I99

ROBERT BURTON'S ANATOMY OF MELANCHOLYBy W. D. NICOL, F.R.C.P.

Physician and Lecturer in Psychological Medicine, Royal Free Hospital; Physician Superintendent, Horton Hospital,Epsom0

' Melancholy is a kind of dotage without a fever, having for its ordinarycompanions fear and sadness, without any apparent occasion.'

In i86i an article appeared in Blackwood, inwhich the writer amusingly introduces Burton tothe well-known British traveller, Leo Rusticus,Esq., who is visiting Oxford with his interestingdaughters about Commemoration time. Theymust need do the sights, hence their visit toChrish Church Cathedral, ' the ugliest possible ofcollegiate churches,' but at least a cathedral.Here they are shown what little there is to see bythe verger, who points out ' in the north aisle,high up against a pillar, a small bust, with a Latininscription underneath, and a queer-lookingdiagram stuck rather awkwardly on one side of it,which the young ladies will probably at the firstglance take for a sun dial, but which is in truth anastrological calculation of a nativity.' ' Burton,sir,' says the verger, ' author of the Anatomy-formerly student of this house.' The young ladieswho conclude he must have been some medicalcelebrity, are quickly informed by the father, whoexplains, ' Anatomy of Melancholy, you know, mydears,' whereupon the verger takes up the narra-tive, ' Yes sir, he was a very melancholy gentle-man and is supposed to have destroyed himself,and that's his horro-scope.' The author of thisarticle tontinues to reflect how papa knows thebook is on his shelves at home, it lies there un-read; indeed how many Fellows of the Collegehave any personal acquaintance with this book.As a boy I remember the volume on my father'sshelves.

Before we discuss the book, let us enquire whatwe know of the author. Unfortunately ourknowledge is somewhat scant, though there appeara few biographical details scattered here and there.We learn more from other sources; his brother,William, who wrote a Description of Leicestershire,tells of his family, who boasted an ancient lineage.Anthony a Wood (I721) in Athenae Oxoniensesprovides perhaps more biological material. RobertBurton was born at Winsley in Leicestershire, the

From a lecture delivered in I947 to the ListerianSociety of King's College Hospital.

fourth of nine children, in I577. A ' Grammarscholar' at Sutton Coldfield in Warwickshire atfirst, after which he entered Brasenose College,Oxford, and then Christ Church. After taking adegree he continued in residence as student tutorand college librarian at Christ Church where hespent the rest of his life. It is recorded that he wasVicar of St. Thomas's, Oxford, and later he wasgiven the living of Seagrave in his own county.The Anatomy is dedicated to George LordBerkeley, the patron of this gift; at some othertime he probably had a preferment at Walsby inLincolnshire. Paul Jordan-Smith in his Biblio-graphia Burtoniana is responsible for throwing aninteresting light on Burton's secular life;apparently this cleric and divine was for threeyears one of the Clerks of the Market of Oxford.This discovery was quite accidental, through thechance purchase of a copy of the Anatomy, inter-leaved and loaned at one time to Professor Murray'for the use of the Dictionary.' The book waspreviously the property of Mr. George Parker ofthe Bodleian Library, who had noted the fact ofBurton's appointment to the Market. This isimportant and gives us a clue to the non-clericalside of Burton's personality and character.He died on January z5th, 1639, so near to the

exact time he had predicted that idle rumour had itthat he hanged himself to prove a prophet. This isunlikely, as a felo-de-se would have precluded hisburial in Christ Church Cathedral.Anthony a Wood, who as a child might have

known him, gives this character of him (Evans:(The Psychiatry of Robert Burton). ' He was anexact Mathematician, a curious Calculator ofNativities, a general read scholar, a thro'-pac'dPhilologist, and one that understood the surveyingof Lands well... I have heard some of the Antientsof Christ Church often say that his Company wasvery merry, facete, and juvenile, and no Man inhis time did surpass him for his ready and dextrousinterlarding his common discourses among themwith Verses from the Poets, or Sentences fromclassical Authors. Which being then all the

by copyright. on A

ugust 25, 2020 by guest. Protected

http://pmj.bm

j.com/

Postgrad M

ed J: first published as 10.1136/pgmj.24.270.199 on 1 A

pril 1948. Dow

nloaded from

POST GRADUATE MEDICAL JOURNAL

fashion in the University, made his Company moreacceptable.' Bishop Kennett in writing of theAnatomy says, 'The author is said to havelaboured long in the Writing of this Book tosuppress his own Melancholy, and yet did butimprove it.... In an interval of vapours he couldbe extremely pleasant, and raise laughter in anyCompany. Yet I have heard that nothing at lastcould make him laugh, but going down to theBridge-foot in Oxford, and hearing the barge-men scold and storm and swear at one another,at which he would set his Hands to his sides andlaugh most profusely.' So much for our limitedknowledge of this strange cleric, though hedoubtless reveals himself and records his manyfrustations in the course of his treatise of theAnatomy.

