Melancholia, μελανχολια is derived from μελαινα, black, and χολη, bile. Hippocrates used this diagnosis for a malady he believed to be produced by black bile with generic yet distinct characteristics of a particular delirium. A diagnosed person, without fever or fury, will fixate on one or two objects. This is different from mania as well as frenzy. In the case of melancholia , delirium often combines with insurmountable sadness, a dark mood, misanthropy, and a firm penchant for solitude. One can count as many kinds of melancholia as there are people afflicted by it: some imagine themselves to be kings, lords, gods; others believe that they have been transformed into animals, wolves, dogs, cats, rabbits. One refers to this as delirium in the case of lycanthropy, cynanthropy, gallantropy, and so forth (see these words). As a corollary of these beliefs, the melancholic imitates animals and follows an animal lifestyle. They run in woods, burn themselves, battle with beasts, and so on. One has witnessed melancholics that abstain from urination in fear of flooding the universe and of producing a new flood. Trallian recounts, a woman always held a finger raised in firm conviction that the finger sustained the world; a few believe they lack heads, others maintained that they had bodies or legs constructed from glass, argyle, wax, et cetera. Melancholics feel quite embarrassed over their anatomy, which is thought to contain residual animal life.

There is a specific kind of melancholia called in Arabic, kutabuk . This is the name of an animal known to run on the surface of water, back and forth, from one side to another side. The prey of the kutabuk are wanderers and vagabonds. A delirious person unlike this animal is extremely rare. Sennert—himself—says to have not been able to observe an exception to this in the course of his medical practice. A physician elector from Saxony, named Janus, recounts that Pasteur fell into this kind of melancholia . Pasteur rested in this state and situation where he laid until friends forced him up. Yet, when he was sitting, he never became erect; he did not speak, made only sighs, was sad, cut down, ate only when another placed food in his mouth, et cetera. One may describe melancholia as a nostalgia or malady of the country, and as fanaticism coupled with so-called demonic possession. Melancholics are usually sad, pensive, dreamers, anxious, steady in study and meditation, tolerant of cold and hunger; they have an austere face, wrinkled eyebrow, brown, tanned complexion, and a constipated stomach. Forestus makes mention of a melancholic symptom, which lasted three months without leaving the stomach, lib. II observ. 43. And one reads in the memoirs of Petersbourg, Tom. I page 368, the history of a melancholic girl, who did not have a bowel movement for several months. They behave and reason sensibly on all concerns unrelated to their delirium.

The causes of melancholia are approximately the same as those of Mania see that word : grief, pains of the spirit, passions, as well as all the love and sexual appetites that go unsatisfied. These causes are generally followed by delirious melancholy in the form of sharp anxiety with a continual lack of production; the overly strong impressions also outraged preachers, and the excessive fears gave sorrow because of the trials which our religion threatens for offenders of the law, making their weak spirits into astonishing revolutions. At the hospital in Montelimart, one beheld several women affected by mania and melancholy due to a city mission. The women had ceaselessly struck horrible paintings presented unwisely to them; they speak of only despair, revenge, punishment, and the like. And, among similar patients, there was an absolute unwillingness to engage any remedy or medicine. They professed to believe that they were in hell, and that nothing could extinguish the fire devouring them. And only with extreme difficulty can one come to the end of melancholia , to withdraw from and extinguish the professed flames. This disturbance impacts the liver, the spleen, the womb, the hemorrhoidal track often give rise to a location for Melancholia . Certain actions dispose the body to this malady: the lengthy use of austere aliments, enduring on salt and smoke without sustenance, debauchery, immoderate experiences with women. Furthermore, some substances slowly produce this effect; and there are substances that also excite too quickly, which is the delirium of the melancholic. Plutarch (in life of Antony ) writes that Antony’s soldiers, while passing through a desert, were obliged to eat grass that threw them into madness. As such, they became stirred up, and carried off their camp’s stones; one had them lay the rocks down on the ground, undertook clearing and transporting the rocks, and a short time later some died vomiting up bile; according to the author, wine was the sole antidote.

