Madness, Melancholy and Medicine, pt 2

On the Treatment of Nervous Disorders

by Maria Grace

The early 19th century saw an epidemic rise in nervous disorders. Thought to be maladies of affluence and sophistication, doctors, surgeons and apothecaries rushed in to provide relief to a suffering and often monied clientele, so much so that after doctors started taking nervous disorders seriously, everyone seemed to be taking medication for them, outdoing each other with exaggerated symptoms and buying an array of medical equipment to deal with them. How strangely 21st century it all sounds.

Doctors did not agree as to the cause of nervous conditions.  Some, like Tennet, argued the stomach was at core of the disorder. Others, including Buchan believed the causes more complex.  Indolence and other things that relaxed or weakened the body like drinking tea, frequent bleeding or purging could lead to nervous disorders. While those things which hurt digestion could contribute to the problem, unfavorable postures of the body and intense application to study were equally likely to cause difficulties. 

The symptoms of nervous disorders were often thought to begin in the stomach, considered the center of the nervous system. These symptoms might be accompanied by difficulty breathing; violent palpitations of the heart, sudden flushes or a sense of cold in various parts of the body, pains throughout the body, variable pulse, fits of crying and convulsive laughing, poor sleep and night-mares. 

Progression of the disease would bring headaches, body cramps, mental disturbances including terror, sadness, weak memory and failure of judgment. 

Treatments for Nervous conditions

In many ways, the recommended treatments for nervous disorders were quite progressive. They included a multipronged approach that included diet, exercise, and adjustments of daily routine as well as medication. 

Since digestive troubles were considered a large contributor to nervous disorders, careful attention to diet was a major part of treatment.  “Persons afflicted with nervous diseases ought never to fast long. Their food should be solid and nourishing, but of easy digestion. Fat meats, and heavy sauces, are hurtful. All excess should be carefully avoided. …Wine and water is a very proper drink at meals: but if wine sours on the stomach, or the patient is much troubled with wind, brandy and water will answer better…All weak and warm liquors are hurtful, as tea, coffee, punch, &c. People may find a temporary relief in the use of these, but they always increase the malady, as they weaken the stomach and hurt digestion.” (Buchan)

As some doctors argue today, exercise was seen as superior to all medicines. Horseback riding and walking were considered ideal, but simply being quick about one’s business and active in their chores was recommended as well. When these were too much, even riding in a carriage could produce beneficial effect.

“A change of place, and the sight of new objects, by diverting the mind, has a great tendency to remove these complaints. For this reason a long journey, or a voyage, is of much more advantage than riding short journeys near home. Long sea voyages have an excellent effect; and to those who can afford to take them, and have sufficient resolution, we would by all means recommend this course.” (Buchan)

Patients were also advised to avoid great fires and seek cool dry air to brace and invigorate the body, though chills were to be avoided. Regular cold baths as well as frequently rubbing the body with a special brush, or a coarse linen cloth should be incorporated into the patient’s routine. Further, “they ought likewise to be diverted, and to be kept as easy and cheerful as possible. There is not anything which hurts the nervous system, or weakens the digestive powers, more than fear, grief, or anxiety.” (Buchan)

Though not seen as actual cures, a number of medicines might be recommended to render the patient’s life more comfortable. Mild purgatives to relieve constipation were recommended as were elixirs to improve digestion and strength the stomach.

Though laudanum was easily available, doctors cautioned against their overuse as opiates “only palliate the symptoms, and generally afterwards increase the disease (and) habit render them at last absolutely necessary.” 

Multiple forms of nervous conditions were recognized including: melancholy, nightmare, swoons, low spirits, hysteric affections and hypochondriac affections. Practioners recommended a unique approach to treatment for each disorder though they were all considered modifications of the same basic disease.

 OF MELANCHOLY

Melancholy was considered a state of insanity that rendered an individual incapable of enjoying the pleasures or performing normal duties of life and might terminate in absolute madness.

To ameliorate melancholy, a patient’s diet should consist of cooling and opening foods. This meant primarily a fruit and vegetable diet, avoiding animal proteins, including fish and shell fish. Onions and garlic were to be avoided as they ‘generate thick blood.’ Melancholic patients should avoid strong liquors of every kind, coffee and tea, instead drinking water, whey or small beer.

Open air exercises of all kinds were recommended to “dissolve the viscid humours, … remove obstructions, promote the perspiration, and all the other secretions.”  (Buchan) In contrast, confinement to a closed room would be the very worst thing for the patient.

A patient’s companions could play a key role in his or her improvement by providing the melancholic with a variety of amusements, entertaining stories, pastimes and music. Music in particular was considered highly efficacious.

Since suppression of ‘customary evacuations’, hard digestion or dryness of the brain were physical factors that contributed to a case of melancholy, medical interventions focused on keeping the body open and evacuating.  Bleeding was often employed as a means of evacuation.

