Part 2

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 René Réaumur who had written a history of insects (1722)--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 inaptitude to motion; a disrelish of amusements, 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 entitled "Cures" as a means to peddle his newly discovered cure-all, water dock, 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. "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 passions of the mind; and although some medical writers emphasized the last of these, 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 bisexual classification, 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 space 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 passion, as is made abundantly clear in his correspondence. 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). 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). The greatest portion of Hill's concluding section combines advertisement 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. A bibliographical study of such works would probably reveal a larger number of titles 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 neoclassical 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."

University of California, Los Angeles

NOTES TO THE INTRODUCTION

The text here reproduced is that of the copy in the Library of the Royal Society of Medicine, London. Title pages of different copies of the first edition of 1766 vary. For example, the title 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.

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.

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.

Backgrounds of English Literature, p. 179.

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).

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.

Science and Literature 1700-1740 (London, 1964), pp. 50-51.

A New Theory of Physick (London, 1725), p. 56.

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.

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.

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.

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).

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

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.

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.

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.