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Delirium Tremens.Symptoms*-In some cases there occur certain warning signs of impending delirium. The patient is peevish and irritable ; his sleep is disturbed, and he appears depressed. After a few days of this state, evidences of mental derangement become apparent. In other cases the symptoms are connected particularly with the stomach, there being nausea, perhaps vomiting ; loss of appetite ; the tongue is thickly coated. The stage which precedes the appearance of delirium, lasting two or three days, is one of great mental depression ; the patient is sometimes so despondent that he makes attempts to commit suicide. This condition is called by drunkards " the horrors. " The attack begins with the manifestation of active delirium. The countenance becomes wild ; the eyes are widely opened and staring ; the patient is in a state of constant activity, making quick nervous movements and talking constantly. His attention is diverted rapidly from one topic to another; he is apt to have delusions ; he imagines himself engaged on important business, and is constantly desirous of going out. He must be, therefore, carefully watched. In addition to these delusions, he has various illusions of the senses ; he sees around him disgusting and unpleasant objects, such as mice, lizards, snakes, etc. ; he hears sounds made by imaginary men and animals, and is often possessed with the idea that he is surrounded by enemies who threaten him with personal violence. At first these delusions occur merely occasionally, the patient meanwhile being in his sound mind and able to recognize the fact that these delusions are imaginary; but after a time they become real to him, and his sane intervals cease. Meanwhile the hands, and perhaps the entire body, is in a state of tremor ; this tremulousness is especially manifest in the tongue, whenever the patient attempts to put the tongue out of the mouth. He is generally weak, but is able when excited to manifest unusual muscular power. After the delirium has become well established the patient is an object of terror to others and of danger to himself. For his delusions often inspire him to acts of violence against others, and to deeds which may result in serious injury or even death to himself, The patient has no conception of danger ; is constantly trying to rise from his bed, and if he succeeds, endeavors to leave the room and the house ; he often neglects to pass out of the room by the door, but springs from the window as the most convenient and quickest way of escape. If he be spoken to quietly there is rarely any difficulty in leading him back to bed ; but if accosted roughly, or if attempts are made to force his movements, he is inclined to suspect mischief and to resist violently. When once aroused to forcible resistance, it is by no means easy to quiet and soothe him ; he employs, in self-defense, any weapons that may be at hand, and must often be overpowered and secured by main force. In most instances the patient's safety can be secured only by confining him in a straight jacket, or by securing him in a room, the walls and floor of which are padded to prevent him from using violence upon himself. Under the influence of these delusions the patient is sometimes led to perform the most singular and ludicrous acts, while at other times he exhibits remarkable power of endurance and recklessness of danger. Thus a case has been known in which a patient laboring under delirium tremens, leaped from a window and ran, barefooted and in his night clothes, fifteen miles over frozen ground, before he was overtaken by his pursuers, who were mounted on horseback. One of the most serious features of such an attack is the wakefulness of the patient ; he lies awake for days and nights consecutively, frequently falling into a doze, as frequently awakened in a short time by some frightful dream. The delirium is usually worse at night, when the patient becomes loudest in his outcries and most violent in his movements. If he sleeps at all it is usually during the day. The patient rarely complains of any pain, nor even of headache, although the head may be hot and the skin dry. After two, three or four days of this state, the patient usually falls asleep. If he once begins to sleep soundly, the danger is usually over ; for after profound slumber for several hours, the patient awakes in his right mind, although, of course, much exhausted. Sometimes he is still delirious after his first sleep, but soon falls asleep a second time and awakens in the possession of his faculties. For the first day or two the patient manifests a constant desire to sleep, and if the case be favorable, spends much of his time asleep. If, however, the patient be unable to obtain refreshing sleep, by the termination of the fourth or fifth day of the attack, the disease is very apt to terminate fatally. In this case the sleeplessness persists, and the patient becomes profoundly exhausted. Yet even when thus prostrated, the delirium continues, and the individual continues his frequent efforts to get out of bed and to resist the imaginary attacks of the enemies or animals which he supposes to surround him. The last hours of life are commonly passed in a state of profound stupor. The disease usually terminates in recovery. It is important to recognize its true nature, and not to mistake it for inflammation of the brain, or one of the forms of meningitis. It can be usually distinguished at once by the absence of pain, by the tremulousness of the patient, as well as by the previous habits of the individual. Yet in this connection it must be remembered that many people are in the habit of drinking secretly to an extent not suspected by their friends. Inflammation of the brain, it will be remembered, is accompanied by intense pain in the head, by extreme susceptibility to light and sound, and by high fever. The use of alcohol sometimes causes a form of delirium which is not to be confounded with delirium tremens. In this case there is active delirium, accompanied sometimes by fits of violence. This is caused, however, not by habitual indulgence in liquor, but by excessive use of alcoholic beverages on a single occasion. It is, therefore, usually the effect of a debauch, and passes away within a few hours after the individual stops drinking. It is characterized by headache and fever. This may occur in habitual drinkers, and be followed by an attack of delirium tremens. Treatment.-The chief object in the treatment of delirium tremens is to induce sleep. For this purpose he must be carefully protected from the inquisitive gaze and questioning of friends and acquaintances. It is also necessary that he be confined in such a way as to prevent him from harming himself. In some cases it will be necessary only for a friend to stay in the room with him, and to judiciously soothe and quiet him during the more violent parts of his delirium ; in other cases it will be necessary to put him in a straight jacket, or in a padded room. In general, no more violence should be used than is absolutely necessary to control him. The following prescription may be ordered : Bromide of potassium, - - - 2 ounces. Hydrate of chloral, - - - - 1 ounce Syrup of orange peel, - 2 ounce Water, ------ 2 ounce * Give a teaspoonful in water every two hours, until four doses have been taken, unless the patient becomes quiet. In using this mixture certain caution must be observed, especially after three or four doses have been given. It will be advisable not to give opium or any of its preparations, which are apt to aggravate the patient's mental condition. So soon as the violence of the attack is over, measures should be taken to tone up the patient's nervous system. For this purpose the following mixture may be used : Tincture of nux vomica, - - - 6 drachms. Tincture of digitalis, - - 6 Tincture of gentian, - - - -6 Wine of pepsin to make four ounces. Mix, and take a teaspoonful before meals. Much good has been observed from the application of a small mustard plaster over the pit of the stomach, especially those cases in which obstinate vomiting occurs. One of the most important items in the treatment of delirium tremens is the employment of nutritious food in an easily digestible form. For this purpose, milk and eggs are the staple articles ; they may be supplemented by soups and beef tea. These should be given in small quantities, at intervals of two or three hours. It must be remembered that delirium tremens is a disease of exhaustion ; notwithstanding the patient's frenzy and frequent exhibition of strength, his nervous system is profoundly prostrated ; hence all measures employed in the treatment of the disease should tend to build up the patient's exhausted powers. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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