DELIRIUM TREMENS is the term given to a disease originating from the abuse of alcoholic stimulants by those of a nervous and irritable temperament, characterized by a combination of delirium with muscular tremors. The tremors are general, but chiefly of the hands, and of the tongue when protruded; and the delirium is of a muttering, sight-seeing, bustling, abrupt, anxious, apprehensive kind. The individual affected cannot follow out a train of thought, explain an• illusion or perverted sensation, or per form any act correctly; and although at one moment partially conscious and rational, is the next incoherent and excited by the most ridiculous fancies of a spectral kind, such as visitorsin the shape of devils, cats, rats, and snakes, or by alarming occurrences, such as robberies, fires, and pursuits for crimes. All this is ushered in and attended by complete sleeplessness; and during the attack, in an uncomplicated form, there is no violence or ferocity of demeanor (see article DELIRIUM Emuosw.i), although mischief to himself or others may be done under false impressions; and he is easily pleased by gen tleness and indulgence, and fretted by restraint and opposition. The face has generally a pale dirty color, and anxious expression; eyes startled but lusterless, sometimes con siderably suffused, and the pupils not contracted, unless under treatment with opium, or when inflammation of the membranes of the brain has supervened; skin warm and ipoist, often perspiring copiously; tongue sometimes loaded, but generally pale, moist, and remarkably clean; appetite small, but the individual will often take whatever is presented to him; thirst by no means urgent, with seldom or never any craving for spirituous liquors; alvine evacuations bilious and offensive; urine scanty, high colored, and often albuminous; the pulse usually ranges from 90 to 120, and is generally soft, but of various -degrees of fullness mat smallness. The precursory symptoms are not peculiar to or pathognomonic of this disease, but common to many other febrile sac lions implicating the functions of the sensorium, of the circulation, of digestion; and the paroxysm—distinguished by the above phenomena—runs a remarkably uniform` course, independently of age and constitution. In genuine uncomplicated cases—that is to say, when not precipitated by other illness, such as bronchitis, pneumonia, erysip elas, and fever; or some accident, such as contusions and fractures—when the illness is more of the nature of the delirium traumatictun (q.v.)—the paroxysm runs its course in from two to three days, and terminates in sleep, from which the individual generally' awakens convalescent.
The above description has been taken from a paper by Dr. Peddie, of Edinburgh, referred to underneath, whose views shall here be further developed. Previous to its publication, the generally received opinions regarding the essential nature of D. T. were,: that it is a disease of exhaustion or irritation of nervous power, and that it has the habitual abuse of intoxicating liquors for its predisposing, and the abstraction or dimi nution of the accustomed stimuli for its exciting, cause; and consequently, that the proper treatment consists in the continuation of stimulants—" a hair of the dog that bit"—together with large opiates to act on the same principle, and force on the salutary, or what has been called the critical sleep. Since then, however, a great revolution has taken place in the views of the medical profession regarding the pathology and treat ment of D. T.; and in consequence of this, a. fatal result in a genuine case of the disease now seldom or never occurs, where these views are understood and acted on.
