Aphorisms
Concerning the Knowledge and Cure of Diseases
Herman Boerhaave
1715 AD

In 1715 AD, Herman Boerhaave, Doctor, believed that insanity was caused entirely by "the Blood become thick, black, fat and earthy ... malignancy of the Blood and Humors, which the Ancients have called Black choler ... Atrabiliar Humor, or Melancholy Juice ... thick oil of the Blood ... nervous Juices from the Brain ... Liquids of the Brain and Nerves" Boerhaave believed that it was easy to cure if you followed his instructions: "the Cure doth also occur easie enough from these Principles". The cure involved: "repeated letting of Blood and strong Purges between each Bleeding, and afterwards when you have lay'd his fury, and have brought him to his Senses, then give him Cordials and Opiates." These became standard cures at Bedlam. But he also recommended water boarding which was clearly a moral treatment since it was to be done by surprise and would strike terror into the person: "Patient unwarily into the Sea, and to keep him under Water as long as he can possibly bear without being quite stifled." Boerhaave was either a bad discector or he invented his observastions about how the brains of mad were different in appearance: "by Anatomical Inspection it has been made evident, that the Brain of those is dry, hard, friable, and yellow in its Cortex; but the Vefleis turgid, varicous and distended with black and very tough Blood." (Aphorisms, Herman Boerhaave, 1715 AD)

Of Melancholy.

1089. Physicians call that Disease a Melancholy, in which the Patient is delirious long, and obstinately, without a Fever, and always intent upon one and the fame Thought.

1090. This Disease arises from that malignancy of the Blood and Humors, which the Ancients have called Black choler : And again, though this Disease doth begin in what is called the Mind, it yet doth render the Choler black in the Body very soon.

1091. It will be therefore needful to draw a small Sketch of this wonderful Disease, whereof the Doctrine is supposed commonly to be so dark, that Antiquity is unjustly blamed for it.

1092. If the most moveable parts of all the Blood be dissipated and have left the less moveable united, then will the Blood become thick, black, fat and earthy. And this defect will be call'd by the Name of an Atrabiliar Humor, or Melancholy Juice.

1093. Whereof the Cause is whatever doth expel the most moveable and fixes the rest: A violent Exercise of the Mind; the dwelling Night and Day mostly upon one and the fame Object; a constant wakefulness; great motions of the Mind, whether of Joy or Sorrow; great and laborious motions of the Body much repeated, chiefly in a very hot and dry Air; hereto refer also Immoderate Veneryi rough, hard, dry, earthy Aliments long used without any Motion or Exercise of the "Body to digest them; The like drink; Parts of Animals ary'd in Smoak, Air or Salt, chiefly of old and tough ones; unripe Fruits; meally unfermented Matters; adstringent, coagulating, sticking and cooling Medicines, and slow Poisons of the like Nature : hot Fevers hanging about long, often returning without a good Crisis and going off without the Help of diluting Means.

1094. When this Evil already bred in the Blood and produced by these Causes doth yet infect equally all the circulating mass of Humors, it will produce some Diseases, which will appear immediately, and are mostly as follows; The Colour of the Patient internally and externally is first paler, yellower, more tawny, livid, black with the like Spots; the Pulse flowery Coldness greater; a slow Breathing; The Circulation through the Blood-vessels good, more sparing through the Side vessels, and less good; hence a slower, less, and thicker separation of all the secretory and excretory Humors, a less wasting of 'em; a lessen'd Appetite; a Leanness; Sorrowfulness; love of Solitude; all the Affections of the Mind violent and lasting ; an Indifferency to all other Matters' , a Laziness as to Motion; and yet a very great and earnest Application to any sort of Study or Labour.

1095. Its matter therefore is the earth and thick oil of the Blood united and closed up together, which is worse in its Effects, and more difficult to cure, according to its degrees of fluidity, softness, dryness, thickness, intimate mixture and time of being so.

I096. Hence are the Diagnostics and Prognostics plain enough (though yet clearer from what follows) and the rationality of the Cure doth also occur easie enough from these Principles.

1097. For as soon as it shews itself by what is did in the Beginning of both, (1093, and 1094.) either as a Cause or an Effect, the Physician ought to procure a continual change of Objects and that without the Patient's knowledge; and such ought to be chosen, which are able to raise a Passion opposite to the most predominant in him : Sleep ought to be procured him by diluting, softning, paregoric, narcotic Medicines, and by Rest; Let him breath a moist and moderately warm Air; his Aliments be light, liquid, like unto our wholsome Liquors, recent, soft, loosening with a gentle soapy Faculty, and he must continue long in the use of 'em : Give diluting Medicines, as soften the Acrimony, resolve the oily Earthines, loosen the Vessels, expel with a gentle Stimulus; Such are the Juices of thorough-ripe Fruits, all things made up with Honey, Garden Herbs, and Broaths made of them; Mineral Waters: The best Drink is a Ptisane sweetened with a little Honey. And above all things, great Care must be taken to debar him from all the Causes of the Illness (1093.)

