In the first period of the illness, the hands do not tremble as they lie on the coverlet, but when the patient tries to take a cup or a spoon, they shake so that everything is upset and spilt. At night the dreams, which have already awakened him in fright, assume the character of a positive hallucination. Often patients spring out of bed, crying that a snake is twining round their neck, and they tear, panting, the clothes from their body, and wander about naked, writhing, as though trying to release their neck from a noose, to free themselves from fetters in which their madness has bound them fast.
Then they grow quiet again, but the delirium has broken out and will develop, leaving them no more peace. They will lend life to every shadow, and see perpetually before them reptiles and insects crawling about and multiplying. What agony! Ever and anon they cry out that monstrous spiders or venomous scorpions are creeping from the walls on to the bed; that black cats with fiery eyes are crouching on their breast; that wolves with open jaws or mad dogs with foaming mouths are biting them, or that loathsome rats, mingling with a black swarm of beetles, are gnawing at their vitals. And then the patients, tortured, annihilated by fear, writhe, gnashing their teeth, groaning, howling, sobbing. They bite their hands, tear the bed-clothes, bury their nails in their faces disfigured with rage. Then they rise to escape, and fall heavily backwards into bed, exhausted, pallid, with distorted face, a rattling in the throat, and their eyes rolling in the most awful despair.
Sometimes this hideous storm blows over, and a little calm returns. The patients are languid, and when questioned answer intelligibly but crossly. In lucid intervals some regret their faults, and say that they drank in order to forget their misfortunes or their misery, but these are only rays of light in the midst of ruins shrouded in darkness. Nearly all remain indifferent to the desolation of the family, shake their heads disconsolately, and talk of suicide. At every feverish attack, by whatever cause produced, the frenzy becomes so great that they must be bound and secured in a strait-jacket.
The trembling increases, the patient cannot sleep; he chatters, walks up and down, wandering about the room like a lost dog. We make out from his laments that the hallucination is gradually taking possession of all his senses. In stammering, disconnected words, he complains from time to time that he is poisoned, has the taste of something loathsome in his mouth, and he rejects everything because he fears treachery. He says there are chemical vapours rising in the room which will suffocate him, and then he runs hither and thither raging, fighting the air with clenched hands, pressing himself close to the wall, or rushing to the window, throwing to the ground furniture and utensils from which he thinks he sees the pestilential vapours poured forth.
My whole life long I shall remember with a shudder the night which, as a student, I spent with one of these unhappy wretches. It was at that time when physicians believed that the danger could be averted and the delirium shortened by a speedy letting of blood. I had been sent by an old physician into a squalid garret, in order to bleed a patient. I found him in bed raging violently. He was a sturdy porter, with inflamed face and swollen neck-veins. When I tried to take him by the arm, he looked at me with bloodshot eyes that seemed to devour me. Then he began to mumble and tremble, pouring forth oaths like stormy thunder, and howling like a lost soul. 'No, no, help! Stop the murderer who is going to kill me—he has a razor to cut my throat!’ His face wore a terrible expression of fear, the furrows on the brow, the dilated nostrils, contracted lips, the gnashing of the teeth, gave evidence of a desperate struggle. Then he writhed in our arms, trying to escape, while we held him back. 'Help!’ he screamed, 'they are going to throw me out of the window, on to the bayonets below! Help, quick, take those cut-throats away! Do you not see that the street is full of soldiers and executioners, who are climbing up on ladders to stab me?’ Until at last, worn out, bathed in perspiration, livid, breathless, still cursing and murmuring, he fell gradually into the lethargy of the dying.
When the disease grows worse, the delirium becomes continual, the trembling increases, the muscles swell to such a degree that it seems as though they would burst. One might almost think that a furious demon were hidden within, agitating the body in the bed, distorting it, hurling it to and fro, as though to shatter it completely. The most terrible apparitions are those of spectres. Some of these are so horrible that the patients are paralysed with dread. They suddenly send forth a terrible shriek, hold their hands in front of them, throw the head back, but still think they see the lean and colourless face of some dead man whom they call by name. Disguised enemies with fleshless countenance, wrapped in grave-clothes, come to lead them away with them; skeletons stride through the room, rattling their bones and gnashing their teeth with devilish glances.
Then Death, dressed in all the horrors of the most corrupt reality, appears to lower them into the grave. 'Take away this rotting corpse which those wretches have put into my bed! Do you not see that it is a liquid, loathsome mass, a putrefied abomination, and that the worms are crawling about the body?’ And they hold their nose to exclude the putrid smell, and look at their hands, on which they see clots of blood, livid streaks, and the revolting blackness of gangrene. Sometimes all ends suddenly, but often they sleep after the delirium has lasted three or four days, and on waking, fall into imbecility, die exhausted, or else become quite mad.