Delirium tremens is a condition of active maniacal excitement which in its worst form is accompanied by intense general nervous excitement, muscular weakness, and hallucinations, chiefly of sight and hearing, of a terrifying or disgusting nature.

Delirium tremens is sometimes excited by a temporary debauch, but as a rule this results in a condition of coma rather than maniacal excitement. Delirium tremens is much more characteristic of chronic than of acute alcoholism.

In the earlier stages the heart action may be apparently vigorous and the pulse full and bounding, but the heart may become suddenly exhausted and cardiac failure is the chief danger.

Dietetic Treatment

The indications for dietetic treatment are to make sure that the alimentary canal, which has been previously disordered and congested, if not inflamed by the excessive irritation of strong alcoholic drink, is emptied of any accumulation of abnormally fermenting food. In the earlier stages brisk purgation or an evacuant enema should be given. If the stomach is overloaded with improper food, free vomiting should be produced by ipecac or apo-morphine, provided the condition of the patient is sufficiently vigorous to warrant this procedure. Large draughts of water, aerated and saline waters, should be taken to promote the activity of the kidneys and to dilute the poison in the system. The alimentary canal having thus been emptied of fermentation products, it becomes necessary to support the patient's strength with abundant nourishment. The appetite for food is usually entirely absent, being replaced by that for drink, but the patient must be urged to take all the nourishment possible, and to this end it may be given in fluid form in small frequent doses. The food should be stimulating and predigested. If there is much gastro-intestinal irritation, pancreatinised milk, strong meat soups, beef tea with dropped eggs added to it, and egg albumin may all be given.

The mucous surface of the stomach has been long accustomed to the stimulating effect of strong alcohol, and if this be suddenly and completely removed, gastric discomfort and craving for drink become intolerable. This condition is often relieved by using strong spices or condiments, such as ginger or Cayenne pepper, in quantities which would be injurious to a normal stomach, and might possibly produce gastritis. These substances may be added to food and non-alcoholic drink, although the stomach may be actually inflamed. Experience proves that highly seasoned food is sometimes borne with the effect of diminishing the suffering of the patient. This applies, of course, only to very robust cases, in which an otherwise vigorous constitution has been abused by excessive indulgence in drink, and the gastric stimulant should not be long continued. In this variety of cases the quantity of food which the patient is encouraged to take need only be limited by the ability to digest it, for the digestive organs can be kept fairly active without being overloaded to the extent of exciting abnormal fermentation.

The nervous system is always strengthened and soothed by abundant nourishment.

Ginger ale constitutes a very serviceable non-alcoholic beverage, which in part relieves the craving for stronger drink. It may be drunk in considerable quantity, and it possesses the advantage of being somewhat laxative, diuretic, and mildly stimulating to the stomach. Care should be taken to obtain a pure article, as there is much inferior ale in market.

It is well known that persons who for many years have indulged excessively in spirituous drinks are very apt to develop delirium tremens if taken suddenly ill, or if they sustain an injury such as a fracture, although they may have drunk no liquor for many weeks. In such cases the patient's life is in serious danger and it may be necessary to give more alcohol to maintain the accustomed influence. The conditions here to be met are very different from those resulting from an ordinary debauch, when liquor should be entirely withheld.