Purging medicines as well as those which increased urine or perspiration were often prescribed for days, weeks or even months at a time. External applications such as blistering ointments and warm baths might also be used.

Of Low Spirits

Physicians of the era believed that those with weak nerves were likely to experience some degree of low spirits, a disturbance much like melancholy, but less severe. Symptoms could include sleeplessness, headaches, indigestion and loss of appetite. These would be exacerbated by solitude and gloomy thoughts.

Treatment for low spirits depended on the suspected cause.  Generous diets, cold baths, exercise, cheerful company and good amusements were thought to be the best medicine overall.  When the stomach or bowels were involved, infusions of Peruvian bark with cinnamon or nutmeg, or purges might be used.  When suppression of menstrual or of the hemorrhoidal flux was suspected, bleeding, blistering or other similar approach was called for.

Those with low spirits were cautioned against the use of too much alcohol, “as the unfortunate and melancholy often fly to strong liquors for relief, by which means they never fail to precipitate their own destruction.” (Buchan) 

Of Hypochondriac Affections

Those of melancholy temperament were the most susceptible to hypochondriac attacks in which “the worst consequences imagined from any unusual feeling even of the slightest kind; and in respect to such apprehensions and feelings, there is always the most obstinate believe and persuasion.” (Perkins) Physical symptoms tended to cluster around digestive upsets, and vague physical discomforts.

The hypochondriac patient should enjoy a solid and nourishing diet, avoiding windy vegetables. Flesh meats were highly recommended, the claret or madeira to wash them down. Every kind of exercise and cold bathing were considered beneficial as were long travels to warmer climates.

Medicines for this disease focused on strengthening the alimentary canal and promoting secretions. Thus the recommendation for “gentle opening medicine, [such] as pills composed of equal parts of aloes, rhubarb, and asafœtida, with as much of the elixir proprietatis as is necessary to form the ingredients into pills. Two, three, or four of these may be taken as often as it shall be found needful, to keep the body gently open. Such as cannot bear the asafœtida may substitute Spanish soap in its place.” (Buchan) 

Of Hysteric Affections

Women, who were considered particularly delicate, were thought to be most susceptible to hysterical complaints. These included fits or laughter or crying, fainting, convulsions, low spirits, anxiety, heart palpations and cramps throughout the body.

Treatment of this disease sought first to shorten the fit, then to prevent their return. Strong patients might be bled during a fit.  Weaker ones required more gentle methods to end the spell. 

Strong smells, hot bricks to the bottoms of the feet, placing the feet and legs into hot water or strong rubbing on the legs, arms or belly might be used to bring a patient back from a paroxysm.

Practioners recommended a milk and vegetable diet, with water to drink, supplemented by a small quantity of spirits, to help cure an individual of their fits.  Additionally cold bathing and everything ‘bracing’ and that kept the mind easy and cheerful was encouraged.

Family and friends were cautioned not to offer too much sympathy for these spells lest they inadvertently excite further episodes. Young ladies who experienced hysterical fits were advised to avoid boarding schools when the disease may be caught by imitation.

Medicines to strengthen the alimentary canal, as described above, were considered appropriate for hysterical affections as well. Vomits and opening medicines were sometimes recommended. Interestingly, opium was prescribed in this case, orally, applied externally or even given in clysters.

 Of the Night-mare

Nightmares were thought to result from indigestion. Some recommended a dram of brandy before bed which was thought to prevent the problem.  Others thought it a poor custom and that foods easy to digest, cheerfulness, exercise and a light supper, early in the evening were better interventions.

If something more was needed, a glass of peppermint-water was recommended in place of the brandy.  And for young people ‘full of blood’, frequent purging could be particularly useful.


References

Buchan, William. Domestic Medicine: Or, A Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, 11th ed., (1790)
Parissien, Steven. Regency Style. Phaidon Press Limited (2000)
Perkins, John. Every Woman Her Own House-keeper; Or, the Ladies’ Library. James Ridgeway: London (1790)
Sales, Roger. Jane Austen and Representations of Regency England. Routledge (1994)
Shoemaker, Robert B. Gender in English Society 1650-1850 Pearson Education Limited (1998)
Tennet, John . Every Man his own Doctor: or, The Poor Planter's Physician, Williamsburg, VA, (1736).
The Home Book of Health and Medicine. Philadelphia: Key and Biddle. (1834)
Wilson, Ben. The Making of Victorian Values, Decency & Dissent in Britain: 1789-1837 The Penguin Press (2007)
Wiltshire, John - Contrib. to Jane Austen in Context. Cambridge University Press (2005)

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 Maria Grace is the author of Darcy's Decision,  The Future Mrs. Darcy, All the Appearance of Goodness, and Twelfth Night at Longbourn and Remember the Past.  Click here to find her books on Amazon. For more on her writing and other Random Bits of Fascination, visit her website. You can also like her on Facebook, follow on Twitter or email her.

