The Anatomy of Melancholy

SUBSECTION 2 Bloodletting

Bloodletting is used both before and after medicinal treatment, usually before, and is often repeated as occasion requires—if there is any need for it at all. For Galen and many others question whether bleeding should be used at all in this kind of head melancholy.

If the disease, say Piso, chapter 23, Altomarus, chapter 7, and Fuchs, chapter 33, “arises primarily from the affected brain, the patient has no need to be bled, unless blood is otherwise excessive, the veins full, the blood inflamed, and the person on the verge of madness.”

In immaterial melancholy, which arises especially from a cold imbalance of the spirits, Hercules de Saxonia, chapter 17, refuses to allow bloodletting. Laurentius, chapter 9, approves it on the authority of the Arabian writers, particularly in the head, as Mesue, Rhazes and Alexander prescribe: opening the veins of the forehead, nose and ears is beneficial.

They commonly place cupping glasses on the patient’s shoulders after scarifying the area, and apply horse-leeches to the head. In all melancholic diseases, whether primary or secondary, they cause the haemorrhoids to bleed, taking as their basis and warrant the eleventh aphorism of Hippocrates’ sixth book, which says that “in melancholic and mad people, the appearance of varicose swelling or haemorrhoids cures the condition.”

Valescus prescribes bloodletting in all three kinds, and Sallust Salvian follows him: “If blood is excessive—as judged by the fullness of the veins, the previous diet, the patient’s laughter, age and so on—begin with the median, or middle, vein of the arm. If the blood is red and clear, stop it; but if it is black, in spring or another suitable season, or thick, let it flow according to the patient’s strength. Some eight or twelve days later, open the head vein and the forehead veins, or provoke bleeding from the nostrils, or use cupping glasses, and so on.”

Trallianus approves this: “If there has been any suppression or stoppage of nosebleeding, haemorrhoidal bleeding or women’s monthly periods, then open a vein in the head or near the ankles.”

Yet he scarcely approves this course if melancholy is situated in the head alone, or in any other mental derangement, “unless it arises primarily from blood, or the disease is aggravated by it: for bloodletting cools and dries, unless the body is very full of blood and the face has a certain redness.”

I therefore conclude with Aretaeus: “Before you let blood, deliberate about it,” and carefully consider every relevant circumstance.