Repeated drunkenness usually ends in an attack of delirium tremens, but this disease is more frequently the result of prolonged drinking which has never culminated in actual drunkenness. It is especially apt to occur in " those who drink hard, but keep from actual loss of consciousness, especially those engaged in hard mental work or subjected to great moral strain or shock; and, too, those of certain temperaments are peculiarly liable to it".

Few persons die in their first attack of delirium tremens, but it is nature's unmistakable warning to the tippler: let him not disregard it, unless he is prepared to die without hope, in maniacal imaginings so frightful that those around his death-bed can never recall the scene without horror !

It is preceded, usually, by loss of sleep, ideas of persecution or injury, with no foundation in fact, and slight hallucinations, especially at night; the man, meanwhile, in the day looking anxious, slightly excited, nervous and tremulous, and perhaps narrating as actual occurrences the hallucinations of the preceding night. Then the senses are partly lost; he sees spectres, horrible and foul creatures about him; has all sorts of painful, terrifying visions (whence the common name of the 'horrors'); is extremely tremulous, and either excited or lies prostrate, trembling violently on movement, sleepless, anxious, and a prey to spectres and terrors of the imagination." *

Action of alcohol on sense organs ? On brain and spinal cord ? Under what conditions may delirium tremens occur?

Dipsomania is often confounded with delirium tremens, but though it may lead to that disease it is an essentially different pathological state. The word properly means a mental disease in which there is periodically an irresistible passion for alcohol; in any form, no matter how distasteful, the dipsomaniac will swallow it with avidity. The disease is sometimes produced by indulgence in drink, but is more often inherited, especially from parents addicted to alcoholic excess. In the families of such, one child is often epileptic, another idiotic, a third eccentric or perhaps quite mad, and a fourth a dipsomaniac. When the fit seizes him the dipsomaniac is as irresponsible as a raving madman. His only safeguard against a frightful debauch is to place himself under restraint as soon as he perceives the symptoms which he has learned to recognize as premonitory of his fit of madness. After a time the paroxysm passes off; the patient regains self-control, loses his passion for drink, is greatly ashamed of himself if he has indulged it, and usually behaves in an irreproachable manner for some weeks or months.

What symptoms usually precede this disease? Describe the condition of a person suffering from delirium tremens. What is dipsomania?

* Dr. Greenfield, on "Alcohol: its Use and Abuse".