The intravenous infusion of saline so lution in delirium tremens increases the amount of the circulating medium in which the toxic materials are dissolved, thereby diluting the poison and bathing the nerve-centers with a more attenu ated solution of the same. The amount of circulating fluid is increased above the normal, so that the excretion of fluids through all the fluid-excreting channels is increased, thereby carrying off in so lution mach of the contained toxins.
The action of the heart is improved by the filling of the relaxed vessels. These snffice to restore the physiological equi librium and turn the balance in the favor of recovery. J. P. Warbasse (Med. sews, Mar. 2, 1901).
Acute Alcoholic Mania (Mania a Potu).
Symptoms.—The patient, in wild, un governable fury, shouts, stamps, strikes, or kicks, and is, for the moment, un controllable. The eyes roll, the face is flushed, and the veins distended and en gorged; the muscles are at their highest point of tension and are in continuous violent action. The pulse is strong, hounding, and tumultuous. Though mechanically conscious, the subject is filled with "blind fury." He is carried away in a tempest of nervous excitation and passion. The paroxysms of violence sometimes last only a few minutes, at other times for from an hour to several days with quiet intermissions. Barely are there delusions, though the infuri ated subject may vent his violence on the first animate or inanimate object in his way. In a few cases the fury is directed against a certain person or thing. Vio lence is succeeded by calm; a few min utes after a storm the temperature is normal, and during the paroxysm rarely raised. In some constitutions a parox ysm may be provoked by a small quan tity of alcohol.
Differential Diagnosis. — It may be differentiated from delirium tremens by the absence of tremors, terror, hallu cinations, delusions, the white tongue, nausea, and the delirium of the latter. Further, mania a potu may arise from a small quantity of an intoxicant taken in a short time, while delirium tremens is due to large quantities taken in rapid succession, or from smaller quantities long continued.
Etiology and Pathology. — Alcoholic mania is occasionally seen in chronic inebriates, and most frequently in peri odic tipplers. In the latter it often
occurs when, soon after an interval of abstinence, an intoxicant is freely par taken of. Some chronic inebriates in variably suffer acute mania if they drink a single glass of spirits, wine, or beer beyond their usual allowance. The par oxysms of acute mania resemble those of epilepsy, and a large proportion of police-court drunken offenders are patients of this class. The symptoms are evoked by the pathological action of acute poisoning by alcohol, in nervous systems liable to such excitation, either congenitally or from the effects of in temperance, traumatism, or brain-tire.
The forms of insanity met with which result from alcoholism are: (1) amnesic, (•) delusional, and (3) chronic varieties which end in dementia. The best work ing hypothesis for the prevention and care of all forms of alcoholic disorders. whether mental or physical, must be Lased upon the practice of total ab stinence. R. Jones (Lancet, Oct. 25, 1902).
Prognosis. The prognosis is much more favorable than in acute mania, the paroxysm usually rapidly passing away, leaving the patient exhausted and peace ful. Barely is there relapse unless alco hol be again taken.
Treatment. — Little treatment is gen erally needed. Non-alcoholic liquids, such as milk, iced milk, milk and soda, or saline draughts with ipecacuanha and small doses of the bromides are sufficient to bring about recovery. Sometimes cold affusions and, in prolonged paroxysms. wet packs prove valuable adjuncts.
When violent mania is present, apo morphine, '/, to '/, grain, hypodermic ally, causes nausea and vomiting and rapid removal of the violent symptoms.
Study of 938 cases of alcoholism, of which 40 suffered from acute excitement, or mania a potu.
No stimulants given in any ease. The uniform prescription was 30 grains of bromide of potassium every two hours in maniacal cases, and every three or four hours in other cases. In cases of noisy mania, '/, grain of morphine sulphate was occasionally given hypodermically at bed-time. All the cases recovered. Lati mer (Johns Hopkins Hosp. Bulletin, No. 119, '91).
Chronic Alcoholism.