Madness, Melancholy and Medicine, Pt 1

by Maria Grace

Symptoms, types and  causes of nervous conditions diagnosed in the Georgian Era

The fine sensibility prized by women in the 18th century gave rise to an epidemic of nervous disorders in the early 19th century. Maladies of affluence and sophistication, nervous disorders paraded one's wealth, refinement and sensibility. Women were particularly susceptible to nervous disorders because of their ‘more delicate physiological network’. In fact, 'Nerves' were a woman’s claim to superior social status, the mark of being a lady.

The wealthy and indolent were not the only suffers though. Given that during the early 19th century people lived in a world where a small ache or upset stomach could be the harbinger of something far worse, or even fatal, it is not really surprising that hysterical diseases, hypochondria and melancholy—what we would call depression—were prevalent, especially when legitimized as disorders by respected doctors.  

General Causes of Nervous Disorders

While doctors agreed that they existed, "there's no Disease puzzled Physicians more than the Vapours, and Hysterick Fits. These complaints are produced by so many Causes, and appear in so many various Shares, that 'tis no easy Matter to describe them.” (Tennet) ‘The Annual Review’ said that after doctors started taking nervous disorders seriously, everyone was taking medication for them, outdoing each other with exaggerated symptoms and buying an array of medical equipment to deal with them. How strangely 21st century it all sounds.

Many factors contributed to the occurrence of nervous disorders. So many that very little did not contribute to these problems. Anything which resulted in too much relaxation or indolence might result in problems, just as did too much application or thought. Too much tea, too much fasting, unwholesome food or awkward posture all might result in the vapours.

Women were particularly susceptible to these disorders due not only to “peculiar organization of their frame…but to their very mode of living.” (Perkins) In specific, he felt an excess of “the passions of the mind”, which women were apt to experience, made them more prone to nervous conditions. Love, especially disappointed love, and anger were considered dangerous. Grief had the potential to be fatal, and fear might produce violent fits and convulsions.

Environmental factors might also weaken or disable one’s constitution, leaving the individual prone to nervous disorders. Intemperate air, excessive luxury and effeminacy had the power to degrade the constitution. Eating the wrong things (rich and fancy foods), or at the wrong times (late in the evenings), sleeping too long in the morning and indulging in too much recreation all contributed to a dangerous indolence that threatened ones vigor.

Symptoms and Types of Nervous conditions

According to William Buchan in his book Domestic Medicine (1790), “Of all diseases incident to mankind, those of the nervous kind are the most complicated and difficult to cure. A volume would not be sufficient to point out their various appearances. They imitate almost every disease; and are seldom alike in two different persons, or even in the same person at different times. Proteus-like, they are continually changing shape; and upon every fresh attack, the patient thinks he feels symptoms which he never experienced before. Nor do they only affect the body; the mind likewise suffers, and is often thereby rendered extremely weak and peevish.”

Like practitioners today, he recognized a number of different nervous conditions discernibly different from one another and which occasioned different courses of treatment. “These however are not to be considered as different diseases, but as various modifications of the same disease.”(Buchan) These disorders included: melancholy, low spirits, hysterical afflictions, hypochondriac affections, and nightmares.

OF MELANCHOLY 

Melancholy was considered a state of insanity that rendered an individual incapable of enjoying the pleasures or performing normal duties of life and might terminate in absolute madness.

It might be the result of inherited disposition, but more commonly intense thinking and violent passions of the mind, including those mentioned above and overreaching pride. Intense anger or cold that forced blood away from the brain could push melancholy into madness. Equally dangerous to the constitution were gloom and mistaken religious notions.

Acute fevers, suppression of ‘customary evacuations’, hard digestion or dryness of the brain constituted physical factors that contributed to a case of melancholy.

Both physical and emotional/behavioral symptoms could be detected in such cases. Physically the body would become ‘bound’, with thin urine, paleness and slow, weak pulse. Behaviorally, the individual might be seen fretful, fickle, attending to trifles and fond of solitude. The patient might be prone to imaginations—we could call them hallucinations—of being dead, an animal, too brittle to move, and the like. In its most extreme forms, melancholy might lead to suicidal behavior.

Today, this disorder would likely be considered an extreme form of depression, possibly with psychotic overtones.

OF LOW SPIRITS

 

Physicians of the era believed that those with weak nerves were likely to experience some degree of low spirits, a disturbance much like melancholy, but less severe. Symptoms could include sleeplessness, headaches, indigestion and loss of appetite. These would be exacerbated by solitude and gloomy thoughts, while cheery company and amusements might ameliorate them.

