Part 4

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,

will waste the flame of this unheeded life: and while he labours to unsphere the spirit of Plato 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.