Subsection 2 Symptoms of windy hypochondriacal melancholy

In this hypochondriacal or flatulent melancholy, the symptoms are so ambiguous, says Crato in a consultation concerning a noblewoman, that the most accomplished physicians cannot determine which part is affected. Matthew Flaccius, consulted about a noble matron, admitted as much. In this disorder, he, Hollerius, Fracastorius, Fallopius and others, called upon to give their judgment on someone suffering from hypochondriacal melancholy, could not discover from the symptoms which part was chiefly affected. Some said the womb, some the heart, some the stomach, and so on. Crato therefore boldly declares, in book 1, consultation 24, that amid the variety of symptoms commonly accompanying this disease, no physician can truly say which part is affected.

Galen, in book 3 of On Affected Parts, lists the ordinary symptoms which all the modern writers repeat from Diocles. His only objection is that Diocles does not include Fear and Sorrow among the other signs. Trincavellius defends Diocles in book 3, consultation 35, because in someone with a strong head and constitution, a noble and valiant spirit, these symptoms often do not appear, owing to his courage. Hercules de Saxonia, with whom I agree, holds the same opinion, which I have mentioned before: Fear and Sorrow are not universal symptoms. Some are afraid without being sad; some are sad without fear; some neither fear nor grieve.

The remaining signs, besides Fear and Sorrow, are these: sour belching, foul undigested matter, heat in the bowels, wind and rumbling in the guts, violent cramps, and sometimes pain in the belly and stomach after food that is hard to digest; much watery fluid rising from the stomach, abundant saliva, cold sweat—“troublesome sweating,” or, as Octavius Horatianus calls it in book 2, chapter 5, unseasonable sweat over the whole body—cold joints and indigestion.

They cannot bear their own foul belching; there is continual wind about the hypochondria, heat and cramping in the bowels; “the parts beneath the heart are drawn upwards”—the midriff and bowels are pulled up; the veins around the eyes look red and swell from vapours and wind. Their ears ring from time to time; vertigo and dizziness come in fits, with troubled dreams, dryness and thinness. They are prone to sweat on every occasion and may be of any colour or complexion.

Many have a heightened colour, especially after meals. Cardinal Caecius was much troubled by this symptom and complained of it to his physician Prosper Calenus: he could not eat or drink a cup of wine without becoming as red in the face as if he had been at a mayor’s feast. That symptom alone troubles many. Others are dark, pale or ruddy. Sometimes their shoulders and shoulder blades ache; there is twitching throughout the body, sudden trembling, palpitation of the heart, and that “cardiac affection,” pain at the mouth of the stomach that makes the patient think the heart itself aches; sometimes suffocation, “difficulty in breathing,” shortness of breath, laboured breathing, a strong pulse and fainting.

Montanus, consultation 55; Trincavelius, book 3, consultations 36 and 37; Fernelius, consultation 43; Frambesarius, book 1 of consultations, consultation 17; Hildesheim, Claudinus and others provide examples of every particular. The distinctive symptoms belonging to each part are these. If it proceeds from the stomach, says Savanarola, the stomach is full of pain and wind. Guianerius adds vertigo, nausea, much spitting, and so on. If from the abdominal wall, there is swelling and wind in the hypochondria, nausea, an urge to vomit and an upward pulling.

If from the heart, there is aching and trembling of that organ, with much heaviness. If from the liver, there is usually pain in the right hypochondrium. If from the spleen, hardness and pain in the left hypochondrium, rumbling, a strong appetite and poor digestion: Avicenna. If, on the other hand, from the mesenteric veins and liver, there is little or no appetite: Hercules de Saxonia. If from the hypochondria, there is swelling with rumbling, impaired digestion, frequent belching, and so on.

From this undigested matter, windy vapours rise to the brain, disturbing the imagination and causing fear, sorrow, dullness, heaviness and many terrifying notions and chimeras. As Lemnius aptly observes in book 1, chapter 16, just as a thick black cloud covers the Sun and intercepts its beams and light, so this melancholic vapour clouds the mind and forces it into many absurd thoughts and imaginings. Rising to the brain from the lower parts like smoke from a chimney, it compels good, wise, honest and judicious people to become deluded, and to say and do things unworthy of their persons, occupations and wisdom.

Because of those rising vapours, cramps and rumblings below, one person cannot be persuaded that he does not have a serpent—a viper—in his guts; another believes he has frogs. Trallianus tells of a woman who imagined that she had swallowed an eel or a serpent. Felix Platerus, in book 1 of his Observations, gives a most memorable example of a fellow countryman who happened to fall into a pit containing frogs and frogspawn. Having swallowed a little of the water, he began to suspect that he had also swallowed frogspawn. With that notion and fear, his imagination worked so strongly that he truly thought he had young live frogs in his belly, “which lived on his own food”—which lived by his nourishment. He was so firmly convinced that for many years afterwards his belief could not be corrected.

He studied medicine for seven years to cure himself, travelled to Italy, France and Germany to consult the best physicians about it, and in 1609 sought Platerus’s advice among the rest. Platerus told him it was wind, a notion of his, and so on; but “he stubbornly contradicted him and tried to prove it both orally and in writing.” Nothing anyone said would do: it was no wind, but real frogs. “And do you not hear them croak?” Platerus would have tricked him by putting live frogs into his excrement; but, being a physician himself, he would not be deceived. He was “otherwise a prudent and learned man,” a wise and learned man otherwise, a doctor of medicine; and after seven years of this delusion, “he was freed from the fantasy”: he was cured. Laurentius and Goulart provide many such examples, if you wish to read them.

Those with this windy, flatulent melancholy have one advantage over other melancholic people: “lucid intervals.” Their symptoms and pains—fear, sorrow and the rest—are usually less continuous, coming instead in fits. Yet in another respect they exceed all others: they are lustful, sexually unrestrained and inclined to intercourse because of wind, “and they readily fall in love, and love almost any woman”—Jason Pratensis. Rhasis holds that sexual intercourse does many of them much good. The other symptoms of the mind are shared with the remaining types.