Anatomy of Melancholy, by Robert Burton

Memb. iii.

Subsect. i.

Cure of Hypochondriacal Melancholy.

In this cure, as in the rest, is especially required the rectification of those six non-natural things above all, as good diet, which Montanus, consil. 27. enjoins a French nobleman, “to have an especial care of it, without which all other remedies are in vain.” Bloodletting is not to be used, except the patient's body be very full of blood, and that it be derived from the liver and spleen to the stomach and his vessels, then 4379to draw it back, to cut the inner vein of either arm, some say the salvatella, and if the malady be continuate, 4380to open a vein in the forehead.

Preparatives and alteratives may be used as before, saving that there must be respect had as well to the liver, spleen, stomach, hypochondries, as to the heart and brain. To comfort the 4381stomach and inner parts against wind and obstructions, by Areteus, Galen, Aetius, Aurelianus, &c., and many latter writers, are still prescribed the decoctions of wormwood, centaury, pennyroyal, betony sodden in whey, and daily drunk: many have been cured by this medicine alone.

Prosper Altinus and some others as much magnify the water of Nile against this malady, an especial good remedy for windy melancholy. For which reason belike Ptolemeus Philadelphus, when he married his daughter Berenice to the king of Assyria (as Celsus, lib. 2. records), magnis impensis Nili aquam afferri jussit, to his great charge caused the water of Nile to be carried with her, and gave command, that during her life she should use no other drink. I find those that commend use of apples, in splenetic and this kind of melancholy (lamb's-wool some call it), which howsoever approved, must certainly be corrected of cold rawness and wind.

Codronchus in his book de sale absyn. magnifies the oil and salt of wormwood above all other remedies, 4382“which works better and speedier than any simple whatsoever, and much to be preferred before all those fulsome decoctions and infusions, which must offend by reason of their quantity; this alone in a small measure taken, expels wind, and that most forcibly, moves urine, cleanseth the stomach of all gross humours, crudities, helps appetite,” &c. Arnoldus hath a wormwood wine which he would have used, which every pharmacopoeia speaks of.

Diminutives and purges may 4383be taken as before, of hiera, manna, cassia, which Montanus consil. 230. for an Italian abbot, in this kind prefers before all other simples, 4384“And these must be often used, still abstaining from those which are more violent, lest they do exasperate the stomach, &c., and the mischief by that means be increased.” Though in some physicians I find very strong purgers, hellebore itself prescribed in this affection. If it long continue, vomits may be taken after meat, or otherwise gently procured with warm water, oxymel, &c., now and then. Fuchsius cap. 33. prescribes hellebore; but still take heed in this malady, which I have often warned, of hot medicines, 4385“because” (as Salvianus adds) “drought follows heat, which increaseth the disease:” and yet Baptista Sylvaticus controv. 32. forbids cold medicines, 4386 “because they increase obstructions and other bad symptoms.” But this varies as the parties do, and 'tis not easy to determine which to use. 4387“The stomach most part in this infirmity is cold, the liver hot; scarce therefore” (which Montanus insinuates consil. 229. for the Earl of Manfort) “can you help the one and not hurt the other:” much discretion must be used; take no physic at all he concludes without great need. Laelius Aegubinus consil. for an hypochondriacal German prince, used many medicines; “but it was after signified to him in 4388letters, that the decoction of China and sassafras, and salt of sassafras wrought him an incredible good.” In his 108 consult, he used as happily the same remedies; this to a third might have been poison, by overheating his liver and blood.

