SECTION 4 MEMBER 1 Prognosis of melancholy

Prognostic signs, or signs of what is to come, are either good or bad. If this illness is not hereditary and is treated at the outset, there is good hope of a cure: “When recent, it is not difficult to cure,” says Avicenna, book 3, fen 1, treatise 4, chapter 18. The form accompanied by laughter is the safest, mildest and least severe of all: Hercules de Saxonia. “If that discharge from haemorrhoids, or varices, which they call water beneath the skin, occurs in a melancholy person, his misery is ended”: Hippocrates, Aphorisms 6.11. Galen, On Epidemics, book 6, commentary 8, confirms the same; and all the Arab authorities and the modern and ancient Latin authorities subscribe to this aphorism of Hippocrates: Montaltus, chapter 25; Hercules de Saxonia; Mercurialis; Vittorius Faventinus; and others.

Schenck, Medical Observations, book 1, chapter on mania, illustrates this aphorism with the example of Daniel Federer, a coppersmith who had long been melancholy and finally became mad. At about twenty-seven years of age, these varices, or water, began to appear in his thighs, and he was freed from his madness. Some say that Marius the Roman was cured in this way, though with great pain. Schenck has other examples of women helped by the return of menstrual flow that had previously stopped. All physicians agree that the opening of haemorrhoids will do as much for men, provided, some say, that it happens spontaneously and is not forced.

All melancholy people improve after a quartan fever; Joubert says that scarcely anyone has that ague twice. But whether it frees him from this illness is a question, for many physicians count prolonged agues among its particular causes, including quartan fever. Rhazes, Continens, book 1, treatise 9: “When melancholy comes out at the surface of the skin, or settles there, breaking out in scabs, leprosy or morphew, or is purged through the stools or urine, or when the spleen is enlarged and those varices appear, the disease is resolved.” Guianerius, chapter 5, treatise 15, adds dropsy, jaundice, dysentery and leprosy as good signs alongside these scabs, morphews and eruptions, and proves it from book 6 of Hippocrates’ Aphorisms.

On the other hand, there are bad prognostic signs. “Chronic melancholy is incurable”: if it has become established, it is incurable—a common axiom—or, as those who put the best construction on it say, “difficult to cure,” hardly curable. Galen attests this in On the Affected Parts, book 3, chapter 6: “Whoever has it, and from whatever cause, it is always prolonged, obstinate, wearisome and difficult to cure once it has become established.” As Lucian said of gout, that she was “the queen of diseases, and inexorable,” so we may say of melancholy. Yet Paracelsus maintains that every disease whatsoever is curable and laughs at those who think otherwise, as Thomas Erastus objects against him in part 3; although elsewhere he regards hereditary diseases as incurable and beyond the power of any art to remove.

Hildesheim, Gleanings 2, On Melancholy, considers it less dangerous if only imagination is damaged, not reason. “The mildest comes from blood; worse is that from scorched choler, but worst of all is that from putrefied melancholy.” Bruel considers the hypochondriacal form the least dangerous and the other two forms the hardest to cure, contrary to Galen. The cure is difficult in men, but much more difficult in women. Both men and women must take note of Montanus’s saying in consultation 230, for an Italian abbot: “This illness commonly accompanies them to the grave. Physicians may ease it, and it may lie hidden for a time, but they cannot cure it completely. It will return more violent and severe than at first, at every small occasion or error.”

As with Mercury’s weather-beaten statue, once gilded all over, whose exposed parts were bare but which still had “gold in the fringes”—a remnant of gold in its crevices—some remains of melancholy will be left in the purest bodies, once affected, and will not be easily rooted out. It often degenerates into epilepsy, apoplexy, convulsions and blindness. On the authority of Hippocrates and Galen, all affirm this if it once occupies the brain’s ventricles; Frambesarius and Sallustius Salvianus add blindness if it gets into the optic nerves. Mercurialis, consultation 20, had a woman patient who became epileptic and blind after melancholy.

If it comes from a cold cause, or continues cold, or increases, epilepsy, convulsions and blindness follow; otherwise they eventually become stupefied and foolish, ridiculous in all their actions, speech and gestures. If it comes from a hot cause, they are more frenzied and violent, and finally mad. “Mania quite often follows melancholy as it grows hot.” If it heats and increases, that is the usual outcome: “He is mad periodically, or continually”—mad in fits or all the time. For, as Sennert maintains on Crato’s authority, this humour contains “a seed-bearing fire,” the very seeds of fire. If it comes from natural melancholy that has been scorched, and in excess, they are often possessed by demons: Montanus.

This illness seldom causes death, except when—which is the greatest and most grievous calamity, the misery of all miseries—they kill themselves, a frequent and familiar occurrence among them. It is Hippocrates’ observation and Galen’s judgment: “Although they fear death, they nevertheless very often bring death upon themselves,” On the Affected Parts, book 3, chapter 7. It is the verdict of all physicians: Rabbi Moses’ aphorism, the prognosis of Avicenna, Rhazes, Aetius, Gordonius, Valescus, Altomarus, Sallustius Salvianus, Capivaccius, Mercatus, Hercules de Saxonia, Piso, Bruel, Fuchsius—all of them.

And often, through fear of death, the unhappy man Conceives such hatred of life and of seeing the light That with grieving heart he brings death upon himself.

Death’s terror frightens him so far That he kills himself and hates the light; To end his fear and grief of heart, He dies by choice to ease his pain.