in succession are passed without sleep; in some individuals, the mind is occupied by one impression, in others, agitated by an endless variety, sometimes the judgment is perverted, at others the imagination excited: the body also exhibits various accompanying peculiarities: the face is flushed or pallid, the eyes are prominent and animated, or sunk in the orbit and dull; frequently the features are sharpened, so as to render the expression unnatural in general, the muscular powers are increased, as is the capability of enduring cold, hunger, fatigue, and long watching; at the same time the natural excretions, and particularly the alvine, become interrupted. The utmost irregularity of appetite and passions usually takes place, and this more or less increases till the disease is established, and there is an absolute necessity for restraining the patient.

Among the variety of maniacs met with in medical practice there is one which, though by no means rare, has been little noticed by writers on this subject: I refer to those cases in which the individuals perform most of the common duties of life with propriety, and some of them, indeed, with scrupulous exactness, who exhibit no strongly

marked features of either temperament, no traits of superior or defective mental endowment, but yet take violent antipathies, harbour unjust suspicions, indulge strong propensities, affect singularity in dress, gait, and phraseology; are proud, conceited and ostentatious; easily excited and with difficulty appeased; dead to sensibility, deli, caey and refinement; obstinately rivetted to the most absurd opinions; prone to controversy and yet incapable of reasoning; always the hero of their own tale; using hyperbolic high-flown language to express the most simple ideas, accompanied by unnatural gesticulation, inordinate action, and frequently by the most alarming expression of countenance. On some occasions they suspect sinister intentions on the most trivial grounds, on others are a prey to fear and dread from the most ridiculous and imaginary sources now embracing every opportunity of exhibiting romantic courage and feats of hardihood, then indulging themselves in all manner of excesses.

Persons of this description, to the casual observer, might appear actuated by a bad heart, but the experienced physician knows it is the head which is defective. They seem as if constantly

affected by a greater or less degree of stimulation from intoxicating liquors, while the expression of countenance furnishes an infallible proof of mental disease. If subjected to moral restraint or a medical regimen, they yield with reluctance to the means proposed, and generally refuse and resist on the ground, that such means are unnecessary where no disease exists; and when, by the system adopted, they are so far recovered as to be enabled to suppress the exhibition of the former peculiarities, and are again fit to be restored to society, the physician and those friends who put them under the physician's care, are generally ever after objects of enmity, and frequently of revenge.

When the peculiarities and propensities of such patients are in themselves innocent and only occasional, though they approach ever so near the confines of insanity, there is no necessity for restraint or confinement: but when the suspicious traits are of an opposite description, and only the occurrence of some exciting cause wanting to render such persons extremely dangerous, then coercion becomes indispensably necessary.

Insanity, more than any other complaint, seems to take entire possession of the whole system, and

almost secures it from other morbid attacks. Mead, (See his Monita, Page 72) I believe, was the first who made the observation, and no fact in medicine is more completely established. During the period of prevailing epidemics, maniacs, in their affliction, seem to possess nearly an immunity from these diseases; and where an exception to this rule has occurred, the original complaint has been removed by the attack of the new disease. From hence a degree of improvement has arisen in the methodus medendi, by the introduction of some new disease into the system of maniacs; as where the patient has not had the small-pox, this complaint may be communicated by inoculation. Indeed a variety of means might be adopted to excite a new order of symptoms, creating considerable commotion in the animal economy, interrupting the morbid associations, and even occasioning temporary disease; and it is highly probable that, in a great proportion of human diseases, health is restored by temporary morbid changes and new specific actions, and that medical men sometimes acquire credit from even the effects of their blunders: this applies to the whole class of empirics.

As connected with the History of Mania, it will be proper to notice some circumstances concerning the pulse: a variety of causes, both mental and corporeal, conspire to induce alterations in the circulation of the blood, and it is very difficult to determine what is a frequent pulse, this being a relative term, unless we were acquainted with the healthy standard in every individual, as the range is often very considerable; in one man it shall be sixty, in another ninety.* But I would by no means convey an idea that the indications from this source are to be wholly neglected, but only that the minute attention to the pulse, which is necessary in other diseases, is not so in Mania. The difference of sex, stature, temperament, age, position, and temperature, as well as the state of the mind, are among the principal circumstances to which we must ascribe the variety exhibited in every disease.

Striking and obvious peculiarities in the pulse are never to be neglected, even in madness; but where these exist without concomitant symptoms,

"Nisi pulsus cujusvis hominis antea innotuerit; ex sola ejus frequentiâ, febris certo discerni nequit.

Burserii Inst. Med. Pract. Vol. I. p. 9.