OF retention and evacuation, there be divers kinds, which are either concomitant, assisting, or sole causes many times of melancholy. Galen reduceth defect and abundance to this head; others "All that is separated, or remains."
Costiveness.] In the first rank of these, I may well reckon up costiveness, and keeping in of our ordinary excrements, which as it often causeth other diseases, so this of melancholy in particular. Celsus, lib. 1. cap. 3. saith, "It produceth inflammation of the head, dulness, cloudiness, headache, &c." Prosper Calenus, lib. de atra bile, will have it distemper not the organ only, "but the mind itself by troubling of it:" and sometimes it is a sole cause of madness, as you may read in the first book of Skenkius's Medicinal Observations. A young merchant going to Nordeling fair in Germany, for ten days' space never went to stool; at his return he was grievously melancholy, thinking that he was robbed, and would not be persuaded but that all his money was gone; his friends thought he had some philtrum given him, but Onelius, a physician, being sent for, found his costiveness alone to be the cause, and thereupon gave him a clyster, by which he was speedily recovered. Trincavelius, consult. 35 lib. 1. saith as much of a melancholy lawyer, to whom he administered physic, and Rodericus a Fonseca, consult. 85. tom. 2. of a patient of his, that for eight days was found, and therefore melancholy affected. Other retentions and evacuations there are, not simply necessary, but at some times; as Fernelius accounts them. Path. lib. 1. cap. 15. as suppression of hæmorrhoids, or monthly issues in women, bleeding at nose, immoderate or no use at all of Venus: or any other ordinary issues.
Detention of hæmorrhoids, or monthly issues, Villanovanus Breviar. lib. 1. cap. 18. Arculanus, cap. 16. in 9. Rhasis, Vittorius Faventinus, pract. mag. Tract. 2. cap. 15. Bruel, &c. put for ordinary causes. Fuchsius, l. 2. sect. 5. c. 30. goes farther, and saith, "That many men unseasonably cured of the hemorrhoids have been corrupted with melancholy, seeking to avoid Scylla, they fall into Charybdis. Galen, l. de hum. commen. 3. ad text. 26. illustrates this by an example of Lucius Martius, whom he cured of madness, contracted by this means: And Skenkius hath two other instances of two melancholy and mad women, so caused from the suppression of their months. The same may be said of bleeding at the nose, if it be suddenly stopped, and have been formerly used, as Villanovanus urgeth: And Fuchsius, lib. 2. sect. 5. cap. 33. stiffly maintains, "That without great danger, such an issue may not be stayed."
Venery omitted produceth like effects. Mathiolus, epist. 5. 1. penult. "avoucheth of his knowledge, that some through bashfulness abstained from venery, and thereupon became very heavy and dull; and some others that were very timorous, melancholy, and beyond all measure sad." Oribasius, med. collect. l. 6. c. 37. speaks of some, "That if they do not use carnal copulation, are continually troubled with heaviness and headache; and some in the same case by intermission of it." Not use of it hurts many, Arculanus, c. 6. in 9. Rhasis, et Magninus, part. 3. cap. 5. think, because it "sends up poisonous vapours to the brain and heart." And so doth Galen himself hold, "That if this natural seed be over-long kept (in some parties) it turns to poison." Hieronymus Mercurialis, in his chapter of Melancholy, cites it for an especial cause of this malady, Priapismus, Satyriasis, &c., Haliabbas, 5. Theor. c. 36. reckons up this and many other diseases. Villanovanus Breviar. l. 1. c. 18. saith, "He knew monks and widows grievously troubled with melancholy, and that for this sole cause." Lodovicus Mercatus, l. 2. de mulierum affect. cap. 4. and Rodericus a Castro, de morbis mulier. l. 2. c. 3 treat largely of this subject, and will have it produce a peculiar kind of melancholy in stale maids, nuns, and widows, Ob suppressionem mensium et venerem omissam, timidæ, mœstæe, anxiæ, verecundæ, supiciosæ, languentes, consilii inopes, cum summa vitæ et rerum meliorum desperatione, &c., they are melancholy in the highest degree, and all for want of husbands. Ælianus Montaltus, cap. 37. de melanchol. confirms as much out of Galen; so doth Wierus, Christoferus a Vega de art. med lib. 3. c. 14, relates many such examples of men and women, that he had seen so melancholy. Fœlix Plater in the first book of his Observations, "tells a story of an ancient gentleman in Alsatia, that married a young wife, and was not able to pay his debts in that kind for a long time together, by reason of his several infirmities: but she, because of this inhibition of Venus, fell into a horrible fury, and desired every one that came to see her, by words, looks, and gestures, to have to do with her," &c. Bernardus Patarnus, a physician, saith, "He knew a good honest godly priest, that because he would neither willingly marry, nor make use of the stews, fell into grievous melancholy fits." Hildesheim, spicel. 2. hath such another example of an Italian melancholy priest, in a consultation had Anno 1580. Jason Pratensis gives instance in a married man, that from his wife's death abstaining, "after marriage, became exceedingly melancholy," Rodericus a Fonseca in a young man so misaffected, Tom. 2. consult. 85. To these you may add, if you please, that conceited tale of a Jew, so visited in like sort, and so cured, out of Poggius Florentinus.
