Anatomy of Melancholy, by Robert Burton

Memb. iv.

Subsect. i.

Physician, Patient, Physic.

Of those diverse gifts which our apostle Paul saith God hath bestowed on man, this of physic is not the least, but most necessary, and especially conducing to the good of mankind. Next therefore to God in all our extremities (“for of the most high cometh healing,” Ecclus. xxxviii. 2.) we must seek to, and rely upon the Physician, 2843who is Manus Dei, saith Hierophilus, and to whom he hath given knowledge, that he might be glorified in his wondrous works. “With such doth he heal men, and take away their pains,” Ecclus. xxxviii. 6. 7. “when thou hast need of him, let him not go from thee. The hour may come that their enterprises may have good success,” ver. 13. It is not therefore to be doubted, that if we seek a physician as we ought, we may be eased of our infirmities, such a one I mean as is sufficient, and worthily so called; for there be many mountebanks, quacksalvers, empirics, in every street almost, and in every village, that take upon them this name, make this noble and profitable art to be evil spoken of and contemned, by reason of these base and illiterate artificers: but such a physician I speak of, as is approved, learned, skilful, honest, &c., of whose duty Wecker, Antid. cap. 2. and Syntax. med. Crato, Julius Alexandrinus medic. Heurnius prax. med. lib. 3. cap. 1. &c. treat at large. For this particular disease, him that shall take upon him to cure it, 2844Paracelsus will have to be a magician, a chemist, a philosopher, an astrologer; Thurnesserus, Severinus the Dane, and some other of his followers, require as much: “many of them cannot be cured but by magic.” 2845Paracelsus is so stiff for those chemical medicines, that in his cures he will admit almost of no other physic, deriding in the mean time Hippocrates, Galen, and all their followers: but magic, and all such remedies I have already censured, and shall speak of chemistry 2846elsewhere. Astrology is required by many famous physicians, by Ficinus, Crato, Fernelius; 2847doubted of, and exploded by others: I will not take upon me to decide the controversy myself, Johannes Hossurtus, Thomas Boderius, and Maginus in the preface to his mathematical physic, shall determine for me. Many physicians explode astrology in physic (saith he), there is no use of it, unam artem ac quasi temerarium insectantur, ac gloriam sibi ab ejus imperitia, aucupari: but I will reprove physicians by physicians, that defend and profess it, Hippocrates, Galen, Avicen. &c., that count them butchers without it, homicidas medicos Astrologiae ignaros, &c. Paracelsus goes farther, and will have his physician 2848predestinated to this man's cure, this malady; and time of cure, the scheme of each geniture inspected, gathering of herbs, of administering astrologically observed; in which Thurnesserus and some iatromathematical professors, are too superstitious in my judgment. 2849“Hellebore will help, but not alway, not given by every physician, &c.” but these men are too peremptory and self-conceited as I think. But what do I do, interposing in that which is beyond my reach? A blind man cannot judge of colours, nor I peradventure of these things. Only thus much I would require, honesty in every physician, that he be not over-careless or covetous, harpy-like to make a prey of his patient; Carnificis namque est (as 2850Wecker notes) inter ipsos cruciatus ingens precium exposcere, as a hungry chirurgeon often produces and wire-draws his cure, so long as there is any hope of pay, Non missura cutem, nisi plena cruoris hirudo. 2851Many of them, to get a fee, will give physic to every one that comes, when there is no cause, and they do so irritare silentem morbum, as 2852Heurnius complains, stir up a silent disease, as it often falleth out, which by good counsel, good advice alone, might have been happily composed, or by rectification of those six non-natural things otherwise cured. This is Naturae bellum inferre, to oppugn nature, and to make a strong body weak. Arnoldus in his 8 and 11 Aphorisms gives cautions against, and expressly forbiddeth it. 2853“A wise physician will not give physic, but upon necessity, and first try medicinal diet, before he proceed to medicinal cure.” 2854In another place he laughs those men to scorn, that think longis syrupis expugnare daemones et animi phantasmata, they can purge fantastical imaginations and the devil by physic. Another caution is, that they proceed upon good grounds, if so be there be need of physic, and not mistake the disease; they are often deceived by the 2855similitude of symptoms, saith Heurnius, and I could give instance in many consultations, wherein they have prescribed opposite physic. Sometimes they go too perfunctorily to work, in not prescribing a just 2856course of physic: To stir up the humour, and not to purge it, doth often more harm than good. Montanus consil. 30. inveighs against such perturbations, “that purge to the halves, tire nature, and molest the body to no purpose.” 'Tis a crabbed humour to purge, and as Laurentius calls this disease, the reproach of physicians: Bessardus, flagellum medicorum, their lash; and for that cause, more carefully to be respected. Though the patient be averse, saith Laurentius, desire help, and refuse it again, though he neglect his own health, it behoves a good physician not to leave him helpless. But most part they offend in that other extreme, they prescribe too much physic, and tire out their bodies with continual potions, to no purpose. Aetius tetrabib. 2. 2. ser. cap. 90. will have them by all means therefore 2857“to give some respite to nature,” to leave off now and then; and Laelius a Fonte Eugubinus in his consultations, found it (as he there witnesseth) often verified by experience, 2858“that after a deal of physic to no purpose, left to themselves, they have recovered.” 'Tis that which Nic. Piso, Donatus Altomarus, still inculcate, dare requiem naturae, to give nature rest.

