Acute hallucinosis differs from delirium tremens: (1) in the predominance of hallucinations of hearing over those of sight; (2) in the absence of any marked disorder of consciousness; and (3) in its course, which is of longer duration.

After a rather prolonged prodromal period marked, as in the case of delirium tremens, by an accentuation of the symptoms of chronic alcoholism, the patient becomes uneasy, distrustful, and suspicious. Gradually false interpretations, illusions, and persecutory ideas become established. He does not dare to leave the house, feeling that he is being watched, insulted or threatened by passers-by or followed by the police. Very early hallucinations of hearing appear followed often by hallucinations of other senses.

The disease rapidly reaches its height of development and then presents the following fundamental features:

(a) Conservation of lucidity: the patient remains well oriented, understands questions, and answers relevantly.

(6) Painful character of the delusions and of the psychosensory disorders: ideas of persecution of a variable nature: fear of being poisoned or assassinated, ideas of jealousy; imaginary insults or threats; frightful visions, especially marked at night, grimacing figures, ghosts, detectives coming to take the patient into custody, executioners, etc.; a taste or an odor of poison or of faecal matter; sensations of scalding, pricking, or electric currents; motor hallucinations. These latter phenomena, but slightly marked in the majority of cases, point to a grave prognosis when they assume a certain intensity; they often forebode a prolonged course of the disease and indicate a tendency towards mental deterioration. Hallucinations of taste and smell often cause refusal of food.

(c) Tendency to systematization: the patient seeks an explanation and a cause for the persecutions. However, the systematization is of rapid development and is not always very accurate.

{d) Depressed mood and aggressive tendencies: the patient, profoundly irritated, wreaks his vengeance upon innocent victims, being determined to defend himself against the persecutions of his enemies or to escape them by any possible means. If such a patient desires to die it is not, as other classes of patients, for the purpose of expiating some crime or of finding relief from remorse, but solely to escape the frightful tortures prepared for him by his enemies. Often he transforms his house into a veritable arsenal and, unfortunately, does not limit himself to mere demonstrations, but makes use of his weapons.

The somatic disorders of chronic alcoholism are all present in this affection. Sleep is diminished and filled with the pathognomonic dreams.

The urine often contains a trace of albumen.

As a general rule an attack of acute hallucinosis tends toward recovery. This takes place gradually after several weeks or at most several months.

The prognosis is, however, not altogether favorable, firstly because recurrencies are common, and secondly because each successive attack leaves a noticeable trace upon the intelligence and accelerates the course of alcoholic dementia.

It is of great importance to make the differential diagnosis between acute hallucinosis and the other affections in which systematized delusions are encountered, viz., dementia praecox, delire chronique, and paranoia. The reader is referred to the respective chapters devoted to these diseases for the points of differentiation.1

• The treatment is that of chronic alcoholism. The violent reactions usually necessitate commitment. Attacks of excitement are to be treated by the usual methods.

Between acute hallucinosis and the alcoholic delusional states there is no sharp line of demarcation; the principal distinction is in the predominance in the latter of delusions, while hallucinations play but a subordinate part. Some cases are acute, of brief duration, and more or less closely connected with sprees or unusual excesses in drinking; others are chronic, subsiding only in part, if at all, upon the withdrawal of alcohol and lighting up again promptly upon the resumption of drinking or even without it merely upon the patient's return from the institution to his home and old surroundings. The delusions are mostly of persecution and often may be plainly seen to originate from a subconscious effort on the part of the patient to place upon others the blame for the conditions resulting from his intemperance: the fellow workmen annoy him in various ways, have plotted against him, have caused him to lose his position; his employer discriminates against him; the labor unions are spreading bad reports about him to prevent him from getting employment; especially characteristic are delusions of jealousy based, for the most part, on misinterpretations of most trivial occurrences: the bedspread is wrinkled as though somebody had lain on it, the wife leaves the house too often daiming to go to the store or to visit her mother, the milkman's "Good-morning" seems suspiciously friendly, the coffee tastes queer, probably on account of poison put in by the wife to get rid of the patient.

These delusions often lead to violent quarrels, disgraceful scenes, beating, and threats or even attempts of homicide.

1G. H. Kirby. Alcoholic Hallucinosis, with Special Reference to Prognosis and Relation to Other Psychoses. Psychiatric Bulletin of the N. Y. State Hospitals, July, 1916.