Hypochondriasis Part 1

Hypochondriasis.

by John Hill.

INTRODUCTION

"When I first dabbled in this art, the old distemper call'd _Melancholy_ was exchang'd for _Vapours_, and afterwards for the _Hypp_, and at last took up the now current appellation of the _Spleen_, which it still retains, tho' a learned doctor of the west, in a little tract he hath written, divides the _Spleen_ and _Vapours_, not only into the _Hypp_, the _Hyppos_, and the Hyppocons; but subdivides these divisions into the _Markambles_, the _Moonpalls_, the _Strong-Fiacs_, and the _Hockogrokles_."

Nicholas Robinson, _A New System of the Spleen, Vapours, and Hypochondriack Melancholy_ (London, 1729)

Treatises on hypochondriasis--the seventeenth-century medical term for a wide range of nervous diseases--were old when "Sir" John Hill, the eccentric English scientist, physician, apothecary, and hack writer, published his _Hypochondriasis_ in 1766.[1] For at least a century and a half medical writers as well as lay authors had been writing literature of all types (treatises, pamphlets, poems, sermons, epigrams) on this most fashionable of English maladies under the variant names of "melancholy," "the spleen," "black melancholy," "hysteria," "nervous debility," "the hyp." Despite the plethora of _materia scripta_ on the subject it makes sense to reprint Hill's _Hypochondriasis_, because it is indeed a "practical treatise" and because it offers the modern student of neocla.s.sical literature a clear summary of the best thoughts that had been put forth on the subject, as well as an explanation of the causes, symptoms, and cures of this commonplace malady.

No reader of seventeenth- and eighteenth-century English literature needs to be reminded of the interest of writers of the period in the condition--"disease" is too confining a term--hypochondriasis.[2] Their concern is apparent in both the poetry and prose of two centuries. From Robert Burton's Brobdingnagian exposition in _The Anatomy of Melancholy_ (1621) to Tobias Smollett's depiction of the misanthropic and ailing Matthew Bramble in _Humphry Clinker_ (1771), and, of course, well into the nineteenth century, afflicted heroes and weeping heroines populate the pages of England's literature. There is scarcely a decade in the period 1600-1800 that does not contribute to the literature of melancholy; so considerable in number are the works that could be placed under this heading that it actually makes sense to speak of the "literature of melancholy." A kaleidoscopic survey of this literature (exclusive of treatises written on the subject) would include mention of Milton's "Il Penseroso" and "L'Allegro," the meditative Puritan and nervous Anglican thinkers of the Restoration (many of whose narrators, such as Richard Baxter, author of the _Reliquiae Baxterianae_,[3] are afflicted), Swift's "School of Spleen" in _A Tale of a Tub_, Pope's hysterical Belinda in the "Cave of Spleen," the melancholic "I" of Samuel Richardson's correspondence, Gray's leucocholy, the psychosomatically ailing characters of _The Vicar of Wakefield_ and _Tristram Shandy_, Boswell's _Hypochondriack Papers_ (1777-1783) contributed to the _London Magazine_, and such "sensible" and "sensitive" women as Mrs. Bennett and Miss Bates in the novels of Jane Austen. So great in bulk is this literature in the mid eighteenth century, that C. A. Moore has written, "statistically, this deserves to be called the Age of Melancholy."[4] The vastness of this literature is sufficient to justify the reprinting of an unavailable practical handbook on the subject by a prolific author all too little known.[5]

The medical background of Hill's pamphlet extends further back than the seventeenth century and Burton's _Anatomy_. The ancient Greeks had theorized about hypochondria: hypochondriasis signified a disorder beneath (hypo) the gristle (chondria) and the disease was discussed princ.i.p.ally in physiological terms. The belief that hypochondriasis was a somatic condition persisted until the second half of the seventeenth century at which time an innovation was made by Dr. Thomas Sydenham. In addition to showing that hypochondriasis and hysteria (thought previously by Sydenham to afflict women only) were the same disease, Sydenham noted that the external cause of both was a mental disturbance and not a physiological one. He also had a theory that the internal and immediate cause was a disorder of the animal spirits arising from a clot and resulting in pain, spasms, and bodily disorders. By attributing the onset of the malady to mental phenomena and not to obstructions of the spleen or viscera, Sydenham was moving towards a psychosomatic theory of hypochondriasis, one that was to be debated in the next century in England, Holland, and France.[6] Sydenham's influence on the physicians of the eighteenth century was profound: Cheyne in England, Boerhaave in Holland, La Mettrie in France. Once the theory of the nervous origins of hypochondria gained ground--here I merely note coincidence, not historical cause and effect--the disease became increasingly fashionable in England, particularly among the polite, the aristocratic, and the refined. Students of the drama will recall Scrub's denial in _The Beaux' Stratagem_ (1707) of the possibility that Archer has the spleen and Mrs. Sullen's interjection, "I thought that distemper had been only proper to people of quality."

