The Anatomy of Melancholy

These same symptoms are repeated by Melanelius in his book on melancholy, compiled from Galen, Rufus and Aëtius; by Rhazes, Gordonius and all the later writers: continual sour and foul-smelling belching, as though the food in their stomachs had putrefied or they had eaten fish; dry bowels, absurd and interrupted dreams, and many imaginary visions before their eyes; dizziness, a tendency to tremble, and an inclination to sexual activity.

Some add palpitations of the heart and cold sweat as usual symptoms, and a jumping in many parts of the body—“a twitching in many parts of the body”—a kind of itching, says Laurentius, on the surface of the skin, sometimes like a flea-bite.

Montaltus, chapter 21, lists staring eyes and much blinking as signs, as does Avicenna: “with fluttering eyes, stammering, intensely red,” and so on, book 3, fen 1, treatise 4, chapter 18. They mostly stammer, a point he took from Hippocrates’ Aphorisms.

Rhazes makes headache and a constricting heaviness a principal sign, with much movement of wind under the skin, as well as stammering or stumbling in speech, and so on; hollow eyes, swollen veins and broad lips. Some, too, if their condition is far advanced, are all too prone to theatrical gestures: laughing, grinning, smirking, muttering, talking to themselves, making strange movements of the mouth and face, uttering inarticulate sounds and exclamations, and so on.

And although they are commonly lean, hairy, cheerless in expression, withered and not very pleasant to look at because of those continual fears, griefs and troubles—dull, heavy, sluggish, restless and unable to set about any business—yet their memories are mostly good; they have gifted minds and excellent powers of understanding.

Their hot and dry brains prevent them from sleeping: “They suffer great and frequent bouts of sleeplessness” (Aretaeus)—long and frequent periods of wakefulness, sometimes staying awake for a month or a year at a time. Hercules de Saxonia solemnly affirms that he heard his mother swear she had not slept for seven months together. Trincavelius, volume 2, consultation 16, speaks of someone who stayed awake for fifty days, and Schenck gives examples of two years, all without harm.

In their nutritive functions, their appetite exceeds their digestion: “They crave much but digest little,” as Rhazes puts it—they long to eat but cannot digest. And although they eat much, they are nevertheless lean and in poor bodily condition, says Aretaeus, withered and hard, much troubled with constipation, undigested matter, obstructions, spitting, belching, and so on.

Their pulse is infrequent and slow, except in the carotid arteries, where it is very strong; but this varies with the intensity of their passions or emotional disturbances, as Struthius has demonstrated at length in his Art of the Pulse, book 4, chapter 13.

To tell the truth, in such chronic diseases the pulse deserves little attention, since there is so much superstition about it, as Crato notes, and Galen makes so many distinctions that he ventures to say no one can observe or understand them.