Hahn. He states that he has several times succeeded in rousing the child, after the supervention of complete coma. Cold evaporating lotions to the shaven scalp are applicable during the whole course of the disease. In adults, ice may be advantageously substituted.
3239. In Delirium Tremens, cold affusion has been advised by Horn, Ritcher, Hoegh-Guldberg, and others. Lind, Barkhausen, Burrow, Albers, and Armstrong, have also found cold affusion serviceable, but agree in stating that it should not be employed if any profuse perspiration be present. In such cases, they recommend the substitution of tepid affusion over the head, the body being at the same time immersed in a hot bath. It is altogether inadmissible if there be much depression of the vital powers. In Narcotism from over-doses of Opium and Belladonna, cold affusion is often an effectual means of rousing the patient.
3240. In Delirium, arising in the course of Fevers, or from Inflammation of the Brain or other causes, the application of cold fluids to the head has received the approbation of all writers. "If, however," observes Dr. Copland,§ "it (cold) be continued too long, or after morbid heat has been subdued, and the features have shrunk, it will be injurious by depressing the nervous energies too low, and favouring the supervention of coma, or violent agitations, terminating in fatal exhaustion."
3241. In Laryngismus Stridulus, it is of the highest importance to diminish, as far as possible, the nervous susceptibility of the child. In order to effect this, Dr. Merei* strongly advises washing the whole body with water, used gradually colder and colder every morning, for a time varying from one to four minutes, together with cold affusion on the head. If the skin of the infant does not seem sufficiently active, he directs the washing to be performed with a mixture of 1 part of Alcohol, and 8 to 15 parts of water. After the washing, the body should be well dried, and, if the day be fine, the child may be taken out in the open air. In children whose constitutions are not much debilitated, this treatment offers the best chance of success.
* On Fevers, p. 253.
Prov. Journ., Nov. 14, 1849.
Amer. Journ. of Med. Sci., Jnly 1859. § Dict. Pract. Med., vol. i. p. 495.
3243. In Cholera, the employment of cold water was first proposed and carried into practice by Dr. Shute, of Gloucester; and from his experience, as well as from that of others, it appears certain that the free internal use of cold water is productive of the most beneficial effects; and that, when it is withheld, the rate of mortality has been much higher than when it has been allowed. On referring to Mr. Ross's table (sect. 1414), it will be seen, that wherever cold water formed part of the treatment, the ratio of deaths was very much lower than when stimulants, or in fact any other remedy, had been employed. Dr. Shute states that, under this system, the state of collapse is sometimes prolonged to two, three, or four days; and others have remarked that, during the reaction, a paroxysm of raging delirium is apt to take place. It is not, therefore, an inoperative system. The cold water is supposed to act, by supplying to the blood the water it loses by the intestinal evacuations, by taking up the urea, determining to the kidneys, and relieving the blood of the presence of this poisonous agent. When water is given, it should be as cold as is procurable, iced if possible; it should be taken in large and repeated draughts, and although for the first four or five times it may be rejected, its use should be persevered in. It soon remains on the stomach; and when this is effected, a beneficial change in the state of the patient is soon observable. The intense thirst which usually accompanies Cholera would alone justify the adoption of this treatment. Whatever other treatment is adopted, cold water in copious draughts will prove a valuable auxiliary, perfectly safe, agreeable to the patient, and likely to be productive of the best effects.