1098. But if that very Matter (1092.) be from the same Causes (1093.) grown thicker, tougher, and less moveable; it must necessarily be drove into the Hypochondriac Vessels; this the Nature of that Humor, the seat and condition of those Vessels and the Laws of motion of the Liquids do demonstrate. Here it will gradually stop, be accumulated and stagnate: Then it is called an Hypochondriac Disease, or in usual terms in England, The Spleen; as it doth obsess the Spleen, Stomach, Pancreas, Caul or Mesentery.

1099. Hence it produces there gradually a sense of a constant weight, anguish, fullness, chiefly after eating and drinking; a difficult breathing from the Bowels of the abdomen being burthened; Impediments of both the Cholers, of the pancreatic, stomachic, mesenteric Juice, and of the Intestines as to the confection, secretion, mixture, and operation upon the Aliments; hence the first digestion vitiated all manner of ways; a corruption of the Aliments in a crude acid, if they were of the vegetable Kind, or into a putrid Alcali, or an oily rustiness, if they were of the animal Kind, hence Belches, Winds, Cramps, Costiveness, and very hard Stools; a Jaundice of a worse sort than the First in (1094.) and all the bad Symptoms of (1094.) now grown much worse.

1100. When it is already grown to the Height of (1098.) and has shewn itself such by its Effects of (1099.) Then ought no time nor means to be neglected towards the Cure; for other ways the Evil soon grows terrible in its Nature; and those Difficulties ought to be prevented if possible: If it continues in this state any time it becomes incurable , and sometimes mortal, as will appear hereafter : If you attack it with purging Medicines, you only drive out the wholesome and moveable Humors, but the tough and bad ones do stay behind, whence the Disease grows worse still : If you attempt the Cure with stimulating and powerfully resolving Medicines, then doth often the loosen'd Matter grow very sharp, and throwing it self with a great violence upon the tender Vessels of the Liver, it destroys them, whence many and incurable Ills.

1101. So that, 1. The Matter is to be render'd moveable slowly, inquiring into the Nature of the predominant Acrimony; then giving soapy Medicines in which there is an Acrimony predominant over that which is in the peccant Matter; These must be continued till the unequal and weak Pulse, a nauseating, or a continual pressing to go to Stool, an Anxiety, and a small Fever do signify that the Matter is put into motion; And then, 2. Drive the same out immediately with a gentle opening Purge, a Glyster of the fame kind, Milk-whey, Mineral-waters, and the like.

1102. But if that very Matter of (1098.) already fixed, and drove in close, has been detain'd there long; the fame begins already to grow sharp and gnawing by its Stagnation, the motion of the Bowels and the heat of surrounding Parts; new Matter is continually laid on, because the Obstruction is made already, and the fame Causes do subsist; hence it extends, gnaws and corrupts the Vessels by its encreased bulk, its present Acrimony and continual Motion; hence the like destruction of the Spleen, Stomach, Pancreas, Caul, Mesentery, Intestines, and Liver, and consequently all the Evils of (1099.) do increase the former much, but disturbs chiefly all the Functions, and above all those of the Brain, by the constant Steam of the putrified Matter received into the Veins. And then may it be called by the true Name of Atra bilis.

1103. Which being discover'd by these its Signs, laid down in (1093. 1094. 1099. 1102.) cannot but with the greatest Prudence and Skill be thinn'd, moved or drove out, because of the Difficulties mention'd in 1100.) Which here are yet greater, and because that the Matter now arrived to its greatest decree of Acrimony is easily stirr'd up, but very difficulty quieted again. Let therefore all his Diet be of a very opposite nature to the known predominant Acrimony of the Matter, described in (1051.) Let the same always be gently resolving, stimulating, loosening by Stool, carrying off almost all the Excrements after each Digestion; his drink be of a Ptyfane with some Honey, or made of ripe Fruits, or Milk-whey; Let his Motions be gentle, but continued; his Heat very temperate ; his Sleep long; Let him frequently use Bathing, Fomentations, Glysters, and drink of those things which being free from Acrimony do thin the Matter by diluting, resolving, cleansing and soaking, and then. do expel the same very slowly and cautiously, and that only through the Passage as Nature directs, having always an eye to the singular Acrimony in this Case, which never fails of being present in view.

