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Full text of "Medical Jurisprudence And Toxicology"

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.