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← ExitThe Anatomy of Melancholy

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Subsection 4. the Species or Kinds of Melancholy

Subsection 4. The Species or Kinds of Melancholy

When the material is varied and confused, how could the species be anything but varied and confused too? Many ancient and recent writers have discussed it confusedly, mixing up melancholy and madness. Heurnius, Guianerius, Gordonius, Salustius, Salvianus, Jason Pratensis and Savonarola maintain that madness is simply melancholy carried further, differing, as I have said, only in degree.

Some make them two distinct species, including Rufus of Ephesus, an ancient writer, Constantine the African, Aretaeus, Aurelianus and Paul of Aegina. Others acknowledge a multitude of kinds and leave their number undefined: Aetius in his Tetrabiblos; Avicenna in book 3, fen 1, treatise 4, chapter 18; Arculanus in chapter 16 of his commentary on book 9 of Rhazes; and Montanus, Medicine, part 1.

If natural black bile is burnt, it produces one kind; if blood is burnt, another; if choler, a third, different from the first. There are as many opinions about the kinds as there are men to hold them. Hercules de Saxonia sets out two kinds, material and immaterial: one from spirits alone, the other from humours and spirits.

Savonarola, rubric 11, treatise 6, chapter 1, On Diseases of the Head, holds that the kinds are infinite: one from the myrach, called myrachial by the Arab physicians; another, gastric, from the stomach; others from the liver, heart, womb or haemorrhoids; one beginning, another fully developed.

Melanchthon supports him: as the humour is burnt and mixed in different ways, so the species differ. But what these writers say about species should, I think, be understood as referring to symptoms. Arculanus interprets his own words that way: infinite species, that is, symptoms. In that sense, as Johannes Gorrheus acknowledges in his Medical Definitions, the species are infinite. Yet according to their location they may be reduced to three kinds: head, body and hypochondria.

This threefold division is approved by Hippocrates in his book on melancholy, if it is his, which some doubt; by Galen in On the Affected Parts, book 3, chapter 6; by Alexander in book 1, chapter 16; by Rhazes in the Continens, book 1, treatise 9, book 1, chapter 16; by Avicenna; and by most of our recent writers. Thomas Erastus makes two kinds: one continuous, which is head melancholy, and the other intermittent, coming and going in attacks. He subdivides the latter into the other two kinds, so that it all amounts to the same thing.

Others make four or five kinds, with Rodericus a Castro in On the Diseases of Women, book 2, chapter 3, and Ludovicus Mercatus, who in his second book On the Disorders of Women, chapter 4, considers the melancholy of nuns, widows and older unmarried women a distinct species. Some place those who claim divine inspiration, those in ecstatic trances and those possessed by demons in this category, adding love melancholy and lycanthropy to the first kind.

The most widely accepted division is into three kinds. The first arises solely from a disorder of the brain and is called head melancholy. The second arises through the influence of the whole body, when the entire temperament is melancholic. The third arises from the abdominal organs—the liver, spleen or membrane called the mesentery—and is named hypochondriacal or windy melancholy. Laurentius subdivides it according to those three organs into hepatic, splenic and mesenteric melancholy.

Love melancholy, which Avicenna calls Ilishi, and lycanthropy, which he calls Cucubuthe, are commonly included in head melancholy. But love melancholy, which Gerardus de Solo calls Amoreos and most call knight’s melancholy, together with religious melancholy, the melancholy of virgins and widows described by Rodericus a Castro and Mercatus, and the other kinds of love melancholy, I shall discuss separately in my Third Partition.

The three preceding species are the subject of my present discussion. I shall dissect them and treat all their causes, symptoms and cures, together and separately, so that everyone affected by this disease in any degree may know how to examine it in himself and apply remedies.

It is difficult, I confess, to distinguish these three species from one another and describe their respective causes, symptoms and cures. They are so often confused with one another and so closely related that even the most exact physicians can scarcely tell them apart. They are also so often mixed with other diseases that the most experienced physicians have been baffled.

Montanus, in consultation 26, mentions a patient who had melancholy and ravenous hunger together, and in consultation 23, melancholy with vertigo. Julius Caesar Claudinus describes it with stone, gout and jaundice; Trincavellius with fever, jaundice, ravenous hunger and so forth. Paulus Regoline, a distinguished doctor of his day, was consulted about such a case and found the tangle of symptoms so bewildering that he did not know which kind of melancholy it belonged to.

