The Anatomy of Melancholy

Subsection 4 Retention and evacuation as causes, and how they act

There are several kinds of retention and evacuation, which often accompany, assist or alone cause melancholy. Galen places deficiency and excess under this heading; others include everything discharged or retained. Foremost among these I may well put constipation and the retention of our usual bodily waste, which, as it often causes other diseases, causes melancholy in particular.

Celsus, book 1, chapter 3, says that it produces inflammation of the head, dullness, cloudiness, headache and so forth. Prosper Calenus, in his book On Black Bile, holds that it disorders not only the bodily organ but the mind itself, by disturbing it. Sometimes it is the sole cause of madness, as you may read in the first book of Schenck’s Medical Observations.

A young merchant going to the fair at Nördlingen in Germany did not pass a stool for ten days. On his return he was severely melancholy, believing he had been robbed; nothing could persuade him that all his money was not gone. His friends thought someone had given him a love potion, but Cnelinus, a physician who was called in, found constipation alone to be the cause. He gave him an enema, and the merchant soon recovered.

Trincavellius, consultation 35, book 1, says the same of a melancholy lawyer whom he treated, and Rodrigo da Fonseca, consultation 85, volume 2, of a patient who was constipated for eight days and consequently affected by melancholy. There are other retentions and evacuations, necessary only at certain times rather than invariably, as Fernel classifies them in his Pathology, book 1, chapter 15: the suppression of haemorrhoidal bleeding, women’s monthly periods or nosebleeds; excessive sexual activity or none at all; or other customary discharges.

Villanovanus, Abridgement, book 1, chapter 18; Arculanus, chapter 16 of his commentary on book 9 of Rhazes; Vittorius Faventinus, Great Practice, treatise 2, chapter 15; Bruel and others list the retention of haemorrhoidal bleeding or monthly periods among the usual causes. Fuchs, book 2, section 5, chapter 30, goes further, saying that many people, cured of haemorrhoids at an unsuitable time, have been afflicted with melancholy: seeking to avoid Scylla, they fall into Charybdis.

Galen, On Humours, commentary 3 on text 26, illustrates this with Lucius Martius, whom he cured of madness brought on in this way. Schenck gives two further cases of women made melancholy and mad by the suppression of their periods. The same may be said of a nosebleed that is suddenly stopped when it has previously been customary, as Villanovanus insists. Fuchs, book 2, section 5, chapter 33, firmly maintains that such a discharge cannot be stopped without great danger.

Abstaining from sex produces similar effects. Mattioli, letter 5 of the penultimate book, vouches from his own knowledge that some people abstained through bashfulness and consequently became very sluggish and dull, while others became very fearful, melancholy and immeasurably sad. Oribasius, Medical Collections, book 6, chapter 37, speaks of some who, unless they have sexual intercourse, are continually troubled by heaviness and headache, and of others brought to the same state by interrupting it.