motley, and for healthy minds "motley's the only wear." But the melancholic mind wears a Quaker's suit of incessant sadness. There is no healthy variety. The mind is fixed on one idea, and the other parts of the mind atrophy in consequence. So it is with the limbs of the body-they wither if they are not used; and it is true too of the limbs of the mind. And in this way, in all cases of simple melancholia, a certain amount of general weakness will be discovered. If a man is in the habit of remembering only in relation to certain things, his power of reproducing in other directions necessarily becomes impaired. If a man is always thinking of himself, always wrapt up in sorrow, he is unobservant of the world, and it passes him without making any impression, for it is only what has been embalmed in attention that will not turn to ashes in the sepulchre of memory. But it is scarcely necessary to dwell longer on this point: its truth must be evident.

? 268.

Physical Symptoms of Simple Melancholia.— Simple melancholia may be associated with many diseases, but there are certain prevailing physical characteristics which may generally be looked for in connection with this disease. We take the following statement of these from Dr. Browne's lecture on simple melancholia: "1. There are frequently painful feelings of a sense of weight, or vacancy, or throbbing, or actual pain in the head. These feelings may occupy the forehead or the coronal region-most frequently the latter-and are usually accompanied by giddiness, especially when any rapid movement is attempted, and by great insomnia. 2. There is frequently impairment of the special senses, which never, however, amount to hallucinations. The eyesight is dim; there are soundings in the ears; a constant bad taste is felt in the mouth; a numbness or hyperæthesia is experienced in the hands and feet, or in some track of skin. 3. There is frequently impairment of general nutrition, with impoverishment of the blood: the body becomes thin and wasted, the skin loses its softness, and is pale or of a dirty color, and the muscles are feeble and relaxed. The

British Medical Journal for 1872, vol. fi., p. 429.

pupils are dilated: the mucous membranes are exsanguine, and all the indications of anæmia are obvious. In extreme cases a degree of leucorythemia may be present so that the blood under the microscope exhibits a distinct increase in the proportion of white cells. 4. There are frequently disturbances in the circulatory and respiratory systems; the heart's action is irregular or tumultuous; attacks of palpitation come on from time to time, especially at night; there is a soft, blowing, cardiac murmur, loudest at the base and propagated along the great vessels; the pulse is feeble and compressible; the extremities are cold; the breathing is sighing in character. 5. The temperature is below the normal standard: it frequently falls as low as 96.8 deg., and rarely rises to 98.4 deg. 6. The digestive functions are frequently disordered; the tongue is coated with a dirty white fur, or is red and irritable. There is complete anorexia, or a capricious appetite. There is vomiting, pyrosis, painful digestion, or dyspepsia in some form, and the bowels are almost invariably constipated. 7. There is frequently derangement of the menstrual functions, amenorrhoea, menorrhagia, or leucorrhoea."

269. Importance of the Study of Simple Melancholia. It is of considerable importance that medical men should understand the real characteristics of this disease, as questions as to its existence or extent not unfrequently occur in courts of law. Experience has taught us that a large numher of the crimes which are committed under the influence of insanity are due to the despair and agony which are symptomatic of simple melancholia; and as the mental impairment is in many cases only to be discovered after careful investigation, the difficulty of deciding the question of responsibility or irresponsibility is often considerable.' The difficulty is less when simple melancholia has passed over into the acute form of the diseae, for then its presence is made known by the existence of recognizable delusions; but while the disease is characterized only by great uneasiness, vague terror, irrational fear, and dull, shrinking depression, the difficulty is excessive. What we have said will, however, be some

Many of the cases of suicide are to be ascribed to simple melancholia.

guidance, and as in most cases diagnostic rules are best understood in relation to illustration, we quote the description of a case of simple melancholia, which will be found in the first part of Dr. Browne's lecture, from which we have already quoted.

