This section is from the book "The London Medical Dictionary", by Bartholomew Parr. Also available from Amazon: London Medical Dictionary.
Insanity seldom attacks at once: its approaches are gradual; and, as suspicion and cunning are the most striking mental symptoms, these are often conspicuous in the earliest stages. In delineating the symptoms, we must distinguish between the idiotic insanity, the melancholic, and the sanguine; for these are the most striking varieties. We mean not at present to dispute the propriety of distinguishing complete idiotism as a species, but merely to mark that languid state peculiar to leucophlegmatic habits, and approaching with slow, undistinguishable steps.
The idiotic insanity commences with silence and reserve; with muttering, inattention to the person who speaks; and a want of recollection of what has lately passed. The muttering becomes more distinct; and it then appears that some images are presented to the mind different from the objects before the patient. In fact, if"false perception" does not take place, objects do not make their usual impression, or the mind, less impressed with the objects around than with its own ideas, suffers the latter only to have any influence. In this state the sleep is usually disturbed, though sometimes sound and uninterrupted; but, when sound, the patient is not refreshed, nor is the mind more steady when awakened. In general, the head appears loaded, and the eyes red; though, in some cases, each symptom is wanting, but the bowels are always slow in their action, and stools are unfrequent; the patient is insensible to the calls of hunger and thirst, to the impressions of cold, but not indifferent to worldly objects. On the contrary, distrust and suspicion predominate; and the greatest cunning is exercised-jo obviate the effects of what the patient supposes most detrimental to his interest. The pulse is often little affected, and the urine copious and pale.
Even in this .situation opposition will excite to violence, and strength, apparently incompatible with the general weakness will be exerted, to counteract what the patient may dislike. In this case the eyes become quick and fiery, the countenance is animated, while the extremities are cold, the hands tremble, and every function, except what is roused to opposition, appears peculiarly weak.
The melancholic madness does not greatly differ; but the patient, when roused to answer, appears to have lost none of his mental faculties. Often, while his fancies prevail, he will reason with acuteness in their support, and his precautions to guard against injury, when he fancies himself a brittle vessel, are ingenious and well conducted. In these circumstances the pulse is languid, the bowels peculiarly torpid, the urine limpid, the sleep often heavy, but without relief, or, when it occurs, the patient is insensible of it, and denies, with violence, having slept. The mind, in this kind of madness, rests on one idea, with unusual pertinacity, and the violence, on contradiction, is peculiarly vehement. The distinction between these two varieties does not seem to consist so much in the temperament, as in the wandering in the former, and the permanent ruling idea in the latter. To which we may add, that the first is the disease of a weak, and the latter of a strong mind. Aretaeus describes the melancholic mania with singular precision."those who are affected with melancholy are sad, dejected, and dull, without apparent cause. They tremble for fear, are destitute of courage, affected with watchings, and fond of solitude. They are prone to anger, changeable in their tempers, and ask a reason for the most trifling and inconsiderable occurrences. They are at some seasons so covetous that they will not part with any thing, hut soon become silly and prodigal. They are generally costive, sometimes discharge no faeces at all, at other times their excrements are dry, round, and covered with a black and bilious humour: they discharge a small quantity of urine, which is acrid and bilious. A large quantity of flatulencies are discharged from their mouths; and sometimes they vomit a certain acrid humour with the bile. Their countenances become pale, their pulse is slow. They are lazy and weak, but discover a preternatural voracity in eating their aliments. When the disorder advances to madness, the patient, when provoked to anger, becomes raging mad. Some wander far from home; some cry out in a hideous manner; some shun the sight of men, betake themselves to solitude, and only converse with themselves; others tear and mangle their bodies. In the highest degree of this disorder they perceive red images before their eyes, so that they in a manner think themselves struck by lightning. They are immoderately inclined to venery, so that they caress publicly, without either dread or shame. But when the disease is in its decline, they become stupid, calm, and mournful; and coming to the knowledge of their misfortune, they are dejected on account of their calamitous and miserable situation."
The sanguine mania greatly differs. It is at first marked by irregularity of spirits, sometimes highly elevated, and proportionally depressed; in either case without sufficient reason. This kind of insanity is often the effect of sudden and excessive joy; and madness was more commonly the effect of success in the South Sea year, than of disappointment. An early symptom is aloud and rapid elocution when speaking on common subjects, a feeling of peculiar high health, and boasting declarations of health and spirits. The sleep is very disturbed, and the watchfulness often unremitted. The subjects are as various as the fancy; each is suddenly indulged, and as quickly superseded by another. The persons most loved, before, are now detested, and strangers, or the most indifferent people, are sought after with anxiety. The eye appears wild and red, quickly glancing at every object; the face flushed, a tingling in the ears is perceived, and suspicion is alive in apprehension of intended injury; for there is always an enemy in the rear, which is often one of the nearest relations. It is not an uncommon fancy to suppose those around them mad, and their greatest amusement to contrive stratagems in order to secure and confine them. When any object is in view, disappointment does not distress them. The object still remains, and it is to be accomplished on another occasion. The prospect is always cheerful, and success constantly at hand. The pulse, in this case, is often natural, but frequently quick: the tongue is always dry, the skin without the softness of health, the urine generally high coloured.
 
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