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372                                              MEDICAL JURISPRUDENCE

Thus, while walking or running, the maniacal patient moves the trunk freely
from the hips, and keeping the arms abducted waives them freely from the

The temperature is generally normal or subnormal but sometimes it is
raised to 10QF. or 101F., when other febrile symptoms develop. The
tongue is brown and furred, and the teeth and lips are covered with sordes.
Constipation is very severe and complete insomnia is a marked symptom.
The patient is unable to retain food even when given by the tube, and
rapidly loses flesh and weight. The pulse is frequent, varying from 130 to
160 per minute, and the respirations are 30 to 40 per minute. Such a con-
dition has been spoken of as acute delirious mania.

The prominent mental symptoms are excitement, loss of self-control,
flight of ideas and great muscular activity. The patient is unable to fix his
attention upon any one subject, and develops incoherent speech. He is
happy in his mood, and has an exaggerated sense of well-being and power.
He is very emotional. He begins to laugh, sing or shout, and then all of a
sudden begins to weep or cry or gets angry. He gets violently excited, and
has a tendency to tear or destroy his clothes, bedding or furniture. He is
fantastic in his dress, and indecent in manners and talk, using obscene and
profane language. He is dirty in his habits, and may defile his body and
room with urine and faeces.

Owing to the flight of ideas the patient drops letters, omits words,
phrases or even sentences, and is unable to keep up the chain of ordered
reason, when he is writing a letter or is engaged in conversation.

The memory is, as a rule, good, but in severe forms of mental excite-
ment there may be a certain clouding of consciousness with disorientation
and great impulsiveness. At these times hallucinations of a visual and
auditory nature are usually present, and are often associated with delusions.
The delusions are usually of a grandiose type, in which the patient imagines
that he possesses great wealth and power, or that he is the ruler of an
extensive empire. These may be followed by delusions of persecution,
when he may commit suicide or murder under the false belief of being
persecuted or poisoned by others. It is, therefore, necessary that such a
patient should be kept in restraint, so that he may not hurt himself or others.
Not infrequently he becomes much more violent, if any attempt is made to
keep him under restraint.

The chief peculiarity of this disease is that the patient can continue to
be boisterous and violent for days and nights without experiencing any sense
of fatigue.

The acute form of mania may last for days, weeks and months. It may
rarely last for years. Sometimes, the symptoms may subside, followed by a
period of quiescence, called a lucid interval. The symptoms may again
recur at a later period without any warning.

The acute symptoms of excitement often subside, and are followed by a
stage of exhaustion, when the limbs are still and flaccid, and the patient
sinks into a state of stupor. This stage lasts one to three weeks, after which
recovery occurs. A few cases may pass into a state of chronic mania.

Chronic Mania.This resembles acute mania, but the symptoms are less
marked. It is characterized by incoherence, hallucinations and delusions,
with occasional attacks of acute excitement. Each of these attacks leaves
the patient weak-minded. The memory is slowly affected, and the patient
passes into a state of dementia, from which recovery never occurs.