If drunkards were taken to a hospital instead of to a. jail, were put into a warm bed, then catheterized, and an ex amination of the urine made at once, the latter would often be found loaded with albumin, urea, blood-casts, uric acid, and epithelium: a condition which, if allowed to continue, soon results in urminie coma and death. Many cases treated by means of active purgation, diuresis, dia phoresis, and active cupping would be restored to normal health. N. B. Ormsby (Cleveland Med. Gaz., No. 4, 1001).
Acute Alcoholic Delirium (Delirium Tremens).—This disorder chiefly occurs in habitual drinkers; but it is also observed in ordinary temperate per sons after a prolonged drinking-spell. Though mostly met with in spirit drinkers, it is seen occasionally in beer-, wine-, and cider- drinkers.
Symptoms. — There are two forms,— the traumatic and the idiopathic. They differ little except in the prodromata. In the traumatic form, after an accident (sometimes a slight traumatism) the characteristic tremors, etc., appear fre quently without warning: but, in the idiopathic form, the patient who is about to have an attack is restless. uneasy, irri table, sleeps badly if at all, suffers from digestive troubles, and has little desire for food. Delirium then appears. The patient cannot rest. but must be in con stant motion. IA e is shaking all over ("the shakes"), is consumed with terrors, continually in deadly fright of things which he mentally sees, or of persons whom he thinks are after him for the commission of some crime. At other times his dread is of something terrible, though he cannot tell what it is. lie is all the while trying to escape from these well-defined or undefined horrors, and, in attempting to escape, fatalities some times occur. Hallucinations of sight are most common: snakes, rats, mice, loath some things, flames, and, in a case of the writer's. roaring lions bounding down the chimney, below the chairs, and rush ing in at the windows. The delirium is best described as one of busy wakeful ness and suspicion. There is a third non-febrile innocent form, in which the temperature does not rise above 100° F.
The visual imagery of acute alcoholic delirium is also characteristic of chronic alcoholic alienation. They are not pri mary, but secondary or illusional hallu cinations. The uniformity of the animal
visual imagery arises from the influence of physical conditions on nervous tissue made abnormally susceptible by alcohol. Normally there is objective projection of appropriate images in motion, and it needs but a retinal condition sufficient to intensify the retinal images of these entoptie objects, and a cortical state of higher impressionability permitting them to dominate consciousness, to induce a kind of ideation in which the idea of objective motion is paramount. This condition is brought about by alcohol. Chaddock (Alienist and Neurologist, Jan., '92).
Compression of the eyeball causes per ception of Purkinje's figures in healthy individuals, visions of objects and per sons in four-fifths of patients suffering from alcoholic delirium. Liepmann (Ber liner klin. Woch., Apr. 8, '95).
Confirmatory experiments; vision of animals noted in 50 per cent. of cases of alcoholic delirium. Jolly (Berliner klin. Woch., Apr. 8, '95).
Visions of animals are present in 40 per cent. of eases at most. Such patients cannot estimate distances. Liepmann (Berliner klin. Woch., Apr. 8, '95).
Visions cannot be attributed solely to suppression of the influence of the light. Conclusion then reached that in those cases in which external excitations do not provoke the visions these are due to internal mechanical excitations upon the retina. The increase of the intra-ocular pressure due to the contraction of the ex trinsic and intrinsic muscles of the eye, produced when the eye is fixed upon anything, may be so considered.
The inner imaginations of delirious alcoholic patients do not refer with a strange predilection to certain animals or to scenes of anguish or fright. Their character rather is decided by the nature of the peripheral excitation than by an anterior tendency given to the mind. If manifestations of anguish and the ap pearance of certain animals predominate in spontaneous visions, the cause should be sought for outside of the patient.
The author looks upon his method as to the study of sensorial illusions in alcoholic patients as superior to simple observation or questioning. H. Liep mann (Archiv f. Psych., vol. xxvii, p. 172, '96).