Subsection 2. Disorders of particular parts as causes.

There is almost no part of the body which, when disordered, does not cause this malady: the brain and its parts, heart, liver, spleen, stomach, matrix or womb, pylorus, mirach, mesentery, hypochondria, mesenteric veins. In a word, says Arculanus, no part fails to cause melancholy, either because it is scorched or because it does not expel the surplus waste from nourishment.

Savonarola, in his Greater Practice, rubric 11, treatise 6, chapter 1, holds the same opinion: melancholy is generated in each particular part. So does Crato, in consultation 17, book 2. Gordonius, who is “a match for them all,” confirms as much in part 2, chapter 19 of his medical work. He places the material of melancholy sometimes in the stomach, liver, heart, brain, spleen, mirach or hypochondria, when the melancholic humour lodges there or the liver is not properly cleared of melancholic blood.

The brain, being too hot or too cold, is a familiar and frequent cause: through blood scorched in this way, as Mercurialis maintains, within or outside the head, the brain itself being disordered. Those with a hot heart and a moist brain are most susceptible to this disease, a view Montaltus endorses in chapter 11 of his work on melancholy, citing Haly Abbas, Rhazes and Avicenna.

Mercurialis, in consultation 11, names coldness of the brain as a cause; Sallustius Salvianus, in his medical lectures, book 2, chapter 1, holds that it arises from a cold and dry disorder of the brain. Piso and Benedictus Victorius Faventinus hold that it proceeds from a hot disorder of the brain; Montaltus, in chapter 10, from the brain’s heat scorching the blood.

The brain is always disordered either in itself or through its connection with other parts: in itself, through its own particular disorder, as Faventinus calls it; or through vapours rising from the other parts and steaming up into the head, altering the animal faculties.

Hildesheim, in his second collection, on mania, thinks it may be caused by a disorder of the heart, sometimes hot, sometimes cold. A hot liver and a cold stomach are listed as usual causes of melancholy: Mercurialis names them as ordinary causes in consultations 11, 6 and 86.

In a letter to Crato in Scholtz’s collection, Monavius holds that hypochondriacal melancholy may proceed from a cold liver; the question is discussed there. Most agree that a hot liver is at fault. The liver is the workshop of the humours, and particularly causes melancholy through its hot and dry disorder.

The stomach and mesenteric veins often contribute because of blockages, which make overheating inevitable; often the material in those parts is so scorched and inflamed that it degenerates into hypochondriacal melancholy. Guianerius, in chapter 2 of treatise 15, holds that the mesenteric veins alone are a sufficient cause.

The spleen contributes to this malady, as they all agree, as does the suppression of haemorrhoidal bleeding. “The spleen is another cause when it fails to purge,” says Montaltus—if it is too cold and dry and does not cleanse the other parts as it should. In consultation 23, Montanus names a blocked spleen as a major cause.

Christophorus à Vega reports from his own knowledge that he has seen melancholy caused by putrefied blood in the seminal vessels and womb; Arculanus, by menstrual blood turned into melancholic humour, and by semen retained too long, through putrefaction or scorching, as I have already explained.

The mesentery, or midriff, the diaphragm, is a cause—the part the Greeks called phrenas—because its inflammation greatly disturbs the mind with convulsions and derangement. In this unnatural melancholy, most of these parts do harm through inflammation, corrupting the humours and spirits, for from them soot-laden and black spirits are generated.

For that reason Montaltus, in chapter 10 on the causes of melancholy, holds that its active cause is a hot and dry disorder, not a cold and dry one, as some maintain: the heat of the brain roasting the blood, excessive heat of the liver and bowels, and inflammation of the pylorus.

All the more so because, as Galen holds, all spices inflame the blood, as do solitude, sleeplessness, fevers, study and meditation, all of which produce heat. He therefore concludes that this disorder causing acquired melancholy is not cold and dry, but hot and dry.

But I have discussed this sufficiently in treating the material of melancholy. I hold that it may be true of unnatural melancholy, which produces madness, but not of natural melancholy, which is colder and, when excessive, produces a milder derangement. Geraldus de Solo maintains this opinion in his commentary on Rhazes.