Nervous Disease in Late Eighteenth-Century Britain

The Reality of a Fashionable Disorder

Heather R Beatty

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317321095
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

This study, based on extensive use of eighteenth-century newspapers, hospital registers and case notes, examines the experience of suffering from nervous disease – a supposedly upper-class malady. Beatty concludes that 'nervousness' was a legitimate medical diagnosis with a firm basis in eighteenth-century medical theory.

1 DEFINING NERVOUS DISEASE IN EIGHTEENTH-CENTURY BRITAIN

By the eighteenth century the disorders ‘commonly called nervous’ already had a long history, stretching back to the Hippocratic writings in the fourth century BC.¹ For hundreds of years doctors and natural philosophers debated the significance of a mind–body connection, the origins of hypochondria and hysteria, and the precise physiology allowing for what was widely acknowledged to be a confusing and inconstant set of symptoms. By the time the eminent nerve doctor Robert Whytt wrote his Observations on the Nature, Causes, and Cure of those Disorders which have been Commonly Called Nervous, Hypochondriac, or Hysteric (1764) in an effort to provide an updated and comprehensive medical text on these matters, the definition of nervous disease was as loaded as its history was long. Cultural implications of suffering from disordered nerves proliferated alongside clinical explanations for nervous disease. Hypochondria, hysteria and general nervous weakness encompassed a befuddling mixture of physical and emotional causes and consequences including emotional superiority, relaxed nervous fibres, wealth, dangerously strong passions, delicate physiology, genius and extreme sympathy between the mind and the malfunctioning body. Opinions regarding the verity and severity of nervous disease were as mixed as these explanations, with sceptics regarding it as an invention of overly sentimental novel readers and obsequious physicians, and believers insisting that anyone who doubted the pain and distress of nervous sufferers was simply ‘ignorant and cruel’.² The confused history of this malady prior to the mid-eighteenth century illuminates the reasons behind these disparate opinions.³ This history also elucidates the struggle of physicians to define the complicated set of disorders denominated ‘nervous’, and highlights the simple elegance and lasting significance of Whytt’s 1764 definition of nervous disease as an ailment ‘owing to an uncommon delicacy or unnatural sensibility of the nerves’.⁴

Historians have long acknowledged the vague nature of the definition of nervous disease and its cultural implications. ⁵ This chapter examines the reasons behind this ambiguity and explores the inevitable clash between cultural and pathological definitions of nervous disease in the eighteenth century.⁶ By addressing these issues it clarifies the reasons behind scepticism about nervous ailments on the part of many medical practitioners and members of the public.⁷ This chapter begins with an overview of the medical faculty’s variety of opinions regarding the causes of nervous disease from the seventeenth to the early eighteenth century. It then explores the ways in which these professional debates prompted an increasingly medically informed public to devise their own opinions regarding nervous ailments. Ultimately it reveals how, fuelled by the popularity of Scottish philosophy and sentimental literature, public definitions replete with flattering social implications of nervous disease predominated over starkly pathological definitions from the 1730s to the middle of the century. As this chapter will show, it was only with Whytt’s publication in 1764 that the medical world asserted its presumed dominion over nervous disease, and that the nerves, in turn, came to dominate the medical world.

Debates over the Structure and Function of the Nerves

For Hippocrates, hypochondriasis was an actual physical disorder in the spleen, or, more generally, the hypochondrium, an abdominal area located under the rib cage.⁸ Despite this physical cause, the symptoms of a disordered hypochondrium identified by the ancient Greeks were largely psychological, including strong emotional turmoil and melancholia. Greek medicine acknowledged the presence of mind–body connection, with Hippocratic writings noting common sense examples of the phenomenon including the way in which fear could make a man turn pale, and anger could cause his face to redden. Galen called similar attention to how the pulse was easily ‘altered by quarrels and alarms which suddenly disturb the mind’.⁹ Consequently, it was not surprising to the ancients that in addition to the physical effects of a deranged hypochondrium like painful digestion and flatulence, patients also experienced emotional symptoms such as fear and sorrow.

