The Anatomy of Melancholy

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.