I THINK THAT OF ALL REMEDIES for delirium tremens the spinal icebag is the one which is comparably the most successful. I reproduce two cases below.

Male public house worker

JB, male, aged twenty-seven. Consulted me at the Farringdon Dispensary, August 29th, 1868. He said, ‘I have always a feeling about me as if something is going to happen, as if I am going to die. I can’t get no sleep of a night; I gets out of bed and feels my flesh – fancying it’s getting limp and dying – and has a sort of creeping feeling about my brain, and fear that if I go to sleep I shan’t wake again.’

He sees an inquest being held over his body; cannot walk along the streets without feeling that the ground will open and swallow him up. Is constantly sighing and shuddering; and he says he has ‘sometimes a sudden fluttering of the heart, and his pulse seems to stop.’ He fears he is impotent, though he is the father of a child. Has nocturnal emissions. Has been separated from his wife during the last four months. Tongue moderately clean; pulse 75.

He is employed in a public-house, and takes ‘about half a pint of brandy or gin, and five or six, or seven, or eight glasses of beer a day’! He naively asks, ‘Is that too much for a man to take in his system daily?’

I ordered the application of the spinal icebag along the whole spine during two hours, or until the ice should have melted, three times a day. No medicine.

September 2nd Feels ‘much better – a thousand times better’; has ‘slept better – first rate.’  He says, ‘It’s braced me up wonderfully, and I feel another man. I don’t shudder and sigh as I did; I’ve no misgiving, more confidence, and can go along the street without being frightened.’ Pulse 99. Treatment as before.

September 9th Reports himself perfectly well. Sleeps soundly. No fear or dread of any kind. Tongue clean and steady; pulse 96. Ordered to continue treatment as before.

October 17th The patient states that he used the icebag as ordered during three weeks altogether; that he has continued quite well ever since, and that he has resolved to change his occupation, in order to avoid the temptation which employment in a public house leads him into.

Tavern keeper

J M, a strong muscular fellow, of about forty-five years of age, was admitted into the City of Dublin Hospital, 25th February, 1868, in a most excited state; he shouted and kicked violently; talked to imaginary persons; and when, about two hours after having taken beef tea, milk, and a bolus containing twenty grains of capsicum, ‘he fell into a disturbed sleep, it was broken by dreams and phantoms of dogs, horses, soldiers, and spiders.’

The next day he insisted that his belly had been cut open, and continued talking in a rapid, unconnected way.

On the evening of the 28th he became so violent, that he frightened two male attendants to such a degree, that they ran out of the ward. During the night it was found necessary to restrain him by putting on the strait-waistcoat.

When admitted he was perspiring freely; his face and eyes were congested; his tongue moist, and coated with creamy fur; his pulse was slow, full, but very compressible, and his hands were tremulous.  For the last twenty years he had led an intemperate life, ‘and having become a tavern-keeper,’ he drank night and day for about six months, and had not ceased up to the time of his admission.

He was treated successively by means of capsicum, tartar-emetic with opium every second hour, a stream of water directed from a height of some feet on his head, and an enema containing tincture of opium and tincture of bella donna. All the remedies tried have proved of no avail.

He was put to bed, and then an icebag was applied from the fourth cervical down to the upper lumbar spines. In a very short-time after its application he fell asleep, and slept so soundly that it was left on for more than two hours, when he awoke, took some beef tea, and then fell asleep once more.

In the evening I found him free from the slightest trace of sweating; the surface was of a uniformly good temperature; the pulse had lost all its feebleness, and had become again slow, full, and regular; the face had acquired its natural colour and expression, and the tremors had greatly diminished; he had slept well all through the day.

From this period his recovery was complete, his appetite soon returned, and he was given a liberal diet without any stimulant. He slept for the greater part of three days, during which the icebag was applied twice daily. He always found it strengthened him, and he said it made him feel as fresh as ever.

On the 10th March he was dismissed cured, and he has since been seen and has had no relapse.