SUBSECT. 1.-- Continent, inward, antecedent, next causes, and how the Body works on the Mind.

As a purly hunter, I have hitherto beaten about the circuit of the forest of this microcosm, and followed only those outward adventitious causes. I will now break into the inner room, and rip up the antecedent immediate causes which are there to be found. For as the distraction of the mind, amongst other outward causes and perturbations, alters the temperature of the body, so the distraction and distemper of the body will cause a distemperature of the soul, and 'tis hard to decide which of these two do more harm to the other. Plato, Cyprian, and some others, as I have formerly said, lay the greatest fault upon the soul, excusing the body; others again accusing the body, excuse the soul, as a principal agent. Their reasons are, because "the manners do follow the temperature of the body," as Galen proves it in his book of that subject, Prosper Calenius de Atra bile, Jason Pratensis, c. de Mania. Lemnius, l.4. c.16. and many others. And that which Gualter hath commented, hom. in. epist. Johannis, is most true; concupiscence and original sin, inclinations, and bad humours, are radical in every one of us, causing these perturbations. affections, and several distempers
offering many times violence unto the soul. "Every man is tempted by his own concupiscence" (James i. 14), the spirit is willing but the flesh is weak, and rebelleth against the spirit, as our apostle teacheth us: that methinks the soul hath the better plea against the body, which so forcibly inclines us, that we cannot resist, Nec nos obniti contra, nec tendere tantum sufficimus. How the body being material, worketh upon the immaterial soul, by mediation of humours and spirits, which participate of both, and ill-disposed organs, Cornelius Agrippa hath discoursed, lib. 1. de occult. Philos. cap. 63, 64, 65. Levinus Lemnius, lib. 1. de occult. nat. mir. cap. 12. et 16. et 21. institut. ad opt. vit. Perkins, lib. 1. Cases of Cons. cap. 12. T. Bright, c. 10, 11, 12. "in his treatise of melancholy," for as anger, fear, sorrow, obtrectation, emulation, &c., si mentis intimos recessus occuparint, saith Lemnius, corpori quoque infesta sunt, et illi teterrimos morbos inferunt, cause grievous diseases in the body, so bodily diseases affect the soul by consent. Now the chiefest causes proceed from the heart, humours, spirits: as they are purer, or impurer, so is the mind, and equally suffers, as a lute out of tune, if one string or one organ be disteinpered, all the rest miscarry, corpus onustum hesternis vitiis, animum quoque prægravat una. The body is domicilium animæ, her house, abode, and stay; and as a torch gives a better light, a sweeter smell, according to the matter it is made of; so doth our soul perform all her actions, better or
worse, as her organs are disposed; or as wine savours of the cask wherein it is kept; the soul receives a tincture from the body through which it works. We see this in old men, children, Europeans; Asians, hot and cold climes; sanguine are merry; melancholy, sad; phlegmatic, dull; by reason of abundance of those humours, and they cannot resist such passions which are inflicted by them. For in this infirmity of human nature, as Melancthon declares, the understanding is so tied to, and captivated by his inferior senses, that without their help he cannot exercise his functions, and the will

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being weakened, hath but a small power to restrain those outward parts, but suffers herself to be overruled by them; that I must needs conclude with Lemnius, spiritus et humores maximum nocumentum obtinent, spirits and humours do most harm in troubling the soul. How should a man choose but be choleric and angry, that hath his body so dogged with abundance of gross humours or melancholy, that is so inwardly disposed? That thence comes then this malady, madness, apoplexies, lethargies, &c., it may not he denied.

Now this body of ours is most part distempered by some precedent diseases, which molest his inward organs and instruments, and so per consequens cause melancholy, according to the consent of the most approved physicians. "This humour (as Avicenna, l. 3. Fen. 1. Tract. 4. c. 18. Arnoldus, breviar. l. 1. 18. Jacchinus, comment. in 9 Rhasis, c. 15. Montaltus, c. 10. Nicholas Piso, c. de Melan. &c., suppose) is begotten by the distemperature of some inward part, innate, or left after some inflammation, or else included in the blood after an ague, or some other malignant disease." This opinion of theirs concurs with that of Galen, l. 3. c. 6. de locis afect. Guianerius gives an instance in one so caused by a quartan ague, and Montanus, consil. 32. in a young man of twenty eight years of age, so distempered after a quartan, which had molested him five years together: Hildesheim, spicel. 2. de Mania, relates of a Dutch baron, grievously tormented with melancholy after a long ague: Galen, l. de atra bile, c. 4. puts the plague a cause. Botaldus in his book de lue vener. c. 2. the French pox for a cause, others phrensy, epilepsy, apoplexy, because those diseases do often degenerate into this. Of suppression of hemorrhoids, hæmorrhagia, or bleeding at the nose, menstruous retentions (although they deserve a larger explication, as being the sole cause of a proper kind of melancholy, in more ancient maids, nuns and widows, handled apart by Rodericus a Castro, and Mercatus, as I have elsewhere signified), or any other evacuation stopped, I have already spoken. Only this I will add, that this melancholy which shall be caused by such infirmities, deserves to be pitied of all men, and to be respected with a more tender compassion, according to Laurentius, as coming from a more inevitable cause.

