On Delirium Tremens, 345 



ment, the skin perspiring, often damp, the pulse rapid, tremor 

 present with delirium, (although, the capacity of rational 

 reply remains) now and then convulsive movements, perhaps 

 cramps in the legs, sleeplessness, often continued vomiting, 

 and dull congested features, and in the midst of these symp- 

 toms the delirium often becoming violent and maniacal. In 

 such cases we have to contend against cerebral irritation and 

 congestion, and the tendency to effusion. We give aperients 

 with calomel, set up counter-irritation, support the exhausted 

 vital and nervous energies by a moderate portion of the 

 wonted stimulus, and endeavour to allay the excitement and 

 irritation by repeated doses of opium. In the use of the 

 opium, I consider the exercise of tact and discrimination ne- 

 cessary, lest we thereby add to the cerebral congestion and 

 favour the process of effusion. As connected with this subject, 

 and with the consideration of cerebral disease generally, it 

 is worthy of remark how numerous and various the diseases 

 of the brain, and the lesions of sense and sensibility, in 

 which, nevertheless, the post mortem appearances shew 

 shades of difference merely, such as a little more or less 

 congestion and turgescence of the veins and sinuses, and 

 choroid plexus, more or less arachnitis and injection of the 

 pia mater, more or less effusion upon the superficies, at the 

 base of, and within the brain. This observation holds good 

 in fever in its different types ; in the state of cerebral con- 

 gestion, often lingering, and accompanied by typhoid symp- 

 toms, the sequence of cholera; in coup de soleil and apo- 

 plexy ; in delirium tremens ; in meningitis ; in acute mania. 

 So that we are led, I think, to attribute the variety in the 

 symptoms to something peculiar in the several effects of the 

 various noxious causes, as well as to the morbid structural 

 changes going on, which are observed after death — for from the 

 bare pathological condition, and when guided by experience 

 too, we are not able to read off and determine the individual 

 character of the disease in these different cases. I am speaking 

 generally, allowing at the same time that, in many instances, 

 a particular set of cerebral symptoms points out to, and is 

 afterwards elucidated by, the discovery of some important 



