Melancholia does not develop as a rule without some warning of what may be looked for. Nutritive disturbances are nearly always prominent features in the case for some time before any mental peculiarities are noticed. Professor Berkley remarks that a feeling of woe and of uneasiness seems to be the way by which the brain expresses its sense of the lack of proper nourishment. Usually there has been distinct digestive disturbance for some months. There is apt to be loss of appetite. There may be some slight yellowness in the whites of the eyes. Commonly there has been an increasing disregard for the patient's usual habits, especially in the matter of exercise and friendly intercourse. There is a disposition to sit apart and brood by the hour, and a well-marked tendency to avoid friends and even members of the family, with an utter disinclination to meet strangers.
One of the marked features of the disease in women is a tendency to untidiness. Women lose all regard for their personal appearance and fail to arrange their clothes properly. Men who have been specially neat in their personal appearance take on slouchy, careless habits, allow their clothes to become soiled and dirty, and have evidently forgotten all their old customs in this matter.
The symptoms are not always continuous. There is often a rhythmic alteration of intensity of symptoms that corresponds more or less to the physiological rhythm of life. In ordinary circumstances human temperature is highest in the afternoon and vital processes are most active at this time. The lowest temperatures occur in the morning, especially in the early hours; and it is at this time that vital processes are least active and the general condition is most depressed. It is not surprising, then, to find that melancholic patients are liable to suffer from deeper mental depression during the morning hours. In suicidal cases it is especially in the morning hours that patients need the closest surveillance.
In a certain number of cases of melancholia, instead of the quiet, often absolute immobility of the patients, there is a form of the disease characterised by the presence of incessant movement and an agitated state of countenance, { 219} that disclose their disturbed mental conditions. In melancholia, as a rule, sleep is very much disturbed, and at times patients do not sleep at all. In the agitated form of melancholia, the patient is often quiet only when under the influence of a sleeping-potion. Patients may tear their hair, disarrange their clothing, strike themselves, hit their heads against the wall, sigh and sob, and repeat some phrase that indicates their deep depression. They are apt to reiterate such expressions as "I am lost," "I am damned."