In true melancholia every emotion, thought, and act is dominated by the sense of profound depression. Nothing can dissipate the cloud of sadness that envelopes the patient. He is lost; there is neither relief for him in this world nor salvation in the next.
In catatonia there is rhythmical forms of movement and of speech alternate with rigidity and mutism. The rigidity affects mostly the muscles of the neck and shoulders. Attention drawn to the fact that rigidity of this nature is not confined to cases of catatonia. It also exists in all cases of melancholia to a greater or less degree; but it is espe cially marked in severe cases of the dis ease, and especially in those cases in which there is an element of stupor. It is most marked in the muscles of the trunk and neck; it is less marked, but very strikingly present, in the muscles of the shoulders and hips, and it is again less marked in the elbows than at the shoulders, less marked at the wrists than at the elbows, and it is practically ab sent from the fingers. Similarly the rigidity is less marked at the knees than at the hips, very slight at the ankles, and again practically absent from the toes.
Personal reasons for believing this proximal rigidity to be a true physical sign of melancholia are: 1. That it does not occur in other forms of insanity.
2. That it disappears from the patient as he gets well.
3. That voluntary rigidity is of the peripheral type.
This is best observed in a resistant child.
Since rigidity is frequently associated with paralysis, one naturally endeavored to ascertain whether there was any weakness of movement at those joints where the rigidity was most marked. This paralysis has been detected. There is very little weakness to be detected in the elbow- or wrist-movements, but, if such a patient be asked to hold his hands straight above his head, he has difficulty in doing so; and it will be observed in extreme cases that the upper arm is not nearly held vertically, and that the elbow is not quite fully ex tended.
This symptom seems most marked in those patients who suffer a large amount of mental pain, especially if associated with an element of stupor.
The conclusion is that in cases of melancholia the cells of the tissues throughout the body have their function of excretion diminished, as well as the cells of the cortex cerebri. W. H. B. Stoddart (Journal of Mental Science, Apr., '98).
The diagnostic criteria of incipient or simple melancholia may be reduced to the following clinical symptoms: 1. Mental depression presenting all degrees of depressed states of feeling.
2. Insomnia, which may be slight or profound, but usually very persistent.
3. Headache or psychalgia,, which is commonly referred to the occipital region.
4. Loss of normal body-weight, pre senting all degrees.
5. Changes in attitude and physiog nomy.
6. Impaired appetite with marked con stipation.
7. Morbid introspection with selfish in clinations.
8. Morbid fear of objects or places constituting the phobias.
When these symptoms present them selves in any individual and become per sistent, whether the cause be known or not, they constitute the actual presence of that form of incipient insanity known as simple melancholia. John Punton (Alienist and Neurologist, Oct., '98).
Diagnosis of melancholia of toxic origin: A blow or steady pressure across a muscle produces contraction, and a swelling persists for some time at the point of contact. This local contraction is exaggerated in fevers of a serious nature, and immediately after death, when the contraction of the whole muscle is diminished. Out of 40 melancholic pa tients, the phenomenon was present in 32. The muscle selected was the biceps; this was seized firmly at about its middle part between the thumb and forefinger, stretched forcibly, then let go. The forms of melancholia in which it was ob served were: Simple melancholia, 1 case; melancholia with stupor, 8 cases; melan cholia with delusions, 16 cases; anxious melancholia, 3 cases; the depressed stage of folk circulaire, 3 cases. Fallon and Wahl (Arch. de Neurol., May, 1900).
Prognosis.—This is generally favor able. Ender appropriate treatment, from 75 to SO per cent. of cases should recover.