One of the most striking characteristics of maniacal patients is the anaesthesia that often develops and is maintained in spite of the most serious injury. Because of this, maniacal patients should be guarded with quite as much care as those suffering from melancholia. I have seen a patient who, during an attack of acute mania, had put her hand over a lighted gas jet, holding it there until the tissues were completely charred. The burner was behind an iron grating, but she succeeded in reaching it. Neither from this dreadful burning itself, nor during the after dressings, did she complain of the slightest pain. Because of this anaesthetic condition and the consequent lack of complaint, maniacal patients often suffer from severe internal trouble without the medical attendant having any suspicion of its existence. There are few conditions that are more painful, for instance, than peritonitis, yet maniacal patients have been known to suffer and die from peritonitis, due to intestinal or gastric perforation, without a single complaint. Unexpected death frequently occurs in mania because of the failure to recognise the existence of serious pathological conditions. Pneumonia may develop, for instance, without the slightest complaint on the part of the patient and go rapidly on to a fatal termination during the exhaustion incident to the constant movement, it being utterly impossible to confine the patient to bed. Meningitis may develop in the same way and proceed to a fatal issue without the patient's making any complaint or any sign that will call attention to its existence. In the meantime, the patient may be constantly in the wildest motion and so add to the exhausting effect of the organic disease. The prognosis of acute mania is not unfavourable. Patients suffering from a first attack will recover completely in eight cases out of ten. Notwithstanding complete recovery, relapses are prone to occur whenever the patient undergoes a severe emotional strain. As a rule not nearly so much mental disturbance is required to produce a second attack {228} as the first one, so that patients require great care. In a certain number of cases recovery is incomplete; persistent delusions remain, and there may even be some weakness of intelligence. Paranoia, as it is called, mild delusional insanity, may assert itself and then may persist for the rest of life. Notwithstanding this, patients may get along in life reasonably well, though their mental condition is decidedly below the normal.