(AN.EMIA AND ITYPER2EMIA) OF THE BRAIN.
Melancholia.
Definition.—Melancholia is a form of mental disturbance characterized by pro found mental depression with suicidal tendencies. Its physical basis is sup posed to be anemia of the brain.
Symptoms.—The symptoms of melan cholia are physical and mental.
First in importance are those refer able to the digestive organs. There is nearly always profound anorexia, often resulting in obstinate refusal to take • food. This may be due to gastric dis turbance, but is more frequently the consequence of visceral hallucinations and delusions which will be referred to later. The tongue is usually coated and the breath offensive. Constipation is nearly always present.
Involuntary defecation is frequent, not because the patient has lost control over the sphincters, but on account of inattention to the sense of fullness in the rectum.
In women there is usually arrest of menstruation. The urine is generally somewhat diminished in quantity and rich in phosphates.
Urine of melancholics is much more toxic than normal urine; that of maniacs is less toxic. Brugia (Jour. de Med., Feb. 12, '93).
The toxicity of the urine was found to be diminished in maniacal states and augmented in melancholia. The urine of maniacal patients, when injected into animals produces excitation and convul sions; that of melancholic patients, rest lessness, dejection, and stupor. There is often in insanity, as in eclampsia, an in verse relation between the toxicity of the urine and that of the blood, the latter being hypotoxic when the urine is hyper toxic and vice versa. Regis (Le Bull. Med., Aug. 0, '93).
Sexual desire is usually diminished.
In nearly all, perhaps in all, cases of melancholia there is depression of nutri tion. The red blood-corpuscles and the percentage of hmmoglobin are reduced.
Results of examination of the blood in fifty-two patients. In mania the cor puscles and hmmoglobin were normal or in excess in nearly all cases. In melan cholia the hmmoglobin was deficient in all examined, and the corpuscles below normal in 50 per cent. In paresis and de
mentia, corpuscles and hmmoglobin were deficient. In paranoia the corpuscles were much above the normal, while the haemoglobin was only slightly below. J. A. IIouston (Boston Med. and Surg. Jour., Jan. 18, '94).
There is usually considerable loss of weight. The skin is usually dry and harsh.
The force of the circulation is dimin ished. There is usually passive conges tion of the blood-vessels.
The blood-pressure varies in different forms of insanity; it is raised in persons who are depressed and who are suffering from melancholia; it varies in cases of so-called agitated melancholia; it is nor mal upon the recovery of a patient whose blood-pressure has been raised during the period of depression; it is lowered in persons suffering from excitement or acute mania; it is normal after the ex citement has passed off and the patient has recovered; it tends to fall as the day advances, causing melancholiacs to be brighter and excited patients to be come more excited; the depression fol lowing upon an attack of acute mania is not necessarily an active depression, but rather more exhaustive in type, and the blood-pressure in these cases may remain low until it finally returns to 'normal upon recovery; the blood-pressure is probably raised in stupor; it is not al ways altered in delusional insanity ex cept when there is also some emotional disturbance; in healthy, active, and ex citable persons it is low as compared with healthy apathetic individuals; the blood-pressure is raised in general paraly sis of the insane when there is depres sion, while in the excited types of this disease it is low, as it is also in the later stages of all types; the feeling of weight and pressure upon the top of the head is apparently vascular in origin, and is lessened or disappears when the blood pressure is lowered. Maurice Craig (Lan cet, June 25, '98).