For the other parts look for remedies in Savanarola, Gordonius, Massaria, Mercatus, Johnson, &c. One for the spleen, amongst many other, I will not omit, cited by Hildesheim, spicel. 2, prescribed by Mat. Flaccus, and out of the authority of Benevenius. Antony Benevenius in a hypochondriacal passion, 4389“cured an exceeding great swelling of the spleen with capers alone, a meat befitting that infirmity, and frequent use of the water of a smith's forge; by this physic he helped a sick man, whom all other physicians had forsaken, that for seven years had been splenetic.” And of such force is this water, 4390“that those creatures as drink of it, have commonly little or no spleen.” See more excellent medicines for the spleen in him and 4391Lod. Mercatus, who is a great magnifier of this medicine. This Chalybs praeparatus, or steel-drink, is much likewise commended to this disease by Daniel Sennertus l. 1. part. 2. cap. 12. and admired by J. Caesar Claudinus Respons. 29. he calls steel the proper 4392alexipharmacum of this malady, and much magnifies it; look for receipts in them. Averters must be used to the liver and spleen, and to scour the mesaraic veins: and they are either too open or provoke urine. You can open no place better than the haemorrhoids, “which if by horseleeches they be made to flow, 4393there may be again such an excellent remedy,” as Plater holds. Sallust. Salvian will admit no other phlebotomy but this; and by his experience in an hospital which he kept, he found all mad and melancholy men worse for other bloodletting. Laurentius cap. 15. calls this of horseleeches a sure remedy to empty the spleen and mesaraic membrane. Only Montanus consil. 241. is against it; 4394 “to other men” (saith he) “this opening of the haemorrhoids seems to be a profitable remedy; for my part I do not approve of it, because it draws away the thinnest blood, and leaves the thickest behind.”

Aetius, Vidus Vidius, Mercurialis, Fuchsius, recommend diuretics, or such things as provoke urine, as aniseeds, dill, fennel, germander, ground pine, sodden in water, or drunk in powder: and yet 4395P. Bayerus is against them: and so is Hollerius; “All melancholy men” (saith he) “must avoid such things as provoke urine, because by them the subtile or thinnest is evacuated, the thicker matter remains.”

Clysters are in good request. Trincavelius lib. 3. cap. 38. for a young nobleman, esteems of them in the first place, and Hercules de Saxonia Panth. lib. 1. cap. 16. is a great approver of them. 4396“I have found (saith he) by experience, that many hypochondriacal melancholy men have been cured by the sole use of clysters,” receipts are to be had in him.

Besides those fomentations, irrigations, inunctions, odoraments, prescribed for the head, there must be the like used for the liver, spleen, stomach, hypochondries, &c. 4397“In crudity” (saith Piso) “'tis good to bind the stomach hard” to hinder wind, and to help concoction.

Of inward medicines I need not speak; use the same cordials as before. In this kind of melancholy, some prescribe 4398treacle in winter, especially before or after purges, or in the spring, as Avicenna, 4399 Trincavellius mithridate, 4400Montaltus paeony seed, unicorn's horn; os de corde cervi, &c.

Amongst topics or outward medicines, none are more precious than baths, but of them I have spoken. Fomentations to the hypochondries are very good, of wine and water in which are sodden southernwood, melilot, epithyme, mugwort, senna, polypody, as also 4401cerotes, 4402plaisters, liniments, ointments for the spleen, liver, and hypochondries, of which look for examples in Laurentius, Jobertus lib. 3. c. pra. med. Montanus consil. 231. Montaltus cap. 33. Hercules de Saxonia, Faventinus. And so of epithems, digestive powders, bags, oils, Octavius Horatianus lib. 2. c. 5. prescribes calastic cataplasms, or dry purging medicines; Piso 4403dropaces of pitch, and oil of rue, applied at certain times to the stomach, to the metaphrene, or part of the back which is over against the heart, Aetius sinapisms; Montaltus cap. 35. would have the thighs to be 4404cauterised, Mercurialis prescribes beneath the knees; Laelius Aegubinus consil. 77. for a hypochondriacal Dutchman, will have the cautery made in the right thigh, and so Montanus consil. 55. The same Montanus consil. 34. approves of issues in the arms or hinder part of the head. Bernardus Paternus in Hildesheim spicel 2. would have 4405 issues made in both the thighs; 4406Lod. Mercatus prescribes them near the spleen, aut prope ventriculi regimen, or in either of the thighs. Ligatures, frictions, and cupping-glasses above or about the belly, without scarification, which 4407Felix Platerus so much approves, may be used as before.

