some profound lesion of a vital organ is to be suspected.

Pure Mania is alleged by some, not to be always free from real fever; but if fever be detected, it is certain that there must also exist some other disorder whence it originates, and hence a suspicion ought to arise, that the case is not one of proper Mania.

When delirium is protracted after the exciting cause has ceased, it assumes the maniacal character.

Our diagnosis will be much assisted by paying attention to the various distinguishing marks, which have been collected in the following form by Georget, and which are so arranged as to be readily available.

FIRST: Acute delirium is not an essential symptom of that disease in which it occurs, since that disease may exist without it.

Insane delirium is the essential, and often the most prominent symptom, for there may be little or no disturbance in the constitution. The functions of the body may undergo little derangement at least in the stage of excitement.

The voluntary motions may not suffer, and the patient may be able to walk about, and to eat and drink as usual.

SECONDLY: In acute delirium, the intellectual functions appear to be suspended, rather than perverted. The patient can scarcely utter a few unintelligible and unconnected words, and these, as well as his actions, are without any relation to the surrounding objects-the senses, too, perform their functions

Y

very imperfectly, or not at all, and the natural affections do not exist.

In the delirium of insanity, the intellect is seldom totally overpowered; some of its functions, only, being affected. It is excess of action, deviation, and want of harmony of these faculties; or preponderance of some fixed and assumed idea, that characterises general or partial insanity. By the partially insane, a connected discourse is often kept up, and they are frequently capable of maintaining the discussion of an argument. The senses, also, perform their functions, because we find that perception exists, although it may not be just, and the mind is awake to objects which are present.

THIRDLY: In acute delirium the mind is wholly absorbed, as in a dream, with its own creations, and preserves the power, when strongly roused to momentary recollection, of directing itself to its situation.

In insane delirium, truth and error are blended together, and are not distinguishable by the patient.

FOURTHLY: In acute delirium, volition, as well as consciousness, is suspended-the patient being, for the most part, in a state of stupor, and when he does attempt an intellectual effort, he appears as if he were in a dream.

In insane delirium, volition is often powerfully exerted, and is influenced by motives in the actions it produces.

FIFTHLY: Few of the circumstances, that may have occurred in the course of acute delirium, are recol

lected on recovery, or are but very faintly remembered.

In insane delirium, a recollection of all that has passed is frequently retained.

SIXTHLY: Acute delirium is not hereditary, any more than is the disease in which it may occur; nor is it announced by signs of predisposition, nor of imperfection.

Insane delirium is very frequently hereditary. The greater number of the insane, or of those destined to become so, exhibit traces of it in the general character of the mind, their manner of life, and of study, &c.

SEVENTHLY: Acute delirium being only the symptom of another disease, its duration is dependent on that of the primary one; and, as this does not remain long in such a state of violence, as to keep up the delirium, a restoration to health, or a termination in death, soon puts a period to the delirium; which, therefore, may only last a few hours or days, and rarely extends beyond one or two weeks.

nate.

In insane delirium, the duration is very indetermiNot being a mortal disease, the patient may live a great many years,—indeed, for the most part, he is not restored to reason until some months, or a year, or even a longer time has elapsed.

EIGHTHLY: Acute delirium cccurs in the acute diseases, common to childhood.

Insane delirium is scarcely known before the approach of puberty.

NINTHLY: Acute delirium does not present any

directly curative indications,-in particular, we never think of removing it by moral means, because, intellect being nearly suspended, no effect could be looked for from them.

In insane delirium, the treatment is very much directed to injured function; it being on this principle that moral means operate.

TENTHLY: When once the health is well-established, a relapse of acute delirium is not to be dreaded.

In insane delirium, the cure is not always durable; relapses, or recurrences, are frequent, and the brain is easily disturbed by slight causes.

LASTLY: The causes of acute delirium are either from remote diseases, or from different influences, which give birth to cerebral affections, of which

this is the symptom.

The causes of insane delirium

act directly upon the intellectual functions of the brain.

CHAPTER VIII.

CLASSIFICATION.

DISEASES affecting the intellectual functions, present themselves to our observation in a variety of forms, which have been arranged into certain divisions, founded on the modifications of the delirium, or disorder of these functions. In considering them in this view, however, we must bear in mind, that there is an insensible gradation of one genus into another; so that at times, some difficulty may be experienced in classifying them.

Much diversity of opinion exists as to the best mode of arrangement, or the "Nosology" of mental dis

eases.

That mode, which arranges disorders according to