DELIRIUM TREMENS. 433 



might make the cases due to direct poisoning worse than those 

 arising from sudden withdrawal of stimulants. 



This disease may develop more or less suddenly. It may be 

 preceded by a stage of melancholy, but the actual commencement 

 of the trouble is characterized by marked hallucinations; the patient 

 sees numerous insects or small animals around him; has hairs in his 

 mouth, which he constantly removes with his fingers and spits out ; 

 he hears music, voices, etc. While subject to these hallucinations, 

 the patient may still control himself enough to answer questions 

 rationally; but while speaking coherently he will look past you and 

 around the room, and it is evidently by a great effort of will that he 

 keeps his attention fixed on the conversation. 



As the disease progresses the harmless animals seen may be re- 

 placed by frightful forms, robbers, the devil, and other terrifying 

 personages, who pursue and threaten the poor patient till he is a 

 most pitiable object. At this time more than ever his nerves are 

 unstrung, his limbs in a perfect quiver from excitement and fear, 

 perspiration bedews his face, the tongue is dry, and he constantly 

 stares around as if following his persecutors with his eyes. He can- 

 not sleep or eat. A good nurse, or a courageous, vigorous friend, 

 may persuade him to drink milk, beef -tea, etc. ; but the power of 

 masticating and of supplying saliva for solid food seems to be 

 absent. 



In the first attack very frequently, and in subsequent ones more 

 rarely, the above symptoms will only last a couple of days ; then 

 the patient will eat a good beef -steak, have a sound sleep, and sub- 

 sequently be well except for a slight gastric catarrh, which is very 

 apt to have been induced by his previous prolonged use of liquor. 

 In severe cases, after one or several days of the delirium, while the 

 patient does not seem to be dangerously ill, he may suddenly die 

 from paralysis of the heart ; or in trying to escape his imaginary 

 tormentors he may jump from a window or otherwise do himself 

 serious injury. If the disease lasts several days, with delirium and 

 inability to eat, the tongue becomes dry, the pulse frequent and 

 dicrotic, and the patient dies in a typhoid state. In these cases 

 there is usually chronic disease of the kidneys and liver ; evidences 

 of chronic inflammation of these organs, and perhaps of the cerebral 

 meninges, being the chief changes found on autopsy. 



Delirium tremens rarely lasts a fortnight; in our own experience 

 those cases that last over six days end in recovery. It must be 

 regarded as a very treacherous disease, and our prognosis may 

 always be guarded till the patient has eaten and retained some safe 

 solid food, such as tender beef or mutton. 