2843. Ecclus. xxxviii. In the sight of great men he shall be in admiration.

2844. Tom. 4. Tract. 3. de morbis amentium, horum multi non nisi a Magis curandi et Astrologis, quoniam origo ejus a coelis petenda est.

2845. Lib. de Podagra.

2846. Sect. 5.

2847. Langius. J. Caesar Claudinus consult.

2848. Praedestinatum ad hunc curandum.

2849. Helleborus curat, sed quod ab omni datus medico vanum est.

2850. Antid. gen. lib. 3. cap. 2.

2851. “The leech never releases the skin until he is filled with blood.”

2852. Quod saepe evenit, lib. 3. cap. 2. cum non sit necessitas. Frustra fatigant remediis aegros, qui victus ratione curari possunt, Heurnius.

2853. Modestus et sapiens medicus, nunquam properabit ad pharmacum, nisi cogente necessitate, 41 Aphor. prudens et pius medicus cibis prius medicinal, quam medicinis puris morbum expellere satagat.

2854. Brev. 1. c. 18.

2855. Similitudo saepe bonis modicis imponit.

2856. Qui melancholicis praebent remedia non satis valida Longiores morbi imprimis solertiam medici postulant et fidelitatem, qui enim tumultuario hos tractant, vires absque ullo commodo laedunt et frangunt, &c.

2857. Naturae remissionem dare oportet.

2858. Plerique hoc morbo medicina nihil profecisse visi sunt, et sibi demissi invaluerunt.

Subsect. ii.

Concerning the Patient.

When these precedent cautions are accurately kept, and that we have now got a skilful, an honest physician to our mind, if his patient will not be conformable, and content to be ruled by him, all his endeavours will come to no good end. Many things are necessarily to be observed and continued on the patient's behalf: First that he be not too niggardly miserable of his purse, or think it too much he bestows upon himself, and to save charges endanger his health. The Abderites, when they sent for 2859Hippocrates, promised him what reward he would, 2860“all the gold they had, if all the city were gold he should have it.” Naaman the Syrian, when he went into Israel to Elisha to be cured of his leprosy, took with him ten talents of silver, six thousand pieces of gold, and ten changes of raiment, (2 Kings v. 5.) Another thing is, that out of bashfulness he do not conceal his grief; if aught trouble his mind, let him freely disclose it, Stultorum incurata pudor malus ulcera celat: by that means he procures to himself much mischief, and runs into a greater inconvenience: he must be willing to be cured, and earnestly desire it. Pars sanitatis velle sanare fuit, (Seneca). 'Tis a part of his cure to wish his own health, and not to defer it too long.

2861Qui blandiendo dulce nutrivit malum,

Soro recusat ferre quod subiit jugum.

He that by cherishing a mischief doth provoke,

Too late at last refuseth to cast off his yoke,

2862Helleborum frustra cum jam cutis aegra tumebit,

Poscentes videas; venienti occurrite morbo.

When the skin swells, to seek it to appease

With hellebore, is vain; meet your disease.

By this means many times, or through their ignorance in not taking notice of their grievance and danger of it, contempt, supine negligence, extenuation, wretchedness and peevishness; they undo themselves. The citizens, I know not of what city now, when rumour was brought their enemies were coming, could not abide to hear it; and when the plague begins in many places and they certainly know it, they command silence and hush it up; but after they see their foes now marching to their gates, and ready to surprise them, they begin to fortify and resist when 'tis too late; when, the sickness breaks out and can be no longer concealed, then they lament their supine negligence: 'tis no otherwise with these men. And often out of prejudice, a loathing, and distaste of physic, they had rather die, or do worse, than take any of it. “Barbarous immanity” (2863Melancthon terms it) “and folly to be deplored, so to contemn the precepts of health, good remedies, and voluntarily to pull death, and many maladies upon their own heads.” Though many again are in that other extreme too profuse, suspicious, and jealous of their health, too apt to take physic on every small occasion, to aggravate every slender passion, imperfection, impediment: if their finger do but ache, run, ride, send for a physician, as many gentlewomen do, that are sick, without a cause, even when they will themselves, upon every toy or small discontent, and when he comes, they make it worse than it is, by amplifying that which is not. 2864Hier. Capivaccius sets it down as a common fault of all “melancholy persons to say their symptoms are greater than they are, to help themselves.” And which 2865Mercurialis notes, consil. 53. “to be more troublesome to their physicians, than other ordinary patients, that they may have change of physic.”

