ness and distention of the stomach surely indicates some organic disease there? What must she eat, to prevent the sensation of weight and oppression? She turns to the window, in order that the doctor may see clearly how sallow she is, and the flushings that rise to her face. Does he think that the pain over the left eye indicates apoplexy? What is the reason that she cannot read for a minute without experiencing a sensation of confusion; a noise as if a kettle was boiling in her ears? She really begins to think that her head must be a steam-engine; that little boys are setting off balloons in her stomach; she fears she will become insane; she is doomed to die in a madhouse. Nevertheless, although her spirits are suffering under an intolerable anxiety, yet, "You know, dear Dr. —— -," would the poor invalid exclaim, no person is so lively as I am when I am well." The doctor prescribes, and takes his leave, delighted to escape for a few hours from a torment, almost insupportable, yet inseparable from his professional life. 66 Such details as these, ludicrous in appearance as they are, are nevertheless the recital of real morbid feelings of the hypochondriac. It is with the intention of setting this fairly before the public, and the relatives of the unfortunate victims of hypochondriasis that I send, Mr. Editor, the following notes from my portfolio. It is a great error to refer to imagination the sufferings of the hypochondriac: they depend on physical disturbances of the bodily system; thence it is not surprising that they should awaken apprehensions, magnified by the concentration of the attention on them. It is these morbid feelings that urge the hypochondriac to unload his bosom of his anxiety, whenever the opportunity of an attentive listener presents itself. He is delighted with the sympathy which his story excites, yet, I have seen in some enough of self-esteem remaining to lead them to think that their details were exciting a degree of contempt; and, consequently, they suppressed a portion of the series of evils of which they had to complain. These persons, however, are, nevertheless so completely under the control of the disease, that they pass rapidly from one physician to another; and leave untried scarcely one of the multitude of nostrums, which the newspapers present daily, to the jaundiced imagination of the hypochondriac. Still there is no evil so dangerous as to treat the sufferings which lead to these caprices as imaginary. Hypochondriacs sometimes suffer from illusions similar to those which occur in insanity: they see individuals and things, which have no real existence. The history detailed by Sir Walter Scott, of a Scottish lawyer, who imagined that he was always attended by a little gentleman, "arrayed in a court dress, with bag and sword, tamboured waistcoat, and chapeau bras ;" and that, after some time, this little dandy changed into a skeleton, which appeared ever present to him, and at length brought on such a state of mental suffering, that he sunk under the malady; is an admirable illustration of the extent to which these illusions may proceed. The poor patient gave no credit to the actual existence of the apparition. "I am sensible," said he, to his physician, " that I am dying, a wasted victim to an imaginary disease."* I knew a lady who always saw a black dog sitting on her table near her. "You cannot see him," she often said to me," because it is a phantom of my diseased imagination.” * Letters on Demonology and Witchcraft, by Sir Walter Scott, Bart., pp. 29-33. And such was also the state of health of Dr. Donne, although he firmly believed in the vision, when he saw his wife pass twice through the room where he sat, with a dead child in her arms, at a time when he was in France, and she in England.* These cases are very different from those, in which men believe that they are made of glass, wax, and other substances. "A baker of Ferrara believed he was made of butter, and on that account would not approach the oven, lest he should melt."+ Cases such as this, are instances of monomania. The two diseases, however, are perfectly distinct in their nature; but it is chiefly with melancholy that hypochondriasis is apt to be confounded. To that species of insanity, indeed, it often leads; and, in many instances, it resembles melancholia so closely, that it may be regarded almost as the first stage of it, and it is occasionally complicated with it. Hypochondriacs, as I have already said, have illusions which originate from internal sensations; these illusions resemble those which occur in melancholia; but the hypochondriac knows them to be illusions, the melancholic madman believes them to be realities; thence the disease differs from melancholia in this very particular. The susceptibility of the nervous system of the hypochondriac leads him to feel acutely, pains and discomforts, which would scarcely attract the attention of a healthy individual, and he has the dread of death constantly before him. Melancholic madmen, instead of dreading the approach of the arch enemy, hail it as their greatest blessing. They contemplate only the wretchedness of life, the dreary, unpromising, hopeless tract, which spreads before them, and they sigh for relief from suffering in the quiet of the grave, which they suppose is alone capable of affording it. Thence the melancholic madman commits suicide; the hypochondriac never even contemplates that mode of escaping from his misery. The distinction depends in a great degree on the different influence of physical and of moral suffering upon the nervous system. The former, physical suffering, concentrates the attention and depraves the reasoning faculty; but it also lowers moral courage; consequently, it never provokes its victim to seek relief from self-murder; on the contrary, it fortunately augments his pusillanimity until he trembles at the very thought of death. The latter, namely, moral suffering, also concentrates the attention, but it rather tends to exalt courage; the physical sufferings of the melancholic madman, are totally absorbed in his moral wretchedness; he seeks death, and reflects only on the relief which it will afford to the wretchedness of his mind. "What though some little pain the passage have, Is not short pain well borne which brings long ease, Sleep after toil, port after stormy seas, Night after day, death after life doth greatly please."