Delirium Tremens Successfully treated by Chloroform. By
Jonathan Letherman, M. D., Assistant Surgeon, U. S.
Army.
Francis Harvey, a Hollander by birtb, is now, and for a long
period has been, in the service of the United States ; is forty-two
years of age, weight one hundred and eighty pounds, is five feet
seven and one-fourth inches in height, and measures thirty-eight
inches around the chest.
This person had been absent from his Post for a few days in
December, 1851, during which time he drank a large quantity of
alcoholic liquors. This indulgence induced a severe attack of
dysentery, which continued for five days after he reported sick
on the 26th of December, and then entirely ceased.
Upon the subsidence of this disease he was seized with well
marked symptoms of delirium tremens. The day following his
recovery he was perfectly sane. During the previous night,
however, he was slightly wandering in his mind, yet not to such
a degree as to require sending for me. But during the night of
January 1st, 1852, I was called up to see him, and, upon visiting
the Hospital, found him trembling violently, having a great dread
of injury, and a sensation as if a serpent were in his head and
breast. He was fearful of every one who came nigh him, but
when informed who I was his fear of me much abated. His pulse
was frequent and weak, his eyes infected with contracted pupils,
and his countenance exhibiting a vacant stare. A large dose of
tincture of opium was ordered. The following morning, finding
him nothing improved, I directed porter and laudanum at inter-
vals throughout the day. and also the compound infusion of
Cinchona.
During the week ending January 9th, this treatment was con-
tinued, except, that finding the failure of opium and stimulants
in combination, these articles were ofttimes given separately,
attention being given to the diet, which was generous, and to the
organs of digestion. The patient, during this period, occasion-
ally experienced a slight sleep, or, more properly, a stupor, after
having taken a large opiate and stimulants, but it was so slight
as to be of no service and totally unrefreshing. The trembling
and fear of injury disappeared, but he was constantly annoyed
by the idea (of the truth of which he seemed fully impressed) of
animals in his head and breast, now of large beasts, now of
serpents. Notwithstanding the subsidence of some of the symp-
toms, the patient at this time was no better. The tongue was
coated and the pulse frequent and weak. Blue pill was directed,
and Brandy 5 ij., Tine. opii. gtt. 60, aq. 3ij. was ordered every
fifteen minutes until the patient should begin to experience sleep.
This latter prescription was continued for seventeen hours, and
although he was somewhat more tranquil, he yet had no sleep,
and I could not pronounce him better. On January 10th the
principal symptoms persisted, and I directed Brandy ^ij., Tine,
opii. gij., aq. *ij. to be given every half hour until he should
exhibit indications of sleeping. This was administered during
the day, but produced not the desired effect. In other cases I
had used opiates and stimulants in combination and with success.
From the 10th until the 16th of the month, the unpleasant
symptoms would somewhat abate after the administration of large
doses of laudanum, but, upon the withdrawal of the drug, or the
diminution of the dose, he would relapse into his former condi-
tion. As yet he had no refreshing sleep. On the 16th, Porter
~ij., Tine. opii. 3ij., Chloroform gtt. xx. were directed every hour,
to be discontinued should any indications of sleep appear. The
day following he was a little better, but had not slept. The di-
rections of the 16th were enforced, the laudanum excepted. On
the 1st of February the patient had slightly improved, but yet
had slept none. Whilst taking chloroform he was a little better,
yet not sufficiently so to be satisfactory; had wandering pains in
his head and breast. Ordered chloroform 3i. in two ounces of
water every 4th hour, porter §iij. every 2d hour. After the
administration of the chloroform the pain in the head was re-
lieved, the whole system rendered quiet and composed, and, for
the first time during a period of five weeks, the patient slept
well throughout the night. Very shortly after the first dose of
chloroform was given emesis occurred, but a sinapism to the
epigastrium relieved all disposition to vomit, and it happened no
more.
Under this treatment the patient rapidly improved, and except-
ing an attack of intermittent fever, a disease which is rife in this
country, nothing intervened to retard his recovery. On the 25th
of February he was considered able to undergo the exposures in-
cident to frontier service, and was consequently reported for
duty.
He continued well until the first of March, when his desire for
liquors, which at that time was uncontrollable, again led him
astray. He was reported sick to me on the evening of March 3d,
and I found him affected with delirium tremens, having the
“ feeling as if the devil were in his head,” and headache. Di-
rected three cups to nucha, and one drachm of chloroform, and
left, with orders to be called should any untoward symptoms ap-
pear during the night. He felt much relieved after the applica-
tion of the cups, and slept through the night. The succeeding
morning he complained of his head, had a slight fever, no appe-
tite, and a coated tongue ; notwithstanding, he was better. Di-
rected Tincture of Valerian half a drachm every 4th hour, and a
drachm of Chloroform every 4th hour, commencing two hours
after the Tine. Valerian. The morning following the patient
was perfectly sensible ; bowels regular, appetite good, and had
slept well throughout the night. The Tine. Valerian was omit-
ted and chloroform alone given in gradually diminishing doses
until the 7th of that month, when he ceased to take any medicine,
and was again returned to duty on the 15th. On the 21st he
left the Post with his company and marched forty-seven miles
to a station farther in the interior of the State.
This man has been in the habit, for some years, of occasionally
indulging to excess in alcoholic liquors, and had he not been en-
dowed with a vigorous constitution, would doubtless have long
since paid the penalty of such excesses. His case interested me
much by reason of its severity, its long duration, and the total
failure of opiates and varied stimulants, administered separately
and in combination, in affording relief. The failure of the pre-
parations of opium was not to be attributed to a want of being
given in quantities sufficiently large, for they were administered,
not by the ordinary doses, but regulated according to their effects
as much as possible.
The quantity of chloroform first exhibited was too small. At
that time, and for some time afterwards, I was not aware that it
had ever had been given in this disease, and was induced to
direct it from the effects I had noticed in other diseases. It then
failed in procuring sleep, yet it caused a perceptible improve-
ment, and I then took into serious consideration the propriety of
largely increasing the dose, and the probable effects thereof. At
that juncture, I received the American Journal of Medical Sci-
ences for the 4th quarter of 1851, wherein I was much pleased
to see the record of a case in which it had been administered
with profit in larger doses. I had no longer any lingering doubts,
and gave it in such doses, and the result was gratifying in the
extreme.
That it was the remedial in this case can scarcely be doubted,
and should any doubts exist as to its efficacy iu the first attack,
its influence in the second can hardly be questioned. The minor
details of treatment have not been given, as the object has been
to contribute additional testimony to the value of chloroform in
this disease, in controlling which it has acted so speedily and so
well.
Attention was given to the different organs of the body, and
remedies from time to time were administered to keep them, so
far as possible, in a healthy condition.
This man is now in the enjoyment of robust health, and has
been so for many months.
Since I treated this case, I have used this drug in several cases
of this disease, and, with one exception, it answered my expecta-
tions fully. It has brought relief, when opiates, instead of di-
minishing, added to the evil influences of the disease.
Fort Meade, Florida, Dec. 1st, 1852.