Chapter 2

[2] Melancholy, hypochondriasis, and the spleen were considered in the seventeenth and eighteenth centuries to be one complex condition, a malady rather than a malaise, which is but a symptom. Distinctions among these, of interest primarily to medical historians, cannot be treated here. As good a definition as any is found in Dr. Johnson's _Dictionary_ (1755): "Hypochondriacal.... 1. Melancholy; disordered in the imagination.... 2. Producing melancholy...." The literature of melancholy has been surveyed in part by C. A. Moore, "The English Malady," _Backgrounds of English Literature 1700-1760_ (Minneapolis, 1953), pp. 179-235. In medical parlance, "hypochondria" means the soft parts of the body below the costal cartilages, and the singular form of the word, "hypochondrium," means the viscera situated in the hypochondria, i.e., the liver, gall bladder, and spleen.

[3] See Samuel Clifford's _The Signs and Causes of Melancholy, with directions suited to the case of those who are afflicted with it. Collected out of the works of Mr. Richard Baxter_ (London, 1716) in the British Museum.

[4] _Backgrounds of English Literature_, p. 179.

[5] See my forthcoming biography, _The Literary Quack: A Life of 'Sir' John Hill of London_, and John Kennedy's _Some Remarks on the Life and Writings of Dr. J---- H----, Inspector General of Great Britain_ (London, 1752).

[6] For some of this background see L. J. Rather, _Mind and Body in Eighteenth Century Medicine: A Study Based on Jerome Gaub's De Regimine Mentis_ (London, 1965), pp. 135-90 _passim_.

[7] _Science and Literature 1700-1740_ (London, 1964), pp. 50-51.

[8] _A New Theory of Physick_ (London, 1725), p. 56.

[9] Biberg was a Swedish naturalist and had studied botany under Linnaeus in Uppsala; Réaumur, a French botanist, had contributed papers to the _Philosophical Transactions_ of the Royal Society in London.

[10] _The Power of Water-Dock against the Scurvy whether in the Plain Root or Essence...._ (London, 1765), had been published six months earlier than _Hypochondriasis_ and had earned Hill a handsome profit.

[11] I have treated aspects of this subject in my article, "Matt Bramble and The Sulphur Controversy in the XVIIIth Century: Medical Background of _Humphry Clinker_," _JHI_, XXVIII (1967), 577-90.

[12] See, for example, Jeremiah Waineright, _A Mechanical Account of the Non-Naturals_ (1707); John Arbuthnot, _An Essay Concerning the Effects of Air on Human Bodies_ (1733); Frank Nichols, _De Anima Medica_ (1750).

[13] Hill's correspondence is not published but shall be printed as an appendix to my forthcoming biography.

[14] I have discussed some of these works in connection with the medical background of John Wesley's _Primitive Physick_ (1747). See G. S. Rousseau, _Harvard Library Bulletin_, XVI (1968), 242-56.

[15] It is difficult to know with certainty when Hill first became interested in the herb. He mentions it in passing in _The British Herbal_ (1756), I, 526 and may have sold it as early as 1742 when he opened an apothecary shop.

[16] Reid's dissertation at Edinburgh, entitled _De Insania_ (1798), contains materials on the relationship of the imagination to all forms of mental disturbance. Secondary literature on hypochondria is plentiful. Works include: R. H. Gillespie, _Hypochondria_ (London, 1928), William K. Richmond, _The English Disease_ (London, 1958), Charles Chenevix Trench, _The Royal Malady_ (New York, 1964), and Ilza Vieth, _Hysteria: The History of a Disease_ (Chicago, 1965), and "On Hysterical and Hypochondriacal Afflictions," _Bulletin of the History of Medicine_, XXX (1956), 233-40.

[17] Joseph Spence, _Observations, Anecdotes, and Characters of Books and Men_, ed. James M. Osborn (Oxford, 1966), I, 264.

I am indebted to A. D. Morris, M.D., F.R.S.M., for help of various sorts in writing this introduction.

