CHAPTER V. CURE OF MELANCHOLY.
IN cases of melancholy, there is need of consideration in
regard to the abstraction of blood, from which the disease
arises, but it also springs from cacochymy in no small amount
thereof. When, therefore, the disease seizes a person in early
life, and during the season of spring we are to open the
median vein at the right elbow, so that there may be a
seasonable flow from the liver; for this viscus is the fountain
of the blood, and the source of the formation of the bile,
both which are the pabulum of melancholy. We must open
a vein even if the patients be spare and have deficient blood,
but abstract little, so that the strength may feel the evacuation
but may not be shaken thereby; for even though the blood
be thick, bilious, coagulated, and black as the lees of oil,
yet still it is the seat and the pabulum of Nature. If, then,
you abstract more than enough, Nature, by the loss of nourishment,
is ejected from her seat. But if the patient has much
blood, for the most part in such cases it is not much vitiated,
but still we must open a vein, and not abstract all the blood
required the same day, but after an interval, or, if the whole
is taken the same day, the strength will indicate the amount.
During the interval, the patient is to be allowed a fuller diet
than usual, in order to prepare him for enduring the evacuation;
for we must assist the stomach, it being in a state of
disease, and distress from the black bile lodging there. Wherefore,
having kept the patient on a restricted diet for one day
previously, we must give black hellebore to the amount of
two drams with honeyed-water, for it evacuates black bile.
And likewise the capillary leaves of Attic thyme, for it also
evacuates black bile. But it is best to mix them together, and
give a part of each, to the amount of two drams altogether.
After the purging we are to administer the bath, and give a little
wine and any other seasoner in the food; for purging fatigues
the powers of the stomach. We are, then, to come down to
the middle parts, and having first relaxed by cataplasms and
bathing, we are to apply a cupping-instrument over the liver
and stomach, or the mouth of it; for this evacuation is
much more seasonable than venesection. We are also to apply
it to the back between the scapulæ, for to this place the
stomach is adjacent. Then again we are to recruit; and if
the strength be restored by the regimen, we are to shave the
head, and afterwards apply the cupping-instrument to it, for
the primary and greatest cause of the disease is in the nerves.
But neither are the senses free from injury, for hence are
their departure and commencement. Wherefore these also
are changed, by participating in the affection. Some, likewise,
from alienation of the senses have perverted feelings. It
is necessary, then, especially to cure the stomach as being
disordered of itself, and from black bile being lodged in it.
Wherefore we must give to drink continuously of the juice of
wormwood from a small amount to a cupful (
cyathus), for it
prevents the formation of bile. Aloe also is a good thing, for
it brings down the bile into the lower gut. If, then, the
disease be of recent origin, and the patient be not much
changed, he will require no other treatment in these circumstances.
There is a necessity, however, for the remaining
part of the regimen to the restoration of the habits, and the
complete purification of the affection, and the strengthening of
the powers, so that the diseases may not relapse. I will explain
afterwards the course of life during convalescence.
But if the disease, having yielded a little to these means,
should be seen relapsing, there will be need of greater
remedies. Let there, then, be no procrastination of time, but
if the disease appear after suppression of the catamenial discharge
in women, or the hemorrhoidal flux in men, we must
stimulate the parts to throw off their accustomed evacuation.
But if it is delayed and does not come, the blood having
taken another direction, and if the disease progress rapidly,
we must make evacuations, beginning from the ankles. And
if you cannot get away from this place so much blood as you
require, you must also open the vein at the elbow. And
after pursuing the restorative process for three or four days,
we are to give the purgative medicine, the hiera. Then we
are to apply the cupping-instrument to the middle parts of
the body, bringing it near to the liver, and do those things
which speedily prove effectual; for melancholy does not yield
to small remedies, and, if long continued, it remains fixed in
a spot. And if the disease lodge in all parts of the
body,--in the senses, the understanding, the blood, and the
bile,--and if it seize on the nerves, and turn to an incurable
condition, it engenders in the system a progeny of other
diseases,--spasms, mania, paralysis. And if they arise from
melancholy, the newly-formed diseases are incurable. Wherefore
we are to use hellebore for the cure of the ailment.
But before the administration of the hellebore, we must train
the stomach to vomiting, attenuate the humours, and render
the whole system freely perspirable; emetics will accomplish
these things sometimes those which are given with an
empty stomach, and sometimes those which consist of radishes.
I will describe the mode and materials of it; and I will also
describe the species of hellebore and the modes of using it;
and how we ought to judge of everything beforehand, and
how to render assistance during the operation of the emetics.
It cannot be doubted that by these means the disease has
either been entirely removed or had intervals of several years.
For generally melancholy is again engendered. But if it be
firmly established, we are no longer to hesitate, but must
have recourse to everything relating to the hellebore. It is
impossible, indeed, to make all the sick well, for a physician
would thus be superior to a god; but the physician can produce
respite from pain, intervals in diseases, and render them
latent. In such cases, the physician can either decline and
deny his assistance, alleging as an excuse the incurable nature
of the disease, or continue to the last to render his services.
The hiera from aloe is to be given again and again; for this
is the important medicine in melancholy, being the remedy
for the stomach, the liver, and the purging of bile. But experience
has proved, that the seed of mallow, to the amount of
a dram, when taken in a drink with water answers excellently.
But there are many other simple medicines which are useful,
some in one case, and some in another.
After these sufferings, the patient is to be recruited. For,
in certain cases, during the time of this treatment, the disease
has been removed; but if the patient come to a renewal of his
flesh and of his strength, all traces of the disease become eradicated.
For the strength of nature produces health, but her
weakness, disease. Let the patient, then, proceed to the process
of restoration by frequenting the natural hot baths; for the
medicinal substances in them are beneficial, such as bitumen,
or sulphur, or alum, and many others besides these which are
possessed of remedial powers. For, after the parching heat of
the disease, and the annoyance of the treatment, dilution is a
good thing. Moreover, rare and soft flesh most readily throws
off the disease; but in melancholy the flesh is dry and dense.
An oily liniment, by gentle friction, with much oil containing
. . . . . . . . . . . . washed bread, with something sweet, as
the Cretan must, and the Scybelitic from Pamphylia, or wine
and honey which have been mixed up together for some time.
Eggs, both cold and hot, which have been stripped of their
shells. Of fleshes, such as are not fatty, and are detergent. Of
swine, the feet and the parts about the head. Of fowls, the
wings, which are not fatty. Of wild animals, hares, goats, and
deer. Of autumnal fruits, whatever is excellent in its kind.
When the stomach rejects the food, we must consider beforehand
that what is taken be not vomited up. Wherefore,
before giving food, we are to administer honeyed-water to the
amount of half a cyathus, which, being drunk, is vomited up
again for cleansing the stomach. For, in this way, the
food remains in the stomach. Medicines which are purgative
of the necessary discharges are--the fruit of the pine, of
the nettle, and seeds of the
coccalus,1 and pepper; bitter
almonds; and let honey give it consistence. But if you wish
to dry, the best thing is myrrh, or the root of iris, the medicine
from vipers, and that of Vestinus, of Mithridates, and
many others. For the epithemes, the
materiel of cataplasms,
melilot and poppies, and the tear (gum?) of turpentine,
and hyssop, and the oil of roses, or of vine-flowers;
wax should give consistence to all these. Liniments of
oil; gestation, promenades, and whatever promotes the reproduction
of flesh, and the strength of the powers, and the restoration
of nature to its pristine state of * * *
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