ACUTE INSANITIES 371 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.