Brain-cells in li) eases of acute alco holism studied, the brains being investi gated by the Nissl method of staining with methyl-violet: (e) patients who died of alcoholism with all the symptoms of meningitis showed on necropsy simple congestion of the membranes (pia arach noid), with some oedema in its texture: (b) microscopical examination rarely showed any migration of leueoeytes or anything approaching encephalitis; (c) the larger (pyramidal and giant) nerve cells showed pigmentation to an intense degree, the pigment being diffused through the cell-body; (d) the cyto plasm showing various degrees of degen eration (fatty and granular) ; (e) the cell-body generally was shrunk. and the nucleus partially so; (f) pericellular nuclei bad proliferated, and were freely present in the perieellular sacs. In eases where death was due to exhaustion the shrinkage of cells was marked. Dana (Quart. .Tour. of Inebriety, Jan., '99).
Etiology. — Acute alcoholism may be due to a temporary exacerbation during continuous alcoholic intoxication.—the idiopathic form; or to an accident, sudden shock, or an acute inflammation, especially pneumonia,—the traumatic form.
Study- of 247 recovered personal eases of delirium tremens. Of these cases 202 were uncomplicated and 45 complicated by other diseases. Although the delirium tremens cannot be regarded as caused by the action of the pneumocoeens, it resembles, in all features. au infectious disease: it has a stage of incubation,— a duration of about four days; it ends with a critical sleep; ig aecompanied by rise of temperature and almost in all cases by albmninuria; and when autopsy is made the spleen is generally found to be the seat of parenchymatous degen eration, as well as the heart, the kid neys. and the liver. Jacobson (Hos pitalstidende. p. 143, '97).
Prognosis. — In private practice the prognosis is favorable in ordinary cases; in hospital practice it is much less so. Of 1241 cases admitted to the Philadel phia Hospital during a fixed period, 121 died. Recurrence occurs if drinking is continued.
[I have noted recurrence from one to five times in 101 out of 442 cases treated in a special institution. NORM AN KERR.] Treatment. — The patient must be kept in bed and carefully watched. Strapping in bed should not be prac ticed, as the restraint causes muscu lar movements and delirium. A sheet tied across the bed is preferable, as this allows more freedom of motion. Attend ants or a padded room is best of all. No alcohol should be given, the strength being sustained by foods, milk, soups, etc.
Experience based on 2012 cases of al coholism warrants the statement that alcohol in any form or quantity is in jurious, and that its absolute and im mediate withdrawal is important. Lati mer (Boston Med. and Sung. •our., June Id, '02).
If the delirium conies on abruptly. the exciting causes are acute and point to the formation of toxins. If the delirium has been preceded by mental changes, and transient alterations of thought and conduct occur, gradually becoming constant and fixed, there are indications of organic lesions of the brain. It is important to ascertain whether the delirium follows from a long period of continuous drinking or whether the drink was preceded by some physical or mental disturbance arising from organic disease, traumatism, or mental strain. T. D. Crotliers (Med. Dee. 14, 1901).
Potassium bromide, drachm, with tincture of capsicum, given every three hours, is recommended for mild cases by Osler.
Sleep should be procured, and the strength supported. As an hypnotic, chloral may be given if the heart be not weak.
In alcoholic delirium the real chance of recovery lies in sleep. The patient is therefore isolated in a quiet. dark. and. if necessary, padded room, no physical restraint being employed. To procure sleep the patient is given 1 to 1 72 drachms of chloral-hydrate. with '/.2 grain of hydrochlorate of morphine, in an infusion of limes. If sleep does not come on in about ten minutes, from to '/;., grain of morphine is injected hyp odermically. After the alcoholic disturb ance has subsided strychnine or mix vomica is given, followed by hydrothera pentic measures. If there should be gas tric complication, an antacid, such as sodium bicarbonate, is administered. Lancereaux Gi.m. de Th6r.. Feb. 15. '93).
In the youtw. with elastic arteries and sound kidneys, opium can be given freely. In older patients, where the vessels are not in such good condition, chloral is less dangerous than opium. A. Gni•pin (Gaz. Slid. de Paris, Feb. 10. '94).
The heroic doses of these narcotics, with the cardiac depression apt to follow their exhibition, call for deliberation in their administration to aged and infirm inebriates, and I prefer, as an hypnotic, a simple febrifuge frequently repeated, such as repeated doses of liquor am monim acetatis. Sleep, thus quietly and safely induced, has proved much more curative than the sleep for which the author formerly resorted to narcotics.