A third thing to be required in a patient, is confidence, to be of good cheer, and have sure hope that his physician can help him. 2866Damascen the Arabian requires likewise in the physician himself, that he be confident he can cure him, otherwise his physic will not be effectual, and promise withal that he will certainly help him, make him believe so at least. 2867Galeottus gives this reason, because the form of health is contained in the physician's mind, and as Galen, holds 2868“confidence and hope to be more good than physic,” he cures most in whom most are confident. Axiocus sick almost to death, at the very sight of Socrates recovered his former health. Paracelsus assigns it for an only cause, why Hippocrates was so fortunate in his cures, not for any extraordinary skill he had; 2869but “because the common people had a most strong conceit of his worth.” To this of confidence we may add perseverance, obedience, and constancy, not to change his physician, or dislike him upon every toy; for he that so doth (saith 2870Janus Damascen) “or consults with many, falls into many errors; or that useth many medicines.” It was a chief caveat of 2871Seneca to his friend Lucilius, that he should not alter his physician, or prescribed physic: “Nothing hinders health more; a wound can never be cured, that hath several plasters.” Crato consil. 186. taxeth all melancholy persons of this fault: 2872“'Tis proper to them, if things fall not out to their mind, and that they have not present ease, to seek another and another;” (as they do commonly that have sore eyes) “twenty one after another, and they still promise all to cure them, try a thousand remedies; and by this means they increase their malady, make it most dangerous and difficult to be cured.” “They try many” (saith 2873 Montanus) “and profit by none:” and for this cause, consil. 24. he enjoins his patient before he take him in hand, 2874“perseverance and sufferance, for in such a small time no great matter can be effected, and upon that condition he will administer physic, otherwise all his endeavour and counsel would be to small purpose.” And in his 31. counsel for a notable matron, he tells her, 2875“if she will be cured, she must be of a most abiding patience, faithful obedience, and singular perseverance; if she remit, or despair, she can expect or hope for no good success.” Consil. 230. for an Italian Abbot, he makes it one of the greatest reasons why this disease is so incurable, 2876“because the parties are so restless, and impatient, and will therefore have him that intends to be eased,” 2877“to take physic, not for a month, a year, but to apply himself to their prescriptions all the days of his life.” Last of all, it is required that the patient be not too bold to practise upon himself, without an approved physician's consent, or to try conclusions, if he read a receipt in a book; for so, many grossly mistake, and do themselves more harm than good. That which is conducing to one man, in one case, the same time is opposite to another. 2878An ass and a mule went laden over a brook, the one with salt, the other with wool: the mule's pack was wet by chance, the salt melted, his burden the lighter, and he thereby much eased: he told the ass, who, thinking to speed as well, wet his pack likewise at the next water, but it was much the heavier, he quite tired. So one thing may be good and bad to several parties, upon diverse occasions. “Many things” (saith 2879 Penottus) “are written in our books, which seem to the reader to be excellent remedies, but they that make use of them are often deceived, and take for physic poison.” I remember in Valleriola's observations, a story of one John Baptist a Neapolitan, that finding by chance a pamphlet in Italian, written in praise of hellebore, would needs adventure on himself, and took one dram for one scruple, and had not he been sent for, the poor fellow had poisoned himself. From whence he concludes out of Damascenus 2 et 3. Aphoris. 2880“that without exquisite knowledge, to work out of books is most dangerous: how unsavoury a thing it is to believe writers, and take upon trust, as this patient perceived by his own peril.” I could recite such another example of mine own knowledge, of a friend of mine, that finding a receipt in Brassivola, would needs take hellebore in substance, and try it on his own person; but had not some of his familiars come to visit him by chance, he had by his indiscretion hazarded himself: many such I have observed. These are those ordinary cautions, which I should think fit to be noted, and he that shall keep them, as 2881 Montanus saith, shall surely be much eased, if not thoroughly cured.

2859. Abderitani ep. Hippoc.

2860. Quicquid auri apud nos est, libenter persolvemus, etiamsi tota urbs nostra aurum esset.

2861. Seneca.

2862. Per. 3. Sat.

2863. De anima. Barbara tamen immanitate, et deploranda inscitia contemnunt praecepta sanitatis mortem et morbos ultro accersunt.

2864. Consul. 173. e Scoltzio Melanch. Aegrorum hoc fere proprium est, ut graviora dicant esse symptomata, quam revera sunt.