1104. But when that Evil of (1102.) is already advanced to a great Acrimony, with the Bowels already much corrupted, if during the said (1102.) causes it be put in motion and stirred up with a muscular Motion, the heat of Sun or Fire, a plentiful and sharp Diet, sharp and much stirring Medicines which will ferment with the sharpness of the Evil, poisons that hurt by the fame operation, or lastly with some Diseases; Then doth the fame, grown sharper and moveable and already changed into an Agent, break, corrupt and dissolve its Vessels into a Rottenness, and change them with the very Atra bilis into putriified Bags ; and now it is the Atra bilis become turgid', And when this is now Brought so far, if liquefied in its Vessels, and transported towards and into the Liver, creeping into the consumed ramifications of the Vena Cava, it be let into the Heart, then doth it create those pernicious Evils : for if it participates of a coagulating Acid, it creates Polypusses of the Heart, Lungs, Aorta, Carotids, their ill Consequences and Death : If it reaches the Brain it produces Apoplexies, Palsies, a Catalepse, an Epilepsy, Deliriums, furious Madness, all these of the worst Sort and Incurable. In the System of Arteries it changes the whole face of Things, there it brings forth very terrible Fevers, which do putrify all things very suddenly : If it participates of the putrifying Alcali, it creates suddenly killing Gangrenes wherever it reacheth. Whence innumerable and incurable Diseases over the whole Body and each singular Part, unless this sirik and Nest be cleansed and stopped up. But if the Matter, having eat through the Vessels of the Bowels, doth fall into the Cavities of the Peritoneum, there ariseth immediately a very great and insuperable Weakness; a Putrefaction and an accumulation of the sharp delapsed Matter; Then a Gangrenous eating of all the abdominal Entrails, whence most admirable and terrible Phænomena, a Tympanitis; Death with a prodigious Stench : But if the fame, when put into a Motion, doth throw it self upon the Liver, and from thence through the dilated and eaten bilious Vessels into the Gall-bladder, the Ductus hepaticus, the common Ductus, into the Intestines, then doth it create Loathings, Vomitings, atrabiliar Bloody-Fluxes, with an Anguish, an Impetus, Pain, Gnawing, all intolerable; whence Inflammations, Ulcerations, Putrifactions 6F the Intestines, Stomach, Gullet, Jaws, and Mouth : Hence terrible Convulsions, and at last a pretty easie Death following upon the Gangrene, and consequently the loss of feeling in all the Parts of the Body.

1105. But when the Matter is become as is (1104.) it has together with a very great toughness, not unlike Pitch, a most sharp acid Acrimony, which is able to eat into Metals, to make Earth ferment; or an Alcaline, very corrosive ; or an oily putrid salt which is worst of all. All which distinct Sorts whence they come, how they are known, how cured has been sufficiently demonstrated before from (58. to 107. and 1051, 1052.)

1106. And it is easie to all, who consider what was said in ( 1000. 1003. 1004.) and the Sear, Structure and Circulation of the Bowels, in which this malignant Humor doth reside, That this Disease is greater than to admit of a Cure. But the chief Helps are such as dilute with a sharpness of an opposite Nature to the predominant Acrimony, or Opium.

1107. From which (1090. to 1107.) the Nature of Melancholy and Hypochondriac Diseases as described in (1089.) is known : for it is evident , that from a long continued preceding sorrowfulness, the Vessels of the abdominal Bowels create a Stagnation, Alteration, and Accumulation of black choler (1092. 3. 5. 1098.1102. 1104.) Which insensibly increased!, though the Body was very healthful but a little before : And also that the fame black choler, when bred from bodily Causes, doth produce that Delirium of (1084.).

1108. The apparent Causes of Melancholy therefore have been observed to be, 1. All things, which fix, exhaust, or confound the nervous Juices from the Brain; as great and much unforeseen frightful Accidents; a great application upon any Object whatever, strong Love, Waking, Solitude, Fear, and hysterical Affections. 2. Those which hinder and confound the Confection, Refection, Circulation, the various Secretions and Excretions of the Blood, chiefly if done in the Spleen, Stomach; Caul, Pancreas, Mesentery, Intestines, Liver, Womb, or hemorroidal Vessels : and consequently quently any hypocondriac Disease, acute ones, imperfectly cured, and chiefly a Phrenitis, ora burning Fever; all exceeding Secretions and Excretions, eating, and drinking cold, earthy, tough, rough, or adstringent Aliments; too great a heat long continued, which doth as it were, roast the Blood; a stagnating, sunny, or too shady Air. 3. A natural disposition of the Body, such as a black, ho3ry, dry, lean or manly one ; A middle Age; a sharp, deep and penetrating Judgment.

