rom combating the shock, or dealing with
concomitant injuries, no treatment is called for.

DELIRIUM IN SURGICAL PATIENTS

Delirium is a temporary disturbance of mind which occurs in the course
of certain diseases, and sometimes after injuries or operations. It may
be associated with any of the acute pyogenic infections; with
erysipelas, especially when it affects the head or face; or with chronic
infective diseases of the urinary organs. In the various forms of
meningitis also, and in some cases of injury to the head, it is common;
and it is sometimes met with after severe haemorrhage, and in cases of
poisoning by such drugs as iodoform, cocain, or alcohol. Delirium may
also, of course, be a symptom of insanity.

Often there is merely incoherent muttering regarding past incidents or
occupations, or about absent friends; or the condition may assume the
form of excitement, of dementia, or of melancholia; and the symptoms are
usually worst at night.

#Delirium Tremens# is seen in persons addicted to alcohol, who, as the
result of accident or operation, are suddenly compelled to lie in bed.
Although oftenest met with in habitual drunkards or chronic tipplers, it
is by no means uncommon in moderate drinkers, and has even been seen in
children.

_Clinical Features._--The delirium, which has been aptly described as
being of a "busy" character, usually manifests itself within a few days
of the patient being laid up. For two or three days he refuses food, is
depressed, suspicious, sleepless and restless, demanding to be allowed
up. Then he begins to mutter incoherently, to pull off the bedclothes,
and to attempt to get out of bed. There is general muscular tremor, most
marked in the tongue, the lips, and the hands. The patient imagines that
he sees all sorts of horrible beings around him, and is sometimes
greatly distressed because of rats, mice, beetles, or snakes, which he
fancies are crawling over him. The pulse is soft, rapid, and
compressible; the temperature is only moderately raised (100-101 F.),
and as a rule there is profuse sweating. The digestion is markedly
impaired, and there is often vomiting. Patients in this condition are
peculiarly insensitive to pain, and may even walk about with a fractured
leg without apparent discomfort.

In most cases the symptoms begin to pass off in three or four days; the
patient sleeps, the hallucinations and tremors cease, and he gradually
recovers. In other cases the tempera