374 MEDICAL JTJEISPRUDENCE normal in frequency. The temperature is usually sub-normal, but is often slightly raised in the evenings. The urine is diminished in quantity, and is passed at long intervals. It may even be passed only once in twenty-four hours. In males impotence is usually observed. In females menstruation is generally absent, but reappears when recovery occurs, or when the disease becomes chronic. The superficial and deep reflexes are often found exaggerated. Mus- cular movements are slow and weak, the larger proximal joints are rigid and the powers of fine inco-ordination are impaired. Sensation is, as a rule, normal, though sensitiveness to noise is a marked feature. The mental symptoms generally appear along with the physical symptoms. Perception is normal, orientation is usually quite correct, and the memory and the intellectual faculties are well preserved, but volitional attention is generally poor and defective. There is paralysis of emotional reaction. Good or bad news or even a joke does not affect the patient, who feels gloomy and miserable, and experiences psychic pain. He has lost the social instinct. He sits apart, refuses to mix with his neighbours, or to take part in outdoor games or social festivities. Hallucinations and delusions are usually present. Hallucinations are often of an auditory type, in which the patient imagines that he hears voices accusing him of various misdeeds or threatening him of punishment. Delusions are generally of a hypochondriacal nature. The patient believes that he suffers from some incurable disease, e.g. closure of the oesophagus, gangrene of the intestines or wasting of the brain, and that he will die a miserable death. Delusions may also be of the religious or persecuting character. The patient believes that he has committed the unpardonable sin against God, or that his food is being poisoned by some persons conspiring to kill him. Suicidal tendencies are common, though the patient may develop homicidal tendency, and may kill his wife and children to save them from the supposed utter ruin, or may kill some person, whom he believes to be giving him and his family all the imaginable trouble of the world. Sometimes, the patient is afraid of some impending disaster, and he is so much agitated or excited in his anxiety, that he keeps on moving inces- santly, wringing his hands, rocking to and fro and bemoaning his piteous plight. Such a patient often resists being fed, dressed or washed. He is unmindful of personal cleanliness, and passes urine and faeces in his garments. On other occasions the patient passes, as it were, into a stuporous condition. He is pathetic, and sits silent and motionless in the same fixed attitude for a long time. He has to be spoon or tube fed, and his bladder and bowels have to be attended to. Acute melancholia may alternate with an attack of mania with a lucid interval intervening between the two. This alternating form of the disease is known as circular insanity or folie circulaire. An attack of acute melancholia, on an average, lasts from six to eight months and ends in recovery. If the attack is not followed by recovery within a year, it usually passes into a chronic condition. Death may occur in the acute stage, when the patient passes into a typhoid state. Chronic Melancholia.—This form results from the acute form, and is characterized by some improvement in the physical signs but not in the mental symptoms. The patient becomes fat and increases in weight. His digestive powers also improve, and the bowels open regularly. The patient, however,.remains persistently depressed, and suffers from hallucinations and delusions.