The Anatomy of Melancholy

Subsection 4. Causes of hypochondriacal, or windy, melancholy.

In repeating these causes, I must “serve up twice-cooked cabbage”—say again what I have said before as I apply them to their proper kinds. Hypochondriacal, or flatulent, melancholy is what the Arabians call myrachial. In my judgment it is the most distressing and frequent kind, though Bruel and Laurentius consider it the least dangerous and less difficult to recognize or cure.

Its causes are internal or external. Internal causes arise from various parts or organs: midriff, spleen, stomach, liver, pylorus, womb, diaphragm, mesenteric veins, the stopping of discharges, and so on.

Montaltus, in chapter 15, cites Galen in naming heat and blockage of those mesenteric veins as an immediate cause: in this way the passage of chyle to the liver is delayed or stopped, or the chyle is corrupted and turned into rumbling and wind.

Montanus gives a clear example in consultation 233, Trincavelius another in book 1, chapter 12, and Plater a third in book 1 of his observations: a doctor of law afflicted with this illness from the same blockage and heat of the mesenteric veins and bowels, “because the veins between the stomach and liver grow hot”—the veins are inflamed around the liver and stomach.

Sometimes those other parts are disordered together and combine to produce this malady: a hot liver and a cold stomach or cold abdomen. Look for examples in Hollerius; Victor Trincavelius, consultation 35, book 3; Hildesheim, collection 2, folio 132; Solenander, consultation 9, “for a citizen of Lyons”; Montanus, consultation 229, for the Earl of Montfort in Germany in 1549; and Frisimelica, in consultation 233 of the same Montanus.

J. Caesar Claudinus gives examples of a cold stomach and an overheated liver in almost every consultation: in consultation 89, for a certain count, and 106, for a Polish baron. The heat inflames the blood and sends thick vapours to the heart and brain.

Mercurialis agrees with them in consultation 89: the stomach is disordered, which he calls the king of the abdomen, because if it is disordered all the rest suffer with it, being deprived of nourishment or fed with bad nourishment. This brings about undigested matter, blockages, wind, rumbling, cramps, and so on.

Besides heat, Hercules de Saxonia considers weakness and blockage of the liver a cause—“a weakened power of the liver,” which he calls the mine of melancholy. Laurentius gives this reason: the overheated liver draws food out of the stomach undigested and burns the humours. Montanus, in consultation 244, proves that a cold liver may sometimes be a cause.

Laurentius, chapter 12, Trincavelius, “book 12, consultation,” and Gualter Bruel seem to place the greatest blame on the spleen. Too large or too small, it fails in its duty to cleanse the liver as it should, sometimes drawing too much blood to itself without expelling it, as P. Cnemiandrus noted in one of his consultations. He calls it “a swelling of the spleen” and the fountain of melancholy.