In addition to weak nerves, low spirits might be brought on by continued mental distress or through more direct physical causes. A weak, relaxed state of the stomach or bowels, or an obstruction thereof might be the culprit. Similarly, “suppression of the menstrual or of the hemorrhoidal flux” (Buchan) could cause them.

Today, this disorder would likely be considered a mild mood disorder, possibly dysthymia.

OF HYPOCHONDRIAC AFFECTIONS

Those of melancholy temperament were the most susceptible to hypochondriac attacks in which “the worst consequences imagined from any unusual feeling even of the slightest kind; and in respect to such apprehensions and feelings, there is always the most obstinate belief and persuasion.” (Perkins) Physical symptoms tended to cluster around digestive upsets, and vague physical discomforts.

The chief cause of the disorder was thought to lie in indolent, luxurious lifestyles or conversely overly unfortunate or studious ones. Congestion of one or more of the abdominal organs was thought to be the foremost cause of this problem.

This disorder sounds most like hypochondria, possibly with a mood disorder like depression or dysthymia as well. 

OF HYSTERIC AFFECTIONS 

Women, who were considered particularly delicate, were thought to be most susceptible to hysterical complaints. These included fits of laughter or crying, fainting, convulsions, low spirits, anxiety, heart palpations, and cramps throughout the body.

These complaints were thought to be brought on by sudden irritations of the stomach or intestines or a sudden suppression of menses. Violent emotions like fear, grief, anger or intense disappointment might aggravate the condition.

Today this disorder might be considered a somatization disorder, or possibly an adjustment disorder depending on the specific symptoms involved.

OF THE NIGHT-MARE 

Patients afflicted by nightmares experience, during sleep, a sensation of oppression or weight on their chest that they cannot shake off. They may cry out during sleep, often fancying themselves in some grave danger to life or limb which results in awakening.

Nightmares were thought to be the result of blood stagnating in the brain and lungs, arising more from indigestion than nervous affection, though those things which oppressed the mind, like deep thought or anxiety, could also contribute to the condition.

Today, this might be diagnosed as a nightmare disorder.

Avoiding Nervous Disorders 

Doctors offered specific advice on how these disorders might be avoided. “Excessive grief, intense study, improper diet, and neglect of exercise, are the great sources of this extensive class of diseases…Grief indulged destroys the appetite and digestion, depresses the spirits, and induces a universal relaxation and debility of the whole system… (While) misfortunes indeed are not to be avoided, but surely their effects, by a vigorous and proper exertion of the mind, might be rendered less hurtful…

"The effects of intense study are pretty similar to those occasioned by grief. It preys upon the animal spirits, and destroys the appetite and digestion. To prevent these effects, studious persons ought… never study too long at a time; nor attend long to one particular subject, especially if it be of a serious nature. They ought likewise to be attentive to their posture, and should take care frequently to unbend their minds by music, diversions, or going into agreeable company.” (Buchan)

Attention should be paid with regard to proper diet, which avoided extremes of all forms. Regular exercise and fresh air should be a part of one’s routine. “But the most general cause of nervous disorders is indolence. The active and laborious are seldom troubled with them. They are reserved for the children of ease and affluence, who generally feel their keenest force. All we shall say to such persons is that the means of prevention and cure are both in their own power. If the constitution of human nature be such, that man must either labor or suffer diseases; surely no individual has any right to expect an exemption from the general rule.” (Buchan)

In part 2 of this article, we will explore the treatments recommended for these disorders.

References

Buchan, William. Domestic Medicine: Or, A Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, 11th ed., (1790)
Parissien, Steven. Regency Style. Phaidon Press Limited (2000)
Perkins, John. Every Woman Her Own House-keeper; Or, the Ladies’ Library. James Ridgeway: London (1790)
Sales, Roger. Jane Austen and Representations of Regency England. Routledge (1994)
Shoemaker, Robert B. Gender in English Society 1650-1850 Pearson Education Limited (1998)
Tennet, John . Every Man his own Doctor: or, The Poor Planter's Physician, Williamsburg, VA, (1736).
The Home Book of Health and Medicine. Philadelphia: Key and Biddle. (1834)
Wilson, Ben. The Making of Victorian Values, Decency & Dissent in Britain: 1789-1837 The Penguin Press (2007)
Wiltshire, John - Contrib. to Jane Austen in Context. Cambridge University Press (2005)

~~~~~~~~~~~~

 Maria Grace is the author of Darcy's Decision,  The Future Mrs. Darcy, All the Appearance of Goodness, and Twelfth Night at Longbourn and Remember the Past.  Click here to find her books on Amazon. For more on her writing and other Random Bits of Fascination, visit her website. You can also like her on Facebook, follow on Twitter or email her.