2865. Melancholici plerumque medicis sunt molesti, ut alia aliis adjungant.

2866. Oportet infirmo imprimere salutem, utcunque promittere, etsi ipse desperet. Nullum medicamentum efficax, nisi medicus etiam fuerit fortis imaginationis.

2867. De promise, doct. cap. 15. Quoniam sanitatis formam animi medici continent.

2868. Spes et confidentia, plus valent quam medicina.

2869. Felicior in medicina ob fidem Ethnicorum.

2870. Aphoris. 89. Aeger qui plurimos consulit medicos, plerumque in errorem singulorum cadit.

2871. Nihil ita sanitatem impedit, ac remediorum crebra mutatio, nec venit vulnus ad cicatricem in quo diversa medicamenta tentantur.

2872. Melancholicorum proprium, quum ex eorum arbitrio non fit subita mutatio in melius, alterare medicos qui quidvis, &c.

2873. Consil. 31. Dum ad varia se conferunt, nullo prosunt.

2874. Imprimis hoc statuere oportet, requiri perseverantiam, et tolerantiam. Exiguo enim tempore nihil ex, &c.

2875. Si curari vult, opus est pertinaci perseverantia, fideli obedientia, et patientis singulari, si taedet aut desperet, nullum habebit effectum.

2876. Aegritudine amittunt patientiam, et inde morbi incurabiles.

2877. Non ad mensem aut annum, sed opportet toto vitae curriculo curationi operam dare.

2878. Camerarius emb. 55. cent. 2.

2879. Praefat. de nar. med. In libellis quae vulgo versantur apud literatos, incautiores multa legunt, a quibus decipiuntur, eximia illis, sed portentosum hauriunt venenum.

2880. Operari ex libris, absque cognitione et solerti ingenio, periculosum est. Unde monemur, quam insipidum scriptis auctoribus credere, quod hic suo didicit periculo.

2881. Consil. 23. haec omnia si quo ordine decet, egerit, vel curabitur, vel certe minus afficietur.

Subsect. iii.

Concerning Physic.

Physic itself in the last place is to be considered; “for the Lord hath created medicines of the earth, and he that is wise will not abhor them.” Ecclus. xxxviii. 4. ver. 7. “of such doth the apothecary make a confection,” &c. Of these medicines there be diverse and infinite kinds, plants, metals, animals, &c., and those of several natures, some good for one, hurtful to another: some noxious in themselves, corrected by art, very wholesome and good, simples, mixed, &c., and therefore left to be managed by discreet and skilful physicians, and thence applied to man's use. To this purpose they have invented method, and several rules of art, to put these remedies in order, for their particular ends. Physic (as Hippocrates defines it) is nought else but 2882“addition and subtraction;” and as it is required in all other diseases, so in this of melancholy it ought to be most accurate, it being (as 2883Mercurialis acknowledgeth) so common an affection in these our times, and therefore fit to be understood. Several prescripts and methods I find in several men, some take upon them to cure all maladies with one medicine, severally applied, as that panacea, aurum potabile, so much controverted in these days, herba solis, &c. Paracelsus reduceth all diseases to four principal heads, to whom Severinus, Ravelascus, Leo Suavius, and others adhere and imitate: those are leprosy, gout, dropsy, falling-sickness. To which they reduce the rest; as to leprosy, ulcers, itches, furfurs, scabs, &c. To gout, stone, colic, toothache, headache, &c. To dropsy, agues, jaundice, cachexia, &c. To the falling-sickness, belong palsy, vertigo, cramps, convulsions, incubus, apoplexy, &c. 2884“If any of these four principal be cured” (saith Ravelascus) “all the inferior are cured,” and the same remedies commonly serve: but this is too general, and by some contradicted: for this peculiar disease of melancholy, of which I am now to speak, I find several cures, several methods and prescripts. They that intend the practic cure of melancholy, saith Duretus in his notes to Hollerius, set down nine peculiar scopes or ends; Savanarola prescribes seven especial canons. Aelianus Montaltus cap. 26. Faventinus in his empirics, Hercules de Saxonia, &c., have their several injunctions and rules, all tending to one end. The ordinary is threefold, which I mean to follow. Διαιτητικὴ, Pharmaceutica, and Chirurgica, diet, or living, apothecary, chirurgery, which Wecker, Crato, Guianerius, &c., and most, prescribe; of which I will insist, and speak in their order.

2882. Fuchsius cap. 2. lib. 1.

2883. In pract. med. haec affectio nostris temporibus frequentissima, ergo maxime pertinet ad nos hujus curationem intelligere.

2884. Si aliquis horum morborum, summus sanatur, sanantur omnes inferiores.

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