KAMA is the form of mental derangement most familiar to ordinary observers. The excitement and violence by which it is sometimes characterized have become, erroneously and unfortunately, the type and standard by which the disease and those subject to it have been recogmzed and treated. These qualities occasionally involved danger to those around, and were always calculated to inspire fear; so that for centuries they were coun teracted by repression, coercion, and harshness. It is worthy of remark that contem poraneously with the establishment of confidence, and with the introduetion of a humane system of treatment, the fury and formidable pugnacity of the insane to a great degree dis appeared. This effect, must, however, in part be referred to that change of type in the nature of the malady itself which is supposed to depend upon a modification in the human constitution, as well as upon external circumstances, and which has been observable in all affections of an inflammatory character since the beginning of the present century. The discontinuance of restraint, and the cessation of the necessity for such a measure in asylums, whether regarded as protective or remedial, may be accepted as a proof of the reality and extent of this change, upon whatever it may depend. It is, moreover, prob able that, by the accuracy of modern diagnosis, cases of wild frenzy, depending upon fever or inflammation of the brain, have been disting,uished from those of true ma-nia, and its true features thus better determined. These are loss of appetite, general uneasiness and irritation, watchfulness, headache, restlessness, intense stimulation of the passions and propensities, rapid ideation, incoherence and loquacity, violence or unbridled agitation and extravagance; and, as the disease advances, emaciation, hollowness of the cheeks and eyes, discoloration of the skin, brilliancy and fixity of eyes. However similar these symptoms may be to what are seen in the fevered and the phrenetic, great caution must be exercised in concluding that the circulation is involved directly, or at all, for of 222 cases examined by Jacobi, 23 only presented any indications of fever, and in these this condition was attributable to hectic and other causes unconnected with mania. Esquirol
rarely rnentions the pulse as affording any guidance in this kind of alienation. The true interpretation of these symptoms appears to be that they are connected with debility and exhaustion; that although, remotely, they may originate in any organ or condition, they proximately depend upon impaired nutrition and irritation of the nervous system, calling for support, stimulation, calm, and repose, alike moral and physical. The classification of the various aspects under which mania occurs has been so far regulated by the bodily affection with which it is complicated or associated. Epileptic mania, the most furious and formidable, and puerperal mania, perhaps the most intractable species, consist in the superaddition of the indications formerly detailed to certain states of the nervons system, and to that of parturition. Whatever the combination or complication, however, the essential psychical characteristic of mania is that all mental powers are involved, and are thrown into a state of exaltation and perversion. When the initiatory extravagance and excitement have subsided, when the affection has become chronic, delusions, previously existinn., become prominent, and impart a predominating complexion to the condition. It is probbable that, wherever delusions or hallucinations are detected, although they may seem solitary deviations from health, there is a broader and deeper substratum of disease, of which they are trivial manifestations; and where mania has ushered in such affections, the original disease may be held to remain while they remain, and to be reacted upon, and,' under certain circumstances, roused into activity through their instrumentality. In the,se views may be found an explanation of those partial mental derangements which appear to co-exist with health.—Bucknill and Tuke, Psychological .31edicine--Sicetches in Bedlam.