Trincavellius, Fallopius and Francanzanus, famous physicians in Italy, were all consulted about the same patient at the same time and gave three different opinions. Elsewhere, asked for his view of a melancholic young man whom he had been called to see, Trincavellius frankly admitted that the man was indeed melancholic but that he did not know which kind to assign him to. His seventeenth consultation contains a similar disagreement about a melancholic monk.

The symptoms that others attribute to disordered organs and humours, Hercules de Saxonia attributes entirely to disordered spirits, and those immaterial, as I have said. Sometimes physicians cannot readily distinguish this disease from others. In Reinerus Solenander’s consultations, section, consultation 5, he and Dr Brande agreed that a patient had hypochondriacal melancholy. Dr Matholdus said it was asthma and nothing else.

Solenander and Guarionius, recently called with other physicians to the melancholic Duke of Cleves, could neither determine the species nor agree among themselves. The species are so entangled that in Caesar Claudinus’s forty-fourth consultation, concerning a Polish count, he judged that the patient suffered at once from head melancholy and from the kind arising from the whole temperament. I could give examples of people who have had all three kinds at once, and others who have had them successively.

So I conclude about our species of melancholy as many political writers do about their pure forms of government. Monarchies, aristocracies and democracies are most prominent in theory, but in practice they are modified and usually mixed, as Polybius tells us: the Spartan and ancient Roman states, the German state today, and many others.

What physicians say in their books about distinct species matters little, since these are usually mixed in their patients’ bodies. Amid such obscurity, variety and confused combinations of symptoms and causes, how difficult it is to discuss the several kinds separately, or establish anything certain and distinct among so many contingencies and complications, when scarcely two people are affected alike in every respect!

It is hard, I confess. Nevertheless, I shall venture into these perplexities and, guided by the thread supplied by the best writers, find my way out of this labyrinth of doubts and errors and proceed to the causes.

1879.The source reads “and old writer” after Rufus of Ephesus; the modern column reads “an ancient writer.” Fen is a subdivision in the Latin Avicennian tradition. “Species” means a medically distinguished kind, and need not correspond to a present-day disease category.

1885.Burton proposes that some authors’ supposedly innumerable species are really differences of symptoms. Hypochondries are the upper abdominal regions beneath the ribs. The name here describes an anatomical seat, rather than the modern sense of excessive worry about illness.

1886.The Rhazes citation repeats “lib. 1.” and shifts between treatise and chapter numbers. Both sequences are preserved pending collation. “Interrupt” means intermittent; the episodes are contrasted with a continuous condition.

1888.“Enthusiasts” means people claiming divine inspiration, not simply keen or eager people. “Extaticall” refers to trance or rapture; “dæmoniacall” to supposed demonic possession. Lycanthropy is the reported condition of believing oneself a wolf or behaving as one. Burton reports rival classifications without separating them into modern medical categories.

1890.The threefold scheme distinguishes a disorder originating in the brain, one affecting the brain through the body’s general temperament, and one arising from the abdominal organs. “Windy” refers to wind or vapours. Hepatic, splenic and mesenteric mean associated with the liver, spleen and mesentery respectively.

1891.Although “this last” follows lycanthropy, Amoreos, “Knight melancholy” and the Third Partition point back to love melancholy; the modern text names it to clarify the antecedent. Compare Part 3, Section 2, Member 1, Subsection 2, printed p. 444, where Burton calls love before marriage “Heroicall melancholy.” The medical forms Ilishi, Cucubuthe and Amoreos, and the source history of “Knight melancholy,” remain unverified. Virginum et viduarum means “of virgins and widows.”

1894.Caninus appetitus literally means “dog-like appetite,” rendered “ravenous hunger.” “Stone” denotes calculous disease without specifying a site. These are reported consultation cases; the compressed marginal numerals have not been resolved into reliable source locations.

1897.“Sect. consil. 5.” lacks a section number in this printing and is not silently completed. The disagreement with Matholdus is retained as Burton reports it; the underlying consultations and the spelling of personal names still need comparison with their editions.

1902.Compare Polybius, Histories 6.3 and 6.11–18, on the mixed constitutions of Sparta and Rome. Burton extends the comparison to the German polity of his own time. “Temperate” here means modified or blended, not mild in temperament. Pure diagnostic kinds, like pure constitutions, are easier to separate in theory than in practice.

1903.“Clue” originally means a ball of thread. The phrase evokes the thread used to escape a labyrinth and gives Burton an image for following earlier writers through competing explanations. This completes Section 1 of the First Partition; Section 2 turns to causes.