BIBLIOGRAPHICAL NOTE

The text of this facsimile of _Hypochondriasis_ is reproduced from a copy in the Library of the Royal Society of Medicine, London.

HYPOCHONDRIASIS.

A

PRACTICAL TREATISE, &c.

HYPOCHONDRIASIS.

SECT. I.

The NATURE of the DISORDER.

To call the Hypochondriasis a fanciful malady, is ignorant and cruel. It is a real, and a sad disease: an obstruction of the spleen by thickened and distempered blood; extending itself often to the liver, and other parts; and unhappily is in England very frequent: physick scarce knows one more fertile in ill; or more difficult of cure.

The blood is a mixture of many fluids, which, in a state of health, are so combined, that the whole passes freely through its appointed vessels; but if by the loss of the thinner parts, the rest becomes too gross to be thus carried through, it will stop where the circulation has least power; and having thus stopped it will accumulate; heaping by degrees obstruction on obstruction.

Health and chearfulness, and the quiet exercise of mind, depend upon a perfect circulation: is it a wonder then, when this becomes impeded the body looses of its health, and the temper of its sprightliness? to be otherwise would be the miracle; and he inhumanly insults the afflicted, who calls all this a voluntary frowardness. Its slightest state brings with it sickness, anguish and oppression; and innumerable ills follow its advancing steps, unless prevented by timely care; till life itself grows burthensome.

The disease was common in antient Greece; and her physicians understood it, better than those perhaps of later times, in any other country; who though happy in many advantages these fathers of the science could not have, yet want the great assistance of frequent watching it in all its stages.

Those venerable writers have delivered its nature, and its cure: in the first every thing now shews they were right; and what they have said as to the latter will be found equally true and certain. This, so far as present experience has confirmed it, and no farther, will be here laid before the afflicted in a few plain words.

SECT. II.

Persons Subject to it.

Fatigue of mind, and great exertion of its powers often give birth to this disease; and always tend to encrease it. The finer spirits are wasted by the labour of the brain: the Philosopher rises from his study more exhausted than the Peasant leaves his drudgery; without the benefit that he has from exercise. Greatness of mind, and steady virtue; determined resolution, and manly firmness, when put in action, and intent upon their object, all also lead to it: perhaps whatever tends to the ennobling of the soul has equal share in bringing on this weakness of the body.

From this we may learn easily who are the men most subject to it; the grave and studious, those of a sedate temper and enlarged understanding, the learned and wise, the virtuous and the valiant: those whom it were the interest of the world to wish were free from this and every other illness; and who perhaps, except for this alloy, would have too large a portion of human happiness.

Though these are most, it is not these alone, who are subject to it. There are countries where it is endemial, and in other places some have the seeds of it in their constitution; and in some it takes rise from accidents. In these last it is the easiest of cure; and in the first most difficult.

Beside the Greeks already named, the Jews of old time were heavily afflicted with this disease; and in their descendants to this day it is often constitutional: the Spaniards have it almost to a man; and so have the American Indians. Perhaps the character of these several nations may be connected with it. The steady honour, and firm valour of the Spaniard, very like that of the ancient Doric nation, who followed the flute not the trumpet to the field; and met the enemy, not with shouts and fury, but with a determined virtue: it is the temper of the Hypochondriac to be slow, but unmoveably resolved: the Jew has shewn this mistakenly, but almost miraculously; and the poor Indian, untaught as he is, faces all peril with composure, and sings his death-song with an unalter'd countenance.

Among particular persons the most inquiring and contemplative are those who suffer oftenest by this disease; and of all degrees of men I think the clergy. I do not mean the hunting, shooting, drinking clergy, who bear the tables of the great; but the retir'd and conscientious; such as attend in midnight silence to their duty; and seek in their own cool breasts, or wheresoever else they may be found, new admonitions for an age plunged in new vices. To this disease we owe the irreparable loss of Dr. YOUNG; and the present danger of many other the best and most improved amongst us. May what is here to be proposed assist in their preservation!