Toward the middle of the eighteenth century, hypochondria was so prevalent in people's minds and mouths that it soon a.s.sumed the abbreviated name "the hyp." Entire poems like William Somervile's _The Hyp: a Burlesque Poem in Five Canto's_ (1731) and Tim Scrubb's _A Rod for the Hyp-Doctor_ (1731) were devoted to this strain; others, like Malcom Flemyng's epic poem, _Neuropathia: sive de morbis hypochondriacis et hystericis, libri tres, poema medic.u.m_ (1740), were more technical and scientific. Professor Donald Davie has written that he has often "heard old fashioned and provincial persons [in England and Scotland]

even in [my] own lifetime say, 'Oh, you give me the hyp,' where we should say 'You give me a pain in the neck'"[7]; and I myself have heard the expression, "You give me the pip," where "pip" may be a corruption of "hyp." As used in the early eighteenth century, the term "hyp" was perhaps not far from what our century has learned to call _Angst_. It was also used as a synonym for "lunacy," as the anonymous author of _Anti-Siris_ (1744), one of the tracts in the tar-water controversy, informs us that "Berkeley tells his Countrymen, they are all mad, or _Hypochondriac_, which is but a fashionable name for Madness." Bernard Mandeville, the Dutch physician and author of _The Fable of the Bees_, seems to have understood perfectly well that hypochondriasis is a condition encompa.s.sing any number of diseases and not a specific and readily definable ailment; a condition, moreover, that hovers precariously and bafflingly in limbo between mind and body, and he stressed this as the theme of his _Treatise of the Hypochondriack and Hysteric Pa.s.sions, Vulgarly Call'd the Hypo in Men and Vapours in Women_ (1711). The mental causes are noted as well in an anonymous pamphlet in the British Museum, _A Treatise on the Dismal Effects of Low-Spiritedness_ (1750) and are echoed in many similar early and mid-eighteenth century works. Some medical writers of the age, like Nicholas Robinson, had reservations about the external mental bases of the hyp and preferred to discuss the condition in terms of internal physiological causes:

...of that Disorder we call the Vapours, or _Hypochondria_; for they have no material distinctive Characters, but what arise from the same Disease affecting different s.e.xes, and the Vapours in Women are term'd the _Hypochondria_ in Men, and they proceed from the Contraction of the Vessels being depress'd a little beneath the Balance of Nature, and the Relaxation of the Nerves at the same Time, which creates that Uneasiness and Melancholy that naturally attends Vapours, and which generally is an Intemperature of the whole Body, proceeding from a Depression of the Solids beneath the Balance of Nature; but the Intemperature of the Parts is that Peculiar Disposition whereby they favour any Disease.[8]

But the majority of medical thinkers had been persuaded that the condition was psychosomatic, and this belief was supported by research on nerves by important physicians in the 1740's and 1750's: the Monro brothers in London, Robert Whytt in Edinburgh, Albrecht von Haller in Leipzig. By mid century the condition known as the hyp was believed to be a real, not an imaginary ailment, common, peculiar in its manifestations, and indefinable, almost impossible to cure, producing very real symptoms of physical illness, and said to originate sometimes in depression and idleness. It was summed up by Robert James in his _Medicinal Dictionary_ (London, 1743-45):

If we thoroughly consider its Nature, it will be found to be a spasmodico-flatulent Disorder of the _Primae Viae_, that is, of the Stomach and Intestines, arising from an Inversion or Perversion of their peristaltic Motion, and, by the mutual consent of the Parts, throwing the whole nervous System into irregular Motions, and disturbing the whole Oeconomy of the Functions.... no part or Function of the Body escapes the Influence of this tedious and long protracted Disease, whose Symptoms are so violent and numerous, that it is no easy Task either to enumerate or account for them....

No disease is more troublesome, either to the Patient or Physician, than hypochondriac Disorders; and it often happens, that, thro' the Fault of both, the Cure is either unnecessarily protracted, or totally frustrated; for the Patients are so delighted, not only with a Variety of Medicines, but also of Physicians.... On the contrary, few physicians are sufficiently acquainted with the true Genius and Nature of this perplexing Disorder; for which Reason they boldly prescribe almost everything contained in the Shops, not without an irreparable Injury to the Patient (article on "Hypochondriacus Morbis").

This is a more technical description than Hill gives anywhere in his handbook, but it serves well to summarize the background of the condition about which Sir John wrote.