It was first intended that the book should bepublished anonymously. ' Suppose the man inthe moon, or whom thou wilt, to be the author.'The first edition appeared in I62I under thepseudonym of Democritus Junior. His desire foranonymity was hardly sincere, as he signed hisname to the postscript of the first edition andthough it was withdrawn in subsequent editions,the third edition was furnished with a portrait ofthe author in the centre of Le Blon's title page.The book was undoubtedly a success, ' The first,second and third editions were suddenly gone,eagerly read.' Though the author added manyalterations in subsequent editions, he found ittiring: in the last edition to be produced in hislifetime, he writes: 'Although this be a SixthEdition in which I should have been more accurate,corrected all those former escapes, yet it wasmagni laboris opus, so difficult and tedious, that asCarpenters do find out of experience, 'tis muchbetter build a new sometimes than repair an oldhouse.... But I am now resolv'd never to put thistreatise out again. Ne quid nimis. I will nothereafter add, alter or retract, I have done. Thelast and greatest exception is, that I being adivine have medled with physick.'

His style is difficult and his arguments not easyto follow. ' I resolve, if you like not my writing,go read something else.' ' I neglect phrases, andlabour wholly to inform my reader's understand-ing, not to please his ear; 'tis not my study orintent to compose neatly, which an Orator re-quires, but to express myself rapidly and plainlyas it happens.' ' I am but a smatterer, I confess, astranger, here and there I pull a flower; I doeasily grant, if a rigid censurer should criticize onthis which I have writ, he should not find threesole faults, as Scaliger in Terence, but 300.' Thebook is amazing for its encyclopaedic knowledge ofclassical, historical and contemporary literature ofthe Western World available to a scholar who had

access not only to his college library, but to theBodleian. One shudders to contemplate whatBurton's thoughts would have been had he livedin our time. At the beginning of the I7th century' in this scribbling age' he deplored the mass ofbooks extant. ' What a catalogue of new books allthis year. ... As already, we shall have a vast chaosand confusion of Books, we are oppressed withthem, our eyes ache with reading, our fingers with

.turning.'He wanted to write the whole treatise in Latin,

but fortunately for posterity his publishers in-sisted on our English version. ' Any scurrilepamphlet is welcome to our mercenary Stationersin English, they print all, but in Latin they will notdeal.' Even so most of the quotations are inLatin and occasionally the author breaks off intoLatin for the space of several pages. His descrip-tion of sexual perversions is not suited to theEnglish language ' I spare to English that whichI have said.' All prescriptions are in Latin, sothat the unlearned reader will not be tempted topractise on himself. Suggested reforms, longoverdue, in the University are likewise hiddenbehind a cloak of Latin.Why does Burton write under the name of

Democritus Junior and why does he elect to writeabout Melancholy ? Before he actually deals withhis subject, by way of introduction there is a verylengthy preface entitled ' Democritus to theReader.' Apart from being explanatory and some-what revealing, as far as the author himself isconcerned, it is full of satire and wit. He modelshimself on Democritus, because this Greekphilosopher was visited in his garden at Abdera byHippocrates, who relates how he found Demo-critus 'under a shady bower, with a book on hisknees, busy at his study, sometimes writing, some-times walking. The subject of his book wasmelancholy and madness, about him lay thecarcases of many several beasts newly by him cutup and anatomized, not that he did contemn God'screatures but to find out the seat of this atra bilisor melancholy, whence it proceeds, and how it wasengendered in men's bodies, to the intent he mightbetter cure himself, and by his writings and ob-servations teach others how to prevent and avoid it.Democritus junior is bold to imitate.' Burtonsays, ' I writ of melancholy, by being busy toavoid melancholy. There is no greater cause ofmelancholy than idleness, no better cure thanbusiness.' Doubtless he was a sufferer himself,'to ease my mind in writing, for I had gravidum,cor, foetum caput, a kind of imposthume in myhead, which I was very desirous to be unladen of.'He debates whether he should have written onsome other subject on humanity or divinity, but' there be so many books in that kind (divinity), so

