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patient becomes restless, irritable and interfering. He is always busy doing
one thing or another, but does not feel tired. He retains his memory and
power of orientation, but lacks in moral control, as evidenced by his
excessive indulgence in alcohol and sexual passions. There is no evidence
of hallucinations or delusions. The patient often recovers from this form
of the disease.

Acute Mania.—The attack of acute mania is usually gradual, preceded by
a prodromal stage lasting two or three weeks.   During this period there

may be constant headache,
general malaise, restless-
ness, insomnia, inability to
concentrate and loss of
weight. The patient is irri-
table and begins to dislike
his friends and relatives.
Sometimes, the attack com-
mences suddenly without
any prodromal symptoms.

The physical symptoms of
acute mania are impaired
general health, pale face,
and bright and staring eyes
with dilated pupils which
react to light and accom-
modation. Gastric derange-
ments are common. The
breath is foul, the tongue is
usually furred and the
bowels are constipated. In
the beginning appetite is im-
paired, but during the
attack it becomes voracious.
Anything that is eaten is
digested. However, the
patient sometimes refuses to
take his food, and it be-
comes necessary to feed him
with the nasal or oesopha-
geal tube.

Fig. 158.—Case of Mania:  Is excitable, violent,
abusive   and   destructive,   talking   incoherently
and thinking himself a great man.
(Dr. Benarsi Das's case,)

The pulse is slightly irregular and frequent, varying from 90 to 120 per
minute. Almost all the secretions are increased. The amount and the
amyolitic power of the saliva are increased, and the hydrochloric acid of the
gastric juice is also increased. The perspiration is profuse and has a mousy
odour. During the period of lactation the mammary secretion is increased,
and may sometimes lead to the formation of mammary abscesses.

At the commencement the urine is diminished in quantity, but further
in the course of the disease the quantity and the total solids of the urine
are increased. In women menstruation is irregular, and the discharge is
generally profuse.

Sensibility to heat and pain is diminished, but the sensations of touch,
hearing and smell are, as a rule, very acute. The superficial reflexes are
slightly exaggerated, but the deep reflexes are usually diminished at fir^,
and may be increased later when the patient is at rest. Muscular &*&&
ments are very peculiar, as they take place in the large proximal foi&ts.