Professor Berkley calls attention to the fact that Shakespeare's statement, "Melancholy is the nurse of frenzy," may have been founded upon the observation that there are { 223} few cases of mental exaltation without a forerunning stage of depression. It is characteristic of the acuity of observation of the poet whose works have created so much discussion as to his early training, that this association of mental states, which became an accepted scientific truth only during the last century, should have been anticipated in a passing remark in the development of a dramatic character. Melancholia precedes mania so constantly that it is not an unusual mistake in diagnosis to consider a patient melancholic when an outbreak of mania is really preparing.
Mania is sometimes said to break out suddenly. As a matter of fact there are always preliminary symptoms; though these are of such a general nature that they may have escaped observation. The patient's history generally shows that there has been loss of appetite and consequent loss in weight, commonly accompanied by constipation and headache with increasing inability to sleep. Usually these symptoms have been present at least for some weeks or a month or more. Then the patient brightens up. Instead of the brooding so common before, there is a tendency to talkativeness; the eye is bright; the expression lively; in the midst of his loquacity the patient becomes facetious and jocular. The backward before become enterprising. Undertakings are attempted that are evidently far beyond the power, pecuniary or mental, of the individual. Active employment is sought, and, where this fails, restless to and fro movement becomes the habit.
Friends notice this change in disposition, and also note a certain lack of connection in the ideas. There is apt to be a distinct change of disposition. A man who has been very loath to make friends before, now becomes easy in his manner toward strangers and takes many people into his confidence. In the severer forms motion becomes constant; the arms are thrown around; to and fro movement at least is kept up; the voice becomes loud and is constantly used. Patients can not be kept quiet, and, as a consequence of their constant movement, their temperature rises and loss of sleep makes them weaker and weaker until perhaps physical exhaustion ensues.