THE affinity of the delirium of insanity and ebriety is, by a superficial observer, supposed to be very close. The wise Seneca has said, "Ebrietas nihil aliud est, quàm voluntaria insania."* But the delirium of each, as I have shewn (p. 309), is distinct. That of which I am about to treat is peculiar to habitual drunkards, and differs materially from the delirium of an ordinary debauch. Although this affection is at first temporary in its effects, yet, by repetition, it becomes permanent, and greatly increases the number of lunatics. This malady, therefore, demands particular notice. Fifty years ago, it was so rare as to be unnoticed by medical writers. It is now too well known in the United Kingdom; more so, perhaps, in North America; and, in fact, in every country where the vice of drunkenness prevails. By the Americans it is designated delirium è temulentiâ, and mania à potu, from its exciting cause; and by Dr. Frank, treme-faciens. Dr. Thomas Sutton has given an excellent description of it,† and has adopted the designation delirium tremens, from a particular symptom which generally accompanies it, and which may be considered pathognomonic; that is, a tremulous movement of the hands. But this symptom + Tracts on Delirium Tremens, &c. 1813. • Epist. 83. is not always a concomitant, and therefore some objection be urged to the appellation. may Dr. Armstrong calls it the "brain fever of drunkenness, "* and considers it a strictly febrile disease. This, however, is contrary to the general view of its pathology; and I think the symptoms, appearance of the blood, and nature of the remedy (opium), which is found to be almost a specific in this disease, evince that it does not present the genuine features of pyrexia. Therefore, though not free from objections, I consider delirium tremens the most appropriate designation. The history of this disease is somewhat curious. It appears that it was recognised as a distinct mental affection by the late Dr. Saunders in his lectures, forty years before Dr. Sutton published his tract; and that it was also considered on the coast of Kent as being peculiar to drunkards, long before that period. From Dr. Armstrong's observations we learn, that the medical practitioners in Northumberland and Durham, about the same time, remarked this disease; and that Dr. S. P. Pearson, of Newcastle on Tyne, in 1801, published an account of it, and recommended opium as a remedy; a remedy, however, many years before prescribed for it by Dr. Young, of the same town. This affection had not then obtained notice in any system of physic, and was confounded generally with acute inflammation of the brain, or with mania. Dr. Sutton remarks, that while he resided in East Kent, from 1798 to 1807, he was first led to perceive the distinction between phrenitis and delirium tremens; and that previously he had considered the latter to depend upon active inflammation of the encephalon, and to require copious depletion, vesicatories, purging, &c. But as the ill success attending this practice was obvious, and other Practical Illustrations, &c. 1819. practitioners in the neighbourhood were treating it by opium with great advantage, he adopted that remedy; and subsequent experience of its good effects has confirmed him in the practice. This judicious physician adds, that 'he never could discover how a practice so different to that which the character of the disease seems to warrant came into use. But I think a ready explanation may be found in the doctrines and stimulating practice of the celebrated Brown, which were in high estimation at the date when this disease appears to have been first observed; and thus opium was prescribed in course as a remedy. Some consider this malady as genuine mania; but besides being usually of the duration only of a few days, if the symptoms be studied, it must be pronounced a real delirium. If, however, it run on above two or three weeks, as in every other case where the circulation is violently stimulated and the brain excited, long-continued or permanent mental derangement will follow. Indeed, if a person subject to this effect from excessive drinking be not cut off by some other disease, frequent repetition of it is sure to terminate in incurable insanity. If the advocates of the corporeal origin of insanity had adduced as a proof of it the effect of alcohol on the understanding, even in ordinary cases of inebriation, it must have sufficed to have established the fact; for nothing is more certain than that the mind in this case is affected through the medium of the body. Long-continued or permanent mania will result from a single debauch in wine. But here is a mental disorder so distinct and uniform in its characters as to be recognised and classed by nosologists, and which confessedly has its origin in the application of a stimulus to an organ remote from the seat of the mind. How could such a proof fail of effect? Delirium tremens is in truth a sympathetic affection of the organ of intelligence, arising from a morbid action of the stomach, and probably of the liver also, produced by the stimulus of ardent spirits. The nervous system is, by frequent application of so strong a stimulus, at first violently excited and irritated; and by repetition, the sensorium is so affected as to occasion a temporary' effect similar to partial palsy. In time, organic changes of the viscera implicated in these morbid actions take place, and death, or permanent alienation of mind, ensues. M. Léveillé, in a memoir on this disease,* enters largely into the consideration of the pathology of it. He conceives it to be a morbid and special excitation of the brain, independent of arachnoiditis or gastro-enteritis, with which it is sometimes complicated; and he supposes that the alcoholic corpuscles are intermingled with the arterial blood with which they come in contact by absorption, and thus act as a stimulant to the cerebral substance. this way the cerebral and gastric phenomena are at once produced, the former being always more important than the latter; and both these effects may be effaced by the operation of one sole remedy, opium. In In four fatal cases M. Léveillé met with, where narcotics were ineffective, he was convinced that death was in consequence of gastritis or entro-gastritis being more severe than usual, or was imagined. The description of this malady has been so faithfully portrayed, that I scarcely need do more than copy it. The first feelings of indisposition are lassitude, indistinct chills, debility, loathing of food, uneasiness, and heat of the head; disturbed short slumbers, frightful dreams, constant restlessness, anxious countenance, and oppression at the pit of the stomach. These symptoms are followed by retching or vomiting, a white moist tongue, wild * Mémoire sur la Folie des Ivrognes; ou sur le Délire Tremblant. Mém. de l'Académie Royale de Médecine, Paris, tome i. 1828. vene. ness and quickness of look; pulse at first a little quickened and rather unsteady, afterwards more rapid; general irritability, watchfulness, and dampness of the skin, which is increased by the least exertion; sometimes profuse sweat, especially about the head and throat, having often an offensive odour. The tremors of the hands which characterise this complaint are constant, the tendons of the wrists are in perpetual action, by which the hands are drawn inwards; sometimes there is also subsultus tendinum and singultus. If the patient be still, and have his hands at liberty, he makes various motions with them, and continually picks the bed-clothes; if his wrists only are confined, he picks his fingers and nails. Great confusion of ideas, lapse of memory, and positive delusions, superWhen the paroxysm runs high, the patients are often unconscious of the calls of nature; the pulse is now very quick, little thirst, and the countenance dull and heavy. They are very suspicious, imagining their pecuniary affairs are ruined; that there are conspiracies to poison, shoot, or rob them; that they are in a strange place; and there is a constant desire of ubiquity. They fancy that they see objects present which are not, and are generally haunted by frightful images, from the apprehension of which, they call loudly for assistance to drive them away; or that they hear voices or strange noises in particular places, and they will listen and speak as if conversing with somebody. Sometimes they declare vermin are crawling over their persons or bed-clothes, and will motion as if driving them off. They imagine they see bright or dark spots, or coruscations of light, passing before them. Sometimes they are intent upon calculations, settling accounts, reckoning money, building or projecting, and various imaginary employments; and are so absorbed that they will disregard all questions, or beg not to be interrupted. They are very impatient of contradiction, |