Body: | A New System of the Spleen
Vapours and Hypochondriack Melancholy
Wherein all the Decays of the Nerves
and Lownesses of the Spirits are mechanically Accounted for
Nicholas Robinson
(doctor and governor of Bedlam)
1729 AD
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Introduction:
1729 AD, Nicholas Robinson, doctor and governor of Bedlam the same
time James Monro, believed insanity was caused by life choices, sin and
thinking too hard, over excitement of emotion, so as to break the nerves of
the brain, "all the Decays of the Nerves and Lownesses of the Spirits are
mechanically accounted for" ... "Fits had so weakened the Fibres of the
Optic Nerves." Its like trying to put too much current through an
electrical wire and it either melts or blows a fuse! Robinson does take a
biologic view of the etiology of mental illness, but he believes it is a
case of the choices, thoughts and emotions of the mind that is ultimately
responsible for the damage. He notes how damaged nerves can be caused by
sin and guilt: "Hence arise their Difference, Scruples, and Fears,
concerning the Sincerity of their Faith and Repentance, as also the
Certainty of their Election or Reprobation; which several Points, from the
preaching of some hot-headed Gospel-Ministers, are so strongly fix'd on the
Minds of silly, weak, unhappy People, as to work them into a State of
Despondency. THEN their Sins fly glaringly in their Faces, and are so
infinitely great, that no Satisfaction can compensate; then they think of
nothing but the fearful Wrath of God just ready to be pour'd out upon them;
that the Sentence of Condemnation is already pass'd, and that they
certainly shall be damn'd to all Eternity." A few years later the doctors
of Bedlam like John Monro, dropped the idea that sin, emotion and life
choice and circumstance caused insanity, and focused on correcting the
physical problems with treatments that amounted torture. Robinson shows how
an atheist is driven to madness through his rejection of God: "take a view
of the Atheist ... What Hope, what Refuge ... the Mind was in Despair
through Doubt ... Where can he rest his hopeless Hope! where seek for
Mercy, when Conscience, Horror, Despair, and all the dismal Scenes of Woe,
that can afflict the most obdurate Heart, fly glaringly in his Face, and
sting his tortur'd Soul, with Pain and Grief unsufferable to human Nature!
Hence spring those frequent Suicides, to which these harden'd Miscreants
have Recourse, to rid them of a Life most loathed, wretched, and miserable
to endure. So that no Scene of Horror can be more dreadful, than to view an
Atheist on his Bed of Sickness, just reviving to a Sense of his being
forsaken of God, and all Hopes of his Mercy." Nicholas Robinson believed
that mental illness was caused by feelings of sin, hopelessness and
condemnation which in turn damaged the brain nerves. In a page out of
modern chemcial psychiatry, Robinson believes drugs are the cure: "But of
all Medicines in the Spleen, I know none equal or fit to compare with that
truly noble Drug we call Opium. It's our Refuge in all Distresses; it gives
Ease and Relief in the most torturing Pains, and when all other remedies
fail; ... for by relaxing the Fibres of the Brain and Nerves". Gotta love
the idea of giving heroin to the insane! It would be much easier if they
simply repent Dr. Robinson! (A New System of the Spleen, Nicholas Robinson,
1729 AD)
"Nicholas Robinson (1697-1775) A New System of the Spleen, Vapours
and Hypochondriack Melancholy, Wherein all the Decays of the Nerves, and
Lownesses of the Spirits are mechanically Accounted for ... (1729), A: pp.
222-25, B: pp. 234-40, C: pp. 241-47. Robinson was one of the most
energetic and enthusiastic of the writers and practitioners of the early
part of the eighteenth century. He trained in medicine at Rheims but
practised and taught in London, where he was a governor of Bethlem. His
adoption of a rigorously 'mechanical' view of mental illness shows the
powerful influence of Willis, whose 'Animal Spirits' become in Robinson the
`Alachinulae' of the fibres of the brain in their relation to the nervous
system and to the entire animal economy. This dynamic view of madness has
two important consequences. The first is that, unlike many of his
contemporaries, Robinson takes madness seriously. That is, he does not
explain the experiences and sufferings of the mad as delusions, products of
a disordered imagination. They are real for the simple reason that they are
bodily in origin. This makes him astonishingly sympathetic in his attitudes
towards patients, and in his accounts of 'religious melancholy Madness' and
'Lunacy and Enthusiastick Madness', given below as extracts B and C, he is
able to enter wholeheartedly into the beliefs and sensations described. The
second consequence, however, is the ferocity of some of his recommended
treatments. Because mental illness is somatic in origin, only cures applied
to the body will have any chance of success. For Robinson, you may as soon
attempt to counsel a man out of the most violent Fever, as endeavour to
work any Alteration in their Faculties by the Impressions of Sound, tho'
never so eloquently apply'd'. Rather, 'the most violent Vomits, the
strongest purging Medicines, and large Bleeding, are to be often repeated'.
