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gravely assured, brought about by the beneficial effects of the opium! This patient, we may likewise state, had taken two glasses of gin daily and a pint of beer from the commencement, nearly three days before the manifestation of the vigilant and delirious paroxysm. Dr. Bennett (p. 412) thinks that much of the supposed beneficial action of opium is dependent "on coincidence with the muscular fatigue and exhaustion which at the same time accompany the elimination of the poison and the tendency to repose." Somewhat upon this principle is to be explained, perhaps, the benefit of the "walking drill," which, according to Dr. Blake's experience in the West Indies, was found efficacious in warding off attacks of delirium tremens in the case of drunken soldiers, not from such exercise proving a new stimulus in place of the rum, to which they had no access, but from its wearing-out and eliminating effects, while the proper nutrition of the body was carefully maintained. We may here, with appositeness, refer to the second and fourth cases detailed by Dr. Cahill, in which sleep followed after fatiguing drives, ordered to be performed as curative means by this physician.

It may be replied to us, that even admitting opium is not always of the value supposed, yet the cases recorded by different writers show how great a tolerance there is of this drug under the circumstances, and that no injury arises from its use, whilst we are also bound to remember the numbers of instances which seem at least to imply recovery in consequence of its employment. True it is that there is often apparently a great sufferance of opium shown during the paroxysm, and that patients recover after a narcotism has been forced on before the crisis. But in other cases there is not any such tolerance seen, and though a narcotic slumber be induced, it culminates in the sleep of death, often preceded by coma and convulsion. If, however, this extreme effect be not brought about, any sleep which results is very short and disturbed, and followed by a delirium as bad as before. Even the most strenuous advocates for the opiate treatment are bound, we think, in fairness, to admit, with a disciple of their own school (Mr. Philips), that—

Every case of delirium tremens is not to be cured with opium, or we should not have nearly 250 deaths annually from this cause alone; neither would Klapp have advocated the exclusive virtues of tartar emetic, nor others that of bloodletting or cathartics."*

"To the 286 deaths," says the Registrar-General, "ascribed by the informants to intemperance, 536 deaths by delirium tremens should be added, making 822 by alcoholism, besides many other deaths by secondary diseases."†

Now these deaths occurred, no doubt, after the employment of opium and stimuli; and it is worthy of remembrance, that Dr. Ware's only cases in which death took place after sleep came on, were those which had been treated by large doses of opium, whilst out of 29 treated "expectantly" only 1 was fatal.

Dr. Laycock's explanation of some of the sources of fallacy here be

*Ranking's Abstract, vol. v. p. 15. 1847.

Eighteenth Annual Report, p. 186. London, 1857.

setting us, is quite satisfactory to our minds, though, as we shall presently see, strongly repudiated by others. He says

"It is a remarkable illustration of the influence which usage and routine exercise on the judgment, to find how unsuspiciously as to its bad effects opium is prescribed in this class of affections. Patients who sleep and recover after its administration, sleep and recover it is said propter hoc. If they do not sleep they have not had enough, but if they sleep and die comatose, with livid face and contracted pupils, then the disease, and not the drug, proves fatal. Here, I think, is a whole string of fallacies." (p. 303.)

If it be true that opium and alcoholic stimulants singly are to be deprecated in the treatment of delirium tremens, we can but say that their combination is a twofold evil. Yet it is by this union that the disease is treated throughout this island

"The common practice [in Scotland] has been," says Dr. Peddie," and I have reason to know still is, to give from one tablespoonful to a wineglassful of spirits every two or three hours, either alone or combined with opium." (p. 27.)

"Put their opiate dose," writes Dr. Watson, "into a glass of gin or pint of porter."

"Porter and gin, brandy and wine, are given freely," writes Dr. Dickson. (Op. cit., p.655).


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But," says Solly, "I always combine them with opium and ammonia." The remedy for the disease is opium. . . .We must allow drams or anything else that has become a bad habit." (Elliotson.)