According to the Hippocratic texts, hysteria was closely related to hypochondria, although it was most common in unmarried or widowed women. With the exception of emotional or physical fits whereby women would convulse or laugh and cry uncontrollably, hysteria exhibited the same symptomology as the maledominated diagnosis of hypochondria: difficulty breathing, an irregular pulse, vomiting, belching, headaches and anxiety. Hysteria was commonly attributed to a ‘wandering womb’, in which the offending uterus would float upward, place pressure on the liver, and encumber the patient’s breathing.¹⁰ The simplest cure for hysteric patients was marriage and quick pregnancy, as a baby in the womb would supposedly help to weigh it down. Practitioners such as the respected Bath physician Robert Peirce subscribed to this notion well into second half of the seventeenth century. Among Pierce’s published cases is one of a nineteen-year-old female who was ‘more than ordinarily troubled with Vapours, and strange Fits (doubtless Hysterical)’. Although Pierce noted that his patient was cured by a course of the Bath waters, he prescribed marriage as the most reliable preventative of future fits. As he reflected in his published notes, ‘I hope my Lady, her Mother, (by giving her to a good Husband) prevented a Relapse’.¹¹

Medical theory changed little from ancient times to the seventeenth century. The celebrated seventeenth-century scholar Robert Burton’s Anatomy of Melancholy (1621) still relied heavily on Hippocratic humoural theories, identifying the four humours as the root cause of all distempers. Consequently, Burton very traditionally associated the melancholic and depressive state with an excess of black bile.¹² Although he composed 1,392 pages on melancholy, Burton did little to clearly define the disorder, claiming instead that ‘whether it be a cause or an effect, a Disease, or Symptome … I will not contende about it’.¹³ Among the symptoms of melancholy he listed feelings of fear and sorrow, disordered imagination and a loss of reason. Like his ancient predecessors, Burton believed strongly in a reciprocal relationship between mind and body:

For as the Body workes upon the minde, by his bad humours, troubling the Spirits, sending grosse fumes into the Braine; and so per consequens disturbing the Soule, and all the faculties of it with feare, sorrow, &c. which are ordinary symptoms of this Disease: so on the other side, the minde most effectually workes upon the Body, producing by his passions and perturbations, miraculous alterations; as Melancholy, despaire, cruell diseases, and sometimes death it selfe.¹⁴

Like Hippocrates, Burton noted that emotional turmoil could result in hypochondria and hysteria. Further blurring the already vague distinction between melancholia, hysteria and hypochondria, Burton identified a particular type of melancholy as ‘hypochondriacal melancholy’. The symptoms of hypochondriacal melancholy were twofold: those that affected the body, and those that affected the mind. Physical symptoms included ‘winde, rumbling in the guts, belly ake, heat in the bowels, convulsions, crudities, short winde, sowre & sharpe belchings, cold sweat, paine in the left side, suffocation, palpitation, heavinesse of the heart, singing in the eares, much spittle and moist, &c’. Psychological symptoms included a tendency to be ‘fearefull, sad, [and] suspitious’ while experiencing ‘discontent, anxiety &c’.¹⁵

Burton also acknowledged a strong connection between hypochondriacal melancholy and mental genius, insisting that most poets and academics were sufferers; The Anatomy included a lengthy chapter specifically devoted to the ‘Misery of Schollers’.¹⁶ Burton was hardly the first to suggest a connection between melancholia and creative genius. Hundreds of years earlier Aristotle even pondered why ‘all men who have become outstanding in philosophy, statesmanship, poetry or the arts are melancholic’.¹⁷ While Burton believed strongly in the ability of a superior mind to affect the body, he also believed that hypochondriacal melancholy could have an ‘inward’ physical cause. The physical source of hypochondriacal melancholy remained a mystery, although the spleen, a ‘cold stomach’ and an ‘over-hot liver’ were the primary culprits.¹⁸ Burton explained the difficulty of determining a physical cause, claiming that ‘in this hypochondriacal or flatuous melancholy, the symptoms are so ambiguous that the most well-trained physicians cannot identify the part involved’.¹⁹ Thus, Burton left his readers with a blurred distinction between melancholy, hysteria and hypochondria, as well as significant ambiguity regarding their physical causes.

In 1667 the renowned London physician and member of the Royal Society, Thomas Willis, lent some clarity to this vague picture with his publication on the Pathology of the Brain. As G. S. Rousseau has argued, Willis’s Pathology marked the beginning of a gradual shift from an understanding of the human body as a system of humours and hydraulics to the eighteenth-century’s notion of the body ruled by the nervous system. Willis argued that the human soul/mind was located in the brain, and that the nerves, running from the brain to the rest of the body were responsible for all of the body’s functions including sensation, movement and thought.²⁰ Because melancholy, hysteria and hypochondria involved problems with both an overly passionate mind and a malfunctioning body, the nerves were the most likely source behind these troubles. ‘[T]hose distempers,’ Willis proclaimed, ‘are for the greatest part convulsions and contractions of the nervous parts’.²¹ He explained,

