MEMBER 3. SUBSECTION 1 Treatment of hypochondriacal melancholy

In this treatment, as in the others, what is required above all is the proper regulation of those six non-natural things, especially a good diet. Montanus, consultation 27, tells a French nobleman to take particular care over it, without which all other remedies are useless.

Bloodletting should not be used unless the patient’s body is very full of blood and it is carried from the liver and spleen to the stomach and its vessels. Then, to draw it back, cut the inner vein of either arm—some say the salvatella—and if the illness persists, open a vein in the forehead.

Preparatory medicines and alteratives may be used as before, except that attention must be paid to the liver, spleen, stomach and regions beneath the ribs, as well as to the heart and brain. To strengthen the stomach and internal parts against wind and obstructions, Aretaeus, Galen, Aëtius, Aurelianus and many later writers regularly prescribe decoctions of wormwood, centaury, pennyroyal and betony boiled in whey and drunk daily. Many have been cured by this medicine alone.

Prosper Altinus and some others praise Nile water just as highly against this illness, as an especially good remedy for windy melancholy. Presumably for this reason, when Ptolemy Philadelphus married his daughter Berenice to the king of Assyria—as Celsus records in book 2—“he ordered Nile water to be brought at great expense”: at great cost to himself, he had Nile water carried with her, and commanded that throughout her life she should drink nothing else.

I find writers who recommend apples in disorders of the spleen and in this kind of melancholy—some call the preparation “lamb’s wool.” However highly it is praised, its cold, raw quality and tendency to produce wind must certainly be corrected.

Codronchus, in his book On Salt of Wormwood, praises wormwood oil and salt above all other remedies: it works better and faster than any simple medicine whatsoever, and is greatly to be preferred to all those nauseating decoctions and infusions, whose sheer quantity must cause discomfort. A small dose of this alone expels wind with great force, promotes urination, cleanses the stomach of all thick humours and undigested matter, helps the appetite, and so on.

Arnoldus has a wormwood wine that he recommends using; every pharmacopoeia describes it.

Gentle purgatives and purging medicines may be taken as before, of hiera, manna and cassia, which Montanus, consultation 230, for an Italian abbot, prefers to all other simple medicines in this kind of illness. These must be used frequently, always avoiding the more violent ones, lest they irritate the stomach and thereby increase the trouble.

Yet in some medical writers I find very powerful purgatives, even hellebore itself, prescribed for this disorder. If it continues for a long time, emetics may be taken after a meal, or vomiting may occasionally be induced gently with warm water, oxymel and the like. Fuchs, chapter 33, prescribes hellebore; but in this illness always beware of hot medicines, as I have often warned, because, as Salvianus adds, dryness follows heat and increases the disease. Yet Baptista Sylvaticus, controversy 32, forbids cold medicines because they increase obstructions and other bad symptoms. But this varies from person to person, and it is not easy to decide which to use.

In this illness the stomach is usually cold and the liver hot. You can therefore scarcely help one without harming the other, as Montanus suggests in consultation 229 for the Earl of Mansfort. Great judgement is needed; take no medicine at all, he concludes, unless there is great need.

Laelius Eugubinus, consultation 77, used many medicines for a German prince with hypochondriacal melancholy; but letters later informed him that a decoction of China root and sassafras, and salt of sassafras, had done the prince an incredible amount of good. In consultation 108 he used the same remedies just as successfully. For a third person, they might have been poison, by overheating his liver and blood.

For remedies for the other parts, consult Savonarola, Gordonius, Massaria, Mercatus, Johnson and others. Among many remedies for the spleen, I will not omit one cited by Hildesheim, Gleanings 2, prescribed by Mat. Flaccus on Benevenius’ authority. In a hypochondriacal disorder, Antony Benevenius cured an exceedingly large swelling of the spleen with capers alone, a food suited to that illness, and frequent use of water from a blacksmith’s forge. With this treatment he helped a sick man whom all other physicians had abandoned, and who had suffered from a diseased spleen for seven years.

Such is the power of this water that creatures drinking it commonly have little or no spleen. See further excellent medicines for the spleen in him and in Lod. Mercatus, who highly praises this medicine.

This “prepared steel,” or steel drink, is likewise highly recommended for this disease by Daniel Sennert, book 1, part 2, chapter 12, and admired by I. Caesar Claudinus, response 29. He calls steel the specific antidote to this illness and praises it highly; look for recipes in their works. Remedies that divert the humours must be used for the liver and spleen, and to cleanse the mesenteric veins; they must either open the passages or promote urination.

There is no better place to open than the haemorrhoidal vessels: if leeches make them flow, there may again be so excellent a remedy, as Plater holds. Sallust Salvian allows no bloodletting except this; from his experience in a hospital he ran, he found that other bloodletting made all mad and melancholic patients worse. Laurentius, chapter 15, calls this use of leeches a sure remedy for emptying the spleen and mesenteric membrane.