In repeating of these causes, I must crambem bis coctam apponere, say that again which I have formerly said, in applying them to their proper species. Hypochondriacal or flatuous melancholy, is that which the Arabians call mirachial, and is in my judgment the most grievous and frequent, though Bruel and Laurentius make it least dangerous, and not so hard to be known or cured. His causes are inward or outward. Inward from divers parts or organs, as midriff, spleen, stomach, liver, pylorus, womb, diaphragma, mesaraic veins, stopping of issues, &c. Montaltus cap. 15. out of Galen recites, [2444]“heat and obstruction of those mesaraic veins, as an immediate cause, by which means the passage of the chilus to the liver is detained, stopped or corrupted, and turned into rumbling and wind.” Montanus, consil. 233, hath an evident demonstration, Trincavelius another, lib. 1, cap. 1, and Plater a third, observat. lib. 1, for a doctor of the law visited with this infirmity, from the said obstruction and heat of these mesaraic veins, and bowels; quoniam inter ventriculum et jecur venae effervescunt, the veins are inflamed about the liver and stomach. Sometimes those other parts are together misaffected; and concur to the production of this malady: a hot liver and cold stomach, or cold belly: look for instances in Hollerius, Victor Trincavelius, consil. 35, l. 3, Hildesheim Spicel. 2, fol. 132, Solenander consil. 9, pro cive Lugdunensi, Montanus consil. 229, for the Earl of Montfort in Germany, 1549, and Frisimelica in the 233 consultation of the said Montanus. I. Caesar Claudinus gives instance of a cold stomach and over-hot liver, almost in every consultation, con. 89, for a certain count; and con. 106, for a Polonian baron, by reason of heat the blood is inflamed, and gross vapours sent to the heart and brain. Mercurialis subscribes to them, cons. 89, [2445]“the stomach being misaffected,” which he calls the king of the belly, because if he be distempered, all the rest suffer with him, as being deprived of their nutriment, or fed with bad nourishment, by means of which come crudities, obstructions, wind, rumbling, griping, &c. Hercules de Saxonia, besides heat, will have the weakness of the liver and his obstruction a cause, facultatem debilem jecinoris, which he calls the mineral of melancholy. Laurentius assigns this reason, because the liver over-hot draws the meat undigested out of the stomach, and burneth the humours. Montanus, cons. 244, proves that sometimes a cold liver may be a cause. Laurentius c. 12, Trincavelius lib. 12, consil., and Gualter Bruel, seems to lay the greatest fault upon the spleen, that doth not his duty in purging the liver as he ought, being too great, or too little, in drawing too much blood sometimes to it, and not expelling it, as P. Cnemiandrus in a [2446]consultation of his noted tumorem lienis, he names it, and the fountain of melancholy. Diocles supposed the ground of this kind of melancholy to proceed from the inflammation of the pylorus, which is the nether mouth of the ventricle. Others assign the mesenterium or midriff distempered by heat, the womb misaffected, stopping of haemorrhoids, with many such. All which Laurentius, cap. 12, reduceth to three, mesentery, liver, and spleen, from whence he denominates hepatic, splenetic, and mesaraic melancholy. Outward causes, are bad diet, care, griefs, discontents, and in a word all those six non-natural things, as Montanus found by his experience, consil. 244. Solenander consil. 9, for a citizen of Lyons, in France, gives his reader to understand, that he knew this mischief procured by a medicine of cantharides, which an unskilful physician ministered his patient to drink ad venerem excitandam. But most commonly fear, grief, and some sudden commotion, or perturbation of the mind, begin it, in such bodies especially as are ill-disposed. Melancthon, tract. 14, cap. 2, de anima, will have it as common to men, as the mother to women, upon some grievous trouble, dislike, passion, or discontent. For as Camerarius records in his life, Melancthon himself was much troubled with it, and therefore could speak out of experience. Montanus, consil. 22, pro delirante Judaeo, confirms it, [2447]grievous symptoms of the mind brought him to it. Randolotius relates of himself, that being one day very intent to write out a physician's notes, molested by an occasion, he fell into a hypochondriacal fit, to avoid which he drank the decoction of wormwood, and was freed. [2448]Melancthon “(being the disease is so troublesome and frequent) holds it a most necessary and profitable study, for every man to know the accidents of it, and a dangerous thing to be ignorant,” and would therefore have all men in some sort to understand the causes, symptoms, and cures of it.