The Geometrician or the learned Philosopher of whatever denomination, whose course of study fixes his eye for ever on one object, his mind intensely and continually employed upon one thought, should be warned also that he is in danger; or if he find himself already afflicted, he should be told that the same course of life, which brought it on, will, without due care, encrease it to the most dreaded violence.

The middle period of life is that in which there is the greatest danger of an attack from this disease; and the latter end of autumn, when the summer heats have a little time been over, is the season when in our climate its first assaults are most to be expected. The same time of the year always increases the disorder in those who have been before afflicted with it; and it is a truth must be confessed, that from its first attack the patient grows continually, though slowly, worse; unless a careful regimen prevent it.

The constitutions most liable to this obstruction are the lean, and dark complexioned; the grave and sedentary. Let such watch the first symptoms; and obviate, (as they may with ease) that which it will be much more difficult to remove.

It is happy a disease, wherein the patient must do a great deal for himself, falls, for the most part, upon those who have the powers of reason strongest. Let them only be aware of this, that the distemper naturally disposes them to inactivity; and reason will have no use unless accompanied with resolution to enforce it.

Though the physician can do something toward the cure, much more depends upon the patient; and here his constancy of mind will be employed most happily. No one is better qualified to judge on a fair hearing what course is the most fit; and having made that choice, he must with patience wait its good effects. Diseases that come on slowly must have time for curing; an attention to the first appearances of the disorder will be always happiest; because when least established it is easiest overthrown: but when that happy period has been neglected, he must wait the effects of such a course as will dilute and melt the obstructing matter gradually; for till that be done it is not only vain, but sometimes dangerous, to attempt its expulsion from the body.

The blood easily separates itself into the grosser and the thinner parts: we see this in bleeding; and from the toughness of the red cake may guess how very difficult it will be to dissolve a substance of like firmness in the vessels of the body. That it can thus become thickened within the body, a Pleurisy shews us too evidently: in that case it is brought on suddenly, and with inflammation; in this other, slowly and without; and here, even before it forms the obstruction, can bring on many mischiefs. Various causes can produce the same effect, but that in all cases operates most durably, which operates most slowly. The watery part of the blood is its mild part; in the remaining gross matter of it, are acrid salts and burning oils, and these, when destitute of that happy dilution nature gives them in a healthy body, are capable of doing great mischief to the tender vessels in which they are kept stagnant.

SECT. III.

The SYMPTOMS of the DISORDER.

The first and lightest of the signs that shew this illness are a lowness of spirits, and inaptitude to motion; a disrelish of amusements, a love of solitude and a habit of thinking, even on trifling subjects, with too much steadiness. A very little help may combat these: but if that indolence which is indeed a part of the disorder, will neglect them; worse must be expected soon to follow.

Wild thoughts; a sense of fullness, weight, and oppression in the body, a want of appetite, or, what is worse, an appetite without digestion; for these are the conditions of different states of the disease, a fullness and a difficulty of breathing after meals, a straitness of the breast, pains and flatulencies in the bowels, and an unaptness to discharge their contents.

The pulse becomes low, weak, and unequal; and there are frequent palpitations of the heart, a little dark-coloured urine is voided at some times; and a flood of colourless and insipid at others; relieving for a moment, but increasing the distemper: there is in some cases also a continual teazing cough, with a choaking stoppage in the throat at times; then heartburn, sickness, hardness of the belly, and a costive habit, or a tormenting and vain irritation.

The lips turn pale, the eyes loose their brightness and by degrees the white grows as it were greenish, the gums want their due firmness, with their proper colour; and an unpleasing foulness grows upon the teeth: the inside of the mouth is pale and furred, and the throat dry and husky: the colour of the skin is pale (though there are periods when the face is florid) and as the obstruction gathers ground, and more affects the liver, the whole body becomes yellow, tawny, greenish, and at length of that deep and dusky hue, to which men of swift imagination have given the name of blackness.

