GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



In all cases of delirium tremens the condition of the kidneys and 

 of the thoracic organs should be carefully scrutinized ; for we should 

 bear in mind that pneumonia attacking a person of intemperate 

 habits presents all the symptoms of delirium tremens, and in many 

 such cases there is neither cough nor expectoration, nor does the 

 patient complain of pain, nor indeed of any symptom likely to 

 direct the attention of the physician to the real nature of the dis- 

 ease. It has not unfrequently happened that a man has died under 

 diagnosis of delirium tremens, and a pneumonia, which had not 

 been even thought of during the progress of the case, has been re- 

 vealed upon dissection. 



The symptoms of Bright's disease also are not always so marked 

 as to attract immediate attention. A uraemic convulsion sometimes 

 admonishes the unwary practitioner that a grave condition of the 

 kidneys has been overlooked. 



TREATMENT of delirium tremens, as of any disease, must depend 

 greatly on the symptoms ; but numerous special plans have had 

 their advocates, such as that by opium, alcohol, and digitalis ; each 

 of these has doubtless proved useful in the hands of its advocates, 

 but no one has proved universally acceptable. The remedy at pres- 

 ent most generally relied on is bromide of potassium. It may be 

 given in doses of thirty grains every hour till the patient sleeps ; 

 if a few doses do not accomplish the desired result, an equal quan- 

 tity of hydrate of chloral may be added to it. When a good sleep 

 has been secured, the hallucinations may not recur, and further 

 treatment may be unnecessary, except such as is required for the 

 general state of the patient. 



Another remedy which is very quieting, and may be used sub- 

 cutaneously when there is difficulty in getting the patient to take 

 bromide of potassium, is hyoscyamin, which may be given in doses 

 of the twenty-fourth of a grain, and if necessary increased to the 

 twelfth or sixth of a grain. 



When the patient comes under treatment with a stomach full of 

 alcohol and undigested food, " just off a spree," it is well to give a 

 mild emetic and a cathartic (perhaps calomel) ; then, unless there 

 are complications, to rely greatly on a good-natured, stout, resolute 

 nurse, and good diet. If the symptoms be not urgent, we may give 

 the mineral acids, Horsford's acid phosphates, and similar remedies. 

 If there is marked sleeplessness, we may try one of the above reme- 

 dies. An important question is whether the patient shall have any 

 alcoholic stimulant. If the stomach is quiet, and apparently in a 

 condition to digest food which the patient objects to taking, it may 