Like many medical men of the period, Robinson was also interested in the
differences between male and female manifestations of mental illness, and
the first extract given is an account of 'A most remarkable History of
Hysterick Fits' in a young woman, though ironically the case is one in
which he is not called upon to prescribe at all." (Patterns of Madness in
the Eighteenth Century, A Reader, Allan Ingram, 1998 AD, p76)
"The idea that insanity is due to "nervous exhaustion," a fatigue of
the brain or nervous system, best treated by rest, has a long history."
(Coercion as Cure, Thomas Szasz, 2007 AD, p 105)
A New System of the Spleen
Wherein all the Decays of the Nerves
and Lownesses of the Spirits are mechanically Accounted for
Nicholas Robinson
1729 AD
A. Of the Symptoms of VAPOURS and HYSTERICK FITS in Women.
[note: this woman probably had epilepsy or a brain tumor]
THE following Relation is the Case of a young Lady I visited, attended with
the most Surprizing Symptoms of Vapours and Hysterick Fits I ever beheld in
my Life. She was of a thin, pale Complexion, of a tall, slender Habit; and
subject to a sharp, acute Pain of her Head, that was greatly exasperated at
certain Seasons.
UPON the Access of the Fit, she fell violently on the Floor, and all her
Body was agitated, shaken, and distorted in a most cruel Manner. Her Head
was violently convuls'd divers Ways, her Eyes were contracted inwardly in
their Orbits, with their Whites turn'd up and fix'd. To these Symptoms
follow'd a light, murmuring Noise in the Bowels, which was succeeded with a
great Distention of the left Hypochonder, that terminated in a round Globe,
swell'd prodigiously above the Surface of her Belly; presently after she
smil'd, and mimick'd a laughing Countenance, then cry'd, sigh'd, and
groan'd, after which she lay still. In about five Minutes Time, the
Convulsions return'd in the most furious Manner; upon which, to my great
Surprize, she was suddenly flung off the Bed, with a prodigious Impulse;
the whole Body being darted, as it were, from a Spring, her Abdomen gave
the greatest Signs of the impulsive Motion; immediately after this I
observ'd the round Globe that form'd the Swelling on the left Hypochonder
vanish'd, though the Convulsions continued, and notwithstanding there were
half a Dozen in the Room, yet much ado had they all to lift her on the Bed
again, so strong was the Fit, above all the natural Powers of her Body.
ALL her Limbs, Hands, Head, and Feet were agitated with divers Bendings,
Motions, and Contractions; all the immoveable Muscles of her Body stretch'd
as on a Rack, and the Spume of Foam that work'd from her Mouth was mix'd
with Streaks of Blood. At length the Rigour of the Fits abated, or at least
seem'd to abate, and she lay still, which was follow'd with an unusual
murmuring Noise from within, that greatly surprized the Bystanders. Some
superstitious People, there present, endeavour'd to impose a Sense on these
inarticulate Sounds; tho' I am sure her Lips never moved: The Noise was not
unlike the Crying of an Infant, which was frequent and sudden.
THUS she lay for near three Hours, and then the muscular Fibrillae began to
relax, and she, by Degrees, to come to herself; but notwithstanding it was
high Noon-Day, and not above twelve of the Clock, yet could she not
discover the least Glimmerings of Light for above five Hours, the Severity
of her Fits had so weaken'd the Fibres of the Optick Nerves. She complain'd
of a great Dizziness of her Head, a Numbness and Stiffness in all her
Limbs, and her Bones were so exceedingly sore, that she scarce would
believe, but that somebody had been drubbing her: As soon as she was
perfectly restor'd to the Use of her Senses, she declar'd that she could
not remember the least Transaction, that happen'd during all this Uproar
and Disorder.