April 1948200

by copyright. on A

ugust 25, 2020 by guest. Protected

http://pmj.bm

j.com/

Postgrad M

ed J: first published as 10.1136/pgmj.24.270.199 on 1 A

pril 1948. Dow

nloaded from

NICOL: Robert Burton's Anatomy of Melancholy

many commentators, treatises, pamphlets, ex-positions, sermons, that whole teams of oxencannot draw them.' Moreover he adds' but at thistime I was fatally driven upon this rock of melan-choly, and carried away by this by-stream, which,as a rillet, is deducted from the main channel of mystudies.' He defends himself for writing on amedical subject, at the expense of the miserableconditions in the Church. ' If any physician inthe meantime shall infer and find himself grievedthat I have intruded into his profession, I will tellhim in brief. I do not otherwise by them, thanthey do by us. If it be to their advantage, I knowmany of their sect which have taken orders in hopeof a benefice, 'tis common transition, and why nota melancholy divine, that can get nothing bysimony, profess Physick ?' Thomas Linacre, firstPresident of the College of Physicians, in his oldage took orders. He draws a sorry picture ofclerical life. ' Many poor country vicars, for wantof other means, are driven to their shifts; to turnmountebanks, quack salvers, empiricks, and if ourgreedy patrons hold us to such hard conditions,as commonly they do they will make most of uswork at some trade, as Paul did, at last turntaskers, maltsters, costermongers, graziers, sell Aleas some have done or worse.'He makes a plea for a closer liaison between the

cleric and the physician. ' It is a disease of thesoul on which I am to treat and as much apper-taining to a Divine as to a Physician. A gooddivine either is or ought to be a good physician-a spiritual Physician at least. They differ but inobject, the one of the body, the other of the soul,and use divers medicines to cure.' ' I could notfind a fitter task to busy myself about,' he con-tinues, ' a more apposite theme, so necessary, socommodious, and generally concerning all sorts ofmen, that should so equally participate of both andrequire a whole physician. A Divine in this com-pound mixed malady can do little alone, aPhysician in some kinds of melancholy much less,both make an absolute cure. And 'tis proper tothem both and I hope not unbeseeming me, whoam by profession a Divine, and by mine inclina-tion a Physician.' He proceeds to argue his theme,by contemporary illustrations. Europe, as now,was then in a state of turmoil, in fact his remarksmay well be applied to the events of recent years.' What would Democritus have said,' he asks ' tosee, hear and read so many bloody battles ... somany thousands slain at once, such streams ofblood able to turn mills . . . to make sport forprinces, without any just cause... whilst statesmenthemselves in the meantime are secure at home,pampered with all delights and pleasures, taketheir ease, and follow their lusts, not consideringwhat intolerable misery poor soldiers endure, their

often wounds, hunger, thirst, etc., the lamentablecases, torments, calamities and oppressions, thataccompany such proceedings, they feel not, takeno notice of it. So wars are begun, by the per-suasion of a few debauched, hair-brain, poor,dissolute, hungry captains, parasitical fauners, un-quiet Hotspurs, restless innovators, green heads,to satisfying one man's private spleen, lust,ambition, avarice, etc. Kingdoms, provinces andpolitick bodies are all subject to this disease ofmelancholy, as well as private men. Beroalduswill have drunkards, afternoon men, and such asmore than ordinarily delight to drink to be mad.The first pot quencheth thirst . . . the secondmakes merry, the third for pleasure, quarta adinsanium, the fourth makes them mad. If thisposition be true, what a catalogue of mad menshall we have ! What shall they be that drink fourtimes four ? '

To return to the problems of nations he main-tains that such as are sick and melancholy thereis need for reform. ' The most frequent maladiesare such as proceed from themselves, as first whenreligion and God's service is neglected, innovatedor altered, where they do not fear God, obey theirPrince, where Atheism, Epicurism, Sacrilege,Simony, etc., and all such impieties are freelycommitted, that country cannot prosper.' TheEngland of Robert Burton's day must have been inneed of export trade as surely as today; he de-plores the export of our best commodities beyondthe seas, only to be sent back to us at dear rates.He advocates a system of town planning, he almostprophesies the regionalization of this country intoI2 or 13 regions, but he is at least mindful of ouruncertain climate and suggests a site aboutlatitude 45° is preferable to our northern zone.A national health service is forecast-' hospitals ofall kinds, for children, orphans, old folks, sickmen, mad men, soldiers, pest houses, etc., notbuilt precario (only to last a short time) or bygouty benefactors,' but ' hospitals so built andmaintained, not by collections, benevolences,donories, for a set number (as in ours) just so manyand no more at such a rate, but for all those whostand in need, be they more or less, and that expublico oerario, and so still maintained.'From commonwealths and cities he descends

to families, ' which have as many corrosives andmolestations, as frequent discontents as the rest.'Unhappy marriages are responsible for melan-choly. ' A good, honest, painful man many timeshath a shrew to his wife, a sickly dishonest,slothful, foolish, careless woman to his mate, aproud, peevish flirt, a liquorish, prodigal quean,and by that means all goes to ruin; or if theydiffer in nature, he is thrifty, she spends all, hewise, she sottish and soft; what agreement can

