The extreme distortion of face produced by acute mania, or melancholia in its higher degree, is easily recognised. It may, however, be needful to distinguish it from the expression of cerebral inflammation, or of fever. The distinguishing characteristics of cerebral inflammation attended by maniacal symptoms are, a greater suffusion of countenance, a firm knitting of the brows expressive of intense pain, and a fierce, prominent, and blood-shot eye. It is in meningitis rather than in mania that it may be truly said—“And each strained ball of sight seemed bursting from his head.” The patient suffering from cerebral inflammation has a motiveless ferocity of aspect, rarely met with in pure mania. The stage of effusion in meningitis, and all the stages of some forms of deep-seated cerebral inflammation, in which the meninges are not affected, require to be distinguished from dementia, rather than from mania. The history of the case, however, and the affection of the muscular system, will generally render the diagnosis easy.

As it is my intention to present a faithful description of the various forms of mental disorder, it is necessary in the first place, to draw attention very briefly, to the classification of diseases of the mind. Very different arrangements have been made by different writers on the symptoms manifested by the insane, and they have grouped them under somewhat opposite heads, guided in some instances by the most prominent symptoms, and in others, by the supposed seat of the malady. Before that attention had been paid to psychological affections, which they now happily have obtained, Cullen's nosology was regarded as clear and natural; and doubtless, it promised advantages over the systems of Sauvages, Vogel, and Linnæus. Cullen placed mental disorders in the class, Neuroses, and under the order, Vesaniæ, which included those disorders in which the judgment is impaired, without coma or pyrexia. These he referred to four great divisions, viz., amentia, melancholia, mania, and oneirodynia. Amentia, might be either congenital, senile, or acquired; melancholia exhibited itself in eight principal varieties, some involving hallucinations of a painful, others of a pleasurable nature; mania, he defined as a false judgment arising from perversions of the imagination, or from false recollection, and commonly producing disproportionate emotions (assuming the person to be awake and free from pyrexia and coma); oneirodynia, the last of Cullen's divisions, included, somnambulism and night-mare.

The treatment of insanity may be said to resemble more a long-continued siege than a vigorous warfare. It is not by action and measures, and certainly not by certain formulæ of medicinal agents that we can hope to make any progress against the disease; not that it is less the province of the medical practitioner to direct the treatment, whatever the means adopted: the progress of the malady has to be watched, and the means of cure varied as circumstances arise. But it is not a well-furnished dispensary, or a large assortment of drugs with which he has to be supplied, his agents are rather careful nursing, wholesome diet, regular employments, diversified amusements, cheerful dwelling, personal cleanliness, and such like; these constitute his materia medica, and these he should have at his command at all times.

“The knowledge concerning the sympathies and concordances between the mind and the body” saith the founder† of modern science, in discoursing of human philosophy, or the knowledge of ourselves, as he terms it, is “fit to be emancipate and made a knowledge by itself. The consideration is double: either how and how far the humours and effects of the body do alter or work upon the mind; or again, how and how far the passions and apprehensions of the mind do alter or work upon the body. The former of these,” (the influence of the body on the mental state,) continues Bacon, “hath been enquired and considered as a part and appendix of medicine, but much more as a part of religion or superstition. For the physician prescribeth cures of the mind in phrensies and melancholy passions; and pretendeth also to exhibit medicines to exhilarate the mind, to confirm the courage, to clarify the wits, to corroborate the memory and the like: but the scruples and superstitions of diet and other regimen of the body in the sect of Pythagoreans, in the heresy of the Manicheans, and in the law of Mahomet do exceed. … The root and life of all which prescripts is besides the ceremony, the consideration of that dependency, which the affections of the mind are submitted unto, upon the state and disposition of the body.”

It would seem rather superfluous to remark, that no science can be definite or precise, whose terms are undefined and inexact, and that it behoves the student in any science, to understand the terms employed, before he can master his subject; more especially is this the case, where the subject treats of abstract qualities and ideas, whose fundamental terms, themselves expressing abstracts, require defining from the very beginning: and yet, the difficulty I have met with, and which others have experienced in those terms which form the subject of the following remarks, will perhaps shew that such precision is not so universally observed as is supposed.