Although melancholia may not be caused by an impoverishment of the blood per se, such impoverishment almost invariably exists, and, in a large ma jority of cases, improvement of the mental symptoms is coincident with provement in the general health and in the quality of the blood. Whitmore Steele (Amer. Jour. of Insanity, Apr., '93).
Analysis of 730 consecutive cases of melancholia admitted to the Carlisle Asylum during twenty-seven years. Taking the three grand groups of mental diseases,—melancholia, mania, and de mentia,—melancholia formed a fraction over 25 per cent.,-334 males and 396 females; 58 per cent. were discharged recovered, S per cent. relieved, 4 per cent. unimproved, and 20 per cent. died; 219 were cases of simple melancholia and 511 melancholia with delusions; 65 per cent. had suicidal tendencies, self-destruction being actually attempted in 33 per cent.; in 29 per cent. sonic physical disease co existed with the mental disorder. The physical diseases most frequently present were phthisis (70 eases), heart disease (57 eases), and cancer (10 cases). Two thirds of the cases were between 30 and 60 years of age. The largest proportion of recoveries occurred between 10 and 30 years. The proportion of relapses was 22 per cent. Hereditary predisposition was ascertained in 3S per cent..
Leaving out of consideration heredi tary predisposition and previous attacks, the cause of melancholia was found, in a marked preponderance of cases, to be of a physical nature. In over 400 of the 730 cases there was aseertaMed to be some such cause at work in originating the mental depression. Intemperance in drink was assigned as a cause in S4 cases, pregnancy in 7, parturition and the puerperal state in 20, lactation in 23, privation and starvation in 28, and in a large number of other eases there was some kind of physical disorder pre ceding the melancholia. In about 250 cases the mental depression was assigned to sonic! moral cause. W. F. Farquharson (Jour. of Mental Sri., Jan., Apr., '94).
Three eases of well-marked melan cholia apparently dependent upon local pelvic disease. These cases recovered, physically and mentally, after appropri ate local treatment. Clue of the cases
had been insane four years, and had been nine months in an insane hospital. W. Gill Wylie (Med. Rec., Aug. 4, '94).
Case of melancholia in which the pa tient had for two years snared from hallucinations of hearing. He became depressed, sleepless, and took to drink. The voices heard were those of friends far away, and they goaded him on to destroy himself in order to avoid dis grace.
He had constant headache on the left side, and had attempted to cut his throat.
Trephined, making a large opening over the centre for hearing, and found a serous cyst, which was drained. The patient completely recovered. Street and Damer Harrison (Liverpool Medico Chirurgieal Jour., July, '97).
Fifty eases of injury to the parietal tuberosity and its neighborhood col lected which were severe enough to in volve the brain and its membranes, and which were followed by melan cholia. One-half of these were relieved by surgical operation. Melancholia is also the type of disease observed when tumors involve this region; it also occurs when the local lesions are in flammatory. Bernard Hollander (Jour. Mental Sei., July, 1901).
The stimuli which give rise to these painful sensations are found in tissue metabolism. Melancholia is pre-emi nently an emotional disease, and the emotions arising are invariably of a painful character. Now, if it can be established that the metabolic process is answerable. for the normal emotions, we may have here the foundation laid for the so-called abnormal emotions at tendant upon melancholia. H. H. Stoner (Medical News, Aug. 17, 1901).
In about one-half of all cases there is a psychopathic ancestry.
Diagnosis.—In many forms of insanity psychical depression is a stage in the de velopment of the disorder. Thus, mania mostly begins with depression; in general paresis, although the feelings are usually exalted, there may be a depressive stage lasting nearly throughout the disease. Many cases of paranoia have a melan choly tinge, and in the toxic psychoses depression is not an unusual symptom. True melancholia must, however, be dif ferentiated from these episodic depres sions.