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Encyclopedia Britannica - Main :: DAH-DEM |
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DELIRIUM (a Latin medical term for madness, from delirare, to be mad, literally to wander from the lira, or furrow) , a . temporary form of brain disorder, generally occurring in connexion with some special
Delirium tremens is one of a train of symptoms of what is termed in medical nomenclature acute alcoholism, or excessive indulgence in alcohol. It must, however, be observed that this disorder, although arising in this manner, rarely comes on as the result of a single debauch in a person unaccustomed to the abuse of stimulants, but generally occurs in cases where the nervous system has been already subjected for a length of time to the poisonous action of alcohol, so that the complaint might be more properly regarded as acute supervening on chronic alcoholism. It is equally to be borne in mind that many habitual drunkards never suffer from delirium tremens.It was long supposed, and is indeed still believed by some, that delirium tremens only comes on when the supply of alcohol has been suddenly cut off ; but this view is now generally rejected, and there is abundant evidence to show that the attack comes on while the patient is still continuing to drink. Even in those cases where several days have elapsed between the cessation from . drinking and the seizure, it will be found that in the interval the premonitory symptoms of delirium tremens have shown them-selves, one of which is aversion to drink as well as foodthe attack being in most instances preceded by marked derangement of the digestive functions. Occasionally the attack is precipitated in persons predisposed to it by the occurrence of some acute disease, such as pneumonia, by accidents, such as burns, also by severe mental strain, and by the deprivation of food, even where the supply of alcohol is less than would have been likely to produce it otherwise. Where, on the other hand, the quantity of alcohol taken has been very large, the attack is sometimes ushered in by fits of an epileptiform character.One of the earliest indications of the approaching attack of delirium tremens is sleeplessness, any rest the patient may obtain being troubled by unpleasant or terrifying dreams. During the day there is observed a certain restlessness and irritability of manner, with trembling of the hands and a thick or tremulous articulation. The skin is perspiring, the countenance oppressed-looking and flushed, the pulse
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In most cases the symptoms undergo abatement in from three to six days, the cessation of the attack being marked by the occurrence of sound sleep, from which the patient awakes in his right mind, although in a state of great
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Although generally the termination of an attack of delirium tremens is in recovery, it occasionally proves fatal by the supervention of coma and convulsions, or acute mania, or by exhaustion, more especially when any acute bodily disease is associated with the attack. In certain instances delirium tremens is but the beginning of serious and permanent impairment of intellect, as is not infrequently observed in confirmed drunkards who have suffered from frequent attacks of this disease. The theory once widely accepted, that delirium tremens was the result of the too sudden breaking off from indulgence in alcohol, led to its treatment by regular and often large doses of stimulants, a practice fraught with mischievous results, since however much the delirium appeared to be thus calmed for the time, the continuous supply of the poison which was the original
The views of the disease which now, prevail, recognizing the delirium as the effect at once of the poisonous action of alcohol upon the brain and of the want of food, encourage reliance to be placed for its cure upon the entire withdrawal, in most instances, of stimulants, and the liberal administration of light nutriment, in addition to quietness and gentle but firm control , without mechanical restraint. In mild attacks this is frequently all that is required. In more severe cases, where there is great restlessness, sedatives have to be resorted to, and many substances have been recommended for the purpose. Opiates administered in small quantity, and preferably by hypodermic injection, are undoubtedly of value ; and chloral, either alone or in conjunction with bromide of potassium, often answers even better. Such remedies, however, should be administered with great caution, and only under medical supervision.Stimulants may be called for where the delirium assumes the low or adynamic form, and the patient tends to sink from exhaustion, or when the attack is complicated with some other disease. Such cases are, however, in the highest degree exceptional, and do not affect the general principle of treatment already referred to, which inculcates the entire withdrawal of stimulants in the treatment of ordinary attacks of delirium tremens.End of Article: DELIRIUM (a Latin medical term for madness, from delirare, to be mad, literally to wander from the lira, or furrow) If you wish, you can link directly to this article.
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