It has been shown that the more the history and phenomena of the affection are examined, the greater will the difficulties surrounding the second part of the proposi tion above stated become. It has been shown that the affection is specific and peculiar, uniform in its symptoms and progress; and that it is essentially a form of nervous poisoning—a toxicological result from the accumulation of alcohol in the system through. the continued abuse of stimulants. It has been observed that the alcohol—in whatever' way it may be atomically changed or chemically combined—acts ou the nervous pulp of the brain through the medium of the circulation, and sets up in it an alcoholism or alcoholic eretliism, manifested by a certain amount and kind of exhaustion of the cere bral and muscular functions, together with decided over-action in the.meningeal vessels;_ and that the alcoholic principle, although acting at first slowly, begins ere long to poison the gray matter of the brain, so that every additional drop thereafter brings it more and more into a poisoned condition, until at length, unless arrested by judicious' treatment, the state of irritation tends to inflammatory action and serious encephalic mischief. While, therefore, the first part of the above proposition is true—though explainable in a very different way from formerly received opinions—the second part, viz., that the diminution or abstraction of the accustomed stimulus is the exciting
cause of the disease, is altogether untenable. .Analogy will not bear out the assertion.. Mercurial fumes, or the oxides of mercury, when long inhaled or absorbed into the body, as in the case of quicksilver miners, gilders, and others, in the course of time' produce an attack of shaking paralysis—the trembkm,ent mercurial of the French patliol-' ogists; but will the workmen thus long exposed be more likely to become affected with tremors when removed from this poisonous atmosphere and occupation, than if con-' tinning at their work? The reverse is well known to be the fact, not only in the case of such artisans, but of those who are beginning to suffer in a somewhat similar way from lead-poisoning. In both affections, when the symptoms are precursory or recent, a' cure can be effected only by removal from the injurious occupation; otherwise, the symptoms deepen with hourly increasing rapidity, until tremors are succeeded by sleep lessness, delirium, and ultimately coma. Then, too, for example, salivation from any of the preparations of mercury, and narcotism from any opiate, are not intensified by withdrawing these agents after a certain point is reached. On the contrary, a con tinuation beyond that stage, particularly in some kinds of constitution, more rapidly develops their peculiar physiological manifestations; and now, an infinitesimal dose will do what a large dose in an earlier stage could not. Thus is it with alcoholic stimu lants in the production of delirium tremens. In those of a highly sanguine tempera ment, and of a nervous irritable disposition, the effect of a certain length of indulgence is to induce this condition (just as in subjects with the tendency to gout, a certain amount of high-living is apt to produce an attack of that affection), and beyond that stage, a small quantity of alcoholic stimulus will keep up and deepen the effect, which, previously, a large dose would not do, or, in another individual, could not produce, whatever quantity is imbibed. Thus is explainable the very common erroneous state ment made in regard to an individual affected with D. T.; that although for a able time he had systematically indulged in considerable quantities of spirits, wine, or malt liquor, or in all of these, yet for a week or two he had drunk very sparingly, and; within the last few days, little or none; indeed, that he was now suffering from the. withdrawal of his wonted stimulus, in meritorious efforts to free himself from a habi of which lie had begun to be ashamed. All this seems plausible: but the statement' should rather have been that, although consuming large quantities of drink at one time, he had felt latterly a smaller quantity affect him; that he then reduced still further the, amount. but experienced an equal if not greater constitutional effect therefrom; and, thus, from day to day, reduction, was forced on him by his own sensations of gastric irritation, nervous excitement, and muscular debility—these feelings being, in fact, neither more nor less than the premonitory symptoms of an attack of D. T., and just what might be looked for on the view that the alcoholic principle is in such instances a cumulative poison, and the exciting as well as the predisposing cause of the affec tion. That such is the true solution of the problem, cannot be doubted; and if a sus pension or diminution of habitual supplies of stimulants be at any time followed by symptoms of D. T., this is not to be regarded as the result of the change in the prac tice of the individual, but as occurring in spite of it, and because the constitutional effect is already produced, and the premonitory stage of the disease begun. In a con siderable number of instances, drink is taken freely up to the period when the disease is developed, there being no diminution of the quantity consumed, and no interval in the practice; and when there really is some diminution from the amount of previous supplies, it is on account of the system being already affected so muchthat a less quan tity now produces a greater or equal effect. On the other hand, it may be safely averred, in contradiction to the popular error, that although stimulants are at once taken away from the habitual dram-drinker, a paroxysm of 'D. T. will not be produced if the peculiar diathesis is not yet established, and the precursory symptoms of the disease are not already begun. He may experience much mental disquietude and physical discomfort, and feel weak for a time, just as a gourmand would feel lowered and depressed by the abstraction of his accustomed good living; but this would soon pass off, without the occurrence of the usual signs of D. T., more especially without those spectral illusions or phantasms, which are common to poisonings with several other agents of the narcotico-acrid class.