SUBSECT. III.-- Of the Matter of Melancholy

OF the matter of melancholy, there is much question betwixt Avicen and Galen, as you may read in Cardan's Contradictious, Valesius' Controversies, Montanus, Prosper Calenus, Cappivaccius, Bright, Ficinus, that have written either whole tracts, or copiously of it, in their several treatises of this subject. "What this humour is, or whence it proceeds, how it is engendered in the body, neither Galen, nor any old writer, hath sufficiently discussed, as Jacchiuus thinks: the Neoterics cannot agree. Montanus, in his Consultations, holds melancholy to be material or immaterial: and so doth Arculanus: the material is one of the four humours before mentioned, and natural. The immaterial or adventitious, acquisite, redundant, unnatural, artificial; which Hercules de Saxonia will have reside in the spirits alone, and to proceed from a "hot, cold, dry, moist distemperature, which, without matter, alter the brain and functions of it." Paracelsus wholly rejects and derides this division of four humours and complexions, but our Galenists generally approve of it, subscribing to this opinion of Montanus.

This material melancholy is either simple or mixed; offending in quantity or quality, varying according to his place, where it settleth, as brain, spleen, meseraic veins, heart, womb, and stomach; or differing according to the mixture of those natural humours amongst themselves, or four unnatural adust humours, as they are diversely tempered and mingled. If natural melancholy abound in the body, which is cold and dry, "so that it be more than the body is well able to bear, it must needs be distempered," saith Faventius, "and diseased;" and so the other, if it be depraved, whether it arise from that other melancholy of choler adust, or from blood, produceth the like effects, and is, as Montaltus contends, if it come by adustion of humours, most part hot and dry. Some difference I find, whether this melancholy matter may be engendered of all four humours, about the colour and temper of it. Galen holds it may be engendered of three alone, excluding phlegm, or pituita, whose true assertion Valesius and Menardus stiffly maintain, and so doth Fuschius, Montaltus, Montanus.
How (say they) can white become black? But Hercules de Saxonia, lib. post. de mela. c. 8, and Cardan are of the opposite part (it may be engendered of phlegm, etsi raro contingat, though it seldom come to pass), so is Guianerius and Laurentius, c.1. with Melanct. in his Book de Anima, and Chap. of Humours; he calls it Asininam, dull, swinish melancholy, and saith that he was an eye-witness of it: so is Wecker. From melancholy adust ariseth one kind; from choler another, which is most brutish; another from phlegm, which is dull; and the last from blood, which is best. Of these
some are cold and dry, others hot and dry, varying according to their mixtures, as they are intended, and remitted. And indeed as Rodericus a Fons. cons. 12. 1. determines, ichors, and those serous matters being thickened become phlegm, and phlegm degenerates into choler, choler adust becomes æruginosa melancholia, as vinegar out of purest wine putrefied or by exhalation of purer spirits is so made, and becomes sour and sharp; and from the sharpness of this humour proceeds much waking, troublesome thoughts and dreams, &c. so that I conclude as before. If the humour be
cold, it is, saith Faventinus, "a cause of dotage, and produceth milder symptoms: if hot, they are rash, raving mad, or inclining to it." If the brain be hot, the animal spirits

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are hot; much madness follows, with violent actions: if cold, fatuity and sottishness, Cappivaccius. The colour of this mixture varies likewise according to the mixture, be it hot or cold; 'tis sometimes black, sometimes not, Altomarus. The same Melanelius proves out of Galen; and Hippocrates in his Book of Melancholy (if at least it be his), giving instance in a burning coal, "which when it is hot, shines; when it is cold, looks black; and so doth the humour." This diversity of melancholy matter produceth diversity of effects. If it be within the body, and not putrefied, it causeth black jaundice; if putrefied, a quartan ague; if it break out to the skin, leprosy; if to parts, several maladies, as scurvy, &c. If it trouble the mind; as it is diversely mixed, it produceth several kinds of madness and dotage: of which in their place.

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SUBSECT. IV.-- Of the species or kinds of Melancholy.

