SUBSECT. I.

Definition of Melancholy, Name, Difference.

Having thus briefly anatomised the body and soul of man, as a preparative to the rest; I may now freely proceed to treat of my intended object, to most men's capacity; and after many ambages, perspicuously define what this melancholy is, show his name and differences. The name is imposed from the matter, and disease denominated from the material cause: as Bruel observes, Μελανχολία quasi Μελαιναχόλη, from black choler. And whether it be a cause or an effect, a disease or symptom, let Donatus Altomarus and Salvianus decide; I will not contend about it. It hath several descriptions, notations, and definitions. [1024]Fracastorius, in his second book of intellect, calls those melancholy, whom abundance of that same depraved humour of black choler hath so misaffected, that they become mad thence, and dote in most things, or in all, belonging to election, will, or other manifest operations of the understanding. [1025] Melanelius out of Galen, Ruffus, Aetius, describe it to be a bad and peevish disease, which makes men degenerate into beasts: Galen, a privation or infection of the middle cell of the head, &c. defining it from the part affected, which [1026]Hercules de Saxonia approves, lib. 1. cap. 16. calling it a depravation of the principal function: Fuschius, lib. 1. cap. 23. Arnoldus Breviar. lib. 1. cap. 18. Guianerius, and others: By reason of black choler, Paulus adds. Halyabbas simply calls it a commotion of the mind. Aretaeus, [1027]a perpetual anguish of the soul, fastened on one thing, without an ague; which definition of his, Mercurialis de affect. cap. lib. 1. cap. 10. taxeth: but Aelianus Montaltus defends, lib. de morb. cap. 1. de Melan. for sufficient and good. The common sort define it to be a kind of dotage without a fever, having for his ordinary companions, fear and sadness, without any apparent occasion. So doth Laurentius, cap. 4. Piso. lib. 1. cap. 43. Donatus Altomarus, cap. 7. art. medic. Jacchinus, in com. in lib. 9. Rhasis ad Almansor, cap. 15. Valesius, exerc. 17. Fuschius, institut. 3. sec. 1. c. 11. &c. which common definition, howsoever approved by most, [1028]Hercules de Saxonia will not allow of, nor David Crucius, Theat. morb. Herm. lib. 2. cap. 6. he holds it insufficient: as [1029]rather showing what it is not, than what it is: as omitting the specific difference, the phantasy and brain: but I descend to particulars. The summum genus is dotage, or anguish of the mind, saith Aretaeus; of the principal parts, Hercules de Saxonia adds, to distinguish it from cramp and palsy, and such diseases as belong to the outward sense and motions [depraved] [1030]to distinguish it from folly and madness (which Montaltus makes angor animi, to separate) in which those functions are not depraved, but rather abolished; [without an ague] is added by all, to sever it from frenzy, and that melancholy which is in a pestilent fever. (Fear and sorrow) make it differ from madness: [without a cause] is lastly inserted, to specify it from all other ordinary passions of [fear and sorrow.] We properly call that dotage, as [1031]Laurentius interprets it, when some one principal faculty of the mind, as imagination, or reason, is corrupted, as all melancholy persons have. It is without a fever, because the humour is most part cold and dry, contrary to putrefaction. Fear and sorrow are the true characters and inseparable companions of most melancholy, not all, as Her. de Saxonia, Tract. de posthumo de Melancholia, cap. 2. well excepts; for to some it is most pleasant, as to such as laugh most part; some are bold again, and free from all manner of fear and grief, as hereafter shall be declared.

SUBSECT. II.

Of the part affected. Affection. Parties affected.

Some difference I find amongst writers, about the principal part affected in this disease, whether it be the brain, or heart, or some other member. Most are of opinion that it is the brain: for being a kind of dotage, it cannot otherwise be but that the brain must be affected, as a similar part, be it by [1032]consent or essence, not in his ventricles, or any obstructions in them, for then it would be an apoplexy, or epilepsy, as [1033]Laurentius well observes, but in a cold, dry distemperature of it in his substance, which is corrupt and become too cold, or too dry, or else too hot, as in madmen, and such as are inclined to it: and this [1034] Hippocrates confirms, Galen, the Arabians, and most of our new writers. Marcus de Oddis (in a consultation of his, quoted by [1035]Hildesheim) and five others there cited are of the contrary part; because fear and sorrow, which are passions, be seated in the heart. But this objection is sufficiently answered by [1036]Montaltus, who doth not deny that the heart is affected (as [1037]Melanelius proves out of Galen) by reason of his vicinity, and so is the midriff and many other parts. They do compati, and have a fellow feeling by the law of nature: but forasmuch as this malady is caused by precedent imagination, with the appetite, to whom spirits obey, and are subject to those principal parts, the brain must needs primarily be misaffected, as the seat of reason; and then the heart, as the seat of affection. [1038]Capivaccius and Mercurialis have copiously discussed this question, and both conclude the subject is the inner brain, and from thence it is communicated to the heart and other inferior parts, which sympathise and are much troubled, especially when it comes by consent, and is caused by reason of the stomach, or mirach, as the Arabians term it, whole body, liver, or [1039]spleen, which are seldom free, pylorus, mesaraic veins, &c. For our body is like a clock, if one wheel be amiss, all the rest are disordered; the whole fabric suffers: with such admirable art and harmony is a man composed, such excellent proportion, as Ludovicus Vives in his Fable of Man hath elegantly declared.

