Melancholy is a disorder of the intellect without fever, occasioned
mostly by a melancholic humour seizing the understanding; sometimes
the brain being primarily affected, and sometimes it being altered by
sympathy with the rest of the body. And there is a third species called
the flatulent and hypochondriac, occasioned by inflammation of the parts
in the hypochondria adjoining to the stomach, by which sometimes noxious
vapours or auræ are transmitted to the brain, and sometimes part of
the substance of the humour. The common symptoms of them all are fear,
despondency, and misanthropy; and that they fancy themselves to be, some,
brute animals, and imitate their cries; and others, earthen-vessels,
and are frightened lest they be broken. Some desire death, and others
are afraid of dying; some laugh constantly, and others weep; and
some believe themselves impelled by higher powers, and foretell what
is to come, as if under divine influence; and these are, therefore,
properly called demoniacs, or possessed persons. The peculiar symptoms
of melancholy, from sympathy with the general system, are leanness,
darkness, and shagginess; the whole appearance melancholic, either by
nature, or acquired by anxiety, want of sleep, the administration of
noxious food, or stoppage of the hemorrhoidal, or menstrual discharge.
Melancholy, from affection of the hypochondria, is indicated by
indigestion, acid eructations, heat and heaviness of them, retraction
of the hypochondria, and sometimes inflammation, especially in the
beginning; and then, when they increase, melancholic symptoms supervene.
These are relieved by digestion, or copious discharges, or flatus, or
vomiting, or eructations. When none of these symptoms, or very few of
them, are present, melancholic symptoms appearing indicate that the brain
is primarily affected, and for the most part from a melancholic humour.
When the complaint is occasioned by yellow bile, which, by too much heat,
has been turned into black, it will bring on the disease called mania,
which occasions ungovernable madness, so that those affected with it will
destroy persons who come near them unguardedly.
_The cure of melancholy._ Those who are subject to melancholy from a
primary affection of the brain are to be treated with frequent baths,
and a wholesome and humid diet, together with suitable exhilaration of
mind, without any other remedy, unless when, from its long continuance,
the offending humour is difficult to evacuate, in which case we must
have recourse to more powerful and complicated plans of treatment. These
cases are to be purged from the first with dodder of thyme (_epithymus_),
or aloes; for if a small quantity of these be taken every day, it will
be of the greatest service, and open the bowels gently. After purging,
as we have mentioned, give wormwood, sometimes macerating and boiling
the herb in water to the amount of two cyathi, and sometimes diluting
the juice with water, to the amount of half a drachm, and giving it
frequently. Let them drink of the most acrid vinegar before going to
sleep, and dip, for the most part, their condiments in it before eating
them. But it will be better if to the vinegar be added squills, poley,
or the slender birthwort. When you meet with an incipient case of the
complaint, from sympathy with the general system (as described above),
and the body is firm, you must, by all means, begin with phlebotomy,
and after phlebotomy, when the strength is recruited, purge downwards,
with the wild cucumber, and the composition from the black hellebore,
and promote the hemorrhoidal and menstrual discharges, if the affection
be occasioned by retention of them. Diuretic remedies are likewise
proper, as also evacuations by perspiration. But if the complaint arise
from disorder of the hypochondria, we must attend to them, and foment
them with a decoction of rue, dill, wormwood, pennyroyal, the seed of
the chaste-tree, and of the fruit of the bay-tree; for these soothe the
pains and diminish flatulence. They may be boiled in oil and applied;
and the cataplasms of them ought to contain the remedies for flatulence,
namely, parsley, or anise, or cumin; and it will not be improper to add
cyperus, iris, and frankincense, to the cataplasms. These things are to
be allowed to remain in general, even during the day, and whether the
patient eat or fast; and, when taken away, apply some other protection,
such as a broad piece of wool. Use dry-cupping for flatulence, and
cupping with scarifications for pains and inflammations. While directing
your attention to the cure, you must not forget mustard, and apply
acrid _smegmata_ and calefacient plasters to the back and belly. In
chronic cases, the most powerful remedy is evacuation, by vomiting with
hellebore. The diet for all melancholics should be wholesome, and
moderately moistening; abstaining from beef, roe’s flesh, dried lentil,
cabbages, snails, thick and dark-coloured wines, and, in a word, from
whatever things engender black bile.
_The cure of mania._ Persons affected with mania are to be treated like
melancholics; and, in particular, we must apply to the head rose-oil, or
rose-oil with vinegar, and purge with the bitter antidote called hiera,
having previously bled them; and we must use leeches to the head. But
nothing is of such service as horse-fennel, either the root or seed
drunk in water. A drachm of the root of bryony with water may be taken
every day. If the maniacs will not be persuaded to take the purgative
medicines, they must be mixed with their food, in a concealed manner,
such as with mouthfuls of meat, or dried figs, or dates, or else with
their drink. But, above all things, they must be secured in bed, so that
they may not be able to injure themselves, or those who approach them; or
swung within a wicker-basket in a small couch suspended from on high.
* * * * *
COMMENTARY. Consult Hippocrates (Aphor.); Galen (Comment. in Aphor.,
de Morb. Vulg.); Celsus (iii, 18); Aretæus (de Morb. Chron. i, 6, and
de Curat. Morb. i, 5); Aëtius (vi, 8); Nonnus (32); Oribasius (Synops.
viii, 17); Alexander (i, 16); Actuarius (de Dig. Morb. ii, 34); Octavius
Horatianus (ii, 2, 5); Mesue (de Ægr. Cap. 34); Serapion (i, 22);
Avicenna (iii, 1, 4); Avenzoar (i, 9, 16); Haly Abbas (Theor. ix, 7;
Pract. v, 23); Alsaharavius (Pract. i, 2, 27); Rhases (ad Mansor. ix, 13;
Contin. 1).
