Delirium tremens

“ The violence of the patient had become more and more fitful, and seemed at length to be giving place to mere stupor. A little longer, and he would sleep. But suppose his heart failed and he died in his sleep. Mr. Taylor had had an uncle who drank, and who died of collapse after just such an attack of delirium tremens. Yes—but how long after? Then, on the other hand, there was no evidence to show how long this man's attack had been going on. Nor was the Rev. Athelstan quite clear that the case was uncomplicated; the brain might be unsound at the best of times. ”

“ Alcoholic subjects are very liable to unexpected death from a good many causes. Patients suffering from delirium tremens, for instance, may die suddenly in the midst of a paroxysm of excitement. Such a termination is not frequent, but it has occurred often enough to make it the custom, at asylums for inebriates, to warn friends who bring patients of the liability of such an accident. It is not so apt to happen during a first attack of delirium tremens as during subsequent attacks. ”

“ Chronic Delirium Tremens.—This mode of termination, described by Lentz, is rare. The acute phenomena subside; the restlessness and the mental agitation diminish. Insomnia gives place to sleep, which is light and disturbed by dreams and nightmare; most of the hallucinations lose their activity and frequency, and finally disappear. The changing delirium settles into a fixed delirium of persecution; the tremor, while it becomes fainter, persists, and the condition is permanent. ”

“ Suicidal and homicidal attempts are not uncommon.
The onset of delirium tremens, first described by Thomas Sutton in 1813, is characterized by states of anxiety, fear, insomnia with disturbing dreams, sensory excitement, hyperesthesias, flashes of light, etc. The development usually is sudden, with a loss of attention, disturbance of apprehension, restlessness, distractibility, numerous hallucinations of the different senses, illusions, clouded states with disorientation, tremors and ataxia. Touch, pain and temperature sensations, according to Kraepelin, are undisturbed. ”

“ Davey agrees that he will not become so far intemperate as what? Why, become so far intemperate as to impair his health, or so far intemperate as to induce delirium tremens. If impairment of health or if delirium trements is caused by or followed his intemperance, then the degree of intemperance which has been forbidden by this condition has been reached. ”

“ These hallucinations, of frequent occurrence during two months of the experiment, became afterward rarer, probably on account of the ingestion of less alcohol.
The author gives the following indications of the stages of hallucination in cases of delirium tremens among men: In the first degree the patient believes he hears abusive language, provocations; he sees thieves, armed persons, animals, or else he hears the voice of his parents, of his friends who call him, who warn him of a danger, who appeal for his help, etc. ”

“ In certain instances delirium tremens is but the beginning of serious and permanent impairment of intellect, as is not unfre- quently observed in confirmed drunkards who have suffered from frequent attacks of this disease. The treatment of delirium tremens has given rise to much discussion among medical men, and the result has been that more rational views now prevail on the subject than formerly. ”

“ It is a singular fact that persons suffering from delirium tremens in America (where, either from the poisonous adulteration of liquors, or from some other cause not fully established, that form of insanity is much more common than among the tipplers of Europe) invariably imagine themselves beset by snakes. ”

“ Each sense may of course be affected, and sight stands next to hearing in its liability to suffer. In delirium tremens, hallucinations of sight are characteristic features; the patient commonly sees reptiles and vermin in his room, serpents crawling over the floor, rats and mice running over his bed, and pushes them away in a state of restless agitation. In some forms of insanity, the sufferer mistakes persons, believing entire strangers to be near friends or relations ”

“ Such are the fiends, snakes, toads, devils and horrid monsters seen by the victim of delirium tremens. Of the same order, but beautiful, instead of the reverse, are the angels, ghillim, houris, fairy-forms, peris and naiads, seen by the rapt enthusiasts of all ages and climes, but especially of the Orient, when inspired by opium, love, and religion; out-creations of their inmost souls,—subjective images objectified. This species of out-projection pertains to all persons, while under the discipline of good and evil, virtue and vice, and all other material conditions and accidents. ”

“ The patient complains of annoying odors or disagreeable tastes, either constantly present or upon the taking of food or drink. Disturbances of general sensibility show themselves in hallucinations in regard to sensations of pricking, burning, or tearing of the surface of the body, or of animals or vermin crawling over the patient. Hallucinations relating to the sexual instinct are far from rare. The hallucinations of every form are apt to be more frequent and more troublesome during the night than during the day.
Restlessness, fear, and anxiety are characteristic phenomena of delirium tremens. ”

“ Delirium is by no means evil, but when it comes by gift of the gods, a very great benefit. In delirium the sibyls of Delphi and Dodona were of great service to Greece, but when in cold blood were of little or none. Frequently, when the gods afflicted men with epidemics, a sacred delirium inspired some men with a remedy for these. ”

“ For remember, I saw his wound, I saw the bracelet of the dinosaurs and I listened to Graydon in his delirium. A man does not tell percisely the same things in the cool blood of health that he raves of in delirium, not at least if these things are but fancies born of that delirium. ”

“ The great one is that people at large are too much accustomed and inclined to regard delirium as aimless, objectless mental action—a chaos of broken ideas and unconnected thoughts, or an uncovering of the sewers of the mind, the revealing of secrets not always innocent. ”

“ Delirium is often a sort of cloud-castle, a sort of magnified and distorted shadow of actualities, but it is a very difficult thing, almost an impossible thing, to reconstruct the real house from the distortion of it, thrown on the clouds of the patient’s brain. ”

“ I continued to linger, in the midst of extreme torture, through many weeks; and so high, and unremitted was my delirium, that my parents, from a persuasion that, should I be restored to health, my reason was forever lost, were reconciled to my departure. One particular I consider as astoning; every thing, which passed in my mind through the whole of this protracted delirium, I can, to this day, recollect as well as any event, which has taken place in any part of my life. ”