SUBSECT. V.—Causes of Melancholy from the whole Body.
As before, the cause of this kind of melancholy is inward or outward. Inward, [2449]“when the liver is apt to engender such a humour, or the spleen weak by nature, and not able to discharge his office.” A melancholy temperature, retention of haemorrhoids, monthly issues, bleeding at nose, long diseases, agues, and all those six non-natural things increase it. But especially [2450]bad diet, as Piso thinks, pulse, salt meat, shellfish, cheese, black wine, &c. Mercurialis out of Averroes and Avicenna condemns all herbs: Galen, lib. 3, de loc. affect. cap. 7, especially cabbage. So likewise fear, sorrow, discontents, &c., but of these before. And thus in brief you have had the general and particular causes of melancholy.
Now go and brag of thy present happiness, whosoever thou art, brag of thy temperature, of thy good parts, insult, triumph, and boast; thou seest in what a brittle state thou art, how soon thou mayst be dejected, how many several ways, by bad diet, bad air, a small loss, a little sorrow or discontent, an ague, &c.; how many sudden accidents may procure thy ruin, what a small tenure of happiness thou hast in this life, how weak and silly a creature thou art. “Humble thyself, therefore, under the mighty hand of God,” 1 Peter, v. 6, know thyself, acknowledge thy present misery, and make right use of it. Qui stat videat ne cadat. Thou dost now flourish, and hast bona animi, corporis, et fortunae, goods of body, mind, and fortune, nescis quid serus secum vesper ferat, thou knowest not what storms and tempests the late evening may bring with it. Be not secure then, “be sober and watch,” [2451]fortunam reverenter habe, if fortunate and rich; if sick and poor, moderate thyself. I have said.
SECT. III. MEMB. I.
SUBSECT. I.—Symptoms, or Signs of Melancholy in the Body.
Parrhasius, a painter of Athens, amongst those Olynthian captives Philip of Macedon brought home to sell, [2452]bought one very old man; and when he had him at Athens, put him to extreme torture and torment, the better by his example to express the pains and passions of his Prometheus, whom he was then about to paint. I need not be so barbarous, inhuman, curious, or cruel, for this purpose to torture any poor melancholy man, their symptoms are plain, obvious and familiar, there needs no such accurate observation or far-fetched object, they delineate themselves, they voluntarily betray themselves, they are too frequent in all places, I meet them still as I go, they cannot conceal it, their grievances are too well known, I need not seek far to describe them.
Symptoms therefore are either [2453]universal or particular, saith Gordonius, lib. med. cap. 19, part. 2, to persons, to species; “some signs are secret, some manifest, some in the body, some in the mind, and diversely vary, according to the inward or outward causes,” Capivaccius: or from stars, according to Jovianus Pontanus, de reb. caelest. lib. 10, cap. 13, and celestial influences, or from the humours diversely mixed, Ficinus, lib. 1, cap. 4, de sanit. tuenda: as they are hot, cold, natural, unnatural, intended, or remitted, so will Aetius have melancholica deliria multiformia, diversity of melancholy signs. Laurentius ascribes them to their several temperatures, delights, natures, inclinations, continuance of time, as they are simple or mixed with other diseases, as the causes are divers, so must the signs be, almost infinite, Altomarus cap. 7, art. med. And as wine produceth divers effects, or that herb Tortocolla in [2454]Laurentius, “which makes some laugh, some weep, some sleep, some dance, some sing, some howl, some drink, &c.” so doth this our melancholy humour work several signs in several parties.
