Part 70

Rhases gives the theories and practice of preceding authors along with his own remarks, which, however, contain no very original opinions. One of his Arabian authorities recommends bleeding at the arm, and also by cupping and opening the occipital arteries, rubbing the head with mustard, purging with hiera, sternutatories, &c. The application of mustard to the head is approved of by most of his authorities.

Like our author, most of the ancient writers approve of Cyrenaic juice, or assafœtida, in cases of epilepsy.

SECT. XIV.—ON MELANCHOLY, MANIA, AND DEMONIACS.

Melancholy is a disorder of the intellect without fever, occasioned mostly by a melancholic humour seizing the understanding; sometimes the brain being primarily affected, and sometimes it being altered by sympathy with the rest of the body. And there is a third species called the flatulent and hypochondriac, occasioned by inflammation of the parts in the hypochondria adjoining to the stomach, by which sometimes noxious vapours or auræ are transmitted to the brain, and sometimes part of the substance of the humour. The common symptoms of them all are fear, despondency, and misanthropy; and that they fancy themselves to be, some, brute animals, and imitate their cries; and others, earthen-vessels, and are frightened lest they be broken. Some desire death, and others are afraid of dying; some laugh constantly, and others weep; and some believe themselves impelled by higher powers, and foretell what is to come, as if under divine influence; and these are, therefore, properly called demoniacs, or possessed persons. The peculiar symptoms of melancholy, from sympathy with the general system, are leanness, darkness, and shagginess; the whole appearance melancholic, either by nature, or acquired by anxiety, want of sleep, the administration of noxious food, or stoppage of the hemorrhoidal, or menstrual discharge. Melancholy, from affection of the hypochondria, is indicated by indigestion, acid eructations, heat and heaviness of them, retraction of the hypochondria, and sometimes inflammation, especially in the beginning; and then, when they increase, melancholic symptoms supervene. These are relieved by digestion, or copious discharges, or flatus, or vomiting, or eructations. When none of these symptoms, or very few of them, are present, melancholic symptoms appearing indicate that the brain is primarily affected, and for the most part from a melancholic humour. When the complaint is occasioned by yellow bile, which, by too much heat, has been turned into black, it will bring on the disease called mania, which occasions ungovernable madness, so that those affected with it will destroy persons who come near them unguardedly.

The cure of melancholy. Those who are subject to melancholy from a primary affection of the brain are to be treated with frequent baths, and a wholesome and humid diet, together with suitable exhilaration of mind, without any other remedy, unless when, from its long continuance, the offending humour is difficult to evacuate, in which case we must have recourse to more powerful and complicated plans of treatment. These cases are to be purged from the first with dodder of thyme (epithymus), or aloes; for if a small quantity of these be taken every day, it will be of the greatest service, and open the bowels gently. After purging, as we have mentioned, give wormwood, sometimes macerating and boiling the herb in water to the amount of two cyathi, and sometimes diluting the juice with water, to the amount of half a drachm, and giving it frequently. Let them drink of the most acrid vinegar before going to sleep, and dip, for the most part, their condiments in it before eating them. But it will be better if to the vinegar be added squills, poley, or the slender birthwort. When you meet with an incipient case of the complaint, from sympathy with the general system (as described above), and the body is firm, you must, by all means, begin with phlebotomy, and after phlebotomy, when the strength is recruited, purge downwards, with the wild cucumber, and the composition from the black hellebore, and promote the hemorrhoidal and menstrual discharges, if the affection be occasioned by retention of them. Diuretic remedies are likewise proper, as also evacuations by perspiration. But if the complaint arise from disorder of the hypochondria, we must attend to them, and foment them with a decoction of rue, dill, wormwood, pennyroyal, the seed of the chaste-tree, and of the fruit of the bay-tree; for these soothe the pains and diminish flatulence. They may be boiled in oil and applied; and the cataplasms of them ought to contain the remedies for flatulence, namely, parsley, or anise, or cumin; and it will not be improper to add cyperus, iris, and frankincense, to the cataplasms. These things are to be allowed to remain in general, even during the day, and whether the patient eat or fast; and, when taken away, apply some other protection, such as a broad piece of wool. Use dry-cupping for flatulence, and cupping with scarifications for pains and inflammations. While directing your attention to the cure, you must not forget mustard, and apply acrid smegmata and calefacient plasters to the back and belly. In chronic cases, the most powerful remedy is evacuation, by vomiting with hellebore. The diet for all melancholics should be wholesome, and moderately moistening; abstaining from beef, roe’s flesh, dried lentil, cabbages, snails, thick and dark-coloured wines, and, in a word, from whatever things engender black bile.

