On the pathology of delirium tremens, and its treatment without stimulants or opiates / by Alexander Peddie.

Date:
1854
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Licence: Public Domain Mark

Credit: On the pathology of delirium tremens, and its treatment without stimulants or opiates / by Alexander Peddie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    considered delirium tremens to be a first degree of paralytic cere- britis Dr Abercrombie appears to have considered it as a dan- gerous form of meningitis ; ^ Dr Bright actually includes it among his cases of arachnitis;^ Dr Hoegh-Guldberg* also views it as a febrile affection, indeed a species of arachnitis; and Frank, Sper- anza, Andreae, and several other writers, have entertained similar opinions.^ Such opinions, I think, come nearer the truth in regard to the nature of the disease than those generally received; and they obtain strength from its symptoms, the injurious effect of stimulating treatment, and the appearances observed in fatal cases. The post- mortem cerebral changes in so far as regards paleness of tissue and shrunken convolutions, steatomatous and other alterations of the coats of the vessels, and to some extent also thickenings and opacity of the arachnoid, along with a large amount of subarachnoid and intraventricular serous effusion, are most likely to be found in those who have had several attacks of the disease, and who have long been noted dram-drinkers. But even after first attacks the membranes generally present great vascular fulness, the arachnoid is thickened, and under it, throughovit the brain, and within the ventricles, there is very considerable serous effusion. Dr Craigie's opinion of the pathology of the affection—which he terms Meningitis fliantasmato- ■phora, or methystic brain fever {jxeBvo} ehrius swny—is the follow- ing :— In the early and incipient stage of methystic brain fever, the symptoms de- pend on irritation of the brain. That is to say, the meningeal veins are loaded with an unusual quantity of venous blood, and the arteries with imperfectly aerated arterial blood, both charged with spirituous particles ; and as this circu- lates slowly, it irritates the brain, and disorders the cerebral functions, first of sensation and perception ; secondly, of memory; thirdly, of fancy; and fourtJdy, of judgment. The cerebral irritation thus induced is the great cause of the sleeplessness and restlessness, as well as of the fantastic delirium and halluci- nations. In this stage of the disease, which is the eretliismus cerebri ahdomin- alis of Topken, the delirium eretliicum of Hufeland, and the encephcdopathia of Leveille, the symptoms may subside spontaneously, or under the use of ap- 1 Traite de Pathologie le Cere'brale, par Scipion Pinel, p. 400. 2 Diseases of the Brain and Spinal Cord, p. 63. 3 Medical Reports, vol. ii. p. 10. * Commentatio de delirio tremente, quoted in Brit, and For. Med. Review, vol. vi. p. 328. ^ Referred to by Dr Craigie, Pract. of Physic, vol, ii. p. 66, 67. « Op. cit., p. 53.