As many doubts almost arise about the [1040]affection, whether it be imagination or reason alone, or both, Hercules de Saxonia proves it out of Galen, Aetius, and Altomarus, that the sole fault is in [1041]imagination. Bruel is of the same mind: Montaltus in his 2 cap. of Melancholy confutes this tenet of theirs, and illustrates the contrary by many examples: as of him that thought himself a shellfish, of a nun, and of a desperate monk that would not be persuaded but that he was damned; reason was in fault as well as imagination, which did not correct this error: they make away themselves oftentimes, and suppose many absurd and ridiculous things. Why doth not reason detect the fallacy, settle and persuade, if she be free? [1042]Avicenna therefore holds both corrupt, to whom most Arabians subscribe. The same is maintained by [1043]Areteus, [1044]Gorgonius, Guianerius, &c. To end the controversy, no man doubts of imagination, but that it is hurt and misaffected here; for the other I determine with [1045] Albertinus Bottonus, a doctor of Padua, that it is first in imagination, and afterwards in reason; if the disease be inveterate, or as it is more or less of continuance; but by accident, as [1046]Herc. de Saxonia adds; faith, opinion, discourse, ratiocination, are all accidentally depraved by the default of imagination.

Parties affected.] To the part affected, I may here add the parties, which shall be more opportunely spoken of elsewhere, now only signified. Such as have the moon, Saturn, Mercury misaffected in their genitures, such as live in over cold or over hot climes: such as are born of melancholy parents; as offend in those six non-natural things, are black, or of a high sanguine complexion, [1047]that have little heads, that have a hot heart, moist brain, hot liver and cold stomach, have been long sick: such as are solitary by nature, great students, given to much contemplation, lead a life out of action, are most subject to melancholy. Of sexes both, but men more often; yet [1048]women misaffected are far more violent, and grievously troubled. Of seasons of the year, the autumn is most melancholy. Of peculiar times: old age, from which natural melancholy is almost an inseparable accident; but this artificial malady is more frequent in such as are of a [1049]middle age. Some assign 40 years, Gariopontus 30. Jubertus excepts neither young nor old from this adventitious. Daniel Sennertus involves all of all sorts, out of common experience, [1050]in omnibus omnino corporibus cujuscunque constitutionis dominatar. Aetius and Aretius [1051]ascribe into the number not only [1052]discontented, passionate, and miserable persons, swarthy, black; but such as are most merry and pleasant, scoffers, and high coloured. Generally, saith Rhasis, [1053]the finest wits and most generous spirits, are before other obnoxious to it; I cannot except any complexion, any condition, sex, or age, but [1054]fools and stoics, which, according to [1055]Synesius, are never troubled with any manner of passion, but as Anacreon's cicada, sine sanguine et dolore; similes fere diis sunt. Erasmus vindicates fools from this melancholy catalogue, because they have most part moist brains and light hearts; [1056]they are free from ambition, envy, shame and fear; they are neither troubled in conscience, nor macerated with cares, to which our whole life is most subject.

SUBSECT. III.

Of the Matter of Melancholy.

Of the matter of melancholy, there is much question betwixt Avicen and Galen, as you may read in [1057]Cardan's Contradictions, [1058]Valesius' Controversies, Montanus, Prosper Calenus, Capivaccius, [1059]Bright, [1060]Ficinus, that have written either whole tracts, or copiously of it, in their several treatises of this subject. [1061]What this humour is, or whence it proceeds, how it is engendered in the body, neither Galen, nor any old writer hath sufficiently discussed, as Jacchinus thinks: the Neoterics cannot agree. Montanus, in his Consultations, holds melancholy to be material or immaterial: and so doth Arculanus: the material is one of the four humours before mentioned, and natural. The immaterial or adventitious, acquisite, redundant, unnatural, artificial; which [1062] Hercules de Saxonia will have reside in the spirits alone, and to proceed from a hot, cold, dry, moist distemperature, which, without matter, alter the brain and functions of it. Paracelsus wholly rejects and derides this division of four humours and complexions, but our Galenists generally approve of it, subscribing to this opinion of Montanus.

