MELANCHOLIA (Lat.. from Ilk. µ(\a-yxoXia, black bile, from A/Xas, mc/us, Hack -4- xoXii, eholr, bile). A form of insanity clr:orar•terized by depression both of emotional state and of nerve functions. The essential feature of this disorder is sadness. dejection. despondency. The melan choliac is gloomy, full of forebodings and fearful anticipations. convinced of physical inferiority and of moral worthlessness, and often contem plates, eve]] if he does not commit, suic•iile. A number of delusions arise in almost all eases. Ile may even commit murder to save himself from his own expected fate. Disturbances of the sense organs may cause hallucinations of smell. taste, and sight. In some cases. overwhelmed by terror or by conviction of wrongdoing, the patient burns or mutilates himself in a paroxysm of fury and during a reduction of consciousness. This con dition, really the outcome of terror, is called melancholic frenzy. This frenzy occurs in alco holics as a result of the familiar hallucinations of frightful animals, tires, and of fearful fore bodings. In melancholia there is more apparent bodily disorder during the attack than in mania. Constipation, of tongue and throat, ab sence of appetite, and headache are prominent.
There are several varieties of melancholia. Mel ancholia fa occurs When the patient is active and excited, restlessly running weeping and beseeehing and his hands. .1/e/ancho1ia allonita occurs when the patient is practically mo tionless, fastening his gaze on the floor, lethargic and relaxed with 'frozen expression.' It is dif
ficult to arouse the atonic melaneholiac to take food, or to answer questions. Ile must he dressed and undressed by an attendant. Melancholia simples has been described. Mc/anch °La sine less happily designated 'reasoning melan cholia,' is a form of the disorder in which there is neither delirium nor delusion nor hallucina tion. This is also known as 'affective melan cholia,' since the emotional or affective sphere is chiefly at fault.
There is a preliminary period during which the patient complains of inability to •fix his at tention, faltering memory, and slow' intellection. An attack of melancholia rarely appears without this preliminary period except when it follows an emotional shock or an exhausting fever. An attack of melancholia lasts from a few weeks to about eight months in most eases. Some attacks continue for over a year. Accurate figures as to the percentage of cases of melancholia to the whole number of insane cannot be reaehed; hut the proportion is about 14 per cent. Sixty per cent. of melancholiacs recover. The treat ment of melancholia consists in constant surveil lance, regular and ample nourishment, cardiac and general stimulants. hygienic measures, and interesting occupation. Travel benefits many, but unremitting vigilance is necessary to prevent accident or suieide. See INSANITY.