On the Causes and Symptoms of Chronic Diseases (1.5)

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.[*]

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.