The cure of mania. Persons affected with mania are to be treated like melancholics; and, in particular, we must apply to the head rose-oil, or rose-oil with vinegar, and purge with the bitter antidote called hiera, having previously bled them; and we must use leeches to the head. But nothing is of such service as horse-fennel, either the root or seed drunk in water. A drachm of the root of bryony with water may be taken every day. If the maniacs will not be persuaded to take the purgative medicines, they must be mixed with their food, in a concealed manner, such as with mouthfuls of meat, or dried figs, or dates, or else with their drink. But, above all things, they must be secured in bed, so that they may not be able to injure themselves, or those who approach them; or swung within a wicker-basket in a small couch suspended from on high.

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COMMENTARY. Consult Hippocrates (Aphor.); Galen (Comment. in Aphor., de Morb. Vulg.); Celsus (iii, 18); Aretæus (de Morb. Chron. i, 6, and de Curat. Morb. i, 5); Aëtius (vi, 8); Nonnus (32); Oribasius (Synops. viii, 17); Alexander (i, 16); Actuarius (de Dig. Morb. ii, 34); Octavius Horatianus (ii, 2, 5); Mesue (de Ægr. Cap. 34); Serapion (i, 22); Avicenna (iii, 1, 4); Avenzoar (i, 9, 16); Haly Abbas (Theor. ix, 7; Pract. v, 23); Alsaharavius (Pract. i, 2, 27); Rhases (ad Mansor. ix, 13; Contin. 1).

Hippocrates, in his Aphorisms, points out the lower intestines as the seat of melancholy, and directs us to cure the complaint by purging. Galen, in his Commentary, agrees with his principles and practice. Galen states correctly that melancholy sometimes changes to epilepsy, and vice versa, that epilepsy is often succeeded by melancholy. (De Loc. Aff. iii, 10.) He gives a curious extract from the works of Diocles, with remarks upon the same.

Aretæus considers melancholy as an incipient mania. He gives a masterly sketch of the different modes in which mania makes its attack, and relates an interesting case of a joiner, who was perfectly sound while engaged at his work, but no sooner left the place where he was occupied than he became mad. For the cure of melancholy he advises blood to be abstracted at the commencement, according to the patient’s strength and condition. He approves then of giving black hellebore, and of applying cupping-instruments over the liver, stomach, or to the head, according as these may happen to be affected. He recommends then wormwood and aloes. When the menstrual or hemorrhoidal discharges are stopped, they are, if possible, to be restored; and for this purpose blood may be abstracted from the ancle, or even from the arm. He also approves very much of the natural hot baths.

Celsus, in cases of melancholy and mania, recommends in particular vomiting and pinging by hellebore; with the black species, if the patient is affected with grief; but with the white, if with gladness. He also approves of bleeding.

Aëtius gives an interesting account of the treatment of melancholy, principally extracted from the works of Galen, Ruffus, Posidonius, Archigenes, and Justus. The remedies which all of them seem to have reposed most confidence in are drastic purgatives combined with bitters and carminatives. They approve, however, of general bleeding and cupping, when indicated by the symptoms of the complaint, and the state of the patient. Nonnus in like manner prescribes bleeding in the forehead, purging with hiera picra, acrid clysters, and bitters, such as gentian and stæchas (lavendula stæchas.)

