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."
Thomas Willis [269] made some very significant references to the relation existing between mania and melancholia, in the seventeenth century:—"After melancholia we have to treat of mania, which has so many relations to the former, that the two disorders often follow each other, the former changing into the latter, and inversely. The melancholic diathesis, indeed, carried to its highest degree, causes frenzy, and frenzy subsiding changes frequently into melancholia (atrabiliar diathesis). These two disorders, like fire and smoke, often mask and replace each other, and if we may say that in melancholia the brain and the animal spirit are obscured by smoke and black darkness, mania may be compared to a great fire destined to disperse and to illuminate it." Morgagni,[270] "the father of pathology," also saw a close relation between these two conditions as is shown by the following quotation from his "De Sedibus et Causis Morborum;" etc., in 1761. "Melancholia," he says, "is so nearly allied to mania, that the diseases frequently alternate, and pass into one another; so that you frequently see physicians in doubt whether they should call a patient a melancholiac or a maniac, taciturnity and fear alternating with audacity in the same patient; on which account, when I have asked under what kind of delirium the insane persons have laboured whose heads I was about to dissect, I have had the more patience in receiving answers which were frequently ambiguous and sometimes antagonistic to each other, yet, which were, perhaps, true in the long course of the insanity." Flemming[271] in 1844 described a "dysthymia atra" (melancholia), a "dysthymia candida" (cheerful dysthymia) or "melancholia hilaris" characterized by elation with playfulness and a "tendency to see everything in the most pleasant and cheerful light" as well as a "dysthymia mutabilis," an alternating variety involving both of the above forms. He also spoke of a "dysthymia sparsa" (apathica) or "melancholia attonita," and a "vesania maniaca" or mania which he divided into the acute, delirious, alcoholic, affective, and puerperal types, together with an "occult amentia" embracing all of these forms. Griesinger[272] in 1845 called attention to the fact that "the transition of melancholia into mania, and the alternation of these two forms, are very common." In 1851 Falret, senior, first described circular insanity in his lectures at the Salpêtrière, quoted by Tuke[273] as follows:—"We have also to mention another case of intermittence observed between the periods of remission and excitement in the forme circulaire des maladies mentales." "It is a special form which we call 'circular' and which consists, not as has been frequently said, in a change of mania into melancholia separated by a more or less prolonged lucid interval, but in the change from maniacal excitement—simple overactivity of all the faculties—into mental torpor."
In 1854 at the Academy of Medicine in Paris Falret presented his "Mémoire sur la folie circulaire, forme de maladie mentale caractérisée par la reproduction successive et régulière de l'état maniaque, de l'état mélancolique, et d'un intervalle lucide plus ou moins prolongé." In the same year Baillarger described his "Folie à double forme," summarized by him in a Bulletin of the Academy of Medicine as follows:—
"(1) Besides monomania, melancholia, and mania, there exists a special form of insanity characterized by two regular periods, one of depression, the other of excitement.
(2) This form of insanity: (1) presents itself in isolated attacks; (2) reproduces itself in intermissions; (3) the attacks may follow each other without interruption.
(3) The duration of the attacks varies from two days to one year.
(4) When the attacks are short, the transition from the first to the second period takes place suddenly, and generally during sleep. It takes place slowly and gradually when the attacks are prolonged.
(5) In the latter case, the patients seem to enter into a state of convalescence at the end of the first period, but this return to health is incomplete; after a fortnight, a month, six weeks or more, the second period breaks out."
This was described as "Folie à double phase" by Bellod, "Folie à formes alternés" by Delaye, "Délire à formes alternés" by Legrand du Saulle, "Die cyclische Psychose" by Ludwig Kirn and "Das circuläre Irresein" by Krafft-Ebing.
At a meeting of the American Association in 1886 the classification of the British Medico-Psychological Association was adopted with the omission of moral insanity and the addition of toxic insanity. This included the following types of mania:—Recent, chronic, recurrent, à potu, puerperal and senile, and classified melancholia as recent, chronic, recurrent, puerperal and senile. In his "Clinical Lectures on Mental Disease" Clouston in 1898 described eight varieties of melancholia and six of mania, not including alternating forms. Kahlbaum in 1882, reverting apparently to the phraseology of Flemming, spoke of dysthymia, hyperthymia and mixed or circular forms—cyclothymia. Many of the conditions afterwards classified under dementia praecox he described as "vesania typica."