Hallucinations of hearing are not so common, but exist in probably 10 to 20 per cent. of cases. Delusions (false per ceptions concerning self) are found in from 5 to 9 per cent., mostly delusions of persecution. Sometimes there is one hallucination, illusion, or delusion throughout, sometimes there is a suc cession.
Case of an army-engineer, a chronic inebriate, in whom delirium of grandeur and self-satisfaction, with intense ambi tions to attain political prominence, came on in a few hours, after a long period of drinking. Subsidence when spirits were withdrawn and recurrence on the re sumption of spirits. Editorial (Quarterly Jour. of Inebriety, July, '97).
The tongue is white and furred. Tremor of this organ, and especially of the muscles, is a more or less marked, but generally present, symptom.
The fever is not very high, being about 100° to 103° F. If higher, it is an unfavorable omen. The pulse is soft, rapid, and readily compressed. The skin is clammy. Insomnia is constantly pres ent; but usually sleep and improvement occur on the third or fourth day. In unfavorable cases the patient grows gradually worse and dies of heart-failure.
Diagnosis.—Acute alcoholism may be mistaken for the delirium of menin gitis, of typhus and typhoid fevers, and of chronic alcoholism. The history and progress of the ease determine the first two, and the absence or significance of thirst, tongue trembling, and tremors the third.
Pulmonary disorders; congestion, es pecially when of traumatic origin; and pneumonia may also give rise to delir ium simulating that of delirium tremens. Fractured ribs may thus become the pri mary factor of violent accesses. The same may be said of erysipelas.
Pathology. — Acute alcoholism is due to gradually produced changes in the nerve-tissues, and especially to retained products of metabolism. The cerebral lesions in alcoholic delirium are of two varieties. The first is observed in all alcoholics, and is due to the alcohol it self: atheromatous degeneration of the vessels, the degree of disorder increasing as the calibre of the vessel is reduced. The nerve-cells also show granular pig mentation and fatty degeneration.
The second variety is derived specially from the character of the delirium, and not from the alcohol itself. It consists in congestion, bmnatic pigmentation in the capillaries and nerve-elements, and degeneration of the nerves and fibres of the cortex, the precursors of general paralysis.
Peddie's view, propounded a quarter of a century ago, that acute alcoholism is really poisoning from the accumulated effects of alcohol on a nervous and ir ritable temperament, has much in its favor.
Delirium tremens occurs when a brain, deteriorated by chronic alcoholism, is in fluenced by a toxic agent, either due to the action of bacteria or to autointoxi cation from diseases of the digestive tract, the kidneys, or the liver. The therapeutic treatment is quite incapable of abbreviating the duration of the dis ease; the critical sleep cannot be in duced by any drug. Jacobson (Hos pitalstidende, p. 143, '97).
Microscopical examination of the cen tral nervous system and spinal ganglia of seven cases of delirium tremens. The changes were quite uniform, and con sisted essentially, first, in thickening of the walls of the arteries, proliferation of the connective tissue in the media, and dilatation and infiltration of the lymph spaces. These changes were more pro nounced in the cortex, and frequently led to minute as many as two hundred of these having been counted in a square centimetre of the cortex. The capillaries appeared to be proliferated, particularly in one case, but they and the veins showed no pronounced anatomical alteration. The neuroglia fibres of the cortex showed, according to Weigert's new method, considerable pro liferation. The Weigert cells were more numerous than normal. The free nuclei, both the small and large varieties, were increased in number in the second and sixth layer of the cortex, and appeared to he accumulated around the degener ating cells. The spinal cord was ap parently normal. There was no degener ation of the fibres in the spinal cord, but the tangential fibres of the cortex were somewhat thinned. The changes in the cells were, as is usual in such cases, lim ited to certain cells, and not uniform. In the spinal ganglia, the cells stained less distinctly. The nucleus was contracted, and in the end its membrane appeared to have become dissolved; the nucleolus showed a curious angular deformity. The cells of the anterior eornua showed in the lumbar region central chromatol ysis without staining of the ground substance. and an increase in size and decrease in part of the chronic:pi:Hie bodies, with alterations in the nuclei. In some eases vacuolation of the cells had occurred. The cells of Purkinje showed change or no alterations. The pyramidal cells of the cortex were usually degenerated, showing contrac tion. alteration of the nucleus, and al terations in the ground-substance. The giant pyramidal cells of the paracentral lobule were nearly all diseased. In gen eral, it was noted that the parietal and occiptal regions were less affected than the others. Tromner (Arehiv f. Psy chiatric, B. 31, H. 3, '90).