Alexander’s plan of treatment is very circumstantially detailed; but it differs very little from our author’s, except that he recommends Armenian bole instead of white hellebore. Like Aretæus, he strongly commends the use of the hot bath for the cure of melancholy. He speaks highly of a well-regulated diet, consisting principally of rock fishes, domestic fowls, and emollient pot-herbs, such as lettuces, mallows, and the like. He forbids cabbages, beef, the flesh of stags and of all other wild animals. Instead of hellebore, Serapion and Avicenna particularly praise the lapis lazuli. Haly Abbas gives a graphic delineation of the bizarre fancies, absurd fears, hopes, and vain imaginations of melancholics and maniacs. Like the other authorities, he attributes the disease to the prevalence of black bile. Without doubt, as has been often remarked, the alvine discharges in such cases are dark-coloured; and this, no doubt, gave rise to the ancient opinion that the disease originates in black bile. When the patient is young, and of a hot temperament, Haly abstracts blood from the arm or temples. He approves particularly of hot drastic purgatives, such as black hellebore, scammony, agaric, and the like. He also gives poppies, lettuces, &c. to compose the patient. He recommends cholagogues, such as the decoction of wormwood, and the like. But his treatment is too minutely and circumstantially detailed to admit of its being done justice to within our narrow limits. The same may be said of the account given by Alsaharavius. Rhases in certain cases approves of venesection for the cure of melancholy. When connected with dyspepsia, he recommends emetics and purgatives, especially black hellebore. He also approves of the tepid bath.

We must now mention the opinions of the Methodists. In cases of melancholy Cælius Aurelianus disapproves of aloes and wormwood, as acting too violently; and also forbids venesection and purging with hellebore. On the contrary, he recommends astringent articles of food, and astringent applications containing galls, alum, hypocistis, &c. to be laid over the stomach. Of mania he gives a fuller account, replete with much valuable matter, that does not readily admit of abridgment. He enumerates many existing causes of the complaint, such as intoxication, inordinate passions, indigestion, exposure to the sun, suppression of the hemorrhoidal and menstrual discharges, and the like. Maniacal persons, he says, are differently affected, one believing himself a cock, another a tile, another a god, another an orator, and such like ridiculous fancies. He then inculcates the important fact that the affection of the mind is always secondary, and not primary, as some had supposed. His moral and medical treatment is of the most emollient kind; and he enjoins retirement and quietude. When the patient’s strength will permit, he approves of venesection, the application of cupping-instruments to the head, and leeches to any other parts of the body which may be particularly affected. He commends strongly the bath of oil and the natural hot baths. He also approves of hellebore. He condemns the practice of the other sects in many respects. He does not approve of abstracting blood from both arms, so as to produce deliquium, nor of keeping the patient constantly in a dark place, nor of opening the temporal artery. He disapproves of applying narcotic fomentations to the head. He properly forbids all corporal punishment, although he approves of contradicting the whims of the maniac, and of reasoning him into a better train of thought.

Isidorus thus distinguishes epilepsy, melancholy, and mania: “Epilepsia autem in phantasia fit, melancholia in ratione, mania in memoria.” (Orig.)

The use of hellebore in mania and melancholy is often alluded to in the works of the Latin Classics. See, in particular, Horace (Sat. ii, 3); Perseus (Sat. iv, 16.) We are inclined to think that it was the black hellebore which was given in Anticyra. See Dioscorides (iv, 146.)

Cicero makes some pertinent remarks on the distinction between mania and melancholy. (Tusc. Disp. iii, 5.)

SECT. XV.—ON INCUBUS, OR NIGHTMARE.

