The term _melancholia_ is applied to _insanity_, when attended with
depression of spirits, arising commonly from some supposed impending
evil; but sometimes it takes place without any such error of judgment,
and is altogether unaccountable. As far as I have seen, this depression
of spirits is in no wise essentially connected with, far less dependent
upon, bodily weakness, as its cause. On the contrary, you will often
find such patients to be of full habit, and complaining of throbbing
headach, with flushing of the face, a full and strong pulse, though
sometimes the pulse is preternaturally slow; the tongue is often white
and dry, as in inflammation in general. These symptoms, considered in
themselves, would call for _antiphlogistic_ measures, such as
_bleeding_ and _purging_; and these are not at all the less
necessary because the patient is in a low and desponding state of mind.
In short, I know of no difference in the medical treatment of _mania_
and _melancholia_, merely as such; you must look to the state of
vascular action, both local and general, in order to lay down a proper
plan of cure.
_Hypochondriasis_ is a still slighter form of _mental derangement_,
and which is characterized by a preposterous anxiety and solicitude with
regard to the patient's own health, which in these cases is often little
if at all disturbed, with the exception of occasional uneasiness at the
stomach, arising from flatulency and other effects of indigestion. This
disorder in the state of the digestive function, is generally considered
by the patient as the real and primary disease, though 99 times in 100
it is merely secondary, the result of torpor of the alimentary canal
altogether. This torpor is the consequence of an oppressed condition of
brain, proceeding, for the most part, from increased arterial action in
this organ. Thus the effect is taken for the cause, and a treatment
directed in conformity with this mistaken notion. Happily, the practice
usually pursued on those occasions, and which is directed to the state
of the stomach and intestinal canal, is, as far as it goes, beneficial
to the primary disease; for occasional _purging_, whether with the
_blue pill_ or _Plummer's pill_, and the use of a simple and
abstemious mode of living, are as well calculated to relieve affections
of the brain, as those of the stomach. But the fault of such a mistaken
view of the subject is, that the treatment is confined too exclusively
to one organ, and that the one not primarily affected; to the neglect of
other means that may be as much or more required for the relief of the
head. Where, for example, the patient complains of throbbing headach,
with other marks of increased arterial action in and about the brain,
it is dangerous to rely solely upon _cathartics_, and to neglect
_bleeding_, a neglect, which, I have more than once seen reason to
believe, has been the occasion of fatal apoplexy ensuing.
The precise difference in the condition of the brain, in the three forms
of _insanity_ now mentioned, is not at all known. Dissection hitherto
has not thrown any light upon the subject; nor is it probable that it
will do so hereafter. The derangement of intellect in all of them, and
the mutual convertibility of one into the other, prove that there is no
essential or fundamental difference between them; and the same is true
with regard to their medical treatment. The moral management of the
patient calls for nicer discrimination, and requires much penetration
and judgment on the part of the practitioner, as well as extensive
experience in mental disorders altogether--_Clutterbuck's Lectures on
the Nervous System_.
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