The Anatomy of Melancholy

SUBSECTION 3 Preparatives and purgatives

After bloodletting we must proceed to other medicines: first prepare, then purge—“clean out Augeas’ stable”—make the body clean before we can hope to do any good. Gualter Bruel would have a practitioner begin with an enema of his own, which he prescribes before bloodletting. Most, such as Mercurialis, Montaltus in chapter 30, and others, proceed from gentle laxatives to preparatives, and then to purgatives. The gentle laxatives are well known: the lenitive electuary, Diaphenicum, Diacatholicon and others.

Preparatives are usually syrups of borage, bugloss, apples, fumitory, thyme and epithyme, with twice as much of the corresponding decoction or distilled water; or waters of bugloss, balm, hops, endive, scolopendry, fumitory and the like; or these boiled in whey. They must be repeatedly administered for many days in succession.

Purgatives come last, and “must not be used at all if the disease can be relieved otherwise,” because they weaken nature and dry the body so much. In administering them, “we must begin with the gentlest.” Some, including Alexander and Salvianus, forbid all hot medicines “lest the patients become more deranged through them”: hot medicines increase the disease “by excessive drying.”

Purge downwards rather than upwards, use potions rather than pills, and once you begin medicinal treatment, persevere with a course of it. For, as one writer observes, “to stir up without drawing out is harmful in every case”: to stir up the humour, as a single purge commonly does, and then fail to follow through does more harm than good. Patients must continue a course of treatment, yet without exhausting and overburdening nature. “Nature must be given rest”: treatment must sometimes be relaxed so that nature can rest.

The gentlest purgatives with which to begin are senna, cassia, epithyme, myrobalans and Catholicon. If these do not succeed, we may proceed to stronger ones, such as Hamech’s confection, Indian pills, fumitory pills, pills of Assaieret, Armenian stone and lapis lazuli, and Diasena. Or, if pills are too dry, some prescribe both hellebores as a last resort, among them Aretaeus, “because this disease will resist a gentle medicine.”

Laurentius and Hercules de Saxonia would have antimony tried last, provided the patient is strong and it is given cautiously. Trincavelli prefers Hierologodium, and Francis Alexander agrees in his Apology, rad. 5: they regard it as an excellent medicine. But Crato, in a consultation for the Duke of Bavaria’s chancellor, rejects it entirely.

Among writers I find a vast chaos of medicines, a confusion of recipes and special formulations intended for this disease. I shall recount some of the principal ones. To begin with, being seasick is very beneficial at suitable times.