April 948 201

by copyright. on A

ugust 25, 2020 by guest. Protected

http://pmj.bm

j.com/

Postgrad M

ed J: first published as 10.1136/pgmj.24.270.199 on 1 A

pril 1948. Dow

nloaded from

POST GRADUATE MEDICAL JOURNAL

there be ? What friendship ? Instead of mutuallove, kind compellations, whore and thief is heard,they fling stools at one another's heads.' Aftercastigating countries, nations, commonwealths,families and individuals he enquires of the reader,' Who am I that so boldly censure others, have Ino faults ? Yes, more than thou hast, whatsoeverthou art. I confess it again, I am as foolish, asmad as any one. My purpose and endeavour is,in the following discourse, to anatomize thishumour of melancholy, through all his parts andspecies, as it is an habit or an ordinary disease, andthat philosophically, medicinally, to shew thecauses, symptoms and several cures of it, that itmay be the better avoided; moved thereunto forthe generality of it and to do good, it being adisease so frequent, . . . as few there are that feelnot the smart of it. ... Being then it is a disease sogrievous, so common, I know not wherein to do amore general service, and spend my time better,than to prescribe means how to prevent and cureso universal a malady, an epidemical disease thatso often, so much, crucifies the body and themind.'

After this long preface, one of the best parts ofthe book, the author proceeds to get down to histhesis. It is most carefully planned, with threepartitions, which again are subdivided intomembers or sections and subsections. The firstpartition deals with the nature of melancholy, itscauses and its symptoms; the second with the cureof melancholy, while the third partition, by far thelargest is devoted to love melancholy, with sectionson religious melancholy, jealousy and despair.Each partition is prefaced by a synopsis, with themost elaborate classifications and subheadings,such as would challenge any synopsis series in ourcontemporary medical manuals. Sandwiched inthese various sections are three digressions, one onanatomy, one on ' air rectified' and one on thenature of supernatural beings. ,

It is a pity that this careful treatment of hissubjects leads to much repetition, which becomeswearisome to the reader. ' I had rather repeatwords ten times than omit anything.' Thequotations from classical, European and con-temporary literature are legion. Evans in hismonograph on the Psychiatry of Robert Burtonwrites, ' He had to thread his way through someremarkable material. Seventeenth centurymedicine (or rather i6th century, for the Anatomywas written too early in the i7th century to benefitby anything but the previous century's learning)was an amalgam of superstition and magic withcommon-sense observations. It incorporated oldwives' tales and folklore with remedies tested inpractice, and seemed not to distinguish the onefrom the other. The great physicians were still

the ancients and their Arabic successors, whoseteaching, erroneous in many respects, had beenvitiated by false translations, textual corruptions,and the embroideries of generations of charlatans.Burton had neither the training nor the knowledgethat would have been required to sift this mass andseparate the false from the true. But then, norhad anyone else in his day.'To return to the first partition, let us see what

he has to say about symptomatology. He makes itquite clear than melancholy is not to be confusedwith madness or what we would call mania;moreover he is aware that the same patient mayexhibit one or other symptom at different times,what we mean by the term manicdepressive in-sanity. He quotes the Abderites as condemningDemocritus for a mad man, ' because he was some-times sad, and sometimes again profusely merry.'He defines madness ' to be a vehement dotage, orraving without a fever, far more violent thanmelancholy, full of anger and clamour, horriblelooks, actions, gestures, troubling the patients withfar greater vehemency both of body and mind,without all fear and sorrow, with such impetuousforce and boldness, that sometimes three or fourmen cannot hold them.' Burton distinguishes be-tween melancholy proper and states of melancholy.Melancholy fits ' are but improperly so called,because they continue not, but come and go, as bysome objects they are moved. This melancholy ofwhich we are to treat, is an habit, morbus senticusor chronicus, a chronick or continute disease, asettled humour, as Aurelianus and others call it,not errant, but fixed; and as it was long increasing,so, now being (pleasant or painful) grown to anhabit, it will hardly be removed.'

Melancholy then is ' a kind of dotage without afever, having for its ordinary companions fear andsadness, without any apparent occasion.' Appre-hension and general retardation that is typical ofthe disease are aptly described, so too ideas ofunworthiness and delusions. ' By reason of thosecontinual fears, griefs, and vexation he is dull,heavy, lazy, restless, unapt to go about anybusiness.' ' Imminent danger, loss, disgrace, stilltorment others, etc., they are all glass, and there-fore will suffer no man to come near them; theyare all cork, as light as feathers ; others are asheavy as lead; some are afraid their heads willfall off their shoulders, that they have frogs intheir bellies.' ' If two talk together, discourse,whisper, jest or tell a tale in general, he thinkspresently they mean him, applies all to himself.'The cyclical nature of the disease is recognized;one 'hath a most grievous fit once in seven years,once in five, another in three or four.' Suicide isreferred to: ' Seldom this malady,' he writes,' procures death, except (which is the greatest,