B Of the SYMPTOMS of SPLEEN, VAPOURS, and HYPOCHONDRIACK
MELANCHOLY, when they degenerate into the natural, or religious melancholy
Madness.
I AM now come into the most gloomy Scene of Nature, that Mankind can
possibly encounter, where nothing but Horror reigns; where the noble
Endowments of the reasonable Soul are often disconcerted to a surprizing
Degree, and this lordly Creature Man almost debas'd below the brutal
Species of the animated Creation.
MELANCHOLY Madness is a Complication of continual and unintermitting
Horrors, that spares neither Body nor Mind. When this Affection is far
advanc'd into the Habit, the Patient appears to all that see him a moving
Piece of Ruin, and wears his Soul in his Countenance, which is mark'd with
all the Characters of Woe, Gloom, and Desperation. He is lost to himself,
his Friends, his Country, and Relations; he is dark and benighted in the
full Glare of Day, and trembles to behold the Face of the Sun, from an
Apprehension, that it insults his Misery. He flies to his Couch, in hopes
to bury his Cares, and lull his Soul into sweet Slumbers: His Couch!
miserable as he is, denies to him that sweet Ease and pleasing Consolation,
and perplexes his Mind with Phantoms of Furies just ready to devour him.
WHEN the Symptoms arise to this surprizing Height, which they seldom fail
of, if not timely remedied, the Body then scarce feels the severest Usage
you can give it; the Reason of which is, that all, or most of the Nerves
that afford the natural Sensations to the several Organs of the Parts are
let down beneath their natural Standard, not unlike, tho' not so much, as
in palsical Affections. However, the immediate Intercourse between the Mind
and Body, is by some Means or other greatly disconcerted; and this is the
Reason, why those finest Sensations that arise from the several Appetites
of Hunger, Thirst, and Venery, are diminish'd, to a Degree scarce able to
create an Attention to those Cravings of Nature; and hence it happens, that
they are able to endure Hunger, Thirst, and Watchings, to a Time almost
incredible, to Persons not acquainted with such Cases; all which several
Phaenomena shall be accounted for, when we come to treat of the Causes of
those Disorders.
SOMETIMES this natural melancholy Madness is improv'd upon the
Constitution, by a Set of religious Objects, and then it comes under the
Denomination of religious Melancholy; in this Case, the Patient is either
too much oppress'd with Fear, or over-presuming; the latter most properly
is call'd Enthusiasm; for these Objects of Fear or Presumption are vary'd,
exalted, or depress'd, according to the different Constitution or
Temperature they reside in. If the Habit be naturally of a phlegmatick Make
or Disposition, then all the Ideas will be despairing. Hence arise their
Difference, Scruples, and Fears, concerning the Sincerity of their Faith
and Repentance, as also the Certainty of their Election or Reprobation;
which several Points, from the preaching of some hot-headed
Gospel-Ministers, are so strongly fix'd on the Minds of silly, weak,
unhappy People, as to work them into a State of Despondency.
THEN their Sins fly glaringly in their Faces, and are so infinitely great,
that no Satisfaction can compensate; then they think of nothing but the
fearful Wrath of God just ready to be pour'd out upon them; that the
Sentence of Condemnation is already pass'd, and that they certainly shall
be damn'd to all Eternity.
THUS, these unhappy Wretches go on to encrease their Woes, before bad
enough, now made worse from the Objects of Despair. But thus much I must
observe in Defence of Religion, that these Disorders are no way the Effects
of religious Duties, nor is Religion any way justly chargeable with their
Consequences; they are owing to the Temperature of the Body, which,
whenever it starts from its natural Standard, obliges the Mind to revolve
upon those Ideas, that were most familiar to it while it was in Health. And
if the Patient was intent upon religious Duties in Health, he will
certainly revolve most upon those under this Disease; and as Fear, Sadness,
and Sorrow, are the Pathogonomicks of phlegmatic Melancholy, he will
naturally take religious Objects by the left Hand, and multiply the Duties
of Religion above the Powers of human Nature to perform, and then quarrel
with himself, for not doing what was above his Power to do, and what
neither God nor his Laws exacted at his Hands.