"If a man has been accustomed to drink largely of malt liquor, a drachm of laudanum will act much more beneficially if taken in a pint or a pot of beer, than if taken alone; a similar remark may be applied to other spirituous liquors."*

"Drachm doses of laudanum," writes Dr. Cormack, "may be alternated every two, three, or four hours, with a couple of grains of the watery extract of opium, till the patient sleep. These may be combined with mulled ale or wine, brandy punch."+

The proper answer to these and analogous recommendations is the following-viz.; out of 403 cases treated in the Royal Infirmary of Edinburgh with alcoholic drinks and opiates, during three years and a quarter, 101, or 25 per cent., died; whilst in 24 cases admitted last year under Dr. Laycock, and in 4 private cases, one death only occurred, and which was after the use of opium and alcoholic excitants, the others having been treated upon an "expectant" plan. From 1842 to 1848 there were 35 cases admitted into the Glasgow Infirmary, of these, 17, or nearly fifty per cent., died; whilst Dr. Peddie tells us that during the last ten years he has treated "upwards of 80 cases of the genuine disease, many of them very severe ones, with uniform success," upon principles totally opposed to those of the school of opium and brandy-and-water. Dr. Morehead writes

"I can say nothing of the treatment of delirium tremens by free opiates and stimulants in temperate climates, but I feel myself justified in very positively asserting, that in the delirium tremens of Europeans in Bombay, it is a course of treatment attended with much hazard, and which when systematically followed, is certain of leading to unfortunate results." "Though, as I have elsewhere remarked, figured statements as data from which

Philips, op. cit.

† Methodus Medendi, p. 50S.

Transactions, No. 6, p. 131.

alone to judge of the success of medical treatment, are open to very evident sources of fallacy, and must be used with much caution; yet I feel satisfied that I run no risk of misleading others, when I point to the statistics of the European General Hospital, in proof of the greater efficacy of the treatment of delirium tremens by the means and in accordance with the principles here advocated. From 1838 to 1841, the years during which I became convinced, from careful clinical observation, of the evils of an exclusive opiate and stimulant treatment, the mortality from delirium tremens was 24.5 per cent. Whereas, from 1842 to 1853, a period during which I know that the disease was chiefly treated in the manner recommended by me, the mortality was 94 per cent. Why the year 1848, in which the mortality again rose to 204 per cent., is the single exceptional year of these twelve, I am unable, from the data before me, to explain; but it would be interesting to inquire, by examination of the diaries of that year, whether there was not then a blacksliding into the old and, I fear, still too common system of treatment in some quarters."*

We are quite willing to admit with Dr. Macpherson, that tables of mortality from the disease we are discussing must be looked at with great circumspection, as so little care is often taken in the classification of cases of ebrietas, acute intoxication, mania à potu, delirium tremens, and apoplexy, to say nothing of not discriminating between complicated and uncomplicated forms of the trembling and vigilant delirium of the drunkard. Whilst Dr. Snowden gives the mortality+ as low as four per cent., there occurred one of no less than 37 per cent. in the Royal Infirmary of Edinburgh, between July, 1843, and September, 1847, which rate, however, is yet exceeded by that of the Glasgow Hospital, where one of nearly fifty per cent. was attained between 1842 and 1848. Dr. Macpherson remarks:

"For the first three years when I was with European soldiers, I thought I could always cure the disease. After a period some sailors in Howrah staggered me; and when I came to the pensioners and invalids of the Calcutta General Hospital, I found that many cases were beyond all treatment." (p. 8.)

Not only are tables fallacious, but statements are directly contradictory. "Seamen," writes Dr. Laycock, "just after leaving the shore, are apt to suffer an attack, and have usually no treatment, yet recover after sleep;" whilst

"Dr. Coates mentions, that in the port of Philadelphia it is common for sailors, on first leaving the scene of their frolics for a new voyage, to be affected with a degree of the disease known by the name of the horrors, and yet all these persons recover mostly under the use of strong drinks."‡

And finally, whilst we have seen how some practitioners have reduced the per-centage of mortality from refraining from the use of alcoholic fluids, we are told by others that " in Philadelphia the deaths were one in eight, but have been reduced by the use of stimulants to one in thirty-nine." But with all the difficulties and discrepancies surrounding this matter, we believe that unprejudiced inquiry will lead to the conclusion that the treatment of delirium tremens by large or frequently-repeated doses of opium, and by the continuous administration of spirits, is not warranted by experience nor in conformity with

* Clinical Researches, &c., vol. ii. p. 550.

† Craigie, op. cit. p. 86.

+ Ibid.

theory. We hold it also to be equally a truth that the withdrawal of accustomed stimulants is never a cause of the paroxysmal outbreak, but frequently a prevention of its more perfect development when only threatening the drunkard. In what the proper treatment of delirium tremens à potu consists, and the modifications of it often advisable in those cases of the disorder complicated with "shock," we leave as questions for consideration upon another occasion.