April 1948202

by copyright. on A

ugust 25, 2020 by guest. Protected

http://pmj.bm

j.com/

Postgrad M

ed J: first published as 10.1136/pgmj.24.270.199 on 1 A

pril 1948. Dow

nloaded from

NICOL: Robert Burton's Anatomy of Melancholy

most grievous calamity, and the misery of allmiseries) they make away themselves, which is afrequent thing and familiar amongst them.'With regard to physical signs he recognizes the

importance of' costivness ' and ' keeping in of ourordinary excrements,' the suppression too of' themonthly issues in women.'The fixed looks, ' neglect habit' are mentioned

of the woman portrayed in the picture by AlbertusDurer.The etiology of this disorder is studied and

analysed with equal precision ; the list of possiblecauses is as protean as the variety of symptoms;in fact no wonder Burton comes to the conclusion'Who is free from melancholy ? Who is nottouched more or less in habit of disposition ? ' Noman living is wholly free.The first cause of melancholy is God Himself;

the concepts of biblical doctrines held in the i7thcentury afforded abundant evidence that thepunishment of sin was responsible for makingsinners mad. Other supernatural causes are ad-duced, wherefore a long digression on the nature ofspirits, bad angels or devils, witches and magiciansof which more later. Stars, too, and otherheavenly bodies, especially the moon, are causes ofmelancholy. The list of etiological factors is solong, that Burton found difficulty in decidingwhich if any was the main cause ; yet there issome sound common sense to be found in hismeanderings, while much else is equivocal, con-fused and far fetched, but not without providingmuch amusement for the reader.

Heredity as an etiological factor is stressed, theinnate constitutional predisposition realized. Weinherit our infirmities from our parents, thoughit is doubtful if the transmigration of nations every600 years is the real remedy 'to amend and purifytheir blood, as we alter seed upon our land.' Aplea for eugenics is put forward. ' How carefulshould we be in begetting of our children.'

Diet is so restricted that, to follow his precepts,these days of rationing would indeed be liberal.Beef breeds gross melancholy blood, pork is unfitfor such as live at ease, all venison is melancholy,so is hare; milk and all that comes of milk, asbutter and cheese increase melancholy. Poultry ofall kinds is forbidden ; herbs, roots and pulse arenought. But heart wine (not black wines) is muchcommended, if it be moderately used. ' Beer, ifit be over new or over stale, over strong, or notsod, smell of the cask, sharp or sour, is mostunwholesome.... But let them say as they list, tosuch as one accustomed unto it, 'tis a mostwholesome and a pleasant drink, it is more subtileand better for the hop that rarefies it, hath anespecial virtue against melancholy. All cakes,

fritters, pancakes, pies, sausages and those severalsauces . . . these do generally, ingender grosshumours, fill the stomach with crudities, and allthose inward parts with obstructions.'

Burton anticipates Freud by 300 years, when weread what he has to say about sexual abstinence-' stale maids, nuns and widows, they are melan-choly in the highest degree, and all for want ofhusbands.' Other authorities are quoted inevidence ofthe evils brought on by over-indulgence,which likewise causes melancholy. Jacchinus' instanceth in a Patient of his, that married ayoung wife in a hot summer, and so dried himselfwith chamber-work, that he became in shortspace from melancholy mad.' Any physical exer-cise, if it be unreasonable, violent or overmuch isbad, but on the other hand let it be a warning tothose of you who are lazily inclined. ' Idleness(the badge of gentry) or want of exercise, thebane of body and mind, the nurse of naughtiness,stepmother of discipline, the chief author of allmischief, one of the seven deadly sins, and a solecause of this and many other maladies.' 'Thusmuch I dare boldly say,' he continues, ' he or shethat is idle, be they of what condition they will,never so rich, so well allied, fortunate, happy,let them have all things in abundance, andfelicity, that heart can wish and desire, all content-ment, so long as he or she or they are idle, theyshall never be pleased, never well in body andmind, but weary still, sickly still, vexed still,loathing still, weeping, sighing, grieving, sus-pecting, offended with the world, with everyobject, wishing themselves gone or dead. ... Andthis is the true cause that so many great men,Ladies and Gentlewomen, labour of this diseasein Country and City.'Shame is another cause of melancholy, as witness

the sad story of' a grave and learned Minister,' atAlkmaar in Holland, who ' was (one day as hewalked in the fields for his recreation) suddenlytaken with a lask or looseness, and thereupon com-pelled to retire to the next ditch ; but being sur-

prised at unawares by some Gentlewomen of hisParish wandering that way, was so abashed, thathe did never after show his head in publick, orcome into the Pulpit, but pined away withMelancholy.'To devotees of race meetings and dog tracks or

cards let Galatoeus' observation be a warning:" If they win, no men living are so jovial andmerry, but if they lose, though it be but a trifle ...

they are so cholerick and testy that no man mayspeak with them, and break many times intoviolent passions, oaths, imprecations and un-

beseeming speeches, little differing from mad menfor the time.'

