- Email: [email protected]
THEORIES OF DELIRIUM TREMENS AND ITS TREATMENT.
712 The PRESIDENT regretted that through indisposition Dr. Radford was unable to be present. He considered the first great cause of rupture was protracted labour, and the object to be had in view was to remove the obstruction as speedily as possible. A second cause was rigidity of the ps uteri, and he agreed with the author as to the necessity of incising the A third and fourth cause existed in the obliquity of the os. uterus, which caused it to become jammed in the pelvis; also, when there is a dead fcetus in utero there is a want of the resiliency which a live child possesses, and the action of the uterus rather tends to squash than to expel it. He also mentioned disease of the uterine tissue as another cause leading to rupture. He thought softening of the tissue might depend upon degeneration, either before labour or during labour, by the pressure of the fcetal head against the pelvis. With respect to gastrotomy, he would say that Dr. Radford had urged the operation, but that it had been overruled by others. The late President of the Society objected to any operative measures whatever when the fcetus had escaped into the abdominal cavity; and he (Dr. Barnes) had seen a case where it was left, and the woman recovered. Dr. BRUNTON observed that the cases. which Dr. Radford had collected were attended by midwives, and he knew that midwives were in the habit of giving very large doses of ergot. He believed that this was one of the great causes of rupture of the uterus; and when it did not cause rupture the placenta was often retained, owing to the irregular contractions of the uterus produced by that drug. The meeting then adjourned.
believed to be an intense "epigastric neuralgia, or feeling of " sinking with gastritis." These are the five cases in which or either opium morphia was given in "appropriate"-that is, in small-doses, chiefly for the relief of gastric symptoms. I admitted in my former letter that the account which, in my lecture, I gave of Dr. Laycock’s theory and treatment of delirium tremens was incomplete. I deny that in any essential particular it was inaccurate or "imaginary." The extracts which I have now given from his paper suffice to show that amongst the "conditions" which favour the occurrence of the disease he attaches considerable importance to the presence of alcohol in the blood; that he speaks of the eliminative process as one to be encouraged and assisted; that he gives no alcoholic stimulants unless they are " specially indicated"; and’ that, as a rule, he gives no opium, though in exceptional cases’ he gives small doses of opium or morphia with other remedies,, chiefly for the relief of gastric pain, and not for the direct purpose of procuring sleep. The statement in my lecture to which Dr. Laycock so violently objects-namely, that " opium and alcohol must, in accordance with Dr. Laycock’s theory, be injurious in the treatment, since opium checks elimination and alcohol tends to perpetuate the disease"-is simply the expression of my own opinion, that, in so far as alcohol is a cause of the disease, it must hinder the cure; and that opium, which is generally acknowledged to check all secretions except that of the skin, must impede the escape of the alcohol, and so be
injurious. I
leave to the
judgment
of
yourself, Sir,
and your for as-
reason
serting that I fix upon him " theories worse than imaginary," and that " the statement as to the eliminative theory of treatment is equally mischievous and imaginary." I am. Sir. vours &c.. GEORGE JOHNSON. Savile-row, June 25th, 1866.
THEORIES OF DELIRIUM TREMENS AND ITS TREATMENT. To the Editor
now
readers, the question whether Dr. Laycock had
of THE LANCET.
SiR,-Unwilling as I am to occupy your pages with profitable controversy, I cannot allow Dr. Laycock’s letter to pass without a brief reply. Dr. Laycock declares that I have not read his paper.
an un-
second
i
DR. LANKESTER AND THE MEDICAL PROFESSION. To the Editor of THE LANCET.
