DELIRIUM TREMENS (called, also, man ia-a-potu). In Medical Jurisprudence. A form of mental disorder, usually accompa nied by tremor, incident to habits of intem perate drinking, which generally appears as a sequel to a period of unusual excess or after a few days' abstinence from stimulat ing drink. It may also be caused in in temperate subjects by an accident, fright, or acute inflammatory disease, such as pneu mOnia.
The nature of the connection between this disease and abstinence is not yet clearly understood. Where the former succeeds a broken limb, or any other severe accident that confines the patient to his bed and obliges him to abstain, seem as if its development were favored by the constitutional dis turbance then existing. In other cases, where the abstinence is apparently voluntary, there is some reason to suppose that it is really the incubation of the disease, and not its cause.
Its approach is generally indicated by a slight tren7or and faltering of the hands and lower extrem ities, a tremulousness of the voice, a certain rest lessness and sense of anxiety which the patient knows not how to describe or account for, disturbed sleep, and impaired appetite. These symptoms hav ing continued two or three days, at the end of which time they have usually increased in severity, the patient ceases to sleep altogether, and soon be comes delirious at intervals. After 'a while the de lirium becomes constant, as well as the utter ab sence of sleep. There is usually an elevation of tem perature of two or three degrees. This state of watchfulness and delirium continues three or four days, when, if the patient recover, it is succeeded by sleep, which at first appears in uneasy and irregu lar naps, and lastly in long, sound, and refreshing slumbers. If sleep does not supervene about this time, the disease may prove fatal.
The mental aberration of delirium tremens is marked by some peculiar characters. Almost in variably the patient manifests feelings of fear and suspicion, and labors under continual apprehensions of being made the victim of sinister designs and practices. He imagines that people have conspired to rob and murder him, and Insists that he can hear them in an. adjoining room arranging their plans and preparing to rush upon him, or that he is forci bly detained and prevented from going to his own home. One of the most common hallucinations in this disease is that of constantly seeing devils,. snakes, or vermin around him and on him. Under the influence of the terrors inspired by these no tions, the wretched patient often endeavors to cut his throat, or jump out of the window, or murder his wife, or some one else whom his disordered imag ination identifies with his enemies.
Delirium tremens must not be confounded with other forms of mental derangement which occur in connection with intemperate habits. Hard drinking may produce a paroxysm of maniacal excitement, or a host of hallucinations and delusions, which dis appear after a few days' abstinence from drink and are succeeded by the ordinary mental condition. In U. S. v. McGlue, 1 Curt. cc. 1, Fed. Cas. No. 15,679, for instance, the prisdner was defendant on the plea that the homicide for which he was indicted was committed in a fit of delirium tremens. There was no doubt that he was laboring under some form of insanity ; but the fact, which appeared in evidence, that his reason returned before the recurrence of sound sleep, rendered it very doubtful whether the trouble was delirium tremens, although in every other respect it looked like that disease.
By repeated decisions the law has been settled in this country that delirium tremens annuls responsi bility for any act that may be committed under its influence: provided, of course, that the mental con dition can stand the tests applied in other forms of insanity. The law does not look to the remote causes of the mental affection ; and the rule on this point is, that if the act is not committed under the immediate influence of intoxicating drinks, the plea of insanity is not invalidated by the fact that it Is the result of drinking at some previous time. Such drinking may be morally wrong ; but the same may be said of other vicious indulgences which give rise to much of the insanity which exists in the world; Whart. Cr. L. § 43; Beasley v. State, 50 Ala. la 20 Am. Rep. 292; Cluck v. State, 40 Ind. 263; Rob erts v. People, 19 Mich. 401 ; Carter v. State, 12 Tex, 500, 62 Am. Dec. 539; Fisher v. State, 64 Ind.
435; U. S. v. McGlue, 1 Curt. cc. 1, Fed. Cas. No. 16,679; U. S. v. Drew, 5 Mao. 28, Fed. Cas. No. 14,993; State v. Wilson, Ray, Med, Jur. 520 ; State v. Har rigan, 9 Houst. (Del.) 369, 31 Atl. 1052 ; Ayres v. State (Tex.) 26 S. W. 396. In England, the existence of delirium tremens hae been admitted as an ex cuse for crime for the same reasons ; Reg v. Wat son and Reg v. Simpson, 2 Tayl. Med. Jur. 599 ; 14 Cox, Cr. Gas. 565, In the case of Birdsall, 1 Beck, Med. Jur. 808, it was held that delirium tremens was not a valid defence, because the prisoner knew,, by repeated experience, that indulgence in drinking would probably bring on an attack of the disease ; see also in Roberts v. People, 19 Mich. 401. See