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SUBSECT. II.-- Distemperature of particular Parts, Causes.

THERE is almost no part of the body, which being distempered, doth not cause this malady, as the brain and his parts, heart, liver, spleen, stomach, matrix or womb, pylorus, mirache, mesentery, hypochondries, meseraic veins; and in a word, saith Arculanus, "there is no part which causeth not melancholy, either because it is adust, or doth not expel the superfluity of the nutriment. Savanarola, Pract. major. rubric. 11. Tract. 6. cap. 1. is of the same opinion, that melancholy is engendered in each particular part, and Crato in consil. 17. lib. 2. Gordonius, who is instar omnium, lib. med. partic. 2. cap. 19. confirms as much, putting the matter of melancholy, sometimes in the stomach, liver, heart, brain, spleen, mirache, hypochondries, when as the melancholy humour resides there, or the liver is not well cleansed "from melancholy blood."

The brain is a familiar and frequent cause, too hot, or too cold, "through adust blood so caused," as Mercurialis will have it, "within or without the head," the brain itself being distempered. Those are most apt to this disease that have a hot heart and moist brain," which Montaltus, cap. 11. de Melanch. approves out of Halyabbas, Rhasis, and Avicenna. Mercurialis, consil. 11. assigns the coldness of the brain a cause, and Salustius Salvianus, med. lect. l. 2. c. 1. will have it "arise from a cold and dry distemperature of the brain." Piso, Benedictus Victorius Faventinus, will have it proceed from a "hot distemperature of the brain;" and Montaltus, cap. 10. from the brain's heat, scorching the blood. The brain is still distempered by himself, or by consent: by himself or his proper affection, as Faventinus calls it, "or by vapours
which arise from the other parts, and fume up into the head, altering the animal faculties."

Hildesheim, spicel. 2. de Mania, thinks it may be caused from a "distemperature of the heart; sometimes hot; sometimes cold." A hot liver, and a cold stomach, are put for usual causes of melancholy: Mercurialis, consil. 11. et consil. 6. consil. 86. assigns a hot liver and cold stomach for ordinary causes. Monavius, in an epistle of his to Crato in Scoltzius, is of opinion, that hypochondriacal melancholy may proceed from a cold liver; the question is there discussed. Most agree that a hot liver is in fault; "the liver is the shop of humors, and especially causeth melancholy by his hot and dry distemperature. The stomach and meseraic veins do often concur, by reason of their obstructions, and thence their heat cannot be avoided, and many times the matter is so adust and inflamed in those parts, that it degenerates into
hypochondriacal melancholy." Guianerius, c. 2. Tract. 15. holds the meseraic veins to be a sufficient cause alone. The spleen concurs to this malady, by all their consents, and suppression of hemorrhoids, dum non expurget altera causa lien, saith Montaltus, if it be "too cold and dry, and do not purge the other parts as it ought," consil. 23. Montanus puts the "spleen stopped," for a great cause. Christopherus a Vega reports of his knowledge, that he hath known melancholy caused from putrefied blood in those seed-veins and womb; "Arculanus, from that menstruous blood turned into melancholy, and seed too long detained (as I have already declared) by putrefaction or adustion."

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The mesenterium, or midriff, diaphragma is a cause which the Greeks called φρεναι [phrenai] because by his inflammation the mind is much troubled with convulsions and dotage. All these, most part, offend by inflammation, corrupting humours and spirits, in this non-natural melancholy: for from these are engendered fuliginous and black spirits. And for that reason Montaltus cap. 10. de causis melan. will have "the efficient cause of melancholy to be hot and dry, not a cold and dry distemperature, as some hold, from the heat of the brain, roasting the blood, immoderate heat of the liver and bowels, sad inflammation of the pylorus. And so much the rather, because that," as Galen holds, "all spices inflame the blood, solitariness, waking, agues, study, meditation, all which heat: and therefore he concludes that this distemperature causing adventitious melancholy is not cold and dry, but hot and dry." But of this I have sufficiently treated in the matter of melancholy, and hold that this may be true in non-natural melancholy, which produceth madness, but not in that natural, which is more cold, and being immoderate, produceth a gentle dotage. Which opinion Geraldus de Solo maintains in his comment upon Rhasis.

