Montalto promoted the four temperaments of humorism first proposed by Hippocrates and Galen; later on he also promoted astrology. Based on his writings, Montalto’s approach seemed to be more psychological than medical; he must have been successful, as his services remained in demand throughout his life.
Only one full case report related to his treatment of a patient is recorded, that of the French Queen’s controversial confidante, Léonora Galigai-Concini. Montalto diagnosed her with “Bulbus hystericus” and recommended a conservative, non-invasive treatment approach comprised of a change in diet, fresh air, daily walks, minor exercises, and sexual abstention for six weeks. His treatment of her apparently helped.7,12 She herself testified to that in 1606.14(p54),17 Interestingly, Léonora would eventually be beheaded for being a Jewish witch in 1617 (one year after Montalto’s death).18
Montalto would later write a treatise on love-sickness and list the treatments he had recommended to be used for Léonora’s case.14 In modern times, Léonora’s illness might have been interpreted as a psychosomatic disease. History provides ample evidence of her possible psychological problems. Hers was a marriage of convenience, and only after the wedding did she learn that her husband had a different sexual orientation. She was also deeply involved in mysticism.18 Hence, Montalto may well have diagnosed what is now understood to be a psychosomatic disease; his treatment could be viewed as an early form of psychotherapy, although such a diagnosis and treatment had not yet been defined.6
Montalto is particularly recognized for his contributions in the form of medical publications, particularly two books with extant copies available only in major European libraries. His books were reviewed in 19298 and the 1930s;2,6 some commentary on his work, with inconsistent data, was published in 1980s;3,4,9,11,12 and a more recent psychiatric review was published in 2003.5
Montalto’s first book was Optica: on vision, on the visual organs and theory of vision
, written in Latin and published in 1606.15
The contents of the book, in addition to the preface, provide ample evidence of Montalto’s medical expertise: he writes that he had been offered a position in the medical faculty of the University of Rome, a position he declined due to fear of compromising his religious convictions.13,14
The book includes chapters discussing the superiority of vision to all other senses, a description of the structure and nature of the eye (with no autopsy details), and he proposes that vision is actually generated in the brain and not in the eye; he also states that vision results from rays emitted from the eye through images received in the eye. In support of his theories, Montalto quoted Exodus 20:18, which literally interpreted reads: “All the people saw the voices” (Figure 1). Hence, he believed that sound was transformed into images and perceived in the brain.
Another chapter in Optica dealt specifically with the function, form, and position of the lens, and yet another one with eye color. The book was considered to be psychologically descriptive rather than a study of vision (optics). The book was widely disseminated, and a second edition was reprinted in 1613. The book must be considered as scientifically precocious for 1604.
Montalto’s second major work was Archipathologia
, dated 1614, a psychological treatise on mental and neurological disorders. This volume included chapters on pain, headaches, delirium (brain fever), melancholy, coma, insomnia, lethargy, incomplete unconsciousness (Coros
), catalepsy, vertigo, night-mare, epilepsy, and apoplexy. A total of 18 “tractates,” over 817 pages, covered all mental disturbances known at that time.18
In each chapter, Montalto offered a Hippocratic explanation, described the symptomatology, established the diagnosis, assumed the prognosis, and, finally, gave a therapeutic suggestion. Most remarkable were the pharmaceuticals offered for each condition.6,18