Hypochondriasis: a Practical Treatise (1766)

Part 1

The Augustan Reprint Society

JOHN HILL

HYPOCHONDRIASIS

A Practical Treatise.

(1766)

Introduction by

G. S. ROUSSEAU

Publication Number 135 William Andrews Clark Memorial Library University Of California, Los Angeles 1969

GENERAL EDITORS

William E. Conway, William Andrews Clark Memorial Library George Robert Guffey, University of California, Los Angeles Maximillian E. Novak, University of California, Los Angeles

ASSOCIATE EDITOR

David S. Rodes, University of California, Los Angeles

ADVISORY EDITORS

Richard C. Boys, University of Michigan James L. Clifford, Columbia University Ralph Cohen, University of Virginia Vinton A. Dearing, University of California, Los Angeles Arthur Friedman, University of Chicago Louis A. Landa, Princeton University Earl Miner, University of California, Los Angeles Samuel H. Monk, University of Minnesota Everett T. Moore, University of California, Los Angeles Lawrence Clark Powell, William Andrews Clark Memorial Library James Sutherland, University College, London H. T. Swedenberg, Jr., University of California, Los Angeles Robert Vosper, William Andrews Clark Memorial Library

CORRESPONDING SECRETARY

Edna C. Davis, William Andrews Clark Memorial Library

EDITORIAL ASSISTANT

Mary Kerbret, William Andrews Clark Memorial Library

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. 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 neoclassical 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. 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, 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." 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.

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 principally 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. 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 assumed 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 medicum (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 own lifetime say, 'Oh, you give me the hyp,' where we should say 'You give me a pain in the neck'"; 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 encompassing 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 Passions, 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 Sexes, 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.

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):

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