Lectures on clinical psychiatry / by Emil Kraepelin ; revised and edited by Thomas Johnstone.
- Emil Kraepelin
- Date:
- 1906
Licence: In copyright
Credit: Lectures on clinical psychiatry / by Emil Kraepelin ; revised and edited by Thomas Johnstone. Source: Wellcome Collection.
Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.
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![spread fingers, a ]ittle uncertainty in speaking, and contraction and bad reaction of the pupils , but the last of these disturbances may be referred to the large use of opium during his illness. His liver is enlarged, and there is sugar in his urine. We see again in this patient a number of features we learned to recognise in the previous case—the characteristically fantastic and dreamlike experiences, the extraordinary clearness to the senses of the hallucinations, the half-apprehensive, half-humorous mood, and the restlessness and tremors. On the other hand, the patient, for the time, has a correct idea of places and things. That seems generally to have been the case during the course of his illness, but at times it was not so—e.g., during the delirious concert. We cannot therefore look upon the difference as essen- tial, but only as one of degree. Lastly, in this patient also we have been able to call up hallucinations by suggestion when the eyes are closed, a phenomenon very frequent in sufferers from alcoholic delirium. We will therefore not be wrong in assuming that this is also a case of delirium tremens.* Both patients had sugar in their urine, though it was only found for a short time in the first case. This is not a regular symptom, but at the height of the disease albumin may generally be found in the urine, and certain changes seem to take place in the blood. All these phenomena point to this conclusion : that the abuse of alcohol leads to severe disturbances in the physical economy, which we must apparently consider to be the direct and immediate cause of delirium tremens. There can hardly be any question of immediate alcoholic poisoning, because the clinical picture is very different from that of intoxication, and also because the delirium ends in a few days, even if drinking is continued. Moreover, the delirium may set in after some time of complete abstention from alcohol. Our present cases also show that the withdrawal of alcohol is in no way responsible for the out- break of the delirium. Both patients went on drinking till the disease was completely developed. This is not without importance in the treatment of the illness. The administra- tion of alcohol has by no means so favourable an influence on the course of the disturbance as has always been assumed hitherto. I have treated delirium tremens myself for more than ten years quite without alcohol, and have had every reason to * The patient became clear after the deUrium had lasted six days, and died a few years later without having had any return of the disease.](https://iiif.wellcomecollection.org/image/b21295499_0132.jp2/full/800%2C/0/default.jpg)
