Section 3. Member 1. Subsection 1. Symptoms or signs of melancholy in the body.

Parrhasius, a painter of Athens, bought a very old man from among the Olynthian captives whom Philip of Macedon brought home to sell. Once he had him in Athens, he subjected him to extreme torture and torment, so that his example would help him portray the pain and suffering of the Prometheus he was about to paint.

For my purpose I need not be so barbarous, inhuman, painstaking or cruel as to torture any poor melancholic person. Their symptoms are plain, obvious and familiar; no such minute observation or far-fetched subject is needed. They draw their own portraits; they reveal themselves of their own accord. They are all too common everywhere; I meet them constantly as I go. They cannot hide their condition; their sufferings are too well known. I need not look far to describe them.

Symptoms, then, are either universal or peculiar to individuals or kinds of the disease, says Gordonius in part 2, chapter 19 of his medical work. Some signs are hidden, some apparent; some belong to the body, some to the mind. They vary in different ways according to the internal or external causes, says Capivaccius; or arise from the stars and celestial influences, according to Jovianus Pontanus, On Celestial Things, book 10, chapter 13; or from the various mixtures of the humours, says Ficino, book 1, chapter 4 of his work on preserving health.

As they are hot or cold, natural or unnatural, intensified or lessened, so Aëtius holds that “melancholic derangements take many forms”: a diversity of melancholic signs. Laurentius attributes them to people’s different temperaments, pleasures, natures and inclinations, to the length of time the condition has lasted, and to whether it occurs alone or is mixed with other diseases. As the causes differ, so must the signs, almost without number: Altomarus, chapter 7 of his Art of Medicine.

And just as wine produces different effects, or that herb Tortocolla in Laurentius, which makes some laugh, some weep, some sleep, some dance, some sing, some howl, some drink, and so on, so this melancholic humour of ours produces different signs in different people.

But to bring them within bounds, these general symptoms may be grouped as those of the body or of the mind. The usual signs appearing in the bodies of melancholic people are these: they are cold and dry, or hot and dry, according to how far the humour has been scorched. From these primary qualities arise many secondary ones, such as colour: black, dark, pale, ruddy, and so on. Some are “intensely red,” as Montaltus observes in chapter 16, citing Galen’s On the Affected Parts, book 3—very red and highly coloured.

Hippocrates, in his book On Madness and Melancholy, lists these signs: they are lean, withered, hollow-eyed, old-looking, wrinkled and rough; much troubled with wind and abdominal cramps or bellyache; frequently belching; with dry, hard bowels, dejected looks and shaggy beards; ringing in the ears, vertigo and light-headedness; little or no sleep, and that interrupted; terrible and frightening dreams. “Anna, my sister, what dreams terrify me in my anxious state?”

These same symptoms are repeated by Melanelius in his book on melancholy, compiled from Galen, Rufus and Aëtius; by Rhazes, Gordonius and all the later writers: continual sour and foul-smelling belching, as though the food in their stomachs had putrefied or they had eaten fish; dry bowels, absurd and interrupted dreams, and many imaginary visions before their eyes; dizziness, a tendency to tremble, and an inclination to sexual activity.

Some add palpitations of the heart and cold sweat as usual symptoms, and a jumping in many parts of the body—“a twitching in many parts of the body”—a kind of itching, says Laurentius, on the surface of the skin, sometimes like a flea-bite.

Montaltus, chapter 21, lists staring eyes and much blinking as signs, as does Avicenna: “with fluttering eyes, stammering, intensely red,” and so on, book 3, fen 1, treatise 4, chapter 18. They mostly stammer, a point he took from Hippocrates’ Aphorisms.

Rhazes makes headache and a constricting heaviness a principal sign, with much movement of wind under the skin, as well as stammering or stumbling in speech, and so on; hollow eyes, swollen veins and broad lips. Some, too, if their condition is far advanced, are all too prone to theatrical gestures: laughing, grinning, smirking, muttering, talking to themselves, making strange movements of the mouth and face, uttering inarticulate sounds and exclamations, and so on.

And although they are commonly lean, hairy, cheerless in expression, withered and not very pleasant to look at because of those continual fears, griefs and troubles—dull, heavy, sluggish, restless and unable to set about any business—yet their memories are mostly good; they have gifted minds and excellent powers of understanding.

Their hot and dry brains prevent them from sleeping: “They suffer great and frequent bouts of sleeplessness” (Aretaeus)—long and frequent periods of wakefulness, sometimes staying awake for a month or a year at a time. Hercules de Saxonia solemnly affirms that he heard his mother swear she had not slept for seven months together. Trincavelius, volume 2, consultation 16, speaks of someone who stayed awake for fifty days, and Schenck gives examples of two years, all without harm.

In their nutritive functions, their appetite exceeds their digestion: “They crave much but digest little,” as Rhazes puts it—they long to eat but cannot digest. And although they eat much, they are nevertheless lean and in poor bodily condition, says Aretaeus, withered and hard, much troubled with constipation, undigested matter, obstructions, spitting, belching, and so on.

Their pulse is infrequent and slow, except in the carotid arteries, where it is very strong; but this varies with the intensity of their passions or emotional disturbances, as Struthius has demonstrated at length in his Art of the Pulse, book 4, chapter 13.

To tell the truth, in such chronic diseases the pulse deserves little attention, since there is so much superstition about it, as Crato notes, and Galen makes so many distinctions that he ventures to say no one can observe or understand them.