4379. Laurentius cap. 15. evulsionis gratia venam internam alterius brachii secamus.

4380. Si pertinax morbus, venam fronte secabis. Bruell.

4381. Ego maximam curam stomacho delegabo. Octa. Horatianus lib. 2. c. 7.

4382. Citius et efficacius suas vires exercet quam solent decocta ac diluta in quantitate multa, et magna cum assumentium molestia desumpta. Flatus hic sal efficaciter dissipat, urinam movet, humores crassos abstergit, stomachum egregie confortat, cruditatem, nauseam, appetentiam mirum in modum renovat, &c.

4383. Piso, Altomarus, Laurentius c. 15.

4384. His utendum saepius iteratis: a vehementioribus semper abstinendum ne ventrem exasperent.

4385. Lib. 2. cap. 1. Quoniam caliditate conjuncta est siccitas quae malum auget.

4386. quisquis frigidis auxiliis hoc morbo usus fuerit, is obstructionem aliaque symptomata augebit.

4387. Ventriculus plerumque frigidus, epar calidum; quomodo ergo ventriculum calefaciet, vel refrigerabit hepar sine alterius maximo detrimento?

4388. Significatum per literas, incredibilem utilitatem ex decocto Chinae, et Sassafras percepisse.

4389. Tumorem splenis incurabilem sola cappari curavit, cibo tali aegritudine aptissimo: Soloque usu aquae, in qua faber ferrarius saepe candens ferrum extinxerat, &c.

4390. Animalia quae apud hos fabros educantur, exiguos habent lienes.

4391. L. 1. cap 17.

4392. Continuum ejus usus semper felicem in aegris finem est assequutus.

4393. Si Hemorroides fluxerint, nullum praestantius esset remedium, quaesanguifugis admotis provocari poterunt. observat. lib. 1. pro hypoc. legulcio.

4394. Aliis apertio haec in hoc morbo videtur utilissima; mihi non admodum probatur, quia sanguinem tenuem attrahit et crassum relinquit.

4395. Lib. 2. cap. 13. omnes melancholici debent omittere urinam provocantia, quoniam per ea educitur subtile, et remanet crassum.

4396. Ego experientia probavi, multos Hypocondriacos solo usu Clysterum fuisse sanatos.

4397. In eradicate optimum, ventriculum aretius alligari.

4398. ℨj. Theriacae, Vere praesertim et aestate.

4399. Cons. 12. l. 1.

4400. Cap. 33.

4401. Trincavellius consil. 15. cerotum pro sene melancholico ad jecur optimum.

4402. Emplastra pro splene. Fernel. consil. 45.

4403. Dropax e pice navali, et oleo rutuceo affigatur ventriculo, et toti metaphreni.

4404. Cauteria cruribus inusta.

4405. Fontanellae sint in utroque crure.

4406. Lib. 1. c. 17.

4407. De mentis alienat. c. 3. flatus egregie discutiunt materiamque evocant.

Subsect. ii.

Correctors to expel Wind. Against Costiveness, &c.

In this kind of melancholy one of the most offensive symptoms is wind, which, as in the other species, so in this, hath great need to be corrected and expelled.

The medicines to expel it are either inwardly taken, or outwardly. Inwardly to expel wind, are simples or compounds: simples are herbs, roots, &c., as galanga, gentian, angelica, enula, calamus aromaticus, valerian, zeodoti, iris, condite ginger, aristolochy, cicliminus, China, dittander, pennyroyal, rue, calamint, bay-berries, and bay-leaves, betony, rosemary, hyssop, sabine, centaury, mint, camomile, staechas, agnus castus, broom-flowers, origan, orange-pills, &c.; spices, as saffron, cinnamon, bezoar stone, myrrh, mace, nutmegs, pepper, cloves, ginger, seeds of annis, fennel, amni, cari, nettle, rue, &c., juniper berries, grana paradisi; compounds, dianisum, diagalanga, diaciminum, diacalaminth, electuarium de baccis lauri, benedicta laxativa, pulvis ad status. antid. florent. pulvis carminativus, aromaticum rosatum, treacle, mithridate &c. This one caution of 4408Gualter Bruell is to be observed in the administering of these hot medicines and dry, “that whilst they covet to expel wind, they do not inflame the blood, and increase the disease; sometimes” (as he saith) “medicines must more decline to heat, sometimes more to cold, as the circumstances require, and as the parties are inclined to heat or cold.”