This material melancholy is either simple or mixed; offending in quantity or quality, varying according to his place, where it settleth, as brain, spleen, mesaraic veins, heart, womb, and stomach; or differing according to the mixture of those natural humours amongst themselves, or four unnatural adust humours, as they are diversely tempered and mingled. If natural melancholy abound in the body, which is cold and dry, so that it be more [1063]than the body is well able to bear, it must needs be distempered, saith Faventius, and diseased; and so the other, if it be depraved, whether it arise from that other melancholy of choler adust, or from blood, produceth the like effects, and is, as Montaltus contends, if it come by adustion of humours, most part hot and dry. Some difference I find, whether this melancholy matter may be engendered of all four humours, about the colour and temper of it. Galen holds it may be engendered of three alone, excluding phlegm, or pituita, whose true assertion [1064]Valesius and Menardus stiffly maintain, and so doth [1065]Fuschius, Montaltus, [1066] Montanus. How (say they) can white become black? But Hercules de Saxonia, lib. post. de mela. c. 8, and [1067]Cardan are of the opposite part (it may be engendered of phlegm, etsi raro contingat, though it seldom come to pass), so is [1068]Guianerius and Laurentius, c. 1. with Melanct. in his book de Anima, and Chap. of Humours; he calls it asininam, dull, swinish melancholy, and saith that he was an eyewitness of it: so is [1069]Wecker. From melancholy adust ariseth one kind; from choler another, which is most brutish; another from phlegm, which is dull; and the last from blood, which is best. Of these some are cold and dry, others hot and dry, [1070]varying according to their mixtures, as they are intended, and remitted. And indeed as Rodericus a Fons. cons. 12. l. 1. determines, ichors, and those serous matters being thickened become phlegm, and phlegm degenerates into choler, choler adust becomes aeruginosa melancholia, as vinegar out of purest wine putrified or by exhalation of purer spirits is so made, and becomes sour and sharp; and from the sharpness of this humour proceeds much waking, troublesome thoughts and dreams, &c. so that I conclude as before. If the humour be cold, it is, saith [1071]Faventinus, a cause of dotage, and produceth milder symptoms: if hot, they are rash, raving mad, or inclining to it. If the brain be hot, the animal spirits are hot; much madness follows, with violent actions: if cold, fatuity and sottishness, [1072]Capivaccius. [1073]The colour of this mixture varies likewise according to the mixture, be it hot or cold; 'tis sometimes black, sometimes not, Altomarus. The same [1074]Melanelius proves out of Galen; and Hippocrates in his Book of Melancholy (if at least it be his), giving instance in a burning coal, which when it is hot, shines; when it is cold, looks black; and so doth the humour. This diversity of melancholy matter produceth diversity of effects. If it be within the [1075]body, and not putrified, it causeth black jaundice; if putrified, a quartan ague; if it break out to the skin, leprosy; if to parts, several maladies, as scurvy, &c. If it trouble the mind; as it is diversely mixed, it produceth several kinds of madness and dotage: of which in their place.

SUBSECT. IV.

Of the species or kinds of Melancholy.

