The presence of delirium is shown by incoherence of expres sion, traceable to hallucinations and illusions which have gene rally a very fleeting character. Sometimes, however, they assume a continuous form, almost resembling fixed delusion.
Incoherence is always combined with some degree of uncon seiouzuess; and it is worthy of consideration how far this proceeds from obtuseness of perception and is related to coma, how far from preoccupation of mind and confusion of thought. When coma is complete, there can be no expression of delirium; but when roused from a state of stupor, the patient may either be able to put out his tongue when desired to do so, and to give tolerably rational and consistent answers, or he may only reply by a vacant stare or an incoherent expression, showing that deli-, rium is present as well as stupor. In delirium there may be the same impoSsibility of obtaining a rational answer, simply from preoccupation and incoherence: the question fails to give rise to any correspondiry idea in the mind of the patient. This cha racter of unconsciousness is very different from that depending on stupor ; it is often only partial, as indicated by his not recog nizing individuals around him, and passing his feces and urine in bed, while an impression stronger than usual produces a rational act. During the time that he is talking or muttering to himself, or addressing fanciful persons whom he imagines to be near him, he may be recalled by firmness of manner to such a state of con sciousness as to give a coherent answer, or to do as he is directed.
OnetegimeLDLL :i oatoaLfm orms._ofiledirium is tkat restless ness which rom tsthepatieut to attempt to get out of bed, and t is even a strengiris so exhausted, that the act might be sup osed to be impossible. There is a1%2§Lal&ays exacer n alailial ana, Ms is njostax.Iced=in,,JET sli cases. Delirium at night is often observed when there is no of wandering of thought by day ; a patient who only mut ters and talks by day will be noisy and unmanageable at night; and it is -perhaps only when mental excitement is at its highest pitch during the day that it does not appear to be increased as evening approaches.
Under the term of include all the incoistent at iswe as words of e irium. These are as
varied as the illusions the unhappy patient labors; but I think it may generally be observed that they are more up roarious as the character of the delusion is more definite. Thus we find one patient noisy and violent, with difficulty kept in bed or restrained from doing a mischief to himself or others, but always governed by some prominent idea; another, who only mutters and rambles on in the most inconsistent manner; while a third is still and listless, either giving no answer at all or one wholly incongruous. All are liable to pass their feces and urihe in bed; not from unconsciousness of the act, but from ignorance of its impropriety. In this view of the subject, the cases are sometimes classed as examples of active and passive forms of deli rium.
It is most important to remember that delirium is not evidence of inflammation, and that in by far the majority of cases it is not accompanied by any inflammatory action at all within the cranium. The history of the case and the correlative symptoms must be carefully studied, because it is so constantly a concomi tant of other diseases.
a. It occurs in most severe attacks of fever.
b. It is constant in delirium tremens.
c. It is often assoeiated with inflammation of some other organ, /causing alteration in the blood, of which pneumonia is perhaps the most common.
d. It may supervene in the course of acute rheumatism, or erysipelas.
e. When the disease is confined to the brain, it may be linked with 'the tubercular diathesis; f. Or it may depend on simple inflammation.
g. It may be an evidence of maniacal affection.
During the existence of delirium all the organs will require closer investigation to elicit evidence of disease, than when the symptoms are unassociated with mental phenomena, because they are so much obscured by the unconsciousness of the patient to sensations of pain or distress; thus, an individual suffering from acute rheumatism will make movements in his delirium, which would have been exquisitely painful to him if his perception had not been blunted ; or one laboring under severe pneumonia or phthisis will cease to cough or suffer any inconvenience from the accumulation of secretion in the lungs. These points ought never to be overlooked.