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The purpose of this paper is to investigate how “manias” in global health governance lead to health inequalities even before, during and in the aftermath of acute health crises such as the COVID-19 pandemic. “Manias” as used here refer to obsessive ir/rational behaviors, misguided policy/strategic choices and the exercise of power that benefit the major global health actors at the expense of stakeholders.

From post-colonial and historical perspectives, this study delineates how the major global health actors influence outcomes in global health governance and international business when they interact at the national–global level using an illustration from an emerging economy.

Power asymmetry in global health governance is constructed around the centralization of economic influence, medico-techno-scientific innovation and the geopolitical hegemony of a conglomerate of super-rich/powerful actors. They cluster these powers and resources in the core region (industrialized economies) and use them to influence the periphery (developing economies) through international NGOs, hybrid organizations, MNCs and multilateral/bilateral agreements. The power of actors to maintain manias lies in not only how they influence the periphery but also the consequences of the periphery’s “passivity” and “voluntary” renunciation of sovereignty in medical innovations and global health policies/politics.

As a quintessential feature of manias, power asymmetry makes it harder for weaker actors to actually change the institutional conditions that produce structural inequalities in global health.

This timely and multidisciplinary study calls for a novel architecture of global health governance. Thus, democratizing global health governance with sufficiently foresighted investments that prioritize equitable access by and the inclusiveness of vulnerable stakeholders will help dismantle institutionalized manias while decreasing health inequalities.

Hypersexuality and gender dysphoria have both been described in the literature as symptoms of mania. Hypersexuality is listed in the Diagnostic and Statistical Manual of Mental Disorders 5 as part of the diagnostic criteria for bipolar disorder. Gender dysphoria is less often described and its relation to mania remains unclear. This case report describes a young homosexual man presenting in a manic episode with co-morbid amphetamine abuse whose mania was marked by hypersexuality and the new onset desire to be a woman. Both of these symptoms resolved with the addition of valproic acid to antipsychotics. This case report presents the existing literature on hypersexuality and gender dysphoria in mania and describes a treatment option that has not been previously reported.

Delirious mania is an understudied psychiatric disorder with a mortality rate as high as 75%. Previous case studies suggest that electroconvulsive therapy (ECT) may be an effective treatment for delirious mania, though this procedure may not always be a viable option. We describe the case of a 20-year old patient, with no previous psychiatric history, who developed delirious mania over the course of four months. ECT was not a viable option for this patient due to his religious beliefs, so alternative treatment modalities were explored. After failing trials of risperidone and olanzapine, significant improvements in symptoms were exhibited with a trial of clozapine. We propose that clozapine may be an effective option in cases of delirious mania, when ECT is not a viable option. Additional research is still necessary to understand the pathology of this condition and potential treatment modalities.

The wild boom and slump of 1845‐1847 was the most important of the nineteenth century railway manias, in terms both of its scale and effects on the economy as a whole. It has almost invariably been seen as a market irrationality, a view fundamentally challenged by Bryer’s theorisation of it as a deliberate and collusive device of the “London wealthy”, aided by central government, to swindle provincial middle class investors. This analysis also greatly extended previous perspectives on the rôle of accounting by asserting that accounting practices were crucial to the success of the process and were thus “deeply implicated” in a great, class‐based swindle. The acceptance of such a perspective would have important implications for the way we understand the functioning of accounting and capitalism in the mid‐nineteenth century, but this paper instead argues that such notions are misconceived, looking to both the evidence that was available when Bryer’s paper was written and to recently collected data on the depreciation accounting practices of the time.

This audit was conducted on acute psychiatric in‐patient wards with the aim of establishing if valproate prescribing in acute mania followed evidence‐based guidelines with particular emphasis on formulations used and whether accelerated valproate dosing was employed.

Case notes from 43 (42 percent male) patients admitted with mania and subsequently discharged on valproate were reviewed. Valproate formulation, weight measurement (necessary for dose‐calculation in accelerated dosing), initial valproate dose and increments, serum valproate monitoring and other prescribed psychotropic agents were noted.

Most (95 percent) patients received sodium valproate (epilim chrono/generic), the remaining received valproate semi‐sodium (depakote). All but one patient received antipsychotic medication in combination. Weight was recorded in only four (9 percent) patients. The mean valproate daily dose after the first week was 1,027 mg (sd=408). It took 29 (sd=42) days to reach the maximum daily dose (1,426 mg sd=467) from valproate initiation. Serum levels were monitored in 34 (79 percent) cases, but the mean period between valproate initiation to the first serum level test was 38 (sd=47) days. A significant positive correlation was found between days taken to reach maximum dose and hospital stay (Spearman's rho=0.41, n=43, p=0.006, two‐tailed).

Accelerated valproate dosing was not common practice, which may have resulted in suboptimal efficacy, probably leading to combination treatment.

This study highlights the need for adequate initial dosing and dose increments when treating manic patients and suggests current practice is not evidence‐based. Local prescribing policy and national guidelines' influence on practice are discussed.

It has to be admitted that sometimes weekend travel has its compensations. Whereas previous sojourns in Frankfurt had meant busy days confined indoors in the city itself, with little opportunity to satisfy the writer's rarely indulged thirst for fresh air and exercise, a free Sunday based in the heart of the Naturpark Hochtaunus just thirty minutes drive from Frankfurt became an unforgettable experience. Schmitten (Niederreifenberg), nestling in a valley surrounded by forest‐clad hills, is the village location of the headquarters of MANIA, and the day before Circuit World's visit to the company in May offered the rare chance to enjoy the Taunus hills in their Spring glory. The fresh pale green of the new foliage on the beech trees presented Nature's artistic contrast with the backcloth of dark coniferous forest, and it was refreshing and exciting to explore the abundance of well marked Wanderwege, many serving in Winter as Langlaufloipen. It was remarkably peaceful, and possible to wander for hours without seeing anyone—alone among regiments of stately pines and clusters of fragile wood anemones, crunching underfoot the remains of last Autumn's beech leaves, invigorated by the clear air and smell of pine resin, and with only birdsong for company (and isn't it a crazy world—German birds ‘speak’ exactly the same language as their British counterparts!).

Offering an empirical study of the rush to promote a new technology of its time, which is a significant phenomenon in its own right, the paper's purpose is to offer a reminder that new technologies often generate speculative and unstable business conditions.

The paper uses Henry English's A Complete View of the Joint Stock Companies Formed during the Years 1824 and 1825 to identify companies (n=70), and follows up cases with record and archive study.

The development of steamship services was an important push of transportation and communication technology. The establishment of steam shipping services in coastal waters and near country trade is an analogy of later technologies such as the telegraph, telephone and latterly computer‐mediated digital communication over the internet with global reach. Unlike the canal and railway manias the outcome was minimal.

As in the Dotcom boom of the early 2000s the study highlights the dangers of speculative business ventures (over‐ambitious promotion and fraud) which lacked a strong link to markets, the pull of significant demand and were weak in terms of business acumen and organization.

As a piece of original business historical research it is not only the findings which are of value, but the paper represents an exemplar of the continued use of archival and record material and information resources to support scholarly activity. Historians of today who wish to study the emerging digital economy may yet encounter problems in an ability to draw on bodies of contemporary evidence. The current issues of digital archiving and digital curation are only just beginning to be appreciated.