Outwardly taken to expel winds, are oils, as of camomile, rue, bays, &c.; fomentations of the hypochondries, with the decoctions of dill, pennyroyal, rue, bay leaves, cumin, &c., bags of camomile flowers, aniseed, cumin, bays, rue, wormwood, ointments of the oil of spikenard, wormwood, rue, &c. 4409Areteus prescribes cataplasms of camomile flowers, fennel, aniseeds, cumin, rosemary, wormwood-leaves, &c.

4410Cupping-glasses applied to the hypochondries, without scarification, do wonderfully resolve wind. Fernelius consil. 43. much approves of them at the lower end of the belly; 4411Lod. Mercatus calls them a powerful remedy, and testifies moreover out of his own knowledge, how many he hath seen suddenly eased by them. Julius Caesar Claudinus respons. med. resp. 33. admires these cupping-glasses, which he calls out of Galen, 4412“a kind of enchantment, they cause such present help.”

Empirics have a myriad of medicines, as to swallow a bullet of lead, &c., which I voluntarily omit. Amatus Lusitanus, cent. 4. curat. 54. for a hypochondriacal person, that was extremely tormented with wind, prescribes a strange remedy. Put a pair of bellows end into a clyster pipe, and applying it into the fundament, open the bowels, so draw forth the wind, natura non admittit vacuum. He vaunts he was the first invented this remedy, and by means of it speedily eased a melancholy man. Of the cure of this flatuous melancholy, read more in Fienus de Flatibus, cap. 26. et passim alias.

Against headache, vertigo, vapours which ascend forth of the stomach to molest the head, read Hercules de Saxonia, and others.

If costiveness offend in this, or any other of the three species, it is to be corrected with suppositories, clysters or lenitives, powder of senna, condite prunes, &c. ℞ Elect. lenit, e succo rosar. ana ℥ j. misce. Take as much as a nutmeg at a time, half an hour before dinner or supper, or pil. mastichin. ℥ j. in six pills, a pill or two at a time. See more in Montan. consil. 229. Hildesheim spicel. 2. P. Cnemander, and Montanus commend 4413“Cyprian turpentine, which they would have familiarly taken, to the quantity of a small nut, two or three hours before dinner and supper, twice or thrice a week if need be; for besides that it keeps the belly soluble, it clears the stomach, opens obstructions, cleanseth the liver, provokes urine.”

These in brief are the ordinary medicines which belong to the cure of melancholy, which if they be used aright, no doubt may do much good; Si non levando saltem leniendo valent, peculiaria bene selecta, saith Bessardus, a good choice of particular receipts must needs ease, if not quite cure, not one, but all or most, as occasion serves. Et quae non prosunt singula, multa juvant.

4408. Gavendum hic diligenter a, multum, calefacientibus, atque exsiccantibus, sive alimenta fuerint haec, sive medicamenta: nonnulli enim ut ventositates et rugitus conpescant, hujusmodi utentes medicamentis, plurimum peccant, morbum sit augentes: debent enim medicamenta declinare ad calidum vel frigidum secundum exigentiam circumstantiarum, vel ut patiens inclinat ad cal. et frigid.

4409. Cap. 5 lib. 7.

4410. Piso Bruel. mire flatus resolvit.

4411. Lib. 1. c. 17. nonnullos praetensione ventris deploratos illico restitutos bis videmus.

4412. Velut incantamentum quoddam ex flatuoso spiritu, dolorem ortum levant.

4413. Terebinthinam Cypriam habeant familiarem, ad quantitatem deglutiant nucis parvae, tribus horis ante prandium vel coenam, ter singulis septimanis prout expedire videbitur; nam praeterquam quod alvum mollem efficit, obstructiones aperit, ventriculum purgat, urinam provocat hepar mundificat.

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