THUS, this unhappy Wretch goes on from bad to worse, always fighting,
groaning, and desponding of Mercy, from a God infinitely merciful: In vain
shall you tell him of the Satisfaction of his Saviour for his Sins; his
Sins are so foul and enormous, that they are above all Satisfaction: No
Blood can wash out the Stains of his Sins, nor blot out the black Catalogue
of his Transgressions.
AND this is the Circle of Ideas, that the most religious Persons will
naturally run through, while the Symptoms of natural Melancholy continue to
oppress them; for Fear and Sadness, being relative Terms, have no
Foundation or Meaning, when they are not referr'd to some Objects: It
therefore naturally follows, that whoever fears, must have some Grounds for
those Fears, either real or imaginary; if they be real Fears, then they
must arise from some Cause that struck the Object of Fear upon the Mind.
BUT if this be the Fate of religious Persons under this Disease, let us
change the Scene, and take a view of the Atheist or Libertine under the
same Affliction. What Hope, what Refuge can he expect from a gracious God,
whose Providence he has so often blasphem'd, ridicul'd and deny'd? Under
the Symptoms of religious Melancholy, the Mind was in Despair through
Doubt; but here, even that Doubt would be the highest Pleasure: He now
perceives God's heavy Wrath ready to be executed upon him, and thinks he is
already in Hell; himself is Hell, and suffers all the Pains of the Damn'd;
he howls, he roars, and, in the Height of his outrageous Frenzy, blasphemes
God and his Religion: Where can he rest his hopeless Hope! where seek for
Mercy, when Conscience, Horror, Despair, and all the dismal Scenes of Woe,
that can afflict the most obdurate Heart, fly glaringly in his Face, and
sting his tortur'd Soul, with Pain and Grief unsufferable to human Nature!
Hence spring those frequent Suicides, to which these harden'd Miscreants
have Recourse, to rid them of a Life most loathed, wretched, and miserable
to endure. So that no Scene of Horror can be more dreadful, than to view an
Atheist on his Bed of Sickness, just reviving to a Sense of his being
forsaken of God, and all Hopes of his Mercy.
C Of the SYMPTOMS of SPLEEN, VAPOURS, and HYPOCHONDRIACK
MELANCHOLY, when they degenerate into Lunacy and Enthusiastick Madness.
THE Mania, or what we call Lunacy or the raging Madness, is only the
foregoing Melancholy improv'd in a hot, biliose, sanguine Constitution;
whereupon all the Impulses are strongly struck on the Seat of the common
Sensorium, and the rational Soul divested of all its noble and
distinguishing Endowments.
THIS Madness presents the Reader with a most dreadful Scene of Horror and
Distraction; the Patient appears with a fierce, grim, and rough Aspect, his
Reason is disturb'd, his Judgment confus'd, and the Exercise of his
Intellectuals is lost and bewilder'd in a bottomless Gulph of most absurd
Cogitations.
SOMETIMES the Fits of Lunacy arise beyond all the Bounds of Nature, and the
Patients acquire a preter-natural Strength, greatly above the Power of the
strongest Man to oppose: They will break the strongest Bars of Iron with a
single Impulse, throw off their Bonds, Chains, and Shackles, to the Wonder
and Surprize of all that see them; nor are they scarce ever tired, tho'
they exercise their Bodies whole Days and Nights, and are almost
continually without Sleep. They will endure the severest Usage, with a
steady and equal Mind; nor shall you perceive them at all scarce affected
with the Extremes of Cold, Fasting, and Stripes, that are enough to sink
the Spirits of the most intrepid Mortals.
OTHERS, again, acquire a Swiftness of Foot, greatly superior to the
swiftest Man. I myself knew a young Woman, that in the Height of her
Lunacy, broke from her Keepers, and run so fast, for near two Miles, that
neither Man nor Horse could overtake her, got into a River, and was
drowned, before any could come to her Relief.
WHEN once the Disease is suffer'd to arise to this Height, they are bold,
impudent, and of a most revengeful Disposition; apt to quarrel, and think,
and speak, and dream, if perchance they slumber or sleep, of nothing but
Battles, Combats, and their Manhood; they are furious and impatient in
Discourse; stiff, irrefragable, and prodigious in their Actions; and, if
provok'd, most violent, outrageous, and ready to kill themselves, and all
others, that come in their Way.
