The prognostic in this disease is usually unfavourable, except when it arises from repelled eruptions, imperfect gout, or the stoppage of the discharge of a fistula in ano. When it arises from a constitutional organization, or without any distinct cause, it is seldom cured. The idiotic mania is more frequently intractable than the violent, and the disease from religious impressions very rarely yields to any plan of relief. When from violent and continued grief, from disappointment, particularly disappointed love, the disease is particularly obstinate. If sleep does not relieve; if emetics and purgatives fail of their effect; if convulsions come on, or considerable debility is observed; the complaint will be obstinate, or death soon ensue.

The diagnosis is not difficult. The absence of fever clearly distinguishes mania from any disease with which it can be confounded.

The cure of mania is simple, or at least art, often disappointed, has ceased to interfere with activity. The wandering delirium from inanition, the singular fancies from swallowing deleterious substances, vanish with increasing strength, the evacuation of the cause, or its continued impression which soon becomes habitual. The varieties of mania which we have mentioned may appear each to require a different plan; but the conduct of receptacles for lunatics is often empirical, and, even when under the direction of a physician, seldom conducted with scientific views. We may not improve, but shall endeavour to connect, the scattered limbs found in different authors.

In each variety of mania we always find a considerable determination to the brain; and, even when the disease arises from some organic affection, which seems to interrupt the free communication between its different parts, this interruption appears to act as a local obstacle, which excites the action of the vessels around. On this view whatever is rational in the conduct of the cure seems to depend; and the remedies we shall mention in the order of their importance.

Emetics have been generally and principally employed, and the source of their advantages arc sufficiently explained in that article. Without any other assistance, they have often removed a maniacal paroxysm; and, when repeated at regular and not very distant intervals, they are often highly useful.

In general, common emetics from the torpor of the stomach will not produce the evacuation, and antimo-nials are required. To these the vitriolated zinc, with mustard whey, must be often added; and the tobacco, the juice of the asarabacca, or groundsel, are often required. The objection made to emetics by those who have never used them, that they determine too powerfully to the head, we have already considered. See Emetica.

Cathartics are, however, chiefly depended on, for reasons which will be sufficiently obvious, and these are particularly useful in melancholic mania. In the sanguine variety the saline are preferable, but they arc scarcely sufficiently active in the melancholic; and when the disease arises from the want of the necessary evacuations from the lower belly, those purgatives which chiefly excite the action of the colon and rectum are most useful. The ancients used hellebore, but they diminished its activity by their mode of preparing it; and we do not find that it possessed peculiar powers, though if the plant they used be, as we have reason to suspect, a species of adonis, it probably combined the qualities of an anodyne with those of a cathartic.

What has been remarked respecting the large proportion of the vital fluid contained in the extreme vessels will sufficiently explain the effects of diapho-retics. Yet we find no striking instances of their utility; and the impatience of maniacs, which leads them to throw off their clothing, seems to counteract this discharge. In fact, however, the heat is above what has been styled the sweating point, and the diaphoresis is best secured by moderating its excess. The only remedy of this kind which seems to have been peculiarly useful is vinegar. It was given with camphor by Dr. Locher of Vienna, but was found equally or more effectual without the camphor. Mr. Pargeter has recommended a camphorated vinegar in this country, but we have not found it peculiarly beneficial. Warm bathing, which is a remedy of this kind, has been highly commended, and is certainly useful when the heat is moderate, not exceeding 96° or 98°. We have not mentioned bleeding, because it is not peculiarly advantageous; but when the mania rises to violent delirium it is necessary, and the blood must be drawn with a decisive boldness, so as to excite deliquium. Bleeding from the jugular veins, and topical bleeding with leeches, or the cupping glass, if the quanity drawn is considerable, will be highly useful; but this, too, is confined to the violent state, when the mania becomes phrenetic,

Blisters, with similar views, have been applied; but they are not favourite remedies. Is it that their discharge is more adapted to relieve active inflammation, and less suited to the chronic fulness; or that danger is supposed to arise from their irritation, which has led practitioners to doubt of their utility ? We believe, indeed, that they are not particularly useful, and that the deeper, purulent discharge from a seton is more advantageous. A blister, to be really beneficial, must be applied to the vertex.

Dr. Mead speaks of the utility of diuretics, but we know not that modern experience supports their credit, for we have not had sufficient confidence in this class of remedies to employ them. The diuretic preferred was the alkaline salts, and the opinion of obstruction, from lenlor, was then so common, that we can easily guess the source of the recommendation, and of the good effects attributed to it.

Sedatives are most obviously indicated, and the whole tribe has been employed with varied success. Each medicine has had its sanguine advocates, and each has, at different times, succeeded. The refrigerants are chiefly trusted, and the neutral salts, combining this power with their purgative effects, are very commonly administered. Nitre is less often employed; but cold, in all its forms, is found peculiarly salutary. The clay cap has yielded to cold affusion of water, or fomentations of the coldest water and vinegar; and madmen have been kept under water by violence till nearly suffocated. The maniac, who has escaped from confinement, and remained exposed to the greatest cold, has returned in his senses; and those who have been with difficulty saved from drowning have escaped from the danger and the disease.