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← ExitThe Anatomy of Melancholy

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Subsection 2. Concerning the Patient.

SUBSECTION 2. Concerning the patient.

Once these precautions have been carefully observed, and we have found a skilful, honest physician to our liking, all his efforts will come to nothing if his patient will not cooperate and accept his guidance. The patient must observe and maintain several necessary practices. First, he must not be too miserly with his money, think that he spends too much on himself, or endanger his health to save expense.

When the people of Abdera sent for Hippocrates, they promised him whatever reward he wanted: all the gold they had; if the entire city were gold, he should have it. When Naaman the Syrian went to Elisha in Israel to be cured of his leprosy, he took ten talents of silver, six thousand pieces of gold and ten changes of clothing (2 Kings 5:5).

Another requirement is that he should not conceal his trouble out of embarrassment. If anything troubles his mind, let him disclose it freely:

“False shame hides the untreated sores of fools.”

By concealing them he does himself great harm and falls into worse trouble. He must be willing to be cured and earnestly desire it. “The wish to recover is part of recovery” (Seneca). To wish for his own health is part of his cure; and he must not put it off too long.

“Whoever has indulged and nourished a sweet evil too late refuses to bear the yoke he has taken on.” And

“You may see people asking for hellebore in vain when their diseased skin is already swelling: meet the illness as it comes.”

He who encourages an evil by indulging it, Too late at last refuses to cast off his yoke. When the skin swells, trying to soothe it With hellebore is useless; confront your disease.

In this way they often ruin themselves; or they do so through ignorance, by failing to recognize their illness and its danger, through contempt, careless neglect, playing down the trouble, miserliness and obstinacy.

The citizens—I cannot now remember of which city—could not bear to hear the news when word came that their enemies were approaching. In the same way, when plague begins in many places and the authorities know it for certain, they order silence and hush it up. But when they see their enemies marching to the gates, ready to catch them unprepared, they begin to fortify and resist when it is too late. When the disease breaks out and can no longer be concealed, then they lament their careless neglect. It is just the same with these patients.

Often, out of prejudice, loathing and dislike of medicine, they would rather die or fare worse than take any of it. Melanchthon calls it “barbarous brutality and deplorable folly” to despise the rules of health and good remedies in this way, and voluntarily bring death and many diseases upon their own heads.

Many others go to the opposite extreme: they spend too freely, are suspicious and anxiously protective of their health, too ready to take medicine on every slight occasion and to magnify every minor ailment, defect or difficulty. If a finger so much as aches, they run, ride or send for a physician—as many gentlewomen do, who are ill without cause, whenever they please, over every trifle or slight dissatisfaction. When he arrives, they make it worse than it is by exaggerating what is not there.

Hieronymus Cappivaccius records it as a common fault of all melancholy people that, to obtain help, they say their symptoms are worse than they are. Mercurialis likewise observes, in consultation 53, that they are more troublesome to their physicians than ordinary patients, so that they may get a change of medicine.

A third requirement in a patient is confidence: he should be cheerful and firmly hope that his physician can help him. Damascen the Arabian likewise requires the physician himself to be confident that he can cure the patient; otherwise his medicine will not work. He should also promise that he will certainly help him—or at least make him believe so.

Galeottus gives this reason: the form of health is contained in the physician's mind. And, as Galen maintains, confidence and hope do more good than medicine: the physician who inspires most confidence cures most. Axiochus, almost sick to death, recovered his former health at the mere sight of Socrates. Paracelsus gives this as the sole reason why Hippocrates was so successful in his cures: it was not because he had any extraordinary skill, but because ordinary people had an exceptionally high opinion of his ability.

To confidence we may add perseverance, obedience and constancy: the patient should not change his physician or take a dislike to him over every trifle. For anyone who does so, says Janus Damascen, or who consults many physicians, falls into many errors; so does anyone who uses many medicines. One of Seneca's chief warnings to his friend Lucilius was that he should not change his physician or prescribed medicine: nothing hinders health more; a wound can never heal when one plaster after another is applied to it.

Crato, in consultation 186, accuses all melancholy people of this fault. It is characteristic of them, if things do not go as they wish and they get no immediate relief, to seek another physician and then another—as people with sore eyes commonly do—twenty in succession. All keep promising a cure; the patients try a thousand remedies, and in this way worsen their disease, making it extremely dangerous and difficult to cure. They try many, says Montanus, and benefit from none.

For this reason, in consultation 24, before taking on his patient, he requires perseverance and endurance: no great result can be achieved in so short a time. He will administer medicine on that condition; otherwise all his effort and advice would be of little use. In his thirty-first consultation, for a distinguished married woman, he tells her that if she wishes to be cured, she must show the most lasting patience, faithful obedience and exceptional perseverance. If she slackens or despairs, she can expect or hope for no good result.

5072.The Abderite appeal belongs to the letters transmitted under Hippocrates’s name, the literary setting of the Democritus story used throughout Burton’s preliminaries. It is cited here as Burton’s source, not authenticated correspondence. The valuables match 2 Kings 5:5; “talent” is a weight, not a coin denomination.

5073.Horace, Epistles 1.16.24. The surrounding passage warns against concealing an internal fever merely because others declare one healthy; Burton makes the maxim a reason to disclose distress.

5074.Seneca, Phaedra 249. The Nurse urges Phaedra to help herself by checking her passion. Burton turns this dramatic counsel into a general maxim about willingness to recover; the subsequent English gloss is retained separately from the translated Latin.

5076.Seneca, Phaedra 134–135. The Nurse warns that someone who indulges passion resists its domination too late. The “sweet evil” is attractive precisely while it is doing harm.

5078.Persius, Satire 3.63–64. Hellebore appears as a purgative sought too late. Burton prints poscentes, where the comparison text reads poscentis; the sense is unchanged. His own English verse follows separately.

5079.Burton’s four English lines gloss the two preceding Latin quotations. The printed “refuseth to cast off his yoke” does not match Seneca’s “refuses to bear the yoke.” The modern version retains this difficulty in Burton’s English instead of silently replacing it with the Latin’s meaning.

5080.Burton himself cannot name the city. No identification is supplied here. He interweaves the story of a city ignoring military danger with the suppression of reports of plague.

5082.The claims that patients exaggerate symptoms and that gentlewomen can be ill at will are Burton’s polemical generalizations. They are preserved as part of his historical account, not adopted as editorial explanations of illness.

5086.Burton reports a medical ethic in which confidence can include reassuring a patient even when the physician privately despairs. “Damascen” and “Janus Damascen” are retained as his names for the authority cited; the particular aphorism collection and its attribution await collation.

5090.Compare Axiochus 364c–365a, transmitted in the Platonic corpus: Clinias predicts that seeing Socrates will help his father rally, and Socrates finds the man already physically improved but still distressed. Burton compresses this into a recovery at the sight of Socrates. The dialogue is conventionally classed as Pseudo-Plato.

5091.The “form of health” means its conception or pattern in the physician’s mind. Burton groups this claim with hope, reputation and imagination; it should not be read as a demonstrated account of how treatment works. The Galeottus, Galen and Paracelsus attributions are not independently collated here.

5094.Seneca, Moral Letters 2.3. In its original setting the medical comparison supports steady, sustained reading instead of constantly changing authors. Burton presents it as advice about physicians and medicine. His marginal quotation differs slightly from the comparison text but preserves the same argument.

5097.“Twenty one after another” is read as twenty physicians, one after another, rather than the exact number twenty-one. This preserves the idiom and the following emphasis on repeated changes; the original spacing is retained on the left.