& 270. Case of Simple Melancholia.-"Jane S-," says Dr. Browne, "is a native of Scotland, but has been resident in Yorkshire for five years. Her mother's brother waɛ once insane and an inmate of an asylum, but with that exception, no member of her family has ever suffered from mental or nervous disease. The patient herself has had no serious illness nor cranial injury, and has always been of sober habits. On the first of May last, she gave birth to an illegitimate child. Her fall from virtue had preyed much upon her mind during her pregnancy, and the depression of spirits thus occasioned deepened considerably at the time of her confinement, when she was in poor lodgings and could not command liberal nourishment or careful nursing, and passed into morbid despondency three days after delivery, when the unexpected announcement of her father's death reached her. She at once formed the idea that her father (who was a very aged man, and really died in the course of nature) had been killed by the shame of her misfortune. She sank into a state of inconsolable grief, wept incessantly, was sleepless, and twice attempted to put an end to her existence and sorrow by jumping through the window. After this, she refused all food, complained of insupportable misery and weakness, and repeatedly threatened suicide; so that, for her own protection, she was sent to this asylum. After reading her history, as you recollect, I introduced you to the patient a thin, pale, care-worn-looking woman, whom you found seated in the day-room, with her head bowed down and her hands crossed upon her lap, in an attitude of listless dejection. Her features were fixed in an expression of mental suffering, the angles of her mouth being drawn down, and the corrugators of the upper eyebrows being firmly contracted. When I spoke to her, she answered slowly and

This was a clinical lecture delivered to a class of students.

with evident reluctance, turning away from me as if shrinking from observation, and seeking solitude. In reply to my repeated questions, however, she told me that she was quite wretched and tired of life, and that she had nothing to look forward to but death. She added that she had killed her father by her conduct, and had no affection for her child, so that she did not care if she never saw it again. Her answers must have satisfied you that she was perfectly intelligent— she at once apprehended the meaning of all that was said to her; that her memory was good-she accurately recalled the facts of her past history, which had been communicated to you; and that no delusion existed in her mind-she repudiated several delusive beliefs which I suggested to her. The nearest approach to a delusional state of mind which she exhibited was in the tendency to exaggerate all the transgressions and peccadillos of her past life and their consequences, which she from time to time displayed. Not only had she killed her father, but she had perhaps shortened her mother's days by her levity as a girl, and brought on the fever which carried off her youngest sister by a beating which she had once given her. She was so miserable, she said, that she had no anxiety about her soul; but she dreamt sometimes that she was in flames of fire, and then started up alarmed. The nurse who was in attendance upon Jane S- added to her statement, for your information, that she could not be induced to employ herself; that she sometimes refused her food; that she was 'lowest' in the morning, and brightened up as the day advanced; that she had sometimes attacks of crying,' and that she slept badly." This is a careful description of a useful typical case of simple melancholia. We pass now to the after form of this disease.

271. Acute Melancholia.-To see things in the making has been thought inexpedient for fools, but it is most instructive to the wise, and nothing can better indicate the true nature of acute melancholia than the process of the transformation of simple melancholia into the more serious form of the disease. This process has been well described by one

British Med. Jour., vol. ii., for 1872. pp. 403. 404.

author. "The vague depression," he says, "or fear, which has been held as it were in solution in the mind, gradually crystalizes into certain delusional forms or beliefs. And these delusional forms or beliefs can be classified into certain systems just as crystals can. Minds have their special delusional tendencies just as chemical substances have their special crystaline forms; and of some it might be predicted that on being attacked by melancholia, they will pass into the hypochondriacal variety as certainly as it may be foretold of borax that on crystalizing it will assume the form of an oblique, rhombic prism." In some ways there is a good deal of truth in this comparison, and in the associating healthy thought with colloidal and unhealthy with crystaline formation. However, here we have the distinctive character of acute melancholia. It is always marked by delusive impressions, and these beliefs have a curious fixity and persistence which is not to be met with in relation to any other disease. These delusions generally run with temperament. In one man, you find such good digestion that he never cares about his soul. He is merry: he finds life a stimulant, and deathat least while he lives-has no dominion over him. is always probing his soul. One man is religious, the other not. One man has intense feelings in relation to his soul's welfare, and another has equally urgent cares as to his bodily well being. In these men, when melancholia supervenes on health, their delusive beliefs will be only intensifications of the impressions they had, and the thoughts which had them during health. The one man will mourn for his lost soul, will weep and wring his hands, because he has committed horrible crimes; will be bowed down with the feeling that God's hand is made bare to smite him; will be conscious that he has incurred Heaven's heavy wrath. But these feelings will be associated with actual delusions. Thus, we know one case where a woman believed that she had murdered her mother by putting her in the water-butt, while the old woman actually died in her bed, tended with all care and consideration by her who harbored the delusion. The horror of this thought, the intense misery which she felt in relation to God's anger at her crime, her uneradicable despair and hopeless

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