April 1 948 203by copyright.

on August 25, 2020 by guest. P

rotectedhttp://pm

j.bmj.com

/P

ostgrad Med J: first published as 10.1136/pgm

j.24.270.199 on 1 April 1948. D

ownloaded from

POST GRADUATE MEDICAL JOURNAL

Study is a cause and we read a long discourseon the miserable conditions in the Church,offered by ' griping' patrons. A sermon 'pub-lickly preached at Paul's Cross by a grave Ministerthen, and now a Reverend Bishop of this land' isquoted in extenso, 'What Christian will be soirreligious, to bring up his son in that course oflife, which by all probability and necessity, en-forcing to sin, will entangle him in Simony andperjury.' Burton asks what is the alternative ' letus give over our books, and betake ourselves tosome other course of life . . . let's turn soldiers,sell our books, and buy swords, guns, and pikes. . . turn our Philosophers' gowns into millers'coats, leave all and rather betake ourselves to anyother course of life, than to continue longer in thismisery.'The whole of the second partition is devoted to

the cure of melancholy. Unlawful cures practisedby the devil and his ministers, sorcerers, witches,magicians, etc., are at the outset deprecated, ' notto be tolerated or endured.' The first of all curesis prayer to God, nevertheless 'we must seek toand rely upon the Physician.' He warns hisreaders of the quack, many mountebanks, quacksalvers, empiricks abound in almost every streetand village. His chief desideratum of the Physicianis honesty, so many he regrets ' to get a fee, willgive Physick to everyone that comes, when thereis no cause.' Another caution is noted, the needfor accurate diagnosis. To the patient, he givesadvice, ' be not too nigardly miserable of the purseor think it too much that he bestows upon him-self, and to save charges endanger his health.'Above all a patient must have confidence in hisphysician and have ' sure hope' that he can helphim; he must have perseverance and obediencetoo, and 'not to change his Physician.' Theaccepted form of therapy for melancholy cameunder three headings-Diet or Living, Apothecary,Chirurgery. ' Make a melancholy nmn fat, asRhasis saith and thou hast finished the cure.'Occupation therapy is advocated. We havealready heard his censures on idleness. Outdoorexercise, ' Recreations of the mind within doors,books, maps, pictures,' such studies will expelidleness and melancholy. In praise of books herefers to King James's visit to Oxford in i605, howhe went to view that famous library renewed bySir Thomas Bodley. 'If I were not a King, Iwould be a University man.'

For women, ' instead of laborious studies, theyhave curious needleworks, cutworks, spinning,home-lace and many pretty devices of their ownmaking, to adorn their houses, cushions, carpets,chairs, stools .... '

To alleviate the sorrow of these patients, some

feigned lie, strange news, witty device, artificialinvention, it is not amiss to deceive them. Philo-dotus the physician cured a melancholy king whothought he had no head, ' by putting a leaden capthereon.' Other remedies are suggested and one,especially, wlhich might well be heeded by theurologists. 'The pleasantist dotage that ever Iread, saith Lurentius, was of a Gentleman atSenes in Italy, who was afraid to piss, lest all theTown should be drowned; the Physicians causedthe bells to be rung backward, and told him theTown was on fire, whereupon he made water, andwas immediately cured.'

Burton is sceptical of apothecary physick:' Physicians kill as many as they save, and who cantell how many murders they make in a year, thatmay freely kill folks, and have a reward for it ?and according to the Dutch proverb, a newPhysician must have a new Church-yard; and whodaily observe it not ?' Of herbs, ' Borage andBugloss may challenge the chiefest place.' Purga-tives both ' upwards' and ' downwards' areadvocated, white hellebore or sneezing powvder,aloes and, last but not least, tobacco, ' a goodvomit, I confess, a virtuous herb, if it be wellqualified, opportunely taken and medicinallyused.' Of chirurgical remedies leeches take firstplace; blood letting was in fashion too. Of moredrastic measures mention is made of ' boring theskull with an instrument to let out the fuliginousvapours.' I wonder what Burton would say of ourmodern practice of prefrontal leucotomy ?The importance of combating insomnia is not

omitted and finally this long partition on therapyends with a catalogue of remedies to expel wind.Love melancholy is the main theme of the last

partition. Burton, with customary thoroughness,anatomizes the subject from every possible aspect.Previously when discussing the symptoms ofwomen's melancholy he rather abruptly pulls him-self up. 'What have I to do with nuns, maids,virgins, widows ? I am a bachelor myself, andlead a monastic life in a college.' But now hedefends himself on the plea that 'an old, a gravediscreet man is fittest to discourse on love mattersbecause he hath likely more experience, observedmore, hath a more staid judgement, can betterdiscern, resolve, discuss, advise, give bettercautions, and more solid precepts, better informhis auditors on such a subject, and by reason ofhis riper years sooner divert.' There is no doubthe was acutely aware of the drawbacks of a lifeof celibacy enforced on him as a cleric and aFellow of a college, and his frustrations find morethan ample scope in discoursing on a subjectwhich, to many clerics was taboo. ' It is an un-natural and impious thing to bar men of this