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SUBSECT. III.-- Causes of Head-Melancholy.

AFTER a tedious discourse of the general causes of melancholy, I am now returned at last to treat in brief of the three particular species, and such causes as properly appertain unto them. Although these causes promiscuously concur to each and every particular kind, and commonly produce their effects in that part which is most weak, ill-disposed, and least able to resist, and so cause all three species, yet many of them are proper to some one kind, and seldom found in the rest. As for example, head-melancholy is commonly caused by a cold or hot distemperature of the brain, according to Laurentius, cap. 5 de melan. but as Hercules de Saxonia contends, from that agitation or disttemperature of the animal spirits alone. Salust. Salvianus, before mentioned, lib. 2. cap. 3. de re med. will have it proceed from cold: but that I take of natural melancholy, such as are fools and dote: for as Galen writes, lib. 4. de puls. 8. and Avicenna, "a cold and moist brain is an inseparable companion of folly."
But this adventitious melancholy which is here meant, is caused of a hot and dry distemperature, as Damascen, the Arabian, lib. 3. cap. 22. thinks, and most writers: Altomarus and Piso call it "an innate burning intemperateness, turning blood and choler into melancholy." Both these opinions may stand good, as Bruel maintains, and Cappivaccius, si cerebrum sit calidus, "if the brain be hot, the animal spirits will be hot, and thence comes madness; if cold, folly." David Crusius, Theat. morb. Hermet. lib. 2. cap. 6. de atrabilis, grants melancholy to be a disease of an inflamed brain, but cold notwithstanding of itself: calida per accidens, frigida per se, hot by accident only; I am of Capivaccius' mind for my part. Now this humour, according to Salvianus, is sometimes in the substance of the brain, sometimes contained in the
membranes and tunicles that cover the brain, sometimes in the passages of the ventricles of the brain, or veins of those ventricles. It follows many times "phrensy, long diseases, agues, long abode in hot places, or under the sun, a blow on the head," as Rhasis informeth us: Piso adds solitariness, waking, inflammations of the head, proceeding most part from much use of spices, hot wines, hot meats: all which Montanus reckons up, consil. 22. for a melancholy Jew; and Heurnius repeats, cap. 12. de Mania: hot baths, garlic, onions, saith Guianerius, bad air, corrupt, much waking, &c., retention of seed or abundance, stopping of hæmorrhagia, the midriff misaffected; and according to Trallianus, l. 1. 16. immoderate cares, troubles, griefs, discontent, study, meditation, and, in a word, the abuse of all those six non-natural
things. Hercules de Saxonia, cap. 16. lib. 1. will have it caused from a cautery, or boil dried up, or an issue. Amatus Lusitanus, cent. 2. cura. 67. gives instance in a fellow that had a hole in his arm, "after that was healed, ran mad, and when the wound was open, he was cured again." Trincavellius, consil. 13. lib. 1. hath an example of a melancholy man so caused by overmuch continuance in the sun, frequent use of venery, and immoderate exercise: and in his cons. 49. lib. 3. from a headpiece overheated, which caused head-melancholy. Prosper Calenus brings in Cardinal Cæsius for a pattern of such as are so melancholy by long study; but examples are infinite.

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SUBSECT. IV.-- Causes of Hypochondriacal or Windy Melancholy.

