CHAPTER V. ON MELANCHOLY
BLACK bile, if it make its appearance in acute diseases of the
upper parts of the body, is very dangerous; or, if it pass
downwards, it is not free from danger. But in chronic
diseases, if it pass downward, it terminates in dysentery and
pain of the liver. But in women it serves as a purgation
instead of the menses, provided they are not otherwise in a
dangerous condition. But if it be determined upwards to the
stomach and diaphragm, it forms melancholy; for it produces
flatulence and eructations of a fetid and fishy nature, and it
sends rumbling wind downwards, and disturbs the understanding.
On this account, in former days, these were called
melancholics and flatulent persons. And yet, in certain of
these cases, there is neither flatulence nor black bile, but mere
anger and grief, and sad dejection of mind; and these were
called melancholics, because the terms
bile (
χολὴ) and
anger
(
ὀργὴ) are synonymous in import, and likewise
black (
μέλαινα),
with
much (
πολλὴ) and
furious (
θηριώδης). Homer is authority
for this when he says:--
"Then straight to speak uprose
The Atreidan chief, who `neath his sway a wide-spread empire held:
Sore vexed was he; his mighty heart in his dark bosom swelled
With rage, and from his eyes the fire like lightning-flashes
broke."
1
The melancholics become such when they are overpowered by
this evil.
It is a lowness of spirits from a single phantasy, without
fever; and it appears to me that melancholy is the commencement
and a part of mania. For in those who are mad, the understanding
is turned sometimes to anger and sometimes to
joy, but in the melancholics to sorrow and despondency only.
But they who are mad are so for the greater part of life,
becoming silly, and doing dreadful and disgraceful things;
but those affected with melancholy are not every one of them
affected according to one particular form; but they are either
suspicious of poisoning, or flee to the desert from misanthropy,
or turn superstitious, or contract a hatred of life. Or if at any
time a relaxation takes place, in most cases hilarity supervenes,
but these persons go mad.
But how, and from what parts of the body, the most of
these complaints originate, I will now explain. If the cause
remain in the hypochondriac regions, it collects about the
diaphragm, and the bile passes upwards, or downwards in cases
of melancholy. But if it also affects the head from sympathy,
and the abnormal irritability of temper change to laughter and
joy for the greater part of their life, these become mad rather
from the increase of the disease than from change of the
affection.
Dryness is the cause of both. Adult men, therefore, are
subject to mania and melancholy, or persons of less age than
adults. Women are worse affected with mania than men.
As to age, towards manhood, and those actually in the prime
of life. The seasons of summer and of autumn engender, and
spring brings it to a crisis.
The characteristic appearances, then, are not obscure; for the
patients are dull or stern, dejected or unreasonably torpid,
without any manifest cause: such is the commencement of
melancholy. And they also become peevish, dispirited, sleepless,
and start up from a disturbed sleep.
Unreasonable fear also seizes them, if the disease tend to
increase, when their dreams are true, terrifying, and clear:
for whatever, when awake, they have an aversion to, as being
an evil, rushes upon their visions in sleep. They are prone to
change their mind readily; to become base, mean-spirited,
illiberal, and in a little time, perhaps, simple, extravagant,
munificent, not from any virtue of the soul, but from the
changeableness of the disease. But if the illness become more
urgent, hatred, avoidance of the haunts of men, vain lamentations;
they complain of life, and desire to die. In many, the
understanding so leads to insensibility and fatuousness, that
they become ignorant of all things, or forgetful of themselves,
and live the life of the inferior animals. The habit of the
body also becomes perverted; colour, a darkish-green, unless
the bile do not pass downward, but is diffused with the
blood over the whole system. They are voracious, indeed,
yet emaciated; for in them sleep does not brace their limbs
either by what they have eaten or drunk, but watchfulness
diffuses and determines them outwardly. Therefore the bowels
are dried up, and discharge nothing; or, if they do, the dejections
are dried, round, with a black and bilious fluid, in which
they float; urine scanty, acrid, tinged with bile. They are
flatulent about the hypochondriac region; the eructations
fetid, virulent, like brine from salt; and sometimes an acrid
fluid, mixed with bile, floats in the stomach. Pulse for the
most part small, torpid, feeble, dense, like that from cold.
A story is told, that a certain person, incurably affected, fell
in love with a girl; and when the physicians could bring him
no relief, love cured him. But I think that he was originally
in love, and that he was dejected and spiritless from being
unsuccessful with the girl, and appeared to the common
people to be melancholic. He then did not know that it was
love; but when he imparted the love to the girl, he ceased
from his dejection, and dispelled his passion and sorrow; and
with joy he awoke from his lowness of spirits, and he became
restored to understanding, love being his physician.