204 April 1948by copyright.

on August 25, 2020 by guest. P

rotectedhttp://pm

j.bmj.com

/P

ostgrad Med J: first published as 10.1136/pgm

j.24.270.199 on 1 April 1948. D

ownloaded from

NICOL: Robert Burton's Anatomy of MelancholyChristian liberty, too severe and inhuman anedict.'The wealth of adjectives and epithets displayed

is truly amazing. The tyranny of love over men iswell illustrated in the following passage: ' For anold fool to dote, to see an old lecher, what moreodious, what can be more absurd ? ... How manydecrepit, hoary, harsh, writhen, bursten bellied,crooked, toothless, bald, blear-eyed, impotent,rotten old men shall you see flickering still inevery place ? One gets him a young wife, anothera courtesan, and when he can scarce lift his legover a sill, and hath one foot already in Charon'sboat, when he hath the trembling in his joints,the gout in his feet, a perpetual rheum in his head," a continuate cough," his sight fails him, thickof hearing, his breath stinks, all his moisture isdried up and gone . .. and very child again, thatcannot dress himself, or cut his own meat, yet hewill be dreaming of, and honing after wenches,what can be more unseemly ?' Similar invectivesare' levelled against old women, who are just asbad.

Burton is extremely bitter against the nuns andmore particularly abbesses; stories are quoted asfactual information and hardly bear repetition.The torture of the man in love cannot be compre-hended, ' the Spanish Inquisition is not com-parable to it.'That love is blind affords Burton another

opportunity of dilating on the follies committed bythe frailty of human nature. ' Though she be verydeformed of herself, ill-favoured, wrinkled,pimpled, pale, red, yellow, tanned, tallow-faced,have a swollen juggler's platter face or a thin, lean,chitty face . . . goggle-eyed, blear-eyed, or withstaring eyes . .. have a sharp fox nose, a red nose,China flat . .. rotten teeth, black, uneven, brownteeth, beetle browed, a witch's beard, her breathstink all over her room, her nose drips winter andsummer, filthy long unpared nails ... gouty legs,her ankles hang over her shoes.... If he love heronce, he admires her for all this, he takes no noticeof any such errors, or imperfections of body andmind; he had rather have her than any womah inthe world.'

Burton concludes, ' there is no end of love'ssymptoms, 'tis a bottomless pit.' Cure for lovemelancholy is first of all 'to be always occupied,seriously intent.' A lean diet is prescribed andyoung men should refrain from reading the Bookof Genesis. All kinds of subterfuges are devisedto put the unfortunate man off; think of what thefair maiden will be like when she grows old, ' onegrows too fat, another too lean.' He proceeds togive us an example of alliteration, which mightwell adorn any textbook of grammar: ' modestMatilda, pretty pleasing Peg, sweet singing Susan,

mincing merry Moll, dainty dancing Doll, neatNancy, jolly Joan, nimble Nell, kissing Kate,bouncing Bess, fair Phillis, fiddling Frank, tallTib, slender Sib, etc., they all quickly lose theirgrace, grow fulsome, stale, sad, heavy, dull, sourand all at last out of fashion.' He is outrageouslyone-sided, ' I will say nothing of dissolute andbad husbands, of bachelors and their vices . . .

and lest I should mar any matches, or disheartenloving maids, for this present I will let them pass ! '

Yet, in spite of this recital of the many pitfallsthat beset us, he comes to the conclusion afterall ' the last refuge and surest remedy . . . whenno other means will take effect, is to let them gotogether and enjoy one another.'

Space does not allow the discussion of religiousmelancholy, which is regarded as a branch of lovemelancholy, largely due to the concept held inBurton's age that the deprivation of love-God'slove-was a cause of melancholy. This review,however, would be incomplete without somereference to the current views on folk-lore anddemonology. The book is a mine of informationregarding both. We read how at Hamel, inSaxony, ' An. 1484, 20 Junii, the devil in likenessof a pied piper, carried away I30 children thatwere never after seen.' Cardan relates of hisfather that in ' An. I49I, I3 August, he conjuredup seven devils, in Greek apparel, about 40 yearsof age, some ruddy of complexion, and some pale,as he thought, he asked them many questions, andthey made ready answer, that they were aerialdevils, that they lived and died as men did; savethat they were Tar longer lived (700 or 8oo years).'Then there is the sad story of Katherine Gualter,

a cooper's daughter, An. 1571, 'that had suchstrange passions and convulsions, three men couldnot sometimes hold her; she purged a live eel,which he (Cornelius Gemma, the narrator) sawa foot and a half long, and touched it himself;but. the eel afterwards vanished; she vomitedsome 24 pounds of fulsome stuff of all colours,twice a day for 14 days; and after that she voidedgreat balls of hair, pieces of wood, pigeons' dung,parchment, goose dung, coals; and after them2 pounds of pure blood, and then again coals andstones, of which some had inscriptions bigger thana walnut.... This I saw with horror. They coulddo no good on her by physick, but left her to theclergy.'We read of aerial spirits, how such a one was

bound to Cardan's father for 28 years. ' The airis not so full of flies in summer as it is at all timesof invisible devils.'

