Subsection 4 Retention and evacuation as causes, and how they act

There are several kinds of retention and evacuation, which often accompany, assist or alone cause melancholy. Galen places deficiency and excess under this heading; others include everything discharged or retained. Foremost among these I may well put constipation and the retention of our usual bodily waste, which, as it often causes other diseases, causes melancholy in particular.

Celsus, book 1, chapter 3, says that it produces inflammation of the head, dullness, cloudiness, headache and so forth. Prosper Calenus, in his book On Black Bile, holds that it disorders not only the bodily organ but the mind itself, by disturbing it. Sometimes it is the sole cause of madness, as you may read in the first book of Schenck’s Medical Observations.

A young merchant going to the fair at Nördlingen in Germany did not pass a stool for ten days. On his return he was severely melancholy, believing he had been robbed; nothing could persuade him that all his money was not gone. His friends thought someone had given him a love potion, but Cnelinus, a physician who was called in, found constipation alone to be the cause. He gave him an enema, and the merchant soon recovered.

Trincavellius, consultation 35, book 1, says the same of a melancholy lawyer whom he treated, and Rodrigo da Fonseca, consultation 85, volume 2, of a patient who was constipated for eight days and consequently affected by melancholy. There are other retentions and evacuations, necessary only at certain times rather than invariably, as Fernel classifies them in his Pathology, book 1, chapter 15: the suppression of haemorrhoidal bleeding, women’s monthly periods or nosebleeds; excessive sexual activity or none at all; or other customary discharges.

Villanovanus, Abridgement, book 1, chapter 18; Arculanus, chapter 16 of his commentary on book 9 of Rhazes; Vittorius Faventinus, Great Practice, treatise 2, chapter 15; Bruel and others list the retention of haemorrhoidal bleeding or monthly periods among the usual causes. Fuchs, book 2, section 5, chapter 30, goes further, saying that many people, cured of haemorrhoids at an unsuitable time, have been afflicted with melancholy: seeking to avoid Scylla, they fall into Charybdis.

Galen, On Humours, commentary 3 on text 26, illustrates this with Lucius Martius, whom he cured of madness brought on in this way. Schenck gives two further cases of women made melancholy and mad by the suppression of their periods. The same may be said of a nosebleed that is suddenly stopped when it has previously been customary, as Villanovanus insists. Fuchs, book 2, section 5, chapter 33, firmly maintains that such a discharge cannot be stopped without great danger.

Abstaining from sex produces similar effects. Mattioli, letter 5 of the penultimate book, vouches from his own knowledge that some people abstained through bashfulness and consequently became very sluggish and dull, while others became very fearful, melancholy and immeasurably sad. Oribasius, Medical Collections, book 6, chapter 37, speaks of some who, unless they have sexual intercourse, are continually troubled by heaviness and headache, and of others brought to the same state by interrupting it.

Arculanus, chapter 6 on book 9 of Rhazes, and Magninus, part 3, chapter 5, think that abstinence harms many people because it sends poisonous vapours up to the brain and heart. Galen himself likewise holds that if natural seed is retained too long, it turns to poison in some people. Girolamo Mercuriale, in his chapter on melancholy, cites this as a particular cause of the disease, of priapism, satyriasis and so forth. Haly Abbas, Theoretical Medicine, book 5, chapter 36, lists this and many other diseases.

Villanovanus, Abridgement, book 1, chapter 18, says he knew many monks and widows severely troubled with melancholy from this cause alone. Luis Mercado, On the Disorders of Women, book 2, chapter 4, and Rodrigo de Castro, On the Diseases of Women, book 2, chapter 3, discuss the subject at length. They hold that it produces a special kind of melancholy in ageing unmarried women, nuns and widows: “because of suppressed menstruation and abstinence from sex, they are fearful, sad, anxious, bashful, suspicious, languid and at a loss what to do, utterly despairing of life and any improvement,” and so forth. They are melancholy to the highest degree, and all for want of husbands.

Aelianus Montalto, On Melancholy, chapter 37, confirms as much from Galen, as does Weyer. Cristóbal de Vega, The Art of Medicine, book 3, chapter 14, relates many such examples of men and women whom he had seen in this melancholy state.

Felix Plater, in the first book of his Observations, tells the story of an elderly gentleman in Alsace who married a young wife and, because of his various ailments, could not pay his conjugal debts for a long time. Deprived of sex, she fell into a terrible frenzy and, with words, looks and gestures, begged everyone who came to see her to have intercourse with her, and so forth.

Bernardus Paternus, a physician, says he knew a good, honest, godly priest who, unwilling either to marry or to visit brothels, fell into severe fits of melancholy. Hildesheim, second collection, gives a similar case of a melancholy Italian priest in a consultation of 1580. Jason Pratensis gives the example of a married man who, abstaining after his wife’s death, became exceedingly melancholy after married life; Rodrigo da Fonseca gives one of a young man similarly affected, volume 2, consultation 85. To these you may add, if you please, that amusing tale in Poggio of Florence, of a Jew afflicted in the same way and thus cured.

Excessive sex is just as bad at the opposite extreme. Galen, On Epidemics, book 6, section 5, text 26, lists melancholy among the diseases aggravated by sexual intercourse. So do Avicenna, 2, 3, chapter 11; Oribasius in the passage cited; Ficino, On Preserving Health, book 2; Marsilius Cognatus; Montalto, chapter 27; and Guaineri, treatise 3, chapter 2. Magninus, part 3, chapter 5, gives the reason: it cools and dries the body and consumes the spirits. He therefore advises all those of a cold, dry constitution to beware of it and avoid it as a mortal enemy.