-SPENSER. The hypochondriac never listens to such arguments as those urged by despair; with all his weight of suffering, his eye brightens with hope, he still anticipates a remedy for his ailments. Although low-spirited and dejected, yet he does not despond; his feelings are in a very different *Life of Dr. Donne, by Isaac Walton, p. 24. state from those labouring under melancholy, or any other form of insanity. The distinction between hypochondriasis and some other diseases, the pathology of the disease, and the medical treatment must be left to the physician; the knowledge of the causes, however, of the malady, and its moral management cannot be too widely diffused. No particular temperament nor constitution seems to be, more than another, the subject of hypochondriasis. The buoyancy of youth, and the gravity of advanced age are both adverse to its formation; it is be tween twenty-five and fifty that it prevails, and men are more frequently than women liable to its attacks. Females in early life are the subjects of hysteria, and when they begin to descend the hill of life, and have seen half a century of years, although they sometimes suffer from hypochondriasis, like my friend the Hon. Mrs., yet it never arises to the same height as in men. The causes of hypochondriasis are of two distinct kinds, namely, physical and moral. The physical causes are the same which generate dyspepsia, and diseases of the alimentary canal, originating chiefly in sedentary occupations, and an improper use, or rather an abuse, of tea, coffee, and similar diluents. Literary men, and those studiously inclined amongst the clergy, indulge in the use of the herb of China to an extraordinary degree; the consequence of which, in conjunction with their sedentary habits, is dyspepsia connected with a constipated and irregular condition of the bowels, which almost invariably terminates in hypochondriasis. This cause, also, fills our hospitals with numerous martyrs to dyspepsia, in the wives of artisans, as well as in old women who live with their families, and in semstresses, who live principally on tea and bread-and-butter. It is indeed mortifying to human vanity to think, that much of the power of exercising the intellectual faculty depends on the condition of the stomach; that a fit of indigestion may create a legion of blue devils, irritate the temper, render sleep imperfect, or disturb it with terrific dreams, and even excite delirium; or else it may obscure the lustre of the imagination, weaken the power of attention, and cast a gloom over every thing around us. Still more mortifying is it, that the best mode of correcting these failures of mental capacity, is a dose of physic which will act briskly on the bowels. The condition of habit, however, which induces the torpidity that demands such assistance, causes irregularity in the circulation of the brain; consequently headachs, vertigo, hypochondriasis, sometimes even insanity, are the result: thence the importance of attending to the condition of the body to ward off its attacks. Nothing more modifies the thinking faculty than diet, exercise, and sleep; and when these are not well regulated, the good effects of medicine, acting on the mind through the body, have been too often experienced to be doubted. The habits of Dryden were not favourable to intellectual labour: thence it is said, that being aware of this, he caused himself to be bled, and took physic whenever he wished to compose; and in the result, found out how greatly the powers of mind depend on the healthful condition of the body; a fact, however, which does not in the least, to borrow the language of Bacon, bring into "question the immortality, nor derogate from the sovereignty of the soul."* The moral causes of hypochondriasm, originate in the errors of education, according to the sex of the individuals. If the person be a female, she is too often doomed to suffer from the care which is taken to cherish the morbid susceptibility of the nervous system. Timidity, delicacy of frame, acute feelings, and sentimentality, are too often considered desirable in women, few of whom are ever taught the necessity of controlling their feelings, and regulating their desires. Their imagination is too much cultivated-their judgment too little exercised; thence the morbid susceptibility of which I have spoken, and it is a well-known fact, that whatever excites powerfully, finally exhausts. Music, the greatest of female accomplishments, fosters that morbid susceptibility; and the close, sedentary application, requisite for the acquirement of this fascinating art to the extent regarded essential, in the present day, aids in producing those disturbances, in the whole economy of the system, which are favourable to hypochondriasis. Thence, in female education, the great importance of balancing the powers of the intellect and the force of emotions. If means to produce this be not adopted, hysteria is likely to occur, the paroxysms of which are almost always followed by depression of spirits and hypochondriasis. Females, nevertheless, are much less prone to the attacks of the latter than men, and indeed are more easily relieved from its influence. In those professions which admit of little bodily exercise, and require an overstrained exertion of mind, we find the sources of hypochondriasis in males. It is truly the malady of literary men, viri chartis impallescentes et inter liberos sepulti.† The votary of Fame, in his consumption of the midnight oil, is little aware that he is at the same time, consuming the lamp of life; that his labours are laying the foundation of anxiety, dejection, and a host of miseries, to imbitter the evening of his days, if he shall ever see it. But it must, nevertheless, be admitted, that it is not he who breathes the pure air of the uplands, who is exempt from hypochondriasis: agriculturists are subject to the disease, as well as the sedentary and the contemplative. Much depends on the nature of the society into which men are thrown, and also their qualifications to enjoy it. The cheerful companionship of the fair sex, change of scene, and consequently of ideas, and travelling, are not only the best prophylactics, but among the best, also, of the remedial means, which can be employed against this malady of the nerves. They have this great influence: they not only abstract the attention from the uncomfortable sensations of the body, but they lessen the load of mental anxiety, which is too often, especially in this speculating and trading country, the source of hypochondriasis. But the hypochondriac must not travel alone, nor with a rapidity to jade or fatigue; under such circumstances, like the learned Smellfungus, setting out with the spleen, every thing will appear discoloured or distorted, all will be pronounced barren, miserable, disgusting, dispiriting, from Dan to Beersheba, and the poor invalid will return home worse than when he departed. To render it truly useful, the daily progresses should be short-those routes chosen which afford new ideas to the mind-town and cities avoided; whilst the varied scenery of moun * Advancement of Learning, book ii. + Hoffman. tainous districts-the wild, the wonderful of nature, contrasted with the soft and beautiful, sought for or chosen. The meandering streamletthe dashing