For Chorus sancti viti, or St. Vitus' dance, itwas still a prevailing practice in Germany formusicians to be hired to play to them and somelusty sturdy companions to dance with them.

April 1948 205

by copyright. on A

ugust 25, 2020 by guest. Protected

http://pmj.bm

j.com/

Postgrad M

ed J: first published as 10.1136/pgmj.24.270.199 on 1 A

pril 1948. Dow

nloaded from

zo6 POST GRADUATE MEDICAL JOUIRNAL April 1948Some stories, however, were even too much for

Burton, who quotes, with his tongue in his cheek,the story of the Roman Prince and the JewishRabbi who was asked why the Jew's God wascompared to a lion. The reply came that it wasno ordinary lion but one in the Wood Ela which,when he asked to see it, the Rabbi prayed to Godhe might, 'and forthwith the lion set forward.But when he was 400 miles from Rome he soroared that all the great-bellied women in Romemade abortions, the City walls fell down, and hecame a hundred miles nearer, and roared a secondtime, their teeth fell out of their heads, the Em-peror him'self fell down dead, and so the lionwent back.'

In contrast to these myths we are provided witha deal of factual information here and there. Forinstance we know that Philip, the French king,who married the King of Denmark's daughter,sent her back to her father after the first nightbecause her breath stunk. The strict observanceof ritual with its severe discipline led to themartyrdom in I270 of a Jew who 'fell into aprivy upon a Saturday and without help could notpossibly get out; he called to his fellows forsuccour, but they denied it, because it was theirSabbath; the bishop hearing of it the next dayforbade him to be pulled out because it was ourSunday. In the meantime the wretch died beforeMonday.'So we have wandered at random through the

pages of this remarkable book which, in some ways,might be regarded as one of the earliest bookswritten in English on psychiatry. Jordan Smithwrites, 'his great book is the enduring expressionof a widely read scholar, of a clever craftsman, who

had the genius to knit together threads from athousand looms and thus to make a fine, stoutpattern all his own.'We have heard how Burton used to go down to

the Bridge-foot at Oxford and listen, to thebargees and how for three years he was a Clerk tothe Market; he was a keen student of humannature.

His concept of melancholy embraced a muchwider field of mental disorders than we wouldaccept today. He describes the hysteric and illus-trates many other types in whom the prominentsymptoms are hallucinations, delusions, per-versions and compulsions. Nevertheless theapprehension and fear experienced by the melan-cholic is very real and far from 'imaginary,' thesense of unworthiness and the narrow marginbetween the pathological and the normal is fullyrealized. ' Some are so gently melancholy, that inall their carriage, and to the outward apprehensionof others it can hardly be discerned, yet to theman intolerable burden, and not to be endured.'Many of his ideas on therapy are fundamentallysound and he is fully alive to the conflicts andrepressions of the mind. The need for socialreform as outlined in the Utopia he describes,is indeed applicable to our present-day prob-lems.

BIBLIOGRAPHY

BLACKWOOD, Vol. 90, 323, i86i.BURTON, Anatomy of Melancholy, edited by A. R. Shilleto, Georga

Bell & Sons, I896.EVANS, Bergen Psychiatry of Robert Burton, Columbia Univ.

Press, I944.JORDAN-SMITH, PAUL, Bibliographia Burtoniana, Stanford

Univ. Press, I931.

MODERN THERAPY OF THYROTOXICOSISBy J. F. GOODWIN, M.D., M.R.C.P.

From the Department of Pharmacology and Therapeutics, University of Sheffield, and the Royal Infirmary, Sheffield.

In 1943, Astwood and his associates, on thebasis of animal experiments, concluded thatthiourea and its derivatives inhibited the synthesisof thyroxin and that the resultant deficiency ofthyroxin resulted in an increased output ofpituitary thyrotropin, which produced thyroidhyperplasia. This thyroid hyperplasia was not in-fluenced by large amounts of iodine but was

abolished by the administration of thyroid powderand by hypophysectomy. There was also almostcomplete disappearance of iodine from the thyroidgland after five days on thiouracil, suggestingthat thiouracil interfered with enzyme systemsnecessary for the normal conversion of di-iodo-tyrosine to thyroxin.

Later in I943, Astwood investigated other re-

by copyright. on A

ugust 25, 2020 by guest. Protected

http://pmj.bm

j.com/

Postgrad M

ed J: first published as 10.1136/pgmj.24.270.199 on 1 A

pril 1948. Dow

nloaded from