IN repeating of these causes, I must crambem bis coctam apponere, say that again which I have formerly said, in applying them to their proper species.
Hypochondriacal or flatuous melancholy, is that which the Arabians call myrachial, and is in my judgment the most grievous and frequent, though Bruel and Laurentius make it least dangerous, and not so hard to be known or cured. His causes are inward or outward. Inward from divers parts or organs, as midriff, spleen, stomach, liver, pylorus, womb, diaphragma, meseraic veins, stopping of issues, etc. Montaltus, cap. 15. out of Galen recites, "heat and obstruction of those meseraic veins, as an immediate cause, by which means the passage of the chilus to the liver is detained, stopped or corrupted, and turned into rumbling and wind? Montanus, consil. 233, hath an evident demonstration, Trincavellius another, lib. 1, cap. 12, and Plater a third, observat. lib. 1, for a doctor of the law visited with this infirmity, from the said
obstruction and heat of these meseraic veins, and bowels; quoniam inter ventriculum et jecur venæ effervescunt, the veins are inflamed about the liver and stomach.
Sometimes those other parts are together misaffected; and concur to the production of this malady: a hot liver and cold stomach, or cold belly: look for instances in Hollerius, Victor Trincavellius, consil. 35, l.3, Hildesheim, Spicel. 2, fol. 132, Solenander, consil. 9, pro cive Lugdunensi, Montanus, consil. 229, for the Earl of Montfort in Germany, 1549, and Frisimelica in the 233 consultation of the said Montanus. I. Cæsar Claudinus gives instance of a cold stomach and overhot liver, almost in every consultation, con. 89, for a certain count; and con. 106, for a Polonian baron, by reason of heat the blood is inflamed, and gross vapours sent to the heart and brain. Mercurialis subscribes to them, cons. 89, "the stomach being misaffected," which he calls the king of the belly, because if he be distempered, all the rest suffer with him, as being deprived of their nutriment, or fed with bad nourishment, by means of which come crudities, obstructions, wind, rumbling, griping, &c. Hercules de Saxonia, besides heat, will have the weakness of the liver and his obstruction a cause, facultatem debilem jecinoris, which he calls the mineral of melancholy. Laurentius assigns this reason, because the liver over hot draws the meat undigested out of the stomach, and burnish the humours. Montanus, cons. 244, proves that sometimes a cold liver may be a cause. Laurentius, c. 12, Trincavellius, lib. l2, consil., and Gualter Bruel, seems to lay the greatest fault upon the spleen, that doth not his duty in purging the liver as he ought, being too great, or too little, in drawing too much blood sometimes to it, and not expelling it, as P. Cnemiandrus in a consultation of his noted
tumorem lienis, he names it, and the fountain of melancholy. Diodes supposed the ground of this kind of melancholy to proceed from the inflammation of the pylorus, which is the nether mouth of the ventricle. Others assign the mesenterium or midriff distempered by heat, the womb misaffected, stopping of hæmorrhoids, with many such. All which Laurentius, cap. 12, reduceth to three, mesentery, liver, and spleen, from whence he denominates hepatic, splenetic, aud meseraic melancholy. Outward causes, are bad diet, care, griefs, discontents, and in a word all those six non-natural things, as Montanus found by his experience, consil. 244, Solenander, consil. 9, for a citizen of Lyons, in France, gives his reader to understand that he knew this mischief procured by a medicine of cantharides, which an unskilful physician ministered his

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patient to drink ad venerem excitandam. But most commonly fear, grief and some sudden commotion, or perturbation of the mind, begin it, in such bodies especially as are ill-disposed. Melancthon, tract. 14, cap. 2. de anima, will have it as common to men, as the mother to women, upon some grievous trouble, dislike, passion, or discontent. For as Camerarius records in his life, Melancthon himself was much troubled with it, and therefore could speak out of experience. Montanus, consil. 22, pro delirante Judæo confirms it, grievous symptoms of the mind brought him to it.
Randolotius relates of himself, that being one day very intent to write out a physician's notes, molested by an occasion, he fell into a hypochondriacal fit, to avoid which he drank the decoction of wormwood, and was freed. Melancthon ("seeing the disease is so troublesome and frequent) holds it a most necessary and profitable study, for every man to know the accidents of it, and a dangerous thing to be ignorant," and would therefore have all men in some sort to understand the causes, symptoms, and cures of it.

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SUBSECT. V.-- Causes of Melancholy from the whole Body.

As before, the cause of this kind of melancholy is inward or outward. Inward, "when the liver is apt to engender such a humour, or the spleen weak by nature, and not able to discharge his office." A melancholy temperature, retention of
hæmorrhoids, monthly issues, bleeding at nose, long diseases, agues, and all those six non-natural things increase it. But especially bad diet, as Piso thinks, pulse, salt meat, shell-fish, cheese, black wine, &c. Mercurialis out of Averroes and Avicenna condemns all herbs: Galen, lib. 3. de loc. affect. cap. 7, especially cabbage. So likewise fear, sorrow, discontents, &c., but of these before. And thus in brief you have had the general and particular causes of melancholy.

Now go and brag of thy present happiness, whosoever thou art, brag of thy temperature, of thy good parts, insult, triumph, and boast; thou seest in what a brittle state thou art, how soon thou mayest be dejected, how many several ways, by bad diet, bad air, a small loss, a little sorrow or discontent, an ague, &c.; how many sudden accidents may procure thy ruin, what a small tenure of happiness thou hast in this life, how weak and silly a creature thou art. "Humble thyself; therefore, under the mighty hand of God," 1 Peter, v. 6. know thyself; acknowledge thy present misery, and make right use of it. Qui stat videat ne cadat. Thou dost now flourish, and hast bona animi, corporis, et fortunæ, goods of body, mind, and fortune, nescis quid serus secum vesper ferat, thou knowest not what storms and tempests the late evening may bring with it. Be not secure then, "be sober and watch," fortunam reverenter habe, if fortunate and rich; if sick and poor, moderate thyself. I have said.

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The Anatomy of Melancholy

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