On alcoholism in gynaecology and obstetrics / by J. Matthews Duncan.

  • Duncan, J. Matthews (James Matthews), 1826-1890.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: On alcoholism in gynaecology and obstetrics / by J. Matthews Duncan. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    lying-in women, is a disease much less striking in its characters, yet it is scarcely liable to be confused with the delirium sympto- matic of fever. Not ouly has it characters less striking than those of delirium tremens, but it is also much more the subject of varia- tions of degree. It may be so slight as scarcely to attract notice, or it may be severe and alarming; yet it appears to me to be, perhaps always, distinct from the regular delirium tremens. It is very difficult to picture the condition of patients in this nervous delirium of chronic alcoholism in a few sentences, and the words of Dupuytren ^ and of Fournier may be well adopted with this object. The former speaks of its iirst period as characterized by agitation, anxiety, insomnia, loss of appetite, nausea, vomiting, hallucinations of hearing, sight, and touch, rarely much thirst, little fever, and tremblings only occasionally. Fournier^ giving a fuller statement fails, as he himself admits, to keep quite true to the distinction from delirium tremens. As to the nervous delirium of the operated on, described by Dupuytren, it approaches, he says, to delirium tremens by so many of its characters that it seems to deserve being confounded with it. But there are more delicate cases where the delirium tremens runs the risk of being mistaken. When it complicates an acute affection, it is often difficult to differentiate it from febrile or symptomatic delirium. A minute study of the phenomena is then indispensable, and even this is not always sufficient entirely to remove doubt. In general, symptomatic delirium does not present the violence, uor tlie agita- tion, nor the need of movement, nor the interminable loquacity of the delirium ebriosum ; and, further, it has not the unquiet and perplexed character ; it is less subjected to sensorial troubles, and hallucinations especially take less part in it; it does not present the same bizarre mixture of just ideas and of wanderings; it does not admit in the same degree of giving place to a momentary return of the reason under the influence of a diversion somewhat active ; finally, it is much more rarely complicated with trembling and persistent insomnia. It will be observed that Fournier speaks of nervous delirium complicating an acute affection. That this may occur there can be no doubt, but what I wish here to remark is, that in all the well- marked cases that have come under my observation there has been a slight degree of an acute affection, which I would as readily de- scribe as complicating the nervous delirium. This has been observed even in the slightest cases, and it was so in the case of delirium tremens. The affection is briefly described as a para- metric swelling and induration, with tenderness, not becoming extensive or persisting, or causing much alarm. ^ It is certain that delirium tremens is very much rarer actually ^ Legons orales, tome ii. p. 234. 2 Nouveau did. de mMecine et de chirurgie pratique, tome i. p. 653.