I had I SIR,-Some severe strictures in the medical press and in stated, with reference to the public newspapers reflecting somewhat unsparingly on the. cases treated in the Edinburgh Royal Infirmary and in private , conduct of the officers of the Coroner’s Court of Central Miclpractice, "these (twenty-eight) cases, with one exception, were I all treated without opium or stimulants, and some without dlesex, and more especially on Dr. Lankester, I am induced, ’i, as a medical practitioner of long standing in this district, to any drugs whatever." Then, amongst the conditions affecting the blood of those I, state, in to the profession and to those officers, that I who suffer from delirium tremens, "alcohol in the blood pre- i have at justice all times received that courtesy and consideration, dominantly" is mentioned. With reference to four cases, the with prompt payment, to which all men are entitled who details of which are given, Dr. Laycock remarks : " The im- I maintain their status in the various responsibilities of medical mediate indications were (1) to allow time for the alcohol life. I am sure there are many gentlemen in this neighbourpresent in the blood to be climinatetl before taking other steps ; hood who would willingly render unto Cesar the things due (2) to procure sleep. The pisrutive rassisted nature in the to Caesar, but from a multiplicity of engagements are prevented elimination." Again, amongst the general rules for treatment, on the present occasion. I am therefore the more anxious I find " no alcoholic stimuli of any kind administered as that my testimony should appear in an early number of articles of diet unless specially indicated. When there is a THE LANCET, called forth by the personal satisfaction and tendency to diaphoresis it should be encouraged as an elimina- gentlemanly demeanour, on evpry occasion where my profestory process......If the patient be alcoholised, and no important sional services have been required at the Coroner’s Court, from complications be discovered, he may consider the sleeplessness Dr. Lankester and his officers, and delirium as of no great pathological importance, and I have known the summoning officer many years, and can. calmly and confidently wait the result of a few days’ judicious bear witness to his integrity, on which I have heard the late watching and general management of the case." The italics Mr. Wakley express a favourable opinion. in the preceding extracts are my own. Under the head of I am, Sir, truly yours, general rules for treatment the use of opiates is not mentioned, WM. SETH GILL. Pentonville, June 24th, 1866. read
it, and in the first page I
find it
,
’
but Dr. Laycock states that out of fifteen
cases
recorded in his
paper "not fewer than six took either opium or morphia in appropriate doses." This statement is inaccurate ; opium or morphia was ordered in six cases, but in only five cases was it taken.
In
out of the six (Case 8) it is said " the strongly marked that an opiate was at last ordered, but happily not given, as he fell asleep before it was given." In Case 9 one-eighth of a grain of muriate of morphia was given three times a day with a small dose of calomel and nitrate of silver, as it is said " solely to relieve the gastric and duodenal irritability, and thus to enable the stomach to digest and to retain food." In Case 10 the gastric pains were very
sleeplessness
one case
was so
To the Editor
of
THE
LANCET.
SiR,—From the letter of Dr. Lankester published in the last number, it appears that my only fault was, that I did not inform the coroner and jury of the reason why I did not attend the inquest. Surely Dr. Lankester cannot have forgotten that I called at the house of his officer in the morning some hours before the appointed time and fully explained the reason of I remain, Sir, your obedient servant, my absence. N. H. CLIFTON. Cross-street, Islington, June 27th, 1866. to Dr. Lankester’s letter has been Dr. Sansom’s * reply received, but arrived too late for insertion this week.
severe; she was " accordingly ordered nitrate of silver and muriate of morphia pill, which speedily gave her relief." In Case 11 one-sixth of a grain of morphia was ordered every THE BIRMINGHAM ABORTION CASE.-Ellen Owen, four hours, apparently for the relief of gastric pain, though this is not expressly stated. In Case 13 a quarter of a grain of i herbalist; Wm. Vernon Smith, "surgeon;" and Wm. Broomopium was given, with nitrate of silver and ipecacuanha, three field, clerk, were committed on Friday last for trial at the times a day. And lastly, in Case 14 morphia, nitrate of silver, assizes, charged with having attempted to cause abortion on the and calomel were given (doses not mentioned) for what was person of a young woman named Elizabeth Ellesmere.
believed to be an intense "epigastric neuralgia, or feeling of " sinking with gastritis." These are the five cases in which or either opium morphia was given in "appropriate"-that is, in small-doses, chiefly for the relief of gastric symptoms. I admitted in my former letter that the account which, in my lecture, I gave of Dr. Laycock’s theory and treatment of delirium tremens was incomplete. I deny that in any essential particular it was inaccurate or "imaginary." The extracts which I have now given from his paper suffice to show that amongst the "conditions" which favour the occurrence of the disease he attaches considerable importance to the presence of alcohol in the blood; that he speaks of the eliminative process as one to be encouraged and assisted; that he gives no alcoholic stimulants unless they are " specially indicated"; and’ that, as a rule, he gives no opium, though in exceptional cases’ he gives small doses of opium or morphia with other remedies,, chiefly for the relief of gastric pain, and not for the direct purpose of procuring sleep. The statement in my lecture to which Dr. Laycock so violently objects-namely, that " opium and alcohol must, in accordance with Dr. Laycock’s theory, be injurious in the treatment, since opium checks elimination and alcohol tends to perpetuate the disease"-is simply the expression of my own opinion, that, in so far as alcohol is a cause of the disease, it must hinder the cure; and that opium, which is generally acknowledged to check all secretions except that of the skin, must impede the escape of the alcohol, and so be
injurious. I
leave to the
judgment
of
yourself, Sir,
and your for as-
reason
serting that I fix upon him " theories worse than imaginary," and that " the statement as to the eliminative theory of treatment is equally mischievous and imaginary." I am. Sir. vours &c.. GEORGE JOHNSON. Savile-row, June 25th, 1866.
