The Anatomy of Melancholy

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.