DELIRIUM IN FEVER.

Hokitika Guardian, 28 November 1918, Page 3

DELIRIUM IN FEVER.

j (Front Papers on Health, by Professor ! Kirk, Edinburgh). ‘ When fever affects the brain and brings on temporary insanity, one of tbo most severe of afflictions occurs to

those whose duty it is to wait upon the fevered patient. When this insanity is induced by mistaken proscriptions of such drugs as cause delirium, one of the 1 very worst results of a depraved medical system appears. The distress oc- | easioned by this medical treatment is a hundred-fold more severe than that | which arises from the natural cause of ■ the disease. We have repeatedly had | the opportunity of contrasting the two effects when having a sufferer under the drug influence and another free from it, both as nearly equal ill <a fever as two cases could well be. The \ pulse in the one case is rapid and the fever heat greater, with all the symptoms at first rather in favour of the drugged patient, yet the other is scarcely at all delirious, and the drugged one manageable only by force. This gives us | two very different matters to consider when trying to give help in relation to this form of disease. We take up the worst in the first instance and assume that you have had to do with a person whose temporary insanity is due to the drugs he has been made to swallow. He has been attacked with fever and lias had no sleep for several nights. Ostensibly to make him sleep, he has got certain narcotic drugs with brandy, hut there is no sign of sleep from these. There is, however, very distinct signs of delirium. He gets more of the same drugs, but still no sleep Only greatly increased insanity. The doctor has not the courage to prescribe enough so as to secure sloop, for he is aware

that it does not take very much of the poisons which he is ordering to cause the last sleep. He therefore goes on or dering just so much as increases the diseased state of the brain which renders the control of the patient more and more difficult. What is to be don*, in such a case? It is clear that you must in some way get rid of these drugs in one way on another, you have a very difficult task still in hand. The effect of such drugs does not cease when they cease to bo given. It will last for days and nights—perhaps for weeks—aftor. You may, however discover some of these effects which are' within reaeli so that you may apply such remedies as may remove them. For example: If you examine the skin of the head you will probably find that it is hard and dry. It. may be that an eruption of matter has taken place at the roots of the hair, and that the whole scalp lias evidently lost its fitness to throw off the waste matter of which it usually relieves the head. You may here take good, strong, white vinegar, warm, an drub it well into the hair and ski i i f the head. Then you may take warm water and follow up the acid with the softening influence of water. Then you may tie up the whole head in a towel, so as to make the softening process much more effective. Probably you will induce sleep with even this first process. If not, it may be repeated, again after a few hours. One remarkable tiling in such a ease is that the delirium and delusions continue after the fever pulse has entirely subsided and the heat has eonie down to its standard degree. This is the effect of the drugs pure and simple. We never saw the least sign of it where drugs were not used. But the treatment of the head is qqual to its removal. Only when the heat of the Fever has gone off, and the pulse is right, it may ho necessary to pack the head in a warm iomentation, so as to soothe and restore the healthy tone to the brain itself. This may have to he done, perhaps, twice a day, and for half an hour or so at a time. In this case good fresh oil should be rubbed in to finish with. If the feet get cold, as they will probably do after the fever is gone, it will be of great im porta nee to give them a good fomenta- | tion pack, and to rub them lightly with oil. putting on cotton stockings to keep them comfortable. If there is any difficulty as to the water, a good bran poultice once on tbo middle of the back will be of service. But in defiance of everything you can do the delirium may continue for some days, and until something like the sleep lost has been made

iip, and the baneful effect of the narcotic on the nerves has been removed. You may have to wait with patience on a comparatively slow recovery of the mind, but by right treatment of the head that time of waiting may only be a few days instead of months. If the pulse becomes rather slow than rapid, and the heat tends to get too low rather than too high, while the reason is not fully restored, it will he well, as we have said, to foment the head fully and carefully. This may be easily done with a piece of flannel large enough to wrap round the. head four-ply. Wring this out of hot water, so as to have a thoroughly hot mass ready to envelop

the whole head; but do not put it on hotter than you can bear on your own hand. Wrap all round this a good thick towel so ns to keep the heat ns long as possible in the head, and allow this to foment the head for half an hour at least, if the patient can bear it comfortably so long. On removing this, dry the head well, and rub olive oil care fully into the roots of the hair. Then cover the head,' ns in other cases with | the greatest care. This will go a great wnv to give fresh life to the brain it self, and so to bring back the full exercise of mind. It will not require to bo done often— perhaps more than four or five, times at most—it may be not more i than once or wire. You must judge of j the frequency required by the effects j produced. It will be well also to do wliat you can to freshen the back, and so to favour the power of the whole spinal system. This can be done by a smart rubbing with good acetic acid or vinegar, and then with good olive oil. We have seen the reason under such treatment return with a rapidity that astonished the medical attendant. He has given the patient three months to ■ gain what was complete in loss than : one. After what wc have thus said of the cure for cases that have been j seriously injured by drugs, it will be no ! cess ary to say much on such cases as are rightly treated from the outset. In these the head is never allowed to get into the state which we have described, ft is cooled with large, cold moist cloth front the outset, and these keep the skin open and soft. Delirium only shows itself when the cooling process desires renewing. If tho head is allowed to get too hot, the patient gets restless, and symptoms of delusion occur; but

these disappear as soon as the cooling is renewed. If (he force of the fever is too great for mere head cooling to master it, then cooling the back down the centre is added, and sleep comes naturally on. Instead of days and nights of sleeplessness, the patient sleeps by far tbo greater part of the time during • which the fever lasts. We have seen • one who required to be strongly cooled 1 every three hours, night and day, for I eight days. About ten or fifteen minutes before tbo cold cloths were put on lie became somewhat delirious, but as soon as they were put on he fell asleep; when they were taken off he awoke only j long enough to be washed down' and dried. Then he fell asleep again, and slept for two hours fully. The wandering of mind was thus kept in check until the fever finally abated. The contrast between such a case and that of i a patient treated with drugs is as great as can well he conceived. No language can adequately express the value of the rational system when we- know something of the experience of those who have to watch day and night in tbo sick chamber the sleepless and utterly insane sufferer in fever. Now, no one need imagine that there is any difficulty in the way of everyone carrying out the right treatment. We have known a young sister who saw her brother brought- home in fever. The medical man predicted a long and serious illness and the necessity of being prepared lor nil the usual features of sucli a case. His sister heard all in thoughtful silence ; but when the doctor went away she said to herself, “May not I lower this flame? At any rate 1 will try.” So through the night she so effectually cooled her brother’s head that when the medical man came next day lie expressed his most agreeable disappointment, saving “It is 1 - be a very light ease after all!” So it turned out to be, but it would not have been so but for that brave sister’s aid. We cannot but earnestly beseech all who have the opportunity to go and do likewise.