1109. If this (1089.) Disease doth continue long it occasions Foolishnefs,Epilepsies,Apoplexies, furious Madness, Convulsions, Blindness, wonderful Fancies, Laughters, Cryings, Singings, Sighings, Belchings, Anguishes; great Evacuations of Urine, sometimes clear like fair Water, at other times very thick; a retention, accumulation, often a sudden Excretion of bloody Fæces in the Vessels of the abdominal Viscera; an obstinate Costiveness, a thin and frequent Spitting, and they can endure to be without Sleep, Aliments, or Fire, even to a Wonder.

1110. A Cure has often unexpectedly been obtain'd at the appearance and breaking out of a nasty Itch sometimes coming up and resembling a Leprosie; or numerous Varices and them very large; or flowing of the much swell'd Piles; or at the voiding of black Choler upwards and downwards.

1111. It grows much worse upon the taking of any Medicines, that weaken Strength , and evacuate roughly; or again upon the taking of such as put the Liquids into a violent Motion, whether they be Cordials, or cryed up under any other Title.

1112. So that the best Method to cure this Disease, is to apply different Remedies and opposite to the different Sorts known from the exact: observation of the proximate Cause and different Constitution of the Patient.

1113. 1, The Indications will be therefore to excite, increase, and bring into a good order the Liquids of the Brain and Nerves which is done a. By withdrawing the Mind from the usual object to others contrary to the fame. b. By causing and raising very artfully another Passion of the Mind contrary to the constant Melancholic one. c. Sometimes by Siding with them in their false and depraved Fancies. d. Or often by opposing the fame with a great Force.

1114. 2. By opening, softning, cutting, stimulating the Obstructions, or the Cause, or the Effects of a false Imagination, with mineral Waters, Milk-whey, Water and Honey, Splanchnick, Hepatic or Antihypochondriac Decoctions, Waters made effectual with the addition of Lixivious or Compound Salts; loosening Mercurials, Vomits, Motions, Exercises, Riding, or going in a Boat; Medicines which evacuate from the Womb (as are the Aristolochica) or the Piles Bathings, Ointments, or Plaisters.

1115. 3. Easing the Symptoms with Bleeding, ducking into cold Water, by Carminatives and Opiates.

1116. 4. After the just mentioned Evacuations, By giving such as Experience doth (hew us to be Exhilarating and to strengthen all the Parts of the Body.

1117. From which (mo. to 1117.) it appears, that the Cure of this Disease (1089.) is perfected in curing the black Choler (1097.1100, 1101. 1103. 1106.) And that we must hence learn the Cure not only of this Disease : But of an infinite Number of others, which are wrongfully reputed incurable.

1118. If Melancholy (1089.) increases so far, that from the great motion of the Liquid of the brain the Patient be thrown into a wild Fury, it is call'd Madness.

1119. Which differs only in degree from the sorrowful kind of Melancholy, is its Offspring, produced from the fame Causes, and cured almost by the fame Remedies.

1120. In which Disease the Patient generally shews a great Strength of the Muscles, an incredible Wakefulness, a bearing to a wonder of Cold and Hunger, frightful Fancies, Endeavours to bite Men like Wolves, or Dogs, &c.

1121. And we must take notice that by Anatomical Inspection it has been made evident, that the Brain of those is dry, hard, friable, and yellow in its Cortex; but the Vefleis turgid, varicous and distended with black and very tough Blood.

1122. And also that almost all the Excretions are suspended.

1123. The greatest Remedy for it is to throw the Patient unwarily into the Sea, and to keep him under Water as long as he can possibly bear without being quite stifled.

1124. When all Remedies have been tryed in vain, it has sometimes happen'd that varicous Tumors, Piles, Dysenteries, Dropsies, great Hæmprragies come of themselves, and Tertian or Quartan s Agues have cured this Disease.

1125. This fort of Madness is occasion'd sometimes after the Body has been exhausted by an autumnal, strong, obstinate intermitting Fever, and not only thus weaken'd by the Disease but by repeated Bleedings, and Purges; which fame will also occasion the return of this Disease.

1126. This sort is cured only with restorative, replenishing, Cordials, strengthning Aliments and Medicines long continued : But if you attempt the Cure of it by Evacuations, you'll cause a Wasting, Weakness, and an insuperable Foolishness. "NB. See Sydenbams Treatise of the Intermitting kind of Fevers from the Year 1661. to 1664."

1127. But a Madness bred in strong, hail, youthful, plethoric People of a hot Constitution, is cured by the fame Means as that sort of Epilepsy in (1081.) By repeated letting of Blood and strong Purges between each Bleeding, and afterwards when you have lay'd his fury, and have brought him to his Senses, then give him Cordials and Opiates.

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