WHEN the matter is divers and confused, how should it otherwise be, but that the species should be divers and confused? Many new and old writers have spoken confusedly of it, confounding melancholy and madness, as Heurthus, Guianerius, Gordonius, Salustius, Salvianus, Jason Pratensis, Savanarola, that will have madness no other than melancholy in extent, differing (as I have said) in degrees. Some make two distinct species, as Ruffus Ephesius, an old writer, Constantinus Africanus, Aretæus, Aurelianus, Paulus Ægineta: others acknowledge a multitude of kinds, and
leave them indefinite, as Ætius in his Tetrabiblos, Avicenna, lib. 3 Fen. 1 Tract. 4 cap. 18. Arculanus, cap. 16. in 9. Rasis, Montanus, med. part. 1. "If natural melancholy be adust, it maketh one kind; if blood, another; if choler, a third, differing from the first; and so many several opinions there are about the kinds, as there be men themselves." Hercules de Saxonia sets down two kinds, "material and immaterial; one from spirits alone, the other from humours and spirits." Savanarola, Rub. 11. Tract. 6. cap. 1. de ægritud. capitis, will have the kinds to be infinite; one from the myrach, called myrachialis of the Arabians; another stomachalis, from the stomach; another from the liver, heart, womb, hemrods: "one beginning, another consummate."
Melancthon seconds him, "as the humour is diversely adust and mixed, so are the species divers;" but what these men speak of species I think ought to be understood of symptoms, and so doth Arculanus interpret himself: infinite species, id est, symptoms; and in that sense, as Jo. Gorrheus acknowledgeth in his medicinal definitions, the species are infinite, but they may be reduced to three kinds by reason of their seat; head, body, and hypochondries. This threefold division is approved by Hippocrates in his Book of Melancholy (if it be his, which some suspect), by Galen, lib. 3. de loc. affectis, cap. 6., by Alexander, lib. 1. cap. 16., Rasis, lib. 1. Continent. Tract. 9. lib. 1. cap. 16., Avicenna, and most of our new writers. Th. Erastus makes two kinds; one perpetual, which is head melancholy; the other interrupt, which comes and goes by fits, which he subdivides into the other two kinds, so that all comes to the same pass.
Some again make four or five kinds, with Rodericus a Castro, de morbis mulier. lib. 2. cap. 3., and Lod. Mercatus, who, in his second book de mulier. affect. cap. 4., will have that melancholy of nuns, widows, and more ancient maids, to be a peculiar species of melancholy differing from the rest: some will reduce enthusiasts, extatical and demoniacal persons to this rank, adding love melancholy to the first, and lycanthropia. The most received division is into three kinds. The first proceeds from the sole fault of the brain, and is called head melancholy; the second sympathetically proceeds from the whole body when the whole temperature is melancholy: the third ariseth from the bowels, liver, spleen, or membrane, called mesenterium, named hypochondriacal or windy melancholy, which Laurentius subdivides into three parts, from those three members, hepatic, splenetic, meseraic. Love melancholy, which Avicenna calls Ilisha: and Lycanthropia, which he calls cucubuthe, are commonly included in head melancholy; but of this last, which Gerardus de Solo calls amoreus, and most knight melancholy, with that of religious melancholy, virginum et viduarum, maintained by Rod. a Castro and Mercatus, and the other kinds of love melancholy, I will speak of apart by themselves in my third partition. The three precedent species are the subject of my present discourse, which I will anatomize and treat of through

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all their causes, symptoms, cures, together and apart; that every man that is in any measure affected with this malady, may know how to examine it in himself; and apply remedies unto it.

It is a hard matter, I confess, to distinguish these three species one from the other, to express their several causes, symptoms, cures, being that they are so often confounded amongst themselves, having such affinity, that they can scarce be discerned by the most accurate physicians; and so often intermixed with other diseases that the best experienced have been plunged. Montanus consil. 26, names a patient that had this disease of melancholy and caninus appetitus both together; and consil. 23, with vertigo, Julius Cæsar Claudinus, with stone, gout, jaundice.
Trincarellius with an ague, jaundice, caninus appetitus, &c. Paulus Regoline, a great doctor in his time, consulted in this case, was so confounded with a confusion of symptoms, that he knew not to what kind of melancholy to refer it. Trincavellius, Fallopius, and Francanzanus, famous doctors in Italy, all three conferred with about one party, at the same time, gave three different opinions. And in another place, Trincavellius being demanded what he thought of a melancholy young man to whom he was sent for, ingenuously confessed that he was indeed melancholy, but he knew
not to what kind to reduce it. In his seventeenth consultation there is the like disagreement about a melancholy monk. Those symptoms, which others ascribe to misaffected parts and humours, Herc. de Saxonia attributes wholly to distempered spirits, and those immaterial, as I have said. Sometimes they cannot well discern this disease from others. In Reinerus Solinander's counsels, (Sect. consil. 5.) he and Dr. Brande both agreed, that the patient's disease was hypochondriacal melancholy. Dr. Matholdus said it was asthma, and nothing else. Solinander and Guarionius, lately sent for to the melancholy Duke of Cleve, with others, could not define what species it was, or agree amongst themselves. The species are so confounded, as in Cæsar Claudinus his forty-fourth consultation for a Polonian Count, in his judgment "he laboured of head melancholy, and that which proceeds from the whole temperature both at once." I could give instance of some that have had all three kinds semel et simul, and some successively. So that I conclude of our melancholy species as many politicians do of their pure forms of commonwealths, monarchies, aristocracies, democracies, are most famous in contemplation, but in practice they are temperate and usually mixed, (so Polybius informeth us) as the Lacedæmonian, the Roman of old, German now, and many others. What physicians say of distinct species in their books it much matters not, since that in their patients' bodies they are commonly mixed. In such obscurity, therefore, variety and confused mixture of symptoms, causes, how difficult a thing is it to treat of several kinds apart; to make any certainty or distinction among so many casualties, distractions, when seldom two men shall be
like affected per omnia? 'Tis hard, I confess, yet nevertheless I will adventure through the midst of these perplexities, and, led by the clue or thread of the best writers, extricate myself out of a labyrinth of doubts and errors, and so proceed to the causes.

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The Anatomy of Melancholy

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