These symptoms do not all appear in any one period of the disease, or in one case, but at one time or other all of them, as well as those which follow: the flesh becomes cold to the touch, though the patient does not himself perceive it; the limbs grow numbed and torpid, the breathing dull and slow, and the voice hollow; and usually the appetite in this period declines, and comes almost to nothing: night sweats come on, black swellings appear on the veins, the flesh wastes and the breast becomes flat and hollow: the mouth is full of a thin spittle, the head is dizzy and confus'd, and sometimes there is an unconquerable numbness in the organs of speech.

I have known the temporary silence that follows upon this last symptom become a jest to the common herd; and the unhappy patient, instead of compassion and assistance, receive the reproof of sullenness, from those who should have known and acted better.

About twenty years ago I met on a visit at Catthorpe in Leicestershire a young gentleman of distinguished learning and abilities, who at certain times was speechless. The vulgar thought it a pretence: and a jocose lady, where he was at tea with company, putting him as she said to a trial, poured out a dish very strong and without sugar. He drank it and returned the cup with a bow of great reserve, and his eye bent on the ground: she then filled the cup with sugar, and pouring weak tea on it, sent it him: he drank that too, looked at her steadily, and blushed for her. The lady declared the man was dumb; the rest thought him perverse, and obstinate; but a constant and steady perseverance in an easy method cured him.

All these are miseries which the disease, while it retains its natural form, can bring upon the patient; and thus he will in time be worn out, and led miserably, though slowly, to the grave. Let him not indulge his inactivity so far as to give way to this, because it is represented as far off; the disease may suddenly and frightfully change its nature; and swifter evils follow.

SECT. IV.

The DANGER.

We have done with the obstruction considered in itself; but this, though often unsurmountable by art, at least by the methods now in use, will be sometimes broken through at once by nature, or by accidents; and bring on fatal evils. These are strictly different diseases, and are no otherway concerned here, than as the consequences of that of which we are treating.

The thick and glutinous blood which has so long stagnated in the spleen, will have in that time altered its nature, and acquired a very great degree of acrimony: while it lies dormant, this does no more mischiefs, than those named already; but when violent exercise, a fit of outrageous anger, or any thing else that suddenly shocks and disturbs the frame, puts it in motion, it melts at once into a kind of liquid putrefaction. Being now thin, it mixes itself readily with the blood again, and brings on putrid fevers; destroys the substance of the spleen itself, or being thrown upon some other of the viscera, corrodes them, and leads on this way a swift and miserable death. If it fall upon the liver, its tender pulpy substance is soon destroyed, jaundices beyond the help of art first follow, then dropsies and all their train of misery; if on lungs, consumptions; if on the brain, convulsions, epilepsy, palsy, apoplexy; if on the surface, leprosy.

The intention of cure is to melt this coagulation softly, not to break it violently; and then to give it a very gentle passage through the bowels. There is no safe way for it to take but that; and even that when urged too far may bring on fatal dysenteries.

Let none wonder at the sudden devastation which sometimes arises from this long stagnant matter, when liquified too hastily: how long, how many years the impacted matter will continue quiet in a schirrous tumour of the breast; but being once put in motion, whether from accident, or in the course of nature, what can describe; or what can stop its havock!

Instances of the other are too frequent. A nobleman the other day died paralytick: dissection shewed a spleen consumed by an abscess, formed from the dissolved matter of such an obstruction: and 'tis scarce longer since, a learned gentleman, who had been several years lost to his friends, by the extreams of a Hypochondriacal disorder, seem'd gradually without assistance to recover: but the lungs suffered while the spleen was freed; and he died very soon of what is called a galloping consumption.

When the obstruction is great and of long continuance, if it be thus hastily moved, the consequence is, equally, a sudden and a miserable death, whether, like the matter of a cancer, it remains in its place; or like that of a bad small pox, be thrown upon some other vital part.