Some doctors—very bad philosophes—attributed demonic operation to the causes of melancholia ; they did not hesitate to ascribe ignorant causes, or what appeared to them to be of something supernatural. The doctors ended up as tragic authors, who not knowing how to bring denouement to a work, took recourse in some divinity to facilitate the ending.

Autopsies performed on corpses with this malady do not present any defect discernible in the brain, which one can allot to it; the failing is usually observed in the abdomen. In all hypochondriacs, the epigastric region appears mainly affected and seems to be related to symptoms of mania: the liver, the spleen, and the uterus. Let us look through convincing examples of various anatomical observations made in this case: 1. Bartholin found the spleen extremely small, and capsules considerably increased its size, centur. 1. hist. 38 . River saw, in a melancholic clergy member on staff in Montpellier, the epiploon filled with scirrhoid tumors , lib. XIII cap jx . Mercatus often wrote of mesenteric varicose vessels that were carcinomatous, blocked, distended by a blackish blood. Wolfrigel made the same observation, miscella 2. curios. ann. 1670 . Antoine de Pozzis said that in the corpse of a melancholic prince, one found a blocked mesentery strewn with blackish varicose veins, a blocked pancreas, an extremely large spleen, a small, black, and scirrhus liver, kidneys containing more than one hundred small stones, and so forth, ibid ann. 4. observ. 29 . Lastly, we remark, in general, that very often the examined corpses of the melancholic show a considerable disturbance in the abdomen; in some, the internal organs appeared to grow larger as if subhuman; in others the organs were extremely small, faded, or absolutely deficient. The small organs were hard and scirrhus, whereas the larger organs were weakened and falling in dissolution. In the majority of examinations, disturbance was observed only in the stomach, the heart and the brain. These organs were flooded with black blood or a black humor, which was thick and sticky like asphalt. Previous people named this atrabile or melancholia ; on this subject, one can consult Bartholin, Dodonée, Lorichius, Hoechstetter, Blazius, Hoffman, et cetera. Considering all these observations, and the most ordinary causes of this disease, one would not find it difficult to believe that all the symptoms that constitute it are aggravated by some weakness in the abdomen, in the epigastric area. It is necessary to presume that there is usually an inherent proximate cause of melancholia and that the brain is only sympathetically affected. As evidence that a disturbance in such organs can excite melancholic delirium, the affected can only pay attention to the simplest laws of animal economy, recall that these organs are strewn with a great quantity of extremely sensitive nerves; consider that a lesion throws disorder and trouble into the entire human machine, sometimes resulting in near death. The inflammation of the diaphragm regulates frenetic delirium, known under the name of parafrenzy ; and finally, it should be known that only the deterioration and the influence of the epigastric region on the rest of the body, mainly on the head, is quite considerable. It is not without cause that Van-Helmont had learned the body was governed by means of a central archeus. This archeus presides over the actions of the body with widespread nerves that can be directed like reins.

The facts we cited are the utmost. One might deduce that black bile or atrabile—which the ancient humans considered to be in troubled hypochondriacs—is not as ridiculous and imaginary as the majority of modern people think. In addition to these observations, melancholics consistently improve from salts and vomiting up black substances such as viscous liquids; often these evacuations have been salutary; one identified in these excretions an odd nature, decad. 1. ann. 6. pag. lxxxxij . Dolée reported an observation of a man who was cured of melancholia by a bluish sweat, which abundantly emerged from a hypochondriac. Schmid, ibid, also recounts on the same disease, a man that was much relieved by an abundant excretion of black urine; but how and by what mechanism? A similar trouble of the abdomen excites delirium, which is a major symptom of melancholia , but is shrouded in ignorance. Yet, it is enough for us to have the noted facts; subsequent research is quite difficult, is purely theoretical, and of zero importance; it would be ridiculous to say, as some authors, that animal spirits can be infected with this black humor. It has been said that animals are troubled, lose their sheen and transparency; consequently, their soul does not see objects anymore, but only confusion, as in a tarnished mirror or through muddy water.