“ Fervently she prayed that, if his life could not be spared, at least the delirium, which continued with increasing violence from the first few hours of his disorder, might vanish before death, and leave enough of light and of calm for making his peace with offended Heaven. After several days, however, nature seemed quite exhausted, and he sunk into a state to like death to be mistaken for the repose of sleep. ”

“ When the disease grows worse, the delirium becomes continual, the trembling increases, the muscles swell to such a degree that it seems as though they would burst. One might almost think that a furious demon were hidden within, agitating the body in the bed, distorting it, hurling it to and fro, as though to shatter it completely. The most terrible apparitions are those of spectres. ”

“ It is, as a rule, most marked at night, and in mild cases may occur only at that time or upon waking in the morning. When the delirium is active the patient may shout and scream, or leave his bed and attempt to throw himself from the window, being endowed apparently for the moment with strength sufficient to enable him to commit these acts of violence. ”

“ But the most invariable accompaniment of the final stage of delirium, and frequently also that of sopor, is in the incessant picking at real or imaginary objects. At one time the patient seizes hold of parts of his clothes or bedding, pulls at his fingers and toes, takes up dirt and stones from the ground, or as often snatches at imaginary objects in the air, on his body, or anything near him. ”

“ And the aspect of each was that of some demon clock-face with one sinister hour always figured thereon - the dreaded, the doom-delivering hour of four.
Baffled in every attempt to shake off the circling and relentless delirium, I glanced once more toward the unshuttered window and beheld again the monster which had come from the grave. Horrible it had been before; indescribable it had now become. The creature, formerly of indeterminate substance, was now formed of red and malignant fire; and waved repulsively its four tentacled claws - unspeakable tongues of living flame. ”

“ Instantly the spirit of hell awoke in me and raged. With a transport of glee, I mauled the unresisting body, tasting delight from every blow; and it was not till weariness had begun to succeed, that I was suddenly, in the top fit of my delirium, struck through the heart by a cold thrill of terror. ”

“ Apocalyptic visions rose, mingled, vanished—monstrous clouds far in the depths of the fantastic abyss into which the soul of the sufferer gazed with horror. He saw the nuraghe with the giant and the saint of Aunt Varvara's delirium. But the moon detached itself from the Saint and fled over the heaven. ”

“ Whirling round and round, extending their arms to the sky, sometimes casting themselves headlong on the ground, biting the earth with savage lips, tearing their flesh with knives, one or two falling stone-dead before our very eyes, these poor people in their delirium cried like animals, and filled the whole woods with their melancholic wailing. ”

“ Men in delirium often say fearful things, which, whether true or false--whether the breakings forth of long suppressed remorse, or the mere dreamings of a disordered imagination--make deep impression on the hearers, and are often transmitted to others with all the evidence of truth. ”

“ He is next seized with violent delirium, and in his horrible paroxysms froths at the mouth, tears the flesh from his hands and arms, pulls his hair, and beats himself violently against the ground, meanwhile uttering the most piercing cries, till, completely exhausted, he remains without motion or feeling, and death ensues. ”

“ At last his face grows dark; radiant visions give way to monstrous phantoms; he sees nothing but menacing figures, murderers ready to cut his throat. Then he makes a spring: in order that he may not be killed, he kills. No one is more to be dreaded, for his delirium sustains him ”

“ Everything seemed flaming and tottering and falling in a wild delirium. The earth itself opened to swallow the last survivors. In the trenches the bodies of the dead were heaped, and twisted or bleeding corpses choked the passageways. ”

“ The supposed possession of estates and the imaginary fulfilment of wishes, the denial or destruction of which has just served as the psychic cause of the insanity, often form the main content of the delirium. ”

“ I shall be unable odically to sterilize myself, but we must hope. From amid the phantasms which that sick brain will throw out upon the astral film—upon the surrounding ether—I must trust that I find the thought, the last thought before delirium came! ”

“ Then, in the attacks of delirium, the things and persons that were the occasion of the emotion—fright, grief—reappear as hallucinations. This influence of what has happened in the past establishes an important difference between the delirium of the insane and that of persons suffering from hysteria. The visions of the insane, whatever they may be, generally have no immediate relation to anterior events, while the form of delirium in hysteria is nearly always determined by an incident which has formerly played an important part in the life of the patient. ”

“ In the experience that I am attempting to describe and to stress on several modes, it is certain that a new torment arises wherever another dies. The childish chasing after forgetfulness, the appeal of satisfaction are now devoid of echo. But the constant tension that keeps man face to face with the world, the ordered delirium that urges him to be receptive to everything leave him another fever. ”

“ In his feverish delirium he saw clouds of pursuers at their very heels, and during the long night he was for ever crying glad tidings which ended in disappointment and heartache. The rise of the sun showed the desert stretching away around them with nothing moving upon its monstrous face except themselves. ”

“ Instantaneous impulses are often brought about by the slightest circumstances. Thus, gazing steadily at the wheels of an approaching train or looking down from some great height may produce a delirium, a distention of the blood-vessels of the brain, that instantly paralyzes the will of the victim. ”

“ For it was well known that many of the pest-stricken in their delirium rushed into the street to die; that the passer-by might at any moment be confronted by some miserable wretch who, seized with madness, would rise and clasp him in an embrace of hideous contagion. ”

“ This was the crisis of the delirium. In the midst of it, the chief actor made his appearance, waving his wand, like Prospero, to work new wonders. Dressed in a long robe of lilac-coloured silk, richly embroidered with gold flowers, bearing in his hand a white magnetic rod; and, with a look of dignity which would have sat well on an eastern caliph, he marched with solemn strides into the room. He awed the still sensible by his eye, and the violence of their symptoms diminished. ”