Hill's _Hypochondriasis_ adds little that is new to the theory of the disease. It incorporates much of the thinking set forth by the writings mentioned above, particularly those of George Cheyne, whose medical works _The English Malady_ (1733) and _The Natural Method of Cureing the Diseases of the Body, and the Disorders of the Mind Depending on the Body_ (1742) Hill knew. He is also conversant with some Continental writers on the subject, two of whom--Isaac Biberg, author of The _Oeconomy of Nature_ (1751), and Rene Reaumur who had written a history of insects (1722)[9]--he mentions explicitly, and with William Stukeley's _Of the Spleen_ (1723). Internal evidence indicates that Hill had read or was familiar with the ideas propounded in Richard Blackmore's _Treatise of the Spleen and Vapours_ (1725) and Nicholas Robinson's _A New System of the Spleen, Vapours, and Hypochondriack Melancholy_ (1729).

Hill's arrangement of sections is logical: he first defines the condition (I), then proceeds to discuss persons most susceptible to it (II), its major symptoms (III), consequences (IV), causes (V), and cures (VI-VIII). In the first four sections almost every statement is commonplace and requires no commentary (for example, Hill's opening remark: "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.") His belief that the condition afflicts sedentary persons, particularly students, philosophers, theologians, and that it is not restricted to women alone--as some contemporary thinkers still maintained--is also impossible to trace to a single source, as is his description (p. 12) of the most prevalent physiological _symptoms_ ("lowness of spirits, and inapt.i.tude to motion; a disrelish of amus.e.m.e.nts, a love of solitude....

Wild thoughts; a sense of fullness") and _causes_ (the poor and damp English climate and the resultant clotting of blood in the spleen) of the illness.

Sections V-VIII, dealing with causes and cures, are less commonplace and display some of Hill's eccentricities as a writer and thinker. He uses the section ent.i.tled "Cures" as a means to peddle his newly discovered cure-all, water dock,[10] which Smollett satirized through the mouth of Tabitha Bramble in _Humphry Clinker_ (1771). Hill also rebelled against contemporary apothecaries and physicians who prescribed popular medicines--such as Berkeley's tar-water, Dover's mercury powders, and James's fever-powders--as universal panaceas for the cure of the hyp.

"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"

(p. 24). However scientifically correct Hill may have been in minimizing the efficacy of current pills and potions advertised as remedies for the hyp, he was unusual for his time in objecting so strongly to them. Less eccentric was his allegiance to the "Ancients" rather than to the "Moderns" so far as chemical treatment (i.e., restoration of the humours by chemical rearrangement) of hypochondriasis is concerned.[11] "The venerable ancients," Hill writes, "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" (p. 24).

Still more idiosyncratic, perhaps, is Hill's contention (p. 25) that the air of dry, high grounds worsens the condition of the patient. Virtually every writer I have read on the subject believed that onset of the hyp was caused by one of the six non-naturals--air, diet, lack of sufficient sleep, too little or too much exercise, defective evacuation, the pa.s.sions of the mind; and although some medical writers emphasized the last of these,[12] few would have concurred with Hill that the fetid air of London was less harmful than the clearer air at Highgate. All readers of the novel of the period will recall the hypochondriacal Matt Bramble's tirade against the stench of London air. Beliefs of the variety here mentioned cause me to question Hill's importance in the history of medicine; there can be no question about his contributions to the advancement of the science of botany through popularization of Linnaeus' system of bis.e.xual cla.s.sification, but Hill's medical importance is summarized best as that of a compiler. His recommendation of the study of botany as a cure for melancholics is sensible but verges on becoming "a digression in praise of the author," a poetic _apologia pro vita sua_ in Augustan fashion:

For me, I should advise above all other things the study of nature.

Let him begin with plants: he will here find a continual pleasure, and continual change; fertile of a thousand useful things; even of the utility we are seeking here. This will induce him to walk; and every hedge and hillock, every foot-path side, and thicket, will afford him some new object. He will be tempted to be continually in the air; and continually to change the nature and quality of the air, by visiting in succession the high lands and the low, the lawn, the heath, the forest. He will never want inducement to be abroad; and the unceasing variety of the subjects of his observation, will prevent his walking hastily: he will pursue his studies in the air; and that contemplative turn of mind, which in his closet threatened his destruction, will thus become the great means of his recovery (pp. 26-27).

Hill was forever extolling the claims of a life devoted to the study of nature, as we see in a late work, _The Virtues of British Herbs_ (1770).

Judicious as is the logic of this recommendation, one cannot help but feel that the emphasis here is less on diversion as a cure and more on the botanic attractions of "every hedge and hillock, every foot-path side, and thicket."