This disease is well characterized by varieties of delirium, which are particular to the infected. Therefore, the undiagnosed can even anticipate their disease when they are ready to be diagnosed. The symptoms that precede melancholia are approximately the same as reported in the Mania article see that word . If sadness and fear are long in duration, it is a sign of forthcoming melancholia . As Hippocrates said, if some part is numbed and language becomes incontinent, this announces melancholia, Aphorisms. 23 lib. VI .

Melancholia is rarely a dangerous disease. It can be inconvenient, disagreeable, or—on the contrary—pleasurable, depending upon the exact delirium. Those who believe they are kings, emperors, or who imagine a taste of some pleasure, can only be annoyed to see the curing of their malady; thus a man who imagines that all the ships which arrive at a port belong to him, would be quite annoyed having to gain good sense, to be disillusioned of such a pleasant error. Horace passed down to us a history of a melancholic who behaved in this way. This melancholic existed only for the theater; he intended to sing beautiful verse and to see performances of superb tragedies; he felt annoyance towards those whose help returned him to being natural, which prevented this pleasure.

[1] Postme occidistis, amici, Non servastis, ait; cui sic extorta voluptas, Et demptus per vim mentis gratissimus error. [2] [Truly, friends, he says, you have killed me, not rescued me, since my pleasure has been wrenched away, and by force a most welcome mental confusion has been removed. Epist. 2. lib. II.

It is not the same for those who believe they are transformed into animals. They have a sad delirium; for example, they refrain from urination in fear of flooding the world. By retaining excretion, they risk much in the way of health and possibly life, which prolonged in the bladder or suppressed can cause disease—it is very unfortunate. The delirious, says Hippocrates, who obsesses on necessary things, is in terribly poor general condition. It is to be feared that if the defects of the lower half of the body and the stomach do not worsen, that the black bile is not formed and does not block vessels. Consequently, it may mix with blood; epilepsy sometimes comes with this melancholia . Transport or metastasis of the melancholic disease, as Hippocrates recognized, is dangerous in spring and autumn; the seasons are followed similarly with convulsion, mortification, or blindness, Aphorisms 56. lib. II . There is much hope that a case of melancholy will dissipate from hemorrhoidal discharge, varixes, black feces, gall, various cutaneous eruptions, and elephantiasis, which Hippocrates observed (a man of quite happy predictions).

It is necessary to ensure further success in treating melancholia , by curing the spirit first and then tackling the defects of the body (when such defects are known). It is necessary that a prudent doctor can captivate the confidence of a patient, that confidence enters the patient’s thoughts, and that the delirium can be adapted to. The delirium perishes when a patient is persuaded that things are only such as they are imagined. A radical recovery should be promised. To facilitate this, a doctor is obliged to often come to a single remedy. Thus, when a patient believes there is a live animal in his body, pretence ought to be made of its withdrawal. If the animal is in the stomach, shaking it a little, and then by skillfully discarding this animal in a basin can produce a purgative effect. The patient must not be aware of this; it is in such a way that some charlatans with similar tricks of cunning abuse the credulity of the people, and pass as skilled in purging the vipers or other animals from the body. If the melancholic believes the animal is in his head, one should attempt treatment by performing an incision upon the tegument, the patient will not benefit from extra sharp pain. And one should show the patient an animal of whose presence the sickness is so strong. This incision has additional advantages, which often put an end to head pains that impose upon the patient. The treatment is always helpful to cauterize; it is very advantageous.

One sees a variety of collected observations, yet the cures have similarities. For example, a painter, by an account of Tulpius, believed that the bones in his body softened like wax. Re-ossification of this man occurred after a single action. For this patient, a doctor acted as if fully persuaded in the truth of the painter’s calamity. The doctor promised a sure remedy, but forced the painter to wait six days, after which time the remedy would begin to work. The painter believed that the remedy required all of this time to take effect, to strengthen, and to fortify his bones. The painter obeyed exactly, after which time he walked without anxiety.

