancies himself busied in his ordinary avocations, and talks perpetually about them, [Instead of being violent towards, and disposed to injure his attendants, the patient thus affected is generally timid, easily cowed, and rarely attempts to strike or struggle with those who wait upon him ; and most of all is he afraid of the spectral shapes which his own fancy conjures up, but which to him are the most dreaded realities.—Ed.] Terminations.—The prognosis will be the more unfavourable in pro- portion as the excitement is violent, as that cannot fail to lead to exhaus- tion ; the pulse becoming irregular, the aspect livid and haggard, the ex- tremities cold, and coma supervening, which is soon followed by death. There will be some hope, however, if the pulse becomes more tranquil and firm, and especially if the patient sleeps. Causes.—The exciting causes of this state are (surgically considered) the various mechanical injuries enumerated in the last chapter ;—acting on constitutions that are weak, and consequently irritable ;* that have an increased disposition to act, without the power to act with. Some exam- ples of it occur in children, especially after burns ; but they are most fre- quently met with in the case of persons of middle age and plethoric habit, who habitually indulge in excess of food and spirituous liquors, and who, as is well known, often die from injuries and accidents, which more tem- perate persons might have recovered from without difficulty. Treatment.—The indications are to moderate the excitement, procure sleep, and support the strength. If the delirium be purely nervous, opium is the remedy, given either in one full dose, (such as gr. ii.—iii. of solid opium, or n^ xl.—Ix. of Battley's solution,) or in repeated small doses (such as gr. |-—|-, every two or three hours) according to the surgeon's judgment; the repeated small doses being, perhaps, best, if debility and restlessness are very great. Dupuytren believed that opium was most ef- ficacious in these cases when administered in the form of enema. Some surgeon's prefer henbane. Musk and assafcetida are useful in some few cases. Beef-tea and other mild nourishment should be given, and, if the patient be an habitual drunkard, it will be advisable to allow him some of his favourite stimulus. Nervous excitement is better allayed by one or two kind but firm attendants than by straps and straight waistcoats. The head should be frequently bathed with tepid water; and the bowels be opened by mild aperients. In cases in which the excitement presents somewhat of an inflammatory character, it may be advisable to try the efTects of tartar emetic with the opium F. W^sin the last stage, when coma supervenes, counter-irritation by means of sinapisms or blisters to the scalp, or feet, or calves of the legs, may be tried, but scarcely any means will avail.f * Ofnne infirmum, naturS, qnerulum. f Vide Graves's Clinical Medicine, 1843, p. 452.](https://iiif.wellcomecollection.org/image/b21049737_0035.jp2/full/800%2C/0/default.jpg)
