DELIRIUM TREMENS. 



135 



and accelerated pulse, to the most alarming state of vital depression, 

 muscular agitation, and mental alienation. In ordinary cases, it is 

 characterized by constant watchfulness, and tremulous quivering 

 motion in the .lips, hands, and muscles, generally, on making any 

 etfort. The pulse, which is at first slow, becomes quick ; there is a 

 constant disposition to talk, now on one subject, and now on ano- 

 ther. In the first variety mentioned, the pulse is full and hard, the 

 skin dry, the delirium furious, the eyes injected, the temperature of 

 the head increased, and the tongue is often dry, and red at its 

 edges. In the second form, which is the most common, the pulse is 

 small, or soft, and ranges between 100 and 120 ; the face is not 

 flushed, nor the skin hot, but is. covered with a clammy perspira- 

 tion. As the disease advances, the mental delusion becomes con- 

 stant, and is generally of a low or melancholic kind, with continued 

 reference to the patient's ruling passions and occupations, and 

 anxiety respecting them. He is perpetually haunted by frightful 

 creatures, or occupied with the most extravagant ideas, and is con- 

 tinually endeavouring to avoid them. If a favourable change do not 

 now take place, the skin becomes more cold and clammy, and ex- 

 hales a peculiar smell, which is, as Dr. Hodgkin has remarked, 

 between a vinous and- alliaceous odour ; the pulse becomes still more 

 frequent, small, weak, and thready, so that it cannot, in some cases, 

 be counted; the general tremor increases ; the patient talks inces- 

 santly, and with great rapidity ; the delirium increases, and the 

 patient either sinks into the calm which sometimes precedes death, 

 or is carried off in a convulsive effort. 



Morbid appeara7ices. — The appearances on dissection give no 

 direct information on the nature of this disease. In the true delirium 

 tremens, the 'membranes of the brain evince but little change, the 

 chief lesion consisting of slight opacity of the arachnoid, especially 

 at the base of the brain. The pia mater is more or less injected, 

 and an effusion of serum is occasionally observed in the ventricles. 

 In those cases which have accompanied or directly followed intoxi- 

 cation, the vessels are often much congested, particularly those of 

 the velum interpositum ; the arachnoid is thickened, and the serum 

 is more abundant, and occasionally is even sanguineous. The ap- 

 pearances of the stomach and liver are not necessarily connected 

 with the pathology of this disease. 



Treatmeyit. — In the form of this disease which is attended with 

 increased vascular action, cupping below the occiput, or leeches 

 behind the ears, will be required ; cold lotions, or cold affusion to 

 the head, when its temperature is increased ; sponging the body with 

 tepid water; purgatives, judiciously combined with stimulants; and 

 aperient and antispasmodic enemata. AVhen the affection has been 

 caused by spirituous liquors, we should assiduously watch the sub- 

 sidence of the inflammatory symptoms, and anticipate the depression 