While Hill's rules and regulations regarding proper diet (Section VII) are standard, several taken almost _verbatim et literatim_ from Cheyne's list in _The English Malady_ (1733), his recommendation (Section VIII) of "Spleen-Wort" as the best medicine for the hypochondriac patient is not. Since Hill devotes so much s.p.a.ce to the virtues of this herb and concludes his work extolling this plant, a word should be said about it.

Throughout his life he was an active botanist. Apothecary, physician, and writer though he was, it was ultimately botany that was his ruling pa.s.sion, as is made abundantly clear in his correspondence.[13] Wherever he lived--whether in the small house in St. James's Street or in the larger one on the Bayswater Road--he cultivated an herb garden that flattered his knowledge and ability. Connoisseurs raved about its species and considered it one of the showpieces of London. His arrogant personality alone prevented him from becoming the first Keeper of the Apothecary's Garden in Chelsea, although he was for a time superintendent to the Dowager Princess of Wales's gardens at Kensington Palace and at Kew. His interest in cultivation of herbs nevertheless continued; over the years Hill produced more than thirty botanical works, many of them devoted to the medical virtues of rare herbs such as "Spleen-Wort." Among these are _The British Herbal_ (1756), _On the Virtues of Sage in Lengthening Human Life_ (1763), _Centaury, the Great Stomachic_ (1765), _Polypody_ (1768), _A Method of Curing Jaundice_ (1768), _Instances of the Virtue of Petasite Root_ (1771), and _Twenty Five New Plants_ (1773).[14] It is therefore not surprising that he should believe a specific herb to be the best remedy for a complicated medical condition. Nor is his reference to the Ancients as authority for the herbal pacification of an inflamed spleen surprising in the light of his researches: he was convinced that every illness could be cured by taking an appropriate herb or combination of herbs. Whereas a few nonmedical writers--such as John Wesley in _Primitive Physick_ (1747)--had advocated the taking of one or two herbs in moderate dosage as anti-hysterics (the eighteenth-century term for all cures of the hyp), no medical writer of the century ever promoted the use of herbs to the extent that Hill did. In fairness to him, it is important to note that his herbal remedies were harmless and that many found their way into the official _London Pharmacopeia_. "The virtues of this smooth Spleen-wort," he insists, "have stood the test of ages; and the plant every where retained its name and credit: and one of our good herbarists, who had seen a wonderful case of a swoln spleen, so big, and hard as to be felt with terror, brought back to a state of nature by it"

(p. 37).[15] The greatest portion of Hill's concluding section combines advertis.e.m.e.nt for the powder medicine he was himself manufacturing at a handsome profit together with a protest against competing apothecaries: "An intelligent person was directed to go to the medicinal herb shops in the several markets, and buy some of this Spleen-wort; the name was written, and shewn to every one; every shop received his money, and almost every one sold a different plant, under the name of this: but what is very striking, not one of them the right" (p. 42).

Treatises on hypochondriasis did not cease to be printed after Hill's in 1766, but continued to issue from the presses into the nineteenth century. A good example of this is the tome by John Reid, physician to the Finsbury Dispensary in London, _Essays on Insanity, Hypochondriasis and Other Nervous Affections_ (1816), which summarizes theories of the malady.[16] A bibliographical study of such works would probably reveal a larger number of t.i.tles in the nineteenth century than in the previous one, but by this time the nature and definition of hypochondria had changed significantly.

If John Hill's volume is not an important contribution in the history of medicine, it is a lucid and brief exposition of many of the best ideas that had been thought and written on the hyp, with the exception of his uninhibited prescribing of herbal medicines as cure-alls. An understanding of this disease is essential for readers of neocla.s.sical English literature, especially when we reflect upon the fact that some of the best literature of the period was composed by writers whom it afflicted. It is perhaps not without significance that the greatest poet of the Augustan age, Alexander Pope, thought it necessary as he lay on his deathbed in May 1744 to exclaim with his last breath, "I never was hippish in my whole life."[17]

University of California, Los Angeles

NOTES TO THE INTRODUCTION

[1] The text here reproduced is that of the copy in the Library of the Royal Society of Medicine, London. t.i.tle pages of different copies of the first edition of 1766 vary. For example, the t.i.tle page of the copy in the British Museum reads, _Hypochondriasis; a Practical Treatise On the Nature and Cure of that Disorder, Commonly called the Hyp and the Hypo_. The copy in the Royal Society of Medicine contains, among other additions, the words "by Sir John Hill" in pencil, and "8vo Lond.

1766," written in ink and probably a later addition.

[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 _pa.s.sim_.

[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; Reaumur, 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 pa.s.sing 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, ent.i.tled _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_, x.x.x (1956), 233-40.