Sometimes the Melancholy, being disturb’d in the spleen, conveys thence the passion to the Brain, whence disorderly and Hypochondriacal fancies happen: And on the contrary, when a violent Passion of the mind, occasionally rais’d within the brain troubles the Spirits residing in it, the impression given the fancy, is convey’d to the spleen by the course and successive affect of the spirits, lying within the nerves.²²

This ‘discovery’ made Willis a pivotal figure in the history of the nerves and nervous disease. As the presumed link between the brain and body, interest in the nerves skyrocketed after Willis, becoming the most significant topic in physiology until the nineteenth century.²³ In addition to identifying hypochondria and hysteria as specifically ‘nervous’ disorders, Willis also expanded the group of symptoms traditionally associated with these ailments to include ‘wandering pains’, ‘flushing of blood’, ‘a danger of swooning’ and a tendency to imagine themselves ‘being affected with diseases of which they are free’.²⁴

While the nerves gained newfound importance in the seventeenth century with Willis’s theory, they were not a new discovery; nerves were present even in the writings of Hippocrates and Galen, although they were often mistaken for sinews, ligaments and tendons. The ancients believed that the nerves were responsible for movement and sensation. The precise structure of the nerves was a matter of debate, with Aristotle arguing that the nerves emanated from the heart, and Galen rightly insisting centuries later that they stemmed from the brain. Galen further postulated that the nerves were hollow tubes, through which the body’s animating fluid, described as ‘pneuma psychikon’ or ‘animal spirits’, flowed, carrying sensory impressions to the brain.²⁵ Fifteen centuries later, Willis agreed, contending that animal spirits were the method by which ‘unseen messages’ were sent from the brain to the rest of the body.²⁶

Like, Willis, Thomas Sydenham, the ‘English Hippocrates’ of the late seventeenth century, also believed that nervous disease was the result of disordered animal spirits and convulsions or contractions of nervous parts. As Sydenham noted in his explanation of hysteria, ‘From this very disorder of the spirits is born that disturbance, and the continually variable abnormalities of both mind and body which prevail in hysterics and hypochondriacs alike’.²⁷ Sydenham further maintained that hypochondria and hysteria were the same disease; female sufferers were simply hysterics, and male sufferers were hypochondriacs. His posthumously published Compleat Method of Curing Almost All Diseases (1693) noted of ‘the disease called in women Hysterical; in men the Hypochondriacal Passion’ that ‘when the mind is disturb’d by some grievous accident, the animal spirits run into disorderly motions’.²⁸

Whereas Sydenham acknowledged that a physical disorder or disorder of the animal spirits was the cause of hypochondriac and hysteric symptoms, he maintained that strong emotions typically initiated these ailments. Thus, hypochondria and hysteria were both mental and physical disorders. Sydenham warned practitioners of the consequent difficulty entailed in diagnosing nervous ailments; because these diseases were often instigated by ‘disturbances of the mind’, he argued that their symptoms could not ‘be accounted for on the common principle of investigating diseases’. Instead, symptoms were varied and inconsistent, thereby frustrating physicians in search of a purely physical distemper.²⁹

Two years after Sydenham’s death, Sydenham’s friend and Thomas Willis’s prized pupil from Oxford, the medically educated philosopher John Locke, published his famous Essay Concerning Human Understanding (1690). In this essay, Locke discussed sensation at length, clearly adopting his tutor’s ideas about the nerves. Just as Willis held the nerves responsible for sensory impressions, and consequently for knowledge, so too did Locke insist that the nerves were ‘conduits’, conveying sensations to a receptive mind.³⁰ Locke’s work further cemented medical ideas about the connection between mind and body, showing how even a person’s train of thought, association of ideas and state of mind could have ‘considerable influence on the body’.³¹ Eighteenth century philosophers like David Hume, who, as will be discussed, further shaped the evolution of nervous theory, were large...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Introduction: Explaining a Fashionable Disorder
• 1 Defining Nervous Disease in Eighteenth-Century Britain
• 2 Quacks, Social Climbers, Social Critics and Gentlemen Physicians: The Nerve Doctors of Late Eighteenth-Century Britain
• 3 ‘Fester’d with Nonsense’: Nervous Patients in Late Eighteenth-Century Britain
• 4 The Pursuit of Health: The Treatment of Nervous Disease
• 5 A Disease of the Body and of the Times
• Epilogue
• Appendix
• Notes
• Works Cited
• Index