Nervous and mental diseases . of conductin all forms of melancholia. Sometimes this refusal rests upon a delu-sional foundation : the patient thinks he can-not digest his food, that it never passesthrough him, that he is too poor to pay forit, that he is too wicked to eat, that he must,do penance, and so on. Or he refuses food]with deliberate suicidal intent. Generally,profound anorexia, constipation, and gastro-intestinal disorders are at the basis of thisrefusal to eat. The pulse is usually subnormal in fre-quency, though sometimes, especially in agi-tated forms, accelerated. The peripherala
Nervous and mental diseases . of conductin all forms of melancholia. Sometimes this refusal rests upon a delu-sional foundation : the patient thinks he can-not digest his food, that it never passesthrough him, that he is too poor to pay forit, that he is too wicked to eat, that he must,do penance, and so on. Or he refuses food]with deliberate suicidal intent. Generally,profound anorexia, constipation, and gastro-intestinal disorders are at the basis of thisrefusal to eat. The pulse is usually subnormal in fre-quency, though sometimes, especially in agi-tated forms, accelerated. The peripheralarteries are contracted and the extremitiescold. The respiration is retarded and super-ficial, as a rule, though it may be increasedin the agitated types. Sleep is much disor-dered, and even altogether absent, in severecases. The patient emaciates both through refusal of food and becauseof disordered digestion. The gastric juice and saliva are often dimin-ished in quantity. The tongue is foul and furred, and obstinate consti-. Fig. 306.—Depressive phase. MANIC-DEPRESSIVE INSANITY. 801 pation is present. As a result of constipation, elevations of temperaturemay be observed, but otherwise the temperature is undisturbed. Thesurface temperature in the extremities is often much reduced. Amen-orrhea is frequently induced by the depressive as well as the manicphase. Varieties.—The depressive phase may show itself as follows : 1. Mild depression, with very light retardation. 2. Strong depression, with very light retardation. 3. Depression with the development of delusions of a depressednature, and various grades of retardation. While the delusions areusually melancholic, they may also be paranoid or hypochondriacal incharacter. 4. Complete retardation, with the facial expression of depression(depressive stupor). 5. Periodic, recurrent, or intermittent types. These designationshave the same significance as in mania, attacks of the depressive phaseoccurring at intervals throughout the
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