Some say that this disorder is called ephialtes in Greek, from the name of a man, or from those in it fancying as if one leaped upon them. But Themison, in the tenth book of his Epistles, calls it pnigaleon, from a Greek word signifying suffocation. It attacks persons after a surfeit, and who are labouring under protracted indigestion. Persons suffering an attack experience incapability of motion, a torpid sensation in their sleep, a sense of suffocation, and oppression, as if from one pressing them down, with inability to cry out, or they utter inarticulate sounds. Some imagine often that they even hear the person who is going to press them down, that he offers lustful violence to them, but flies when they attempt to grasp him with their fingers. The evil must be guarded against at the commencement; for when it continues long, and attacks every night, it is the forerunner of some serious disease, such as apoplexy, mania, or epilepsy, when the exciting cause is determined to the head; for such as persons affected with epilepsy are, during the day, those labouring under nightmare are in their sleep. We must evacuate the patient’s general system by opening a vein and administering purgatives. Black hellebore is especially serviceable to such persons when given to the amount of a drachm, if three oboli of scammony, and some of the aromatics, such as anise, wild carrot, and Macedonian parsley, be mixed with it. The composition called hiera, from wild gourd, is also of great service; it is the hiera of Ruffus. The diet should be light, and they ought to avoid everything that is flatulent. They are benefited also by the fruit of peony: fifteen of the black grains of which may be pounded with water and drunk frequently.

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COMMENTARY. See Aëtius (vi, 12); Oribasius (Synops. viii, 2); Actuarius (i, 16); Cælius Aurelianus (Tard. Pass. i, 3); Psellus (Opus Medicum); Avicenna (iii, 1, 5, 7); Alsaharavius (Pract. i, 33); Rhases (ad Mansor. ix, 12, Contin. i.)

The other ancient authors treat the complaint, like our author, by evacuants. Bleeding (Rhases recommends this to be done at the ancle), drastic purgatives, and friction of the extremities are the common remedies. Alsaharavius says that, if not cured by bleeding, it is to be treated, as epilepsy, with hiera and the like. Even Cælius in this case nearly agrees with the others, recommending restricted diet, and, if the disorder is great, venesection. He also approves of applying cupping-instruments with scarifications on the side of the throat, and, when the disease is protracted, of emetics, and shaving the head. For the cure of incubus, Mesue and Rhases recommend bleeding and an attenuant diet. Ruffus, as quoted by the latter, recommends vomiting, purging, an attenuant diet, sternutatories, masticatories, and ointments to the head, containing castor and the like.

Psellus gives a very graphic description of incubus. (Op. Med.)

SECT. XVI.—ON LYCAON, OR LYCANTHROPIA.

Those labouring under lycanthropia go out during the night imitating wolves in all things, and lingering about sepulchres until morning. You may recognize such persons by these marks: they are pale, their vision feeble, their eyes dry, tongue very dry, and the flow of the saliva stopped; but they are thirsty, and their legs have incurable ulcerations from frequent falls. Such are the marks of the disease. You must know that lycanthropia is a species of melancholy which you may cure at the time of the attack, by opening a vein and abstracting blood to fainting, and giving the patient a diet of wholesome food. Let him use baths of sweet water, and then milk-whey for three days, and purging with the hiera from colocynth twice or thrice. After the purgings, use the theriac of vipers, and administer those things mentioned for the cure of melancholy. When the disease is already formed, use soporific embrocations, and rub the nostrils with opium when going to rest.

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COMMENTARY. See Aëtius (vi, 11); Oribasius (Synops. viii, 10); Actuarius (Meth. Med. i, 16); Anonymus (de Lycanth. ap. Phys. et Med. Min.); Psellus (Carm. de Re Med. ibid.); Avicenna (iii, i, 5, 22); Haly Abbas (Theor. ix, 7, Pract. v, 24); Alsaharavius (Pract. i, 2, 28); Rhases (Divis. 10, Cont. i.)

All the other authorities give much the same account of this species of melancholy as Paulus. If we adopt Dr. Mead’s theory respecting the dæmoniacs mentioned in Scripture, we may conclude that the man, whose state is described in Luke (viii, 27), was affected with this disease. Dr. Mead is farther of opinion that Nebuchadnezzar was seized with lycanthropia. The reader will find much curious information on this head in Burton’s ‘Anatomy of Melancholy,’ from which all Mead’s opinions are borrowed.