Let not the patient be too much alarmed; this is laid down to caution, not to terrify him: it is fit he should know his danger, and attend to it; for the prevention is easy; and the cure, even of the most advanced stages, when undertaken by gentle means, is not at all impracticable: to assist the physician, let him look into himself, and recollect the source of his complaint. This he may judge of from the following notices.

SECT. V.

The Causes of the HYPOCHONDRIASIS.

The obstruction which forms this disease, may take its origin from different accidents: a fever ill cured has often caused it; or the piles, which had been used to discharge largely, ceasing; a marshy soil, poisoned with stagnant water, has given it to some persons; and altho' indolence and inactivity are oftenest at the root, yet it has arisen from too great exercise.

Real grief has often brought it on; and even love, for sometimes that is real. Study and fixed attention of the mind have been accused before; and add to these the stooping posture of the body, which most men use, though none should use it, in writing and in reading. This has contributed too much to it; but of all other things night studies are the most destructive. The steady stillness, and dusky habit of all nature in those hours, enforce, encourage, and support that settled gloom, which rises from fixt thought; and sinks the body to the grave; even while it carries up the mind to heaven. He who would have his lamp

_At midnight hour Be seen in some high lonely tower,_[18]

will waste the flame of this unheeded life: and while he labours to unsphere the spirit of Plato[18] will let loose his own.

SECT. VI.

The Cure of the HYPOCHONDRIASIS.

Let him who would escape the mischiefs of an obstructed spleen, avoid the things here named: and let him who suffers from the malady, endeavour to remember to which of them it has been owing; for half the hope depends upon that knowledge.

Nature has sometimes made a cure herself, and we should watch her ways; for art never is so right as when it imitates her: sometimes the patient's own resolution has set him free. This is always in his power, and at all times will do wonders.

The bleeding of the piles, from nature's single efforts, has at once cured a miserable man; where their cessation was the cause of the disorder. A leprosy has appeared upon the skin, and all the symptoms of the former sickness vanished. This among the Jews happened often: both diseases we know were common among them: and I have here seen something very like it: Water-Dock has thrown out scorbutic eruptions, and all the former symptoms of an Hypochondriacal disorder have disappeared: returning indeed when these were unadvisedly struck in; but keeping off entirely when they were better treated. A natural purging unsuppressed has sometimes done the same good office: but this is hazardous.

It is easy to be directed from such instances; only let us take the whole along with us. Bleeding would have answered nature's purpose, if she could not have opened of herself the hæmorrhoidal vessels; but he who should give medicines for that purpose, might destroy his patient by too great disturbance. If a natural looseness may perform the cure, so may an artificial; when the original source of the disorder points that way. But these are helps that take place only in particular cases.

The general and universal method of cure must be by some mild and gently resolving medicine, under the influence of which the obstructing matter may be voided that, or some other way with safety. The best season to undertake this is the autumn, but even here there must be caution.

In the first place, no strong evacuating remedy must be given; for that, by carrying off the thinner parts of the juices, will tend to thicken the remainder; and certainly encrease the distemper. No acrid medicine must be directed, for that may act too hastily, dissolve the impacted matter at once, and let it loose, to the destruction of the sufferer; no antimonial, no mercurial, no martial preparation must be taken; in short, no chymistry: nature is the shop that heaven has set before us, and we must seek our medicine there. The venerable ancients, who knew not this new art, will lead us in the search; and (faithful relators as they are of truth) will tell us whence we may deduce our hope; and what we are to fear.

But prior to the course of any medicine, and as an essential to any good hope from it, the patient must prescribe himself a proper course of life, and a well chosen diet: let us assist him in his choice; and speak of this first, as it comes first in order.

SECT. VI.

Rules of Life for Hypochondriac Persons.

Air and exercise, as they are the best preservers of health, and greatest assistants in the cure of all long continued diseases, will have their full effect in this; but there requires some caution in the choice, and management of them. It is common to think the air of high grounds best; but experience near home shews otherwise: the Hypochondriac patient is always worse at Highgate even than in London.