THEORIES OF DELIRIUM TREMENS AND ITS TREATMENT. To the Editor
now
readers, the question whether Dr. Laycock had
of THE LANCET.
SiR,-Unwilling as I am to occupy your pages with profitable controversy, I cannot allow Dr. Laycock’s letter to pass without a brief reply. Dr. Laycock declares that I have not read his paper.
an un-
second
i
DR. LANKESTER AND THE MEDICAL PROFESSION. To the Editor of THE LANCET.
I had I SIR,-Some severe strictures in the medical press and in stated, with reference to the public newspapers reflecting somewhat unsparingly on the. cases treated in the Edinburgh Royal Infirmary and in private , conduct of the officers of the Coroner’s Court of Central Miclpractice, "these (twenty-eight) cases, with one exception, were I all treated without opium or stimulants, and some without dlesex, and more especially on Dr. Lankester, I am induced, ’i, as a medical practitioner of long standing in this district, to any drugs whatever." Then, amongst the conditions affecting the blood of those I, state, in to the profession and to those officers, that I who suffer from delirium tremens, "alcohol in the blood pre- i have at justice all times received that courtesy and consideration, dominantly" is mentioned. With reference to four cases, the with prompt payment, to which all men are entitled who details of which are given, Dr. Laycock remarks : " The im- I maintain their status in the various responsibilities of medical mediate indications were (1) to allow time for the alcohol life. I am sure there are many gentlemen in this neighbourpresent in the blood to be climinatetl before taking other steps ; hood who would willingly render unto Cesar the things due (2) to procure sleep. The pisrutive rassisted nature in the to Caesar, but from a multiplicity of engagements are prevented elimination." Again, amongst the general rules for treatment, on the present occasion. I am therefore the more anxious I find " no alcoholic stimuli of any kind administered as that my testimony should appear in an early number of articles of diet unless specially indicated. When there is a THE LANCET, called forth by the personal satisfaction and tendency to diaphoresis it should be encouraged as an elimina- gentlemanly demeanour, on evpry occasion where my profestory process......If the patient be alcoholised, and no important sional services have been required at the Coroner’s Court, from complications be discovered, he may consider the sleeplessness Dr. Lankester and his officers, and delirium as of no great pathological importance, and I have known the summoning officer many years, and can. calmly and confidently wait the result of a few days’ judicious bear witness to his integrity, on which I have heard the late watching and general management of the case." The italics Mr. Wakley express a favourable opinion. in the preceding extracts are my own. Under the head of I am, Sir, truly yours, general rules for treatment the use of opiates is not mentioned, WM. SETH GILL. Pentonville, June 24th, 1866. read
it, and in the first page I
find it
,
’
but Dr. Laycock states that out of fifteen
cases
recorded in his
paper "not fewer than six took either opium or morphia in appropriate doses." This statement is inaccurate ; opium or morphia was ordered in six cases, but in only five cases was it taken.
In
out of the six (Case 8) it is said " the strongly marked that an opiate was at last ordered, but happily not given, as he fell asleep before it was given." In Case 9 one-eighth of a grain of muriate of morphia was given three times a day with a small dose of calomel and nitrate of silver, as it is said " solely to relieve the gastric and duodenal irritability, and thus to enable the stomach to digest and to retain food." In Case 10 the gastric pains were very
sleeplessness
one case
was so
To the Editor
of
THE
LANCET.
SiR,—From the letter of Dr. Lankester published in the last number, it appears that my only fault was, that I did not inform the coroner and jury of the reason why I did not attend the inquest. Surely Dr. Lankester cannot have forgotten that I called at the house of his officer in the morning some hours before the appointed time and fully explained the reason of I remain, Sir, your obedient servant, my absence. N. H. CLIFTON. Cross-street, Islington, June 27th, 1866. to Dr. Lankester’s letter has been Dr. Sansom’s * reply received, but arrived too late for insertion this week.
severe; she was " accordingly ordered nitrate of silver and muriate of morphia pill, which speedily gave her relief." In Case 11 one-sixth of a grain of morphia was ordered every THE BIRMINGHAM ABORTION CASE.-Ellen Owen, four hours, apparently for the relief of gastric pain, though this is not expressly stated. In Case 13 a quarter of a grain of i herbalist; Wm. Vernon Smith, "surgeon;" and Wm. Broomopium was given, with nitrate of silver and ipecacuanha, three field, clerk, were committed on Friday last for trial at the times a day. And lastly, in Case 14 morphia, nitrate of silver, assizes, charged with having attempted to cause abortion on the and calomel were given (doses not mentioned) for what was person of a young woman named Elizabeth Ellesmere.