We have discussed urination very much. To treat such problems, it is necessary to use a ruse. For instance, a person with a frightened look can say to a melancholic that an entire radiant city is on fire; and, there is no hope, except in the melancholic, which can prevent the city from being reduced to cinders. Such ruses have caused excitement and urination, if one strongly believes the act would stop a fire. Apropos of this, the doctor sometimes overtly opposes a patient’s senses. The patient must be passionately excited to forget the subject of delirium: it is an ingeniously wise doctor that seizes such opportunities. Another example is a patient that believed he had legs of glass; in fear of breaking them, he made no movement. A sorrowful handmaid was advised to approach him and thrash him with a wooden plank. The melancholic man became violently angry, so much so that he lifted the handmaid and then ran after her to beat her. When kinetic abilities had returned to him, he was very surprised to be able to support himself on his legs and to be cured. In another example, Trallian recounts that a doctor ameliorated the melancholic delirium of a man who imagined not having a head. A painful lead weight was rested upon his skull, which made him believe in his head. One must, in consideration of these melancholics, say nothing on the subject of their delirium; by this means, they often even forget it; they reason and act very sensibly for a time; but as soon as one touches upon this cord, the melancholic demonstrates new signs of madness. Furthermore, one must remove arousing objects from view. One of these melancholics had imagined being a rabbit, and simultaneously was a rational man quite sensible in a discussion circle. Unfortunately, when a dog entered the room, he started to flee, ran, and promptly hid under a bed—to avoid the dog’s pursuit. One can, in such cases, occupy the mind of these people elsewhere; to distract them with balls, spectacles, to amuse them, and so on. And, the effects of music are marvelous.

In regards to healing the body, the most effective methods noted are those drawn from the diet; they are preferable over pharmacological as well as surgical solutions. I suggest the word diet here, in all its extent, regarding the ingestion of the six unnatural things. One must forbid melancholic meats hardened by salt and smoke, ardent liquors—but not wine, which is a great anti-melancholic that fortifies and delights the stomach—; the lightest meats are most appropriate as they are easy to digest; well-ripened fruits of summer are quite beneficial. One must wait much with this malady for a change of air, the return of springtime, traveling, horsemanship, discomfort in the abdomen, genital exercises (especially when their deprivation caused the disease), and even more pleasure with an object of affection, and so forth. The disease of homesickness requires a return to one’s fatherland; it is dangerous to postpone this definite remedy too long. One is sometimes obliged to return home. In spite of these treatments, with some remedies one must be careful to not relapse into bizarre constitutions, which bear the sumptuous names of exhilarans, anti-melancholicques , and so forth. These remedies seem to be made only to impose darkness, ad fucum and pompam , one says. The only remedies really recommended are those that can discharge hemorrhoids or remembrances: the saline aperitifs, nitrous, mirabilite, Seignette salt, vitriolic tartar, and the like. If prudently managed, the treatments of this malady—hemorrhaging, violence, melting aloe, hepatic management, methods with soap in particular—are quite effective in radically curing patients; but according to varying signs, circumstances, and cases. According to the opinion of Hippocrates, it is sometimes also necessary to purge, Aphorisms. 9. liv. IV. It is worth insisting on purgative catharsis, even if the treatments are a little rough. Among such treatments, it is necessary to decide upon those that prior observers regarded as affecting black bile. These black bile altering treatments are known under the name, mélanagogues . Some treatments include mild and mediocre measures—such as Indian microbes, insect larva, epithelia alteration, senna. Some treatments include strong measures—such as the stone of Arménie, lazuli, bitter apple, the black hellebore, and so forth.

Notes

1. [Pol]

2. [Translation from the Latin courtesy of Ruth Scodel.]