THEY sleep but little; their Urine is of a fiery, flameous Colour, and but
little in Quantity; their Pulse is quick, low, and very unequal, which
certainly indicates, that the Fever is lodg'd upon the Nerves and Spirits,
contrary to the Antients, that averr'd, that this Disease might be without
a Fever; their Stools are white, hard, and but little in Quantity; their
respiration varies, but generally is slow, and scarce perceivable.
PERSONS, of the greatest natural Parts, of the finest Genius's, and most
elevated Imaginations, are often observ'd, in their Flights, to start into
Madness; for being naturally of warm, biliose Constitutions, it necessarily
follows, that (while the aspiring Soul is pursuing some lofty Thought,
soaring to an uncommon Height, and teeming with the grand Discovery) the
Impulses prove too strong for the feeble Brain to support, the Intenseness
of Thought disconcerts the tender Fibres, and the whole Magazine of most
beautiful Ideas are shatter'd, and jumbled into the greatest and most
irregular Confusion, by the Force of the labouring Imagination.
WHEN once these finest Fibres of the Brain, that immediately support the
regular Exercise of our Thoughts, have suffered such a fatal Shock; no
Operation of the Mind, that is regular, sedate, and uniform, can ever after
be expected; but all his Actions will be express'd by sudden Fits and
Catches; and shew themselves in all the Diversity of Characters, according
to the prevailing Passions that struck the Impulse. Thus the gay and merry,
the fond and loving, the angry, revengeful, or Scholastick Characters,
succeed each other, by sudden Starts and Sallies, according to the natural
Passion he was subject to, before the Invasion of the Disease.
IF the Patient was proud, ambitious, haughty, or imperious, in his natural
Temper, then, upon the Access of the Lunacy, he will imagine himself
metamorphos'd into a King, a Prince, or Viceroy; and demand suitable
Attendance to the regal Power, princely Dignity, or noble Character, he
ought to bear in the World, in case he was the very Person he takes himself
to be: Those of a fierce, savage, and cruel Nature, imagine themselves
transform'd into Wolves, Bears, or Tigers, and fancy they retain all the
Ferocity of those savage Animals.
SOMETIMES this raging Lunacy is improv'd upon the Habit of warm, biliose
Constitutions, from a set of religious Objects, and then it arises to
Enthusiasm; a Species of Madness quite different from religious Melancholy,
and which produces different Effects: For whereas the Patient under the
Symptoms of religious Melancholy, was greatly oppress'd with Fear, Sadness,
and Despair; these, on the contrary, from an over-weening Opinion of their
own Sanctity or Holiness, are elevated to the highest Degree of Familiarity
with their Maker: They are his Viceroys, chosen Saints and Servants, sent
on especial Errands, to reclaim the unbelieving World.
WHEN the Brain is once well-warm'd, then every groundless Opinion, or silly
Fancy, that strongly settles itself on their Minds, is an Illumination from
the Spirit of God, and of divine Authority; and then every Impulse that
drives them on to any odd and ridiculous Action, is immediately a divine
Call from Heaven; it's a Commission from Above, and must be obey'd. If you
tell them of Mistakes, Errors, the Delusions of their Senses, or
Suggestions of Satan, they will answer you, that they see the Light
infus'd, hear the Call, feel the Impulse, and cannot be mistaken; it's
clear and visible to them, as the Sun at Noon-Day, and consequently needs
no other Proof than its own Evidence: They feel the Hand of God moving them
within, and the Impulses of his Holy Spirit directing them in all their
Enthusiastick Thoughts, Words, and Actions.
But of all Medicines in the Spleen, I know none equal or fit to compare
with that truly noble Drug we call Opium. It's our Refuge in all
Distresses; it gives Ease and Relief in the most torturing Pains, and when
all other remedies fail; ... for by relaxing the Fibres of the Brain and
Nerves, it sets their illachinulae at such a Distance from each other, as
either totally destroys their Sensations, or at least greatly impairs them;
whereupon it comes to pass, that the Perceptions are intercepted for a
while, and a pleasing Stupefaction brought upon all the Organs, that serve
the several Senses, which Phaenomenon we call Sleep.
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