Hippocrates, in his Aphorisms, points out the lower intestines as the
seat of melancholy, and directs us to cure the complaint by purging.
Galen, in his Commentary, agrees with his principles and practice. Galen
states correctly that melancholy sometimes changes to epilepsy, and _vice
versa_, that epilepsy is often succeeded by melancholy. (De Loc. Aff.
iii, 10.) He gives a curious extract from the works of Diocles, with
remarks upon the same.
Aretæus considers melancholy as an incipient mania. He gives a masterly
sketch of the different modes in which mania makes its attack, and
relates an interesting case of a joiner, who was perfectly sound while
engaged at his work, but no sooner left the place where he was occupied
than he became mad. For the cure of melancholy he advises blood to be
abstracted at the commencement, according to the patient’s strength and
condition. He approves then of giving black hellebore, and of applying
cupping-instruments over the liver, stomach, or to the head, according as
these may happen to be affected. He recommends then wormwood and aloes.
When the menstrual or hemorrhoidal discharges are stopped, they are, if
possible, to be restored; and for this purpose blood may be abstracted
from the ancle, or even from the arm. He also approves very much of the
natural hot baths.
Celsus, in cases of melancholy and mania, recommends in particular
vomiting and pinging by hellebore; with the black species, if the patient
is affected with grief; but with the white, if with gladness. He also
approves of bleeding.
Aëtius gives an interesting account of the treatment of melancholy,
principally extracted from the works of Galen, Ruffus, Posidonius,
Archigenes, and Justus. The remedies which all of them seem to have
reposed most confidence in are drastic purgatives combined with bitters
and carminatives. They approve, however, of general bleeding and cupping,
when indicated by the symptoms of the complaint, and the state of the
patient. Nonnus in like manner prescribes bleeding in the forehead,
purging with hiera picra, acrid clysters, and bitters, such as gentian
and stæchas (_lavendula stæchas_.)
Alexander’s plan of treatment is very circumstantially detailed; but it
differs very little from our author’s, except that he recommends Armenian
bole instead of white hellebore. Like Aretæus, he strongly commends the
use of the hot bath for the cure of melancholy. He speaks highly of a
well-regulated diet, consisting principally of rock fishes, domestic
fowls, and emollient pot-herbs, such as lettuces, mallows, and the like.
He forbids cabbages, beef, the flesh of stags and of all other wild
animals. Instead of hellebore, Serapion and Avicenna particularly praise
the lapis lazuli. Haly Abbas gives a graphic delineation of the bizarre
fancies, absurd fears, hopes, and vain imaginations of melancholics and
maniacs. Like the other authorities, he attributes the disease to the
prevalence of black bile. Without doubt, as has been often remarked, the
alvine discharges in such cases are dark-coloured; and this, no doubt,
gave rise to the ancient opinion that the disease originates in black
bile. When the patient is young, and of a hot temperament, Haly abstracts
blood from the arm or temples. He approves particularly of hot drastic
purgatives, such as black hellebore, scammony, agaric, and the like. He
also gives poppies, lettuces, &c. to compose the patient. He recommends
cholagogues, such as the decoction of wormwood, and the like. But his
treatment is too minutely and circumstantially detailed to admit of its
being done justice to within our narrow limits. The same may be said of
the account given by Alsaharavius. Rhases in certain cases approves of
venesection for the cure of melancholy. When connected with dyspepsia, he
recommends emetics and purgatives, especially black hellebore. He also
approves of the tepid bath.
We must now mention the opinions of the Methodists. In cases of
melancholy Cælius Aurelianus disapproves of aloes and wormwood, as
acting too violently; and also forbids venesection and purging with
hellebore. On the contrary, he recommends astringent articles of food,
and astringent applications containing galls, alum, hypocistis, &c. to
be laid over the stomach. Of mania he gives a fuller account, replete
with much valuable matter, that does not readily admit of abridgment. He
enumerates many existing causes of the complaint, such as intoxication,
inordinate passions, indigestion, exposure to the sun, suppression
of the hemorrhoidal and menstrual discharges, and the like. Maniacal
persons, he says, are differently affected, one believing himself a
cock, another a tile, another a god, another an orator, and such like
ridiculous fancies. He then inculcates the important fact that the
affection of the mind is always secondary, and not primary, as some
had supposed. His moral and medical treatment is of the most emollient
kind; and he enjoins retirement and quietude. When the patient’s
strength will permit, he approves of venesection, the application of
cupping-instruments to the head, and leeches to any other parts of the
body which may be particularly affected. He commends strongly the bath
of oil and the natural hot baths. He also approves of hellebore. He
condemns the practice of the other sects in many respects. He does not
approve of abstracting blood from both arms, so as to produce deliquium,
nor of keeping the patient constantly in a dark place, nor of opening the
temporal artery. He disapproves of applying narcotic fomentations to the
head. He properly forbids all corporal punishment, although he approves
of contradicting the whims of the maniac, and of reasoning him into a
better train of thought.
Isidorus thus distinguishes epilepsy, melancholy, and mania: “Epilepsia
autem in phantasia fit, melancholia in ratione, mania in memoria.” (Orig.)
The use of hellebore in mania and melancholy is often alluded to in the
works of the Latin Classics. See, in particular, Horace (Sat. ii, 3);
Perseus (Sat. iv, 16.) We are inclined to think that it was the black
hellebore which was given in Anticyra. See Dioscorides (iv, 146.)
Cicero makes some pertinent remarks on the distinction between mania and
melancholy. (Tusc. Disp. iii, 5.)