§ 260. Delirium tremens, phrenesia, or encephalitis potatorum.

This disease is partly of a physical, partly of a psychical nature. It is generally preceded by pressure in the region of the stomach or liver, loss of appetite, vomiting of water, tremor when not in a state of intoxication, languor, confusion of the head, restless sleep or else sleeplessness, anguish, unsteadiness and vehemence, quarrelsomeness, and lowness of spirits. These symptoms precede the attack for days and weeks, after which the paroxysm sets in suddenly, in consequence of an intoxication.

Although the disease may be brought on by the abuse of any kind of spirituous drink, yet it is principally occasioned by brandy, and more particularly in individuals of an ardent disposition, lively fancy, sanguine and choleric temperament, and general nervous irritability, and who have been suffering with gastric derangement, nocturnal restlessness, and mental derangement.

§ 261. We have already stated above, that the attack is preceded by derangements of the abdominal organs, loss of appetite, vomiting, constipation, which sometimes alternates with diarrhoea, increasing, in some instances, to a perfect cholera morbus. Symptoms of mental derangement are likewise present; ill-humour, weakness of memory, anxiety, confusion of ideas. The patient stutters, the movements of the body become unsteady, the sleep is unrefreshing and disturbed, with unpleasant dreams; there is great disposition to sweat, and the patient is troubled with illusions of sight and hearing. The more the disease progresses, the more sleep becomes disturbed, and the fancies with which the patient was haunted during sleep, continue even in the waking state, and are supposed by him to be realities. Little by little sleep ceases entirely, the looks and manners of the patient betray great internal uneasiness and anxiety; he talks a good deal, seems very busy, and finally becomes delirious, the delirium being sometimes of a merry, at others of a vehement character, the latter particularly when the patient's desires are opposed; at times the patient is tormented with anguish, and apprehension of imaginary dangers. The strange and peculiar expression of the eye and features is characterized by an awkward desire to conceal the internal state; if, however, the patient should be troubled with one fixed idea only, those attempts at concealment do not exist. The patient is, as it were, in a waking dream, from which he can be roused for a short time, by speaking to him, or by other impressions: when roused, he talks rationally, considers himself sick, which is not the case otherwise, asks for aid, after which he relapses into his dreams. When the paroxysms are at their height, he is apt to confound persons well known to him with others. He expresses his fancies by his gestures, which are sometimes very comical on that account. The patient is exceedingly jealous. He does not like to be left alone, because his anxiety increases in solitude and when in bed. It is difficult to keep him in bed, particularly towards the termination of the malady, and any attempt to oppose his leaving the bed and walking about the room, frequently induces a fit of rage. The disease generally exacerbates towards evening. On account of the violent starting and trembling of all the limbs, it is difficult to determine the pulse with any degree of accuracy. The upper limbs tremble more than the lower, even before the attack has set in; the trembling is worse after the attack has set in, and diminishes or increases with the disease. The more feeble the patient, the more profuse the sweat, which generally smells sour and is cool; sometimes the sweat is entirely wanting.

The tongue is generally coated whitish, the thirst is not very great, the appetite scanty, stool sluggish, or even suppressed, the secretion of urine is likewise diminished. In consequence of the congestions of the head, which are always present, the face is red, though it has sometimes a jaundiced appearance. At the commencement of the disease, when the patient has not yet lost his senses, he frequently complains of heat in the head, headache, and buzzing in the ears; afterwards the eyes and eyelids turn red.

The disease sometimes runs its course in a few hours, or in a few days, or even in some days or weeks; hence we distinguish acute and chronic delirium tremens.

Terminations: (1.) In recovery, by sleep, which sometimes lasts 24 hours, the trembling ceases, the face brightens up, bilious discharges from the bowels take place. Relapses are apt to set in after the least excesses. (2.) In death, by paralysis of the brain, or apoplexy.

The prognosis is rather favourable; it depends upon the mode of treatment.

§ 262. I am unable to say, for want of sufficient experience, whether the last stage of this disease can be cured by homoeopathic remedies. As regards the first stages of this disease, it is certain that they can be cured, and that the development of the disease can be arrested.

One of the best specifics for delirium tremens arising from abuse of brandy, even if the disease should be considerably advanced, is Nux vomica. To promote the cure, the patient should be given small portions of brandy, in water, one portion of brandy to three portions of water; this will bring on sleep, without interfering with the suitable specific.

Coffea Cruda is an excellent remedy to regulate the excessive irritability of the nervous system, to quiet the fancy and excessive muscular mobility. Every homoeopath knows that our mode of changing crude drugs to remedial agents, alters the original substance to such an extent that the homoeopathic preparation, as, in this instance, Coffea, will be found sufficient, even if the same substance should have been constantly used by the patient in its crude state.

Arsenic is an excellent remedy for trembling of the limbs, pale, jaundiced complexion, bloated face, cold and blue skin, fainting fits, particularly during vomiting, anxious heat, starting, anguish, melancholy, sadness, despondency, vehemence, or derangement of the will-faculty generally, etc.*

Opium is likewise a very useful remedy in delirium tremens, inasmuch as it increases the irritability and action of the voluntary, and diminishes those of the involuntary muscles; hence the slower pulse, the suppression of stool, etc.; on its secondary action, it exalts the fancy and courage, and stupefies, at the same time, the sentient power and the consciousness. As Nux v. is a specific remedy for this disease in the first stage, so is Opium in the second, and should at once be substituted for the former remedy if the disease progresses uncontrollably towards the second stage.

Camphor seems to me a suitable remedy when the nervous excitement, the mobility and tremor of the limbs, do not yield to any of the above-named remedies. As opium corresponds to Nux, so does Camphor to Coffea, and will be exhibited with advantage if the latter remedy, though indicated, should prove of no avail.

According to some, Stramonium, one or two doses, is frequently indicated. Hyoscyamus, in alternation with Belladonna, is said to have cured a case very much like delirium tremens, though not entirely the same. Some maintain likewise that Nux com, is only useful in the stage of convalescence.

For the remaining mental derangement, mania, craziness, idiocy, (which is more frequent in females.) paralysis, habitual sweats, dyspepsia, cachexia, organic diseases of the liver, etc., Nux vom. is likewise the most suitable remedy, though Veratrum, Acid, phosphor., Aurum, etc., are likewise very valuable in some cases.

* A characteristic indication for Arsenic is this: Vermin crawling about the bed, ugly animals staring at the patient, strange faces, etc. At the same time the patient seems to talk rationally. One of them asked me repeatedly to remove the vermin from the bed-clothes; it seemed to be his honest belief that the vermin was there He likewise saw money, dice, etc., and begged me to pick them up for him. He was cured with Arsenic, in a week. I had cured him of delirium tremens four times. - Hempel.

For the inclination which some men possess to drink from morning to night, in order to keep themselves in a constant state of intoxication, I have administered the tincture of sulphur with great success.