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← ExitThe Anatomy of Melancholy

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Subsection 2 Bloodletting

SUBSECT. 2. Blood-letting.

Phlebotomy is promiscuously used before and after Physick, commonly before, and upon occasion is often reiterated, if there be any need at least of it. For Galen, & many others make a doubt of bleeding at all in this kind of head-melancholy.

If the malady, saith Piso cap. 23. & Altomarus cap. 7. Fuchsius cap. 33. shall proceed primarily from the misaffected brain, the Patient in such case shall not need at all to bleed, except the blood otherwise abound, the veins be full, inflamed blood, and the party ready to run-mad.

In immateriall melancholy, which especially comes from a cold distemperature of spirits, Hercules de Saxonia cap. 17. will not admit of Phlebotomy; Laurentius cap. 9. approves it out of the authority of the Arabians, but as Mesue, Rhasis, Alexander appoint, especially in the head, to open the veins of the fore-head, nose and ears is good.

They commonly set cupping-glasses on the parties shoulders, having first scarified the place, they apply horse-leeches on the head, and in all melancholy diseases, whether essentiall or accidentall, they cause the Hæmrods to be opened, having the eleventh Aphorism of the 6. book of Hippocrates for their ground and warrant, which saith, that in melancholy and mad-men, the varicous tumour or hemorrhoides appearing doth heal the same.

Valescus prescribes blood-letting in all three kinds, whom Salust. Salvian follows, If the blood abound, which is discerned by the fulness of the veins, his precedent diet, the parties laughter, age, &c. begin with the median or middle vein of the arm: if the blood be ruddy and clear, stop it, but if black in the spring time, or a good season, or thick, let it run, according to the parties strength: and some eight or twelve dayes after, open the head vein, and the veins in the forehead, or provoke it out of the nostrils, or cupping-glasses, &c.

Trallianus allows of this, If there have been any suppression or stopping of blood at nose, or hemrods, or womens moneths, then to open a vein in the head or about the ankles.

Yet he doth hardly approve of this course, if melancholy be sited in the head alone, or in any other dotage, except it primarily proceed from blood, or that the malady be increased by it: for blood-letting refrigerates and dries up, except the body be very full of blood, and a kind of ruddiness in the face.

Therefore I conclude with Areteus, before you let blood, deliberate of it, and well consider all circumstances belonging to it.

7768.BurtonPrinted page 384, u: “Si ex primario cerebri affectu melancholici evaserint, sanguinis detractione non indigent, nisi ob alias causas sanguis mittatur, si multus in vasis, &c. frustra enim fatigatur corpus &c.” “If they have become melancholic from a primary affection of the brain, they do not need bloodletting, unless blood is drawn for other reasons—if there is much in the vessels, and so forth; for otherwise the body is wearied to no purpose, and so forth.”

7770.BurtonPrinted page 384, x: “Competit iis phlebotomia frontis.” “Bloodletting at the forehead is suitable for them.”

7773.BurtonPrinted page 385, y: “Si sanguis abundet, quod scitur ex venarum repletione, victus ratione præcedente, risu ægri, ætate & aliis, Tundatur mediana; & si sanguis apparet clarus & ruber, supprimatur; aut si vere, si niger aut crassus permittatur fluere pro viribus ægri, dein post 8. vel 12. diem aperiatur cephalica partis magis affectæ, & vena frontis, aut sanguis provocetur setis per nares, &c.” “If blood is excessive, as may be known from the fullness of the veins, the previous regimen, the patient’s laughter, age and other signs, open the median vein. If the blood appears clear and red, stop it; or, if it is spring, if the blood is black or thick, let it flow according to the patient’s strength. Then, after the eighth or twelfth day, open the cephalic vein on the more affected side and the vein of the forehead, or provoke bleeding with bristles through the nostrils, and so forth.” The note continues beneath the main text.

7775.BurtonPrinted page 385, z: “Si quibus consuetæ suæ suppressæ sunt menses, &c. talo secare oportet, aut vena frontis si sanguis peccet cerebro.” “If any women’s customary monthly courses have been suppressed, and so forth, one should bleed at the ankle; or at the vein of the forehead if the blood is at fault in the brain.” Printed beneath the main text.

7777.BurtonPrinted page 385, a: “Nisi ortum ducat à sanguine, ne morbus inde augeatur: phlebotomia refrigerat & exiccat, nisi corpus sit valde sanguineum, rubicundum.” “Unless it takes its origin from blood, lest the disease thereby be aggravated: bloodletting cools and dries, unless the body is very full of blood and ruddy.” Printed beneath the main text; the initial prohibition is supplied by Burton’s surrounding sentence.

7779.BurtonPrinted page 385, b: “Cum sanguinem detrahere oportet, deliberatione indiget. Areteus lib. 7. c. 5.” “When blood must be drawn, the matter requires deliberation.” Aretaeus, book 7, chapter 5. Printed beneath the main text.