Intemperate Venus is all but as bad in the other extreme. Galen. 1. 6. de morbis popular. sect. 5. text. 26, reckons up melancholy amongst those diseases which are "exasperated by venery:" so doth Avicenna, 2, 3. c. 11. Oribisius, loc. citat. Ficinus, lib. 2. de sanitate tuenda. Marsiius Cognatus, Montaltus, cap. 27. Guianerius, Tract. 3. cap. 2. Maguinus, cap. 5, part. 3. gives the reason, because "it infrigidates and dries up the body, consumes the spirits, and would therefore have all such as are cold and dry to take heed of and to avoid it as a mortal enemy." Jacchinus in 9. Rhasis, cap. 15, ascribes the same cause, and instanceth in a patient of his, that married a young wife in a hot summer, "and so dried himself with chamber-work, that he became in short space from melancholy, mad:" he cured him by moistening remedies. The like example I find in Lælius a Fonte Eugubinus, consult. 129. of a gentleman of Venice, that upon the same occasion was first melancholy, afterwards mad. Read in him the story at large.
Any other evacuation stopped will cause it, as well as these above named, be it bile, ulcer, issue, &c. Hercules de Saxonia, lib. 1. c. 16. and Gordornius, verify this out of their experience. They saw one wounded in the head, who as long as the sore was open, Lucida habuit mentis intervallia, was well; but when it was stopped, Rediit melancholia, his melancholy fit seized on him again.
Artificial evacuations are much like in effect, as hot houses, baths, bloodletting, purging, unseasonably and immoderately used. Baths dry too much, if used in excess, be they natural or artificial, and offend extreme hot or cold; bone dries, the other refrigerates over much. Montanus, consil. 137, saith, they over-heat the liver. Joh. Struthius, Stigmat. artis. l. 4. c. 9. contends, "that if one stays longer than ordinary at the bath, go in too oft, or at unseasonable times, he putrefies the humours in his body." To this purpose writes Magnini, l. 3. c. 5. Guianerius, Tract. 15. c. 21, utterly disallows all hot baths in the melancholy adust. "I saw (saith he) a man that laboured of the gout,who to be freed of his malady came to the bath, and was instantly cured of his disease, but got another worse, and that was madness." But this judgment varies as the humour doth, in hot or cold: baths may be good for one melancholy man, bad for another; that which will cure it in this party, may cause it in a second.
Phlebotomy.] Phlebotomy, many times neglected, may do much harm to the body, when there is a manifest redundance of bad humour; and melancholy blood; and when these humours heat and boil, if this be not used in time, the parties affected, so inflamed, are in great danger to be mad; but if it be unadvisedly, importunely, immoderately used, it doth as much harm by refrigerating the body, dulling the spirits, and consuming them: as Job. Curio in his 10th Chapter well reprehends, such kind of letting blood doth more hurt than good: "The humours rage much more than they did before, and is so far from avoiding melancholy, that it increaseth it, and weakeneth the sight." Prosper Calenus observes as much of all phlebotomy, except they keep a very good diet after it; yea, and as Leonartus Jacchinus speaks out of his own experience, "The blood is much blacker to many men after their letting of blood than, it was at first." For this cause belike Salust. Salvinianus, l. 2. c. 1. will admit or hear of no blood-letting at all in this disease, except it be manifest it proceed from blood: he was (it appears) by his own words in that place, master of an hospital of mad men, "and found by long experience, that this kind of evacuation, either in head, arm, or any other part, did more harm than good." To this opinion of his, Felix Plater is quite opposite, "though some wink at, disallow and quite contradict all phlebotomy in melancholy, yet by long experience I have found innumerable so saved, after they had been twenty, nay, sixty times let blood, and to live happily after it. It was an ordinary thing of old, in Galen's time, to take at once from such men six pounds of blood, which now we dare scarce take in ounces; sed viderint medici;" great books are written of this subject.
Purging upward and downward, in abundance of bad humours omitted, may be for the worst; so likewise as in the precedent, if overmuch, too frequent or violent, it weakeneth their strength, saith Fuchsius, l. 2. sect. 2. c. 17. or if they be strong or able to endure physic, yet it brings them to an ill habit, they make their bodies no better than apothecaries' shops, this and such like infirmities must needs follow.