...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.[8]
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):
If we thoroughly consider its Nature, it will be found to be a spasmodico-flatulent Disorder of the Primae Viae, that is, of the Stomach and Intestines, arising from an Inversion or Perversion of their peristaltic Motion, and, by the mutual consent of the Parts, throwing the whole nervous System into irregular Motions, and disturbing the whole Oeconomy of the Functions.... no part or Function of the Body escapes the Influence of this tedious and long protracted Disease, whose Symptoms are so violent and numerous, that it is no easy Task either to enumerate or account for them.... No disease is more troublesome, either to the Patient or Physician, than hypochondriac Disorders; and it often happens, that, thro' the Fault of both, the Cure is either unnecessarily protracted, or totally frustrated; for the Patients are so delighted, not only with a Variety of Medicines, but also of Physicians.... On the contrary, few physicians are sufficiently acquainted with the true Genius and Nature of this perplexing Disorder; for which Reason they boldly prescribe almost everything contained in the Shops, not without an irreparable Injury to the Patient (article on "Hypochondriacus Morbis").
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)[9]—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,[10] 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.[11] "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,[12] 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."