The Anatomy of Melancholy

MEMBER 3 Surgical remedies

In bloodletting three main circumstances must be considered: who, how much and when. That is, it should be performed on someone able to endure it, or for whom it is appropriate: someone of a suitable age, neither too young nor too old, excessively weak, fat or thin, or exhausted by labour; someone who needs it, is full of bad blood and harmful humours, and may obtain relief from it.

The quantity depends on the person’s bodily constitution: whether he is strong or weak, full or depleted, and can spare more or less.

Morning is the most suitable time. Some dispute whether it is best done fasting or after food; whether the moon’s motion or the planets’ aspects should be observed—some affirm this, some deny it, some allow it in acute diseases but not chronic ones—and whether it should precede or follow medicinal treatment. Heurnius’ maxim is, “Treatment must begin with bloodletting, not with medication”: you must begin with bloodletting and not medicine. Some make an exception for this particular disease.

But what am I doing? Horatius Augenius, a physician of Padua, has recently written seventeen books on this subject; Jobertus and others have written on it too.

Three particular kinds of bloodletting are in use. The first is opening a vein with a sharp knife, in the arm, head, knees or any other part thought suitable.

Cupping glasses, with or without scarification, “bring relief very quickly,” says Fernel: they act immediately. They are applied to various parts to divert humours, aches, wind and the like.

Horse-leeches are widely used in melancholy, especially on the haemorrhoids. Horatius Augenius, book 10, chapter 10; Plater, On Mental Derangement, chapter 3; Altomarus, Piso and many others prefer them to any other evacuation of this kind.

Cauteries, or searing with hot irons, burnings, borings and lancings are frightening procedures. Dropax and sinapismus were therefore devised: plasters to raise blisters, and corrosive applications made from pitch, mustard seed and the like.

Issues, made by the foregoing methods and continually kept open in various parts of the body, have their uses here on different occasions, as will be shown.