The hyperadrenergic syndrome, delirium tremens, as contrasted with tile milder alcohol withdrawal syndromes, is a medical emergency. The clinical features of delirium tremens were carefully described almost 200 years ago. Since then, many therapies have been suggested as superior to preceding therapeutic approaches. Unfortunately, morbidity and mortality remain relatively unchanged for the last 100 years. Using a literature review, we review the history of delirium tremens, including the suggested therapeutic approaches. We recommend a rational approach to management and therapy, based on present knowledge.