The Cyclopædia of Anatomy and Physiology. Edited by ROBERT B. TODD, M.D., F.R.S. In Six Volumes, illustrated by 2853 Woodcuts and Engravings; accompanied by an Analytical Index for each Volume, and a General Index to the whole Work.-London, 1835-59. Royal Octavo. pp. 5427.

Ir is not unlikely that many of our readers who glance at the above heading find themselves singling out the same part of it for special notice. One touch of Nature makes the whole world of kin. The wing of Time, like the foot of Death, makes no difference of persons. And a retrospect of twenty-five years gives much the same general vista to all active minds. The objects it comprises may be very different; and the nearer of them, even if similar, very differently lit by the intellect, and coloured by the passions, of the observer. But they are all ranged in strict accordance with what we may term the laws of mental perspective; their lines equally converging; their vanishing points identical; and, at a given distance, even their light and shade (at any rate, their colour) more uniform than might be expected. So that to look back on so large a portion of the term allotted to Man as a quarter of a century, probably suggests to all of us the same text, however different the sermon each may preach to himself thereupon. Misty hopes which have vanished, almost unregretted. True friends who have departed, leaving places perhaps filled up, but memories ever open. And going off into the now scarce remembered starting-point of infancy, the path of daily life, with its long series of elevations and depressions, gains and losses, successes and reverses-objects which are continually dwindling down to truer relative dimensions, as the whirling sphere bears us onwards through the universe, and leaves them every hour more distant.

And perhaps the narrowing of such a view from a simply human, to a scientific, retrospect may, while it deepens the sympathies and the responsibilities of the gazer, afford no very different conclusion. Perhaps, indeed, the knowledge which makes the student of modern science in some sense the Priest of Nature, makes him in a certain degree its Prophet also: with the duty of not only seeing, but speaking, aright; of not only recognising, but proclaiming, that awful dawn even now breaking over the mountains, where he stands watching with his fellows. At any rate, the scientific labourer little knows the drift

and object of his own pursuits, the true rewards of the toils which he will never live to complete, and with which he can scarcely expect that even his name will remain connected many years after he has gone down into silence, if he ignores the tremendous lesson his retrospect would afford him; or neglects, while gazing round on the new views perpetually opening out on his sight, to look backwards, as well as forwards, on his general course. If he cannot trace ninety-nine hundredths of his most worldly and material knowledge directly or indirectly to Christianity, he is not only ignorant of causation to a degree which scarcely fits him to be even a microscopist or entomologist, but really almost deserves the theological venom which an inaccurate (or even accurate) word sometimes calls down from devout-as distinguished from Christian-writers. And if, amid all the glare and clang of the thousand anvils at which Art and Science are now fulfilling the will of Omniscience, in forging the engines of the world's future destiny; amid the thousand giant forms of knowledge daily starting up into life (like the stones cast back wards by Deucalion and Pyrrha), from the casual observations of men of the past; if, in all these, he cannot trace the onward progress of a world that is daily ripening to

"One far off divine event,

To which the whole creation moves,"

-why, then, he reads the lesson of his daily life to as little purpose as he haply once read, at his mother's knee, the prophecy of him who was the philosopher, as well as the prophet, of 2500 years ago; and who, sitting on a height of knowledge, human and divine, approached only with reverence by our own Newton, uttered as the summary and the end of his presagings, the comprehensive prophecy, that "many should run to and fro, and knowledge should be increased," in these latter days on which our lot has been cast.

Perhaps considerations like these may seem out of place in a scientific Review. Perhaps some would even prohibit us from mentioning any topics but such as are capable of being strictly classified under special departments of Medicine or its collateral sciences. But surely, not to dwell on the pleonasm really involved in that vulgar phrase "scientific knowledge," or on the absurdity of supposing that we are to dissect through all the details and husks of knowledge, in order to let its costly kernel drop unheeded; surely it becomes us, as a profession, not to add any wilful concealment or distortion to the errors of that portraiture in which the general public has been taught to recognise our body corporate. The attitude of the medical profession towards religious subjects is wofully misunderstood. From the days of Chaucer, whose physician's "reading was but little in the Bible," every scribe and poetaster has depicted us as comparatively irreligious, addicted to materialism, disinclined to believe, and especially averse to anything like being preached to.

All this arises from an error which, if not inherent to the human mind, at any rate reaches back in the world's annals to long before the historic age. Repeated under various phases, its most definite aspect



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