INSANITY. 



149 



poking eloquence. He seems to understand better than 

 at other times what is going forward around him, but 

 gives an erroneous ami generally a malignant construc- 

 tion to every transaction. There have been cases in 

 which he has felt a strong inclination to assault, and 

 even to murder every person that came in his way, al- 

 though he could converse rationally, and deplore those 

 ungovemed inclinations by which he felt himself so 

 inevitably swayed. Sometimes there is an inclination 

 to suicide, seeming to arise not so much from a sense 

 of unhappiness, as from a mere tendency to extrava- 

 gance. The patient is so prone to novelty, and so re- 

 gardless of consequences, as to grasp eagerly at any op- 

 portunity that may be given him, of throwing himself 

 tram * dangerous height. Here we have only a great- 

 er degree of those nervous feelings which are experi- 

 enced by some person* in apparent health and sound- 

 ness of mind. We have known a man of the greatest 

 respectability, who acknowledged that, whenever he 

 passed a particular bridge, he felt a slight inclination to 

 throw himself over, accompanied with a slight dread 

 that this inclination might hurry him away. 



The delirious raving* which characterize mania in 

 it* perfect form, are a* various as the characters and 

 of individuals. Sometimes they are confined to 

 i object, which absorbs an inordinate degree of in- 

 but most generally there is a fabe judgment on 



[ of maniacs has often been remarked, as 

 with which they 

 , and the pertinent 



ft..r> 



prepose in order to obtain sati*. 

 " of the evasions practised by an 

 A patient in the lunatic asy- 

 wben the writer of this article at- 



leaded that institution, was found one morning to have 

 lost his ear, and, when interrogated about the instru- 

 ment with which he had thus mutilated himself, be 

 first made a great mystery of it, and then boasted of 

 his address in abstracting a button from bis neighbour's 

 coat, sharpening it on a stone, and cutting off hi* ear 

 with it before any person could observe him. In this 

 instance, we may remark the horrid contrast between 

 the unnatural object which the patient had in view, 

 anc. 1 'he skill which he employed to accomplish it. A 

 similar contrast under a variety of forms is of frequent 

 occurrence. The impressions which objects make on 

 the patient's mind are often extravagant, while the rea- 

 sonings which be establishes on these impression* are 



Mania i* often abject to intermission*, daring which 



the patient appears as well aa previous to the attack, 

 except that, not being engaged in hi* usual occupations, 

 ^^ betnsf sensible of the ex tstina* tendency to disease 



he shews less of the regular interest which be used to 

 take in surrounding object*, and a degree of shyness to- 

 wards those who address him. It is currently sen. 

 posed by persons not intimately acquainted with the 

 phenomena of mental disease, that the lucid interval 

 must be the most horrid of all possible state* of mind. 

 They conceive that the temporary return of reason, 

 bringing to the patient's mind a view of hi* deplorable 

 malady, must continually shock him with much greater 

 violence, than it can affect those who imagine to them- 

 selves the same disease in other*. This, howe 



wever, i* a 

 an exercise 

 but in some 



eoirrvrt than it i* (bund in the generality 

 who never laboured under liie disease. TLe 

 1 



The lucid interval brings with it 

 lewe indeed to be depended on, b 



patient becomes resigned to his situation, and feels the Mania- 

 propriety of not suffering the thought of it to distress 1 *~"~Y"^"' 

 him. Were it not for this reflection, which his expe- 

 rience has taught him, it could not be supposed that ma- 

 nia would have any intermission, or ever terminate in. 

 recovery. The sensibility, besides, is often exhausted 

 to such a degree, by the perplexity suffered previous to 

 the attack, that circumstances really gloomy have much 

 less influence than formerly in depressing the mind. 

 The patient also experiences a secret delight in the re- 

 turn of sound impressions, and knows that the best way 

 of cherishing them is to avoid every afflicting thought. 



It is seldom that mania returns at regular periods. 

 Of two hundred patients under the care of M. I'inel, 

 in the Bicctre of I'aris, only six were of this description, 

 and their periods were different from one another. 



A violent attack of maniacal excitement is sometimes Tennina- 

 followed by a sudden debility, in which the patient is tioo. 

 speedily carried off. 



Sometimes person* who have been for a long time in 

 a maniacal state, recover composure of intellect, which 

 continues for a year or two without any relapse; but 

 afterwards lose the whole energy of their constitution,' 

 and are cut off by that species of decay which is called 

 atrophia. 



Very often it happens that a patient, after being for 

 some time recovered from mania, is cut off by an apo- 

 plectic attack. It is very common for the disease to 

 degenerate into a chronic idiotism, which continues for 



m 



The corporeal phenomena of mania are of less uni- Corporeal 

 formity than the mental ; but, when they occur, they lymptora*. 

 throw light on the existing state of the constitution, 

 and attention to them becomes necessary in practice. 

 Want of sleep is the most common symptom of this 

 kind. An apparent increase of strength i* also very 

 frequent. Fever, constipation, drynew of the skin, and 

 increased heat in the head, are frequent symptoms. It 

 has been supposed, that patients under mania are less 

 sensible to external cold than healthy subjects. This 

 has been denied by Mr. Haslam ; and probably will 

 only apply to this disease in its acute state, and it* 

 earnest stages. 



The prognosis of mania is in general difficult The Prognosis 

 earlier in life that it comes on after puberty, we, carte. 

 rit parilmt, have better hopes of a recovery. The pre- 

 vious dispositions of the patient are worthy of our at- 

 tention. In persons naturally shy, and easily discou- 

 raged, the prognosis, though not rendered decidedly 

 bad, is rather leas favourable than in others. Mania ac- 

 companied with mirth, is less hurtful to the health, and 

 law obstinate than that whkh i* marked by horror and 

 distress. 



When this affection has succeeded to a long conti- 

 nued religious melancholy, we have little expectation 

 of a perfect cure, particularly if the patient has been 

 strongly attached to discouraging opinions. 



Where the patient's turn of mind has been previous- 

 ly characterised by singularities, and still more where 

 hi* whole conduct has indicated a want of common 

 prudence and feeling, an attack of mania, though ap- 

 parently cured, leaves behind it a character of increased 

 folly. In persons ol ingenuous dispositions it is some- 

 times followed by a character of greater modesty ; but 

 the morbid tangibility is increased in proportion to the 

 increase of external prudence, and the patient runs a 

 risk of being carried off by apoplexy. 



The disease becomes less hopeful in proportion t* 

 the length of it* continuance. Hence, in tome inatitu 



