It is seldom that mania returns at regular periods. Of two hundred patients under the care of M. Pinel, in the Bicetre of Paris, only six were of this description, and their periods were different from one another.
A violent attack of maniacal excitement is sometimes followed by a sudden debility, in which the patient is speedily carried off.
Sometimes persons who have been for a long time in a maniacal state recover composure of intellect, which con tinues for a year or two without any relapse ; but afterwards lose the whole energy of constitution, and are cut of by that species of decay which is called atrophic.
Very often it happens that a patient, after being for some time recovered from mania, is cut of by an apoplectic at tack. It is very common for the disease to degenerate into a chronic idiotism, which continues for life.
The corporeal phenomena of mania are of less uniformi ty than the mental ; but, when they mem., they 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 in crease of strength is also very frequent. Fever, constipa tion, dryness of the skin, and increased heat in the head, arc frequent symptoms. It has been supposed, that pa tients 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 its earliest stages.
The prognosis of mania is in general difficult. The earlier in life that it comes on after puberty, we, caderis fianous, have better hopes of a recovery. The previous dispositions of the patient ate worthy of our attention. In persons naturally shy, and easily discouraged, the progno sis, though not rendered decidedly bad, is rather less fa vourable than in others. Mania accompanied with mirth, is less hurtful to the health, and less obstinate, than that which is marked by horror and distress.
When this affection has succeeded to a long continued 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 previously characterized by singularities, and still more where his whole conduct has indicated a want of common pru dence and feeling, an attack of mania, though appa rently cured, leaves behind it a character of increased folly. In persons of ingenuous dispositions, it is sometimes
followed by a character of greater modesty ; but the morbid sensibility is increased in proportion to the increase of ex ternal prudence, and the patient runs a risk of being car ried of by apoplexy.
The disease becomes less hopeful in proportion to the length of its continuance. Hence, in some institutions, patients who have laboured under it for a year, are put in the list of incurable, and curative measures are not in such cases kept in view. In others, two years are allowed for this species of probation. These predictions, however, must not be absolute. Recovery has in many cases taken place, after the patient had laboured under his complaint for several years.
Mania has always been considered as an hereditary dis ease. This opinion is certainly founded in truth. When we find the features and expression of the countenance so often exactly copied from the parents, we Inive good rea son to conclude that the conformation and character which predispose the constitution to mania, are communicated in the same manner. The fact is also well confirmed in this particular disease by the experience of mankind. We cannot, however, ascribe so much influence to this cause as is generally done. Other causes contribute to the re petition of it in the same family, independently of commu nication from the parents. It has been sometimes main tained, that the present frequency of mania in this country has proceeded from the intermarriages of persons of sound constitutions with those who have laboured under this hereditary disposition : but we have no reason to suppose that, at the time is hen mania became so prevalent, such intermarriages were more frequent than formerly, or that these are now more common, in proportion to the cases of mania that exist. Where both parents are pre disposed to mania, the predisposition has a chance of being communicated with greater certainty to the children ; but where a sound constitution is married to one of an opposite character, there is as great a chance of the offspring being improved as of its being deteriorated, unless other causes of general operation tend to increase the frequency of the disease.