Three hundred and sixteen cases from hospitals in nineteen other states were reported as follows:— _Number_ _Percentage_ Delirium with infectious diseases 69 21.83 Post-infectious psychoses 30 9.49 Exhaustion delirium 75 23.73 Delirium of unknown origin 33 10.44 Cardio-renal diseases 45 14.24 Diseases of the ductless glands 15 4.74 Other conditions 49 15.50 We have, thus, a total of 936 cases distributed as follows:—Delirium with infectious diseases, 19.76 per cent; post-infectious psychoses, 16.77; exhaustion delirium, 20.83; delirium of unknown origin, 8.01; cardio-renal diseases, 13.88; diseases of the ductless glands, 3.84; and other conditions, 16.88 per cent. Four and one hundredth per cent of the first admissions in Massachusetts, 3.45 per cent of the New York admissions, and 2.07 per cent of admissions to twenty-one other institutions during the same period of time were cases of psychoses due to other somatic diseases. They constituted 2.81 per cent of 34,935 admissions to all of the institutions above noted. CHAPTER XI THE MANIC-DEPRESSIVE PSYCHOSES The manic-depressive psychoses as first described by Kraepelin are of comparatively recent origin. The history of the clinical entities included in this new grouping, however, may be easily traced back to the earliest days of psychiatry. Although these terms were not used perhaps as they came to be later, mania and melancholia were, as has already been shown, known in the Hippocratic era, over four hundred years before the time of Christ. They were referred to again in the works of Aretaeus in the first century A. D. and were recognized by Celsus, Caelius Aurelianus and Galen. Daniel Sennert[267] of Wittenberg (1572-1637) defined melancholia as a "delirium or deprival of imagination and reason, without fever, with fear and sadness, arising from dark and melancholy animal spirits, and occasioning corresponding phantoms." Mania he described as a "delirium or deprival of imagination and reason without fear, but, on the contrary, with audacity, temerity, anger, and ferocity, without fever, arising from a fervent and fiery disposition." Sydenham[268] recommended bleeding, followed by purgation, as the treatment indicated for mania:—"Thus the humours, which in mania would invade the citadel of the brain, are gradually drawn off towards the lower parts, a fresh bias being given to them."