An experimental study of the etiology of rum fits and delirium tremens

Isbell, H.; Fraser, H. F.; Wikler, A.; Belleville, R. E.; Eisenman, A. J.

Ten healthy morphine addicts who had been abstinent from narcotics for at least 3 months volunteered for a study of chronic intoxication with alcohol. The objective was to maintain each subject continually in the maximum state of intoxication compatible with safe ambulatory management for a period of 6 to 13 weeks, and then to discon- tinue alcohol abruptly. Alcohol was given orally at intervals in an average daily dose of 266 to 489 ml of 95% ethyl alcohol for 7-87 days. Convulsions and delirium did not appear during the period in which patients were consuming large amounts of alcohol sufficient to maintain high blood alcohol levels. Three patients withdrew from the experiment after 16 days of drinking, or less, and one after 34 days of drinking. Symptoms following discontinuance of alcohol by these patients were mild, consisting chiefly of tremulousness, nausea, perspiration and insomnia, and of brief duration. Six of the patients drank for 48-87 days. Following abrupt withdrawal of alcohol, all developed tremors, marked weakness, nausea, vomiting, diarrhea, hyperreflexia, fever and hypertension. Two of these 6 patients had seizures; 3 had a frank delirium; 2 had transient visual or auditory hallucinations or both; and 1 escaped both convulsions and hallucinations. These phenomena occurred despite the ingestion of an adequate diet, with multiple vitamin supplements, throughout the periods of intoxication and withdrawal. The intensity of symptoms following withdrawal of alcohol appeared to be correlated roughly with the amount of alcohol consumed and with the length of the period of intoxication. The eeg findings taken during and following the study bear out this relationship. The concentration of alcohol in the blood (usually determined with an automatic breathmeter) was followed in 3 of the patients. No evidence of residual impairment could be detected 3 months after discontinuance of drinking, as judged by physical, physchiatric, psychological, laboratory, and electroencephalo-graphic examinations.