When the matter is divers and confused, how should it otherwise be, but that the species should be divers and confused? Many new and old writers have spoken confusedly of it, confounding melancholy and madness, as [1076] Heurnius, Guianerius, Gordonius, Salustius Salvianus, Jason Pratensis, Savanarola, that will have madness no other than melancholy in extent, differing (as I have said) in degrees. Some make two distinct species, as Ruffus Ephesius, an old writer, Constantinus Africanus, Aretaeus, [1077] Aurelianus, [1078]Paulus Aegineta: others acknowledge a multitude of kinds, and leave them indefinite, as Aetius in his Tetrabiblos, [1079]Avicenna, lib. 3. Fen. 1. Tract. 4. cap. 18. Arculanus, cap. 16. in 9. Rasis. Montanus, med. part. 1. [1080]If natural melancholy be adust, it maketh one kind; if blood, another; if choler, a third, differing from the first; and so many several opinions there are about the kinds, as there be men themselves. [1081]Hercules de Saxonia sets down two kinds, material and immaterial; one from spirits alone, the other from humours and spirits. Savanarola, Rub. 11. Tract. 6. cap. 1. de aegritud. capitis, will have the kinds to be infinite; one from the mirach, called myrachialis of the Arabians; another stomachalis, from the stomach; another from the liver, heart, womb, haemorrhoids, [1082]one beginning, another consummate. Melancthon seconds him, [1083]as the humour is diversely adust and mixed, so are the species divers; but what these men speak of species I think ought to be understood of symptoms; and so doth [1084] Arculanus interpret himself: infinite species, id est, symptoms; and in that sense, as Jo. Gorrheus acknowledgeth in his medicinal definitions, the species are infinite, but they may be reduced to three kinds by reason of their seat; head, body, and hypochrondries. This threefold division is approved by Hippocrates in his Book of Melancholy, (if it be his, which some suspect) by Galen, lib. 3. de loc. affectis, cap. 6. by Alexander, lib. 1. cap. 16. Rasis, lib. 1. Continent. Tract. 9. lib. 1. cap. 16. Avicenna and most of our new writers. Th. Erastus makes two kinds; one perpetual, which is head melancholy; the other interrupt, which comes and goes by fits, which he subdivides into the other two kinds, so that all comes to the same pass. Some again make four or five kinds, with Rodericus a Castro, de morbis mulier. lib. 2. cap. 3. and Lod. Mercatus, who in his second book de mulier. affect. cap. 4. will have that melancholy of nuns, widows, and more ancient maids, to be a peculiar species of melancholy differing from the rest: some will reduce enthusiasts, ecstatical and demoniacal persons to this rank, adding [1085] love melancholy to the first, and lycanthropia. The most received division is into three kinds. The first proceeds from the sole fault of the brain, and is called head melancholy; the second sympathetically proceeds from the whole body, when the whole temperature is melancholy: the third ariseth from the bowels, liver, spleen, or membrane, called mesenterium, named hypochondriacal or windy melancholy, which [1086]Laurentius subdivides into three parts, from those three members, hepatic, splenetic, mesaraic. Love melancholy, which Avicenna calls ilishi: and Lycanthropia, which he calls cucubuthe, are commonly included in head melancholy; but of this last, which Gerardus de Solo calls amoreus, and most knight melancholy, with that of religious melancholy, virginum et viduarum, maintained by Rod. a Castro and Mercatus, and the other kinds of love melancholy, I will speak of apart by themselves in my third partition. The three precedent species are the subject of my present discourse, which I will anatomise and treat of through all their causes, symptoms, cures, together and apart; that every man that is in any measure affected with this malady, may know how to examine it in himself, and apply remedies unto it.

It is a hard matter, I confess, to distinguish these three species one from the other, to express their several causes, symptoms, cures, being that they are so often confounded amongst themselves, having such affinity, that they can scarce be discerned by the most accurate physicians; and so often intermixed with other diseases, that the best experienced have been plunged. Montanus consil. 26, names a patient that had this disease of melancholy and caninus appetitus both together; and consil. 23, with vertigo, [1087]Julius Caesar Claudinus with stone, gout, jaundice. Trincavellius with an ague, jaundice, caninus appetitus, &c. [1088]Paulus Regoline, a great doctor in his time, consulted in this case, was so confounded with a confusion of symptoms, that he knew not to what kind of melancholy to refer it. [1089]Trincavellius, Fallopius, and Francanzanus, famous doctors in Italy, all three conferred with about one party, at the same time, gave three different opinions. And in another place, Trincavellius being demanded what he thought of a melancholy young man to whom he was sent for, ingenuously confessed that he was indeed melancholy, but he knew not to what kind to reduce it. In his seventeenth consultation there is the like disagreement about a melancholy monk. Those symptoms, which others ascribe to misaffected parts and humours, [1090]Herc. de Saxonia attributes wholly to distempered spirits, and those immaterial, as I have said. Sometimes they cannot well discern this disease from others. In Reinerus Solenander's counsels, (Sect, consil. 5,) he and Dr. Brande both agreed, that the patient's disease was hypochondriacal melancholy. Dr. Matholdus said it was asthma, and nothing else. [1091]Solenander and Guarionius, lately sent for to the melancholy Duke of Cleve, with others, could not define what species it was, or agree amongst themselves. The species are so confounded, as in Caesar Claudinus his forty-fourth consultation for a Polonian Count, in his judgment [1092]he laboured of head melancholy, and that which proceeds from the whole temperature both at once. I could give instance of some that have had all three kinds semel et simul, and some successively. So that I conclude of our melancholy species, as [1093]many politicians do of their pure forms of commonwealths, monarchies, aristocracies, democracies, are most famous in contemplation, but in practice they are temperate and usually mixed, (so [1094]Polybius informeth us) as the Lacedaemonian, the Roman of old, German now, and many others. What physicians say of distinct species in their books it much matters not, since that in their patients' bodies they are commonly mixed. In such obscurity, therefore, variety and confused mixture of symptoms, causes, how difficult a thing is it to treat of several kinds apart; to make any certainty or distinction among so many casualties, distractions, when seldom two men shall be like effected per omnia? 'Tis hard, I confess, yet nevertheless I will adventure through the midst of these perplexities, and, led by the clue or thread of the best writers, extricate myself out of a labyrinth of doubts and errors, and so proceed to the causes.