Part 3

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.

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.