DELIRIUM TREMENS. 211 



of sight, which usually take the fonn of disgusting or terrifying objects, such 

 us snakes, inserts, or monsters. Sometimes he fancies he sees armed men pursuing 

 him >\ith threatening gestures. More rarely he hears voices denouncing threats or 

 mocking him, and occasionally he thinks he smells disgusting odours. He manifests 

 great impudence of any interference or assistance in his ordinary duties, which he 

 discharges in a bustling and tremulous manner. Usually there are at first no real 

 delusions; and even when there are hallucinations the patient frequently recognises 

 them as such, and is able by an effort of the will to banish them. There is commonly 

 u complete loss of appetite, and little or no food is taken. After a time, distinct 

 delusions become apparent ; the patient talks incessantly in a rambling fashion, and 

 points to imaginary terrific shapes about him, which he is constantly seeking to push 

 aside with a restless motion of his hands. The delirium is not a fierce or 

 mischievous delirium, but a busy delirium : he does whatever he is told, but does it 

 in a hurried way, with a sort of unsuccessful anxiety to perform it properly. He is 

 not altogether inattentive to the objects and proceedings that are going on around 

 him, but his mind soon wanders away to other subjects. Sometimes he is very 

 .suspicious that those about him intend to do him some injury, or he thinks that ho 

 is surrounded by enemies. He is haunted by spectra, fancies that rats, mice, and 

 other vermin are running over his bed, or perhaps sees spiders crawling on the 

 ceiling, or a horse's head thrust through the wall of the room. He addresses remarks 

 to imaginary strangers, and looks suspiciously behind the curtains, under the 

 impression that the devil is there waiting for him, or that there is somebody watch- 

 ing him. It is seldom that he meditates harm either to himself or others, and there 

 is usually a mixture of cowardice or dread with the delirium. If you question him 

 about his disease, he answers quite to the purpose, describes in an agitated manner 

 his feelings, puts out his tongue, and does whatever you bid him ; but a moment later 

 he is wandering from the scene around him to one that exists only in his imagination. 

 He gives orders to absent servants, refers to some imaginary appointment he must 

 keep, or speaks of strange adventures he has met with during the night. The 

 publican thinks that he is drawing beer for hosts of customers, and the lawyer tjiat 

 he is making an effective speech to the jury. The patient may be recalled by 

 addressing him in a firm and determined manner, and may even be temporarily 

 reasoned out of his delusions. The tremor which, from its striking prominence in 

 many cases, has given the disease its name, is by no means universally present. It 

 is usually observed in the case of confirmed dram-drinkers, but often enough it is 

 only an exaggeration of a tremulousness of the hands, which has existed for months 

 or even years. Even when the tremor is not present there is a constant restless- 

 ness ; the patient shifts from side to side in bed, and will get out twenty times in an 

 hour, if allowed to do so. The tremulous tongue is moist and creamy, the pulse is 

 frequent, the eyes are in almost constant movement, and the pupils are usually, 

 though by no means always, dilated. Very often the face is flushed, but sometimes 

 it remains deadly pale. Usually there is much sweating, which is obviously due in 

 great part to the constant muscular movements. Attacks of sickness are not 

 uncommon, the bowels are confined, and pain may be complained of about the pit of 

 the stomach. 



