In this cure, as in the rest, is especially required the rectification of those six non-natural things above all, as good diet, which Montanus, consil. 27. enjoins a French nobleman, "to have an especial care of it, without which all other remedies are in vain." Bloodletting is not to be used, except the patient's body be very full of blood, and that it be derived from the liver and spleen to the stomach and his vessels, then to draw it back, to cut the inner vein of either arm, some say the salvatella, and if the malady be continuate, to open a vein in the forehead.
Preparatives and alteratives may be used as before, saving that there must be respect had as well to the liver, spleen, stomach, hypochondries, as to the heart and brain. To comfort the stomach and inner parts against wind and obstructions, by Areteus, Galen, Ætius, Aurelianus, &c., and many latter writers, are still prescribed the decoctions of wormwood, centaury, pennyroyal, betony sodden in whey, and daily drunk: many have been cured by this medicine alone.
Prosper Altinus and some others as much magnify the water of Nile against this malady, an especial good remedy for windy melancholy. For which reason belike Ptolemeus Philadelphus, when he married his daughter Berenice to the king of Assyria (as Celsus, lib. 2. records), magnis impensis Nili aquam afferri jussit, to his great charge caused the water of Nile to be carried with her, and gave command, that during her life she should use no other drink. I find those that commend use of apples, in splenetic and this kind of melancholy (lamb's-wool some call it), which howsoever approved, must certainly be corrected of cold rawness and wind.
Codronchus in his book de sale absyn. magnifies the oil and salt of wormwood above all other remedies, "which works better and speedier than any simple whatsoever, and much to be preferred before all those fulsome decoctions and infusions, which must offend by reason of their quantity; this alone in a small measure taken, expels wind, and that most forcibly, moves urine, cleanseth the stomach of all gross humours, crudities, helps appetite," &c. Arnoldus hath a wormwood wine which he would have used, which every pharmacopoeia speaks of.
Diminutives and purges may be taken as before, of hiera, manna, cassia, which Montanus consil. 230. for an Italian abbot, in this kind prefers before all other simples, "And these must be often used, still abstaining from those which are more violent, lest they do exasperate the stomach, &c., and the mischief by that means be increased." Though in some physicians I find very strong purgers, hellebore itself prescribed in this affection. If it long continue, vomits may be taken after meat, or otherwise gently procured with warm water, oxymel, &c., now and then. Fuchsius cap. 33. prescribes hellebore; but still take heed in this malady, which I have often warned, of hot medicines, "because" (as Salvianus adds) "drought follows heat, which increaseth the disease:" and yet Baptista Sylvaticus controv. 32. forbids cold medicines, "because they increase obstructions and other bad symptoms." But this varies as the parties do, and 'tis not easy to determine which to use. "The stomach most part in this infirmity is cold, the liver hot; scarce therefore" (which Montanus insinuates consil. 229. for the Earl of Manfort) "can you help the one and not hurt the other:" much discretion must be used; take no physic at all he concludes without great need. Laelius Ægubinus consil. for an hypochondriacal German prince, used many medicines; "but it was after signified to him in letters, that the decoction of China and sassafras, and salt of sassafras wrought him an incredible good." In his 108 consult, he used as happily the same remedies; this to a third might have been poison, by overheating his liver and blood.
For the other parts look for remedies in Savanarola, Gordonius, Massaria, Mercatus, Johnson, &c. One for the spleen, amongst many other, I will not omit, cited by Hildesheim, spicel. 2, prescribed by Mat. Flaccus, and out of the authority of Benevenius. Antony Benevenius in a hypochondriacal passion, "cured an exceeding great swelling of the spleen with capers alone, a meat befitting that infirmity, and frequent use of the water of a smith's forge; by this physic he helped a sick man, whom all other physicians had forsaken, that for seven years had been splenetic." And of such force is this water, "that those creatures as drink of it, have commonly little or no spleen." See more excellent medicines for the spleen in him and Lod. Mercatus, who is a great magnifier of this medicine. This Chalybs præparatus, or steel-drink, is much likewise commended to this disease by Daniel Sennertus l. 1. part. 2. cap. 12. and admired by J. Caesar Claudinus Respons. 29. he calls steel the proper alexipharmacum of this malady, and much magnifies it; look for receipts in them. Averters must be used to the liver and spleen, and to scour the mesaraic veins: and they are either too open or provoke urine. You can open no place better than the haemorrhoids, "which if by horse-leeches they be made to flow, there may be again such an excellent remedy," as Plater holds. Sallust. Salvian will admit no other phlebotomy but this; and by his experience in an hospital which he kept, he found all mad and melancholy men worse for other bloodletting. Laurentius cap. 15. calls this of horse-leeches a sure remedy to empty the spleen and mesaraic membrane. Only Montanus consil. 241. is against it; "to other men" (saith he) "this opening of the haemorrhoids seems to be a profitable remedy; for my part I do not approve of it, because it draws away the thinnest blood, and leaves the thickest behind."
Ætius, Vidus Vidius, Mercurialis, Fuchsius, recommend diuretics, or such things as provoke urine, as aniseeds, dill, fennel, germander, ground pine, sodden in water, or drunk in powder: and yet P. Bayerus is against them: and so is Hollerius; "All melancholy men" (saith he) "must avoid such things as provoke urine, because by them the subtile or thinnest is evacuated, the thicker matter remains."
Clysters are in good request. Trincavelius lib. 3. cap. 38. for a young nobleman, esteems of them in the first place, and Hercules de Saxonia Panth. lib. 1. cap. 16. is a great approver of them. "I have found (saith he) by experience, that many hypochondriacal melancholy men have been cured by the sole use of clysters," receipts are to be had in him.
Besides those fomentations, irrigations, inunctions, odoraments, prescribed for the head, there must be the like used for the liver, spleen, stomach, hypochondries, &c. "In crudity" (saith Piso) "'tis good to bind the stomach hard" to hinder wind, and to help concoction.
Of inward medicines I need not speak; use the same cordials as before. In this kind of melancholy, some prescribe treacle in winter, especially before or after purges, or in the spring, as Avicenna, Trincavellius mithridate, Montaltus paeony seed, unicorn's horn; os de corde cervi, &c.
Amongst topics or outward medicines, none are more precious than baths, but of them I have spoken. Fomentations to the hypochondries are very good, of wine and water in which are sodden southernwood, melilot, epithyme, mugwort, senna, polypody, as also cerotes, plaisters, liniments, ointments for the spleen, liver, and hypochondries, of which look for examples in Laurentius, Jobertus lib. 3. c. pra. med. Montanus consil. 231. Montaltus cap. 33. Hercules de Saxonia, Faventinus. And so of epithems, digestive powders, bags, oils, Octavius Horatianus lib. 2. c. 5. prescribes calastic cataplasms, or dry purging medicines; Piso dropaces of pitch, and oil of rue, applied at certain times to the stomach, to the metaphrene, or part of the back which is over against the heart, Ætius sinapisms; Montaltus cap. 35. would have the thighs to be cauterised, Mercurialis prescribes beneath the knees; Laelius Ægubinus consil. 77. for a hypochondriacal Dutchman, will have the cautery made in the right thigh, and so Montanus consil. 55. The same Montanus consil. 34. approves of issues in the arms or hinder part of the head. Bernardus Paternus in Hildesheim spicel 2. would have issues made in both the thighs; Lod. Mercatus prescribes them near the spleen, aut prope ventriculi regimen, or in either of the thighs. Ligatures, frictions, and cupping-glasses above or about the belly, without scarification, which Felix Platerus so much approves, may be used as before.