But to confine them, these general symptoms may be reduced to those of the body or the mind. Those usual signs appearing in the bodies of such as are melancholy, be these cold and dry, or they are hot and dry, as the humour is more or less adust. From [2455]these first qualities arise many other second, as that of [2456]colour, black, swarthy, pale, ruddy, &c., some are impense rubri, as Montaltus cap. 16 observes out of Galen, lib. 3, de locis affectis, very red and high coloured. Hippocrates in his book [2457]de insania et melan. reckons up these signs, that they are [2458] “lean, withered, hollow-eyed, look old, wrinkled, harsh, much troubled with wind, and a griping in their bellies, or bellyache, belch often, dry bellies and hard, dejected looks, flaggy beards, singing of the ears, vertigo, light-headed, little or no sleep, and that interrupt, terrible and fearful dreams,” [2459]Anna soror, quae, me suspensam insomnia terrent? The same symptoms are repeated by Melanelius in his book of melancholy collected out of Galen, Ruffus, Aetius, by Rhasis, Gordonius, and all the juniors, [2460]“continual, sharp, and stinking belchings, as if their meat in their stomachs were putrefied, or that they had eaten fish, dry bellies, absurd and interrupt dreams, and many fantastical visions about their eyes, vertiginous, apt to tremble, and prone to venery.” [2461]Some add palpitation of the heart, cold sweat, as usual symptoms, and a leaping in many parts of the body, saltum in multis corporis partibus, a kind of itching, saith Laurentius, on the superficies of the skin, like a flea-biting sometimes. [2462]Montaltus cap. 21. puts fixed eyes and much twinkling of their eyes for a sign, and so doth Avicenna, oculos habentes palpitantes, trauli, vehementer rubicundi, &c., lib. 3. Fen. 1. Tract. 4. cap. 18. They stut most part, which he took out of Hippocrates' aphorisms. [2463]Rhasis makes “headache and a binding heaviness for a principal token, much leaping of wind about the skin, as well as stutting, or tripping in speech, &c., hollow eyes, gross veins, and broad lips.” To some too, if they be far gone, mimical gestures are too familiar, laughing, grinning, fleering, murmuring, talking to themselves, with strange mouths and faces, inarticulate voices, exclamations, &c. And although they be commonly lean, hirsute, uncheerful in countenance, withered, and not so pleasant to behold, by reason of those continual fears, griefs, and vexations, dull, heavy, lazy, restless, unapt to go about any business; yet their memories are most part good, they have happy wits, and excellent apprehensions. Their hot and dry brains make them they cannot sleep, Ingentes habent et crebras vigilias (Arteus) mighty and often watchings, sometimes waking for a month, a year together. [2464]Hercules de Saxonia faithfully averreth, that he hath heard his mother swear, she slept not for seven months together: Trincavelius, Tom. 2. cons. 16. speaks of one that waked 50 days, and Skenkius hath examples of two years, and all without offence. In natural actions their appetite is greater than their concoction, multa appetunt pauca digerunt as Rhasis hath it, they covet to eat, but cannot digest. And although they [2465]“do eat much, yet they are lean, ill-liking,” saith Areteus, “withered and hard, much troubled with costiveness,” crudities, oppilations, spitting, belching, &c. Their pulse is rare and slow, except it be of the [2466]Carotides, which is very strong; but that varies according to their intended passions or perturbations, as Struthius hath proved at large, Spigmaticae. artis l. 4. c. 13. To say truth, in such chronic diseases the pulse is not much to be respected, there being so much superstition in it, as [2467]Crato notes, and so many differences in Galen, that he dares say they may not be observed, or understood of any man.
Their urine is most part pale, and low coloured, urina pauca acris, biliosa (Areteus), not much in quantity; but this, in my judgment, is all out as uncertain as the other, varying so often according to several persons, habits, and other occasions not to be respected in chronic diseases. [2468]“Their melancholy excrements in some very much, in others little, as the spleen plays his part,” and thence proceeds wind, palpitation of the heart, short breath, plenty of humidity in the stomach, heaviness of heart and heartache, and intolerable stupidity and dullness of spirits. Their excrements or stool hard, black to some and little. If the heart, brain, liver, spleen, be misaffected, as usually they are, many inconveniences proceed from them, many diseases accompany, as incubus, [2469]apoplexy, epilepsy, vertigo, those frequent wakings and terrible dreams, [2470]intempestive laughing, weeping, sighing, sobbing, bashfulness, blushing, trembling, sweating, swooning, &c. [2471]All their senses are troubled, they think they see, hear, smell, and touch that which they do not, as shall be proved in the following discourse.