ACUTE INSANITIES 373 Melancholia.—This form of insanity is characterized "by difficulty of thinking, mental depression and inhibition of motor impulses. It affects women more than men, especially in early and ad- vanced life. It may he described under three head- ings : simple melancholia, acute melancholia and chro- nic melancholia. Simple Melancholia.—This is the mildest of the three forms of the disease, and is spoken of as simple retar- dation. It is characterized by mental depression with- out hallucination or delu- sions. It is associated with apprehension of evil, loss of appetite, constipation, and sleeplessness, especially to- wards early morning. The face has an anxious expres- sion, the forehead is wrinkl- ed and the eyes are dull. There is lack of interest in the surroundings with in- ability to attend to daily pursuit of life. Speech is slow and in whispers, and answers are given in mono- syllables with great diffi- culty. There is fear that the natural affection of relatives is lost. There is also a ten- dency to commit suicide. Fig. 159.—Case of Melancholia: Has a sad facial^ expression, is depressed and occasionally weeps without reason, has irregular sleep, does not reply to questions properly, and sometimes does not take food for a week. (Dr. Benarsi Dos's case.) The thought processes are retarded, but there is no disorientation or clouding of consciousness, and memory and intellect are good. Acute Melancholia.—In this form the three chief symptoms of melan- cholia are well marked. The onset is usually gradual, preceded by a prodromal stage lasting one to three weeks. During this stage there are complaints of persistent headache, insomnia, gastric disturbances and irri- tability of temper, which are likely to be confused with neurasthenia or hypochondriasis. According to Overbeck-Wright the chances of recovery and the avoidance of the acute attack of the disease are very great indeed, if this prodromal stage be recognised, and the patient be promptly put under proper treatment.5 The physical condition of acute melancholia is manifested by marked anaemia and progressive loss of weight. The tongue is dry and coated with a thick white or brown fur, and appetite is lost owing to the marked deficiency in the secretion of the gastric juices, especially pepsin. The bowels are constipated owing to deficiency of the intestinal juices. The pupils are frequently dilated. The pulse is rapid, weak and irregular. The skin is dry owing to the diminution of perspiration. The hands and feet are blue and cold due to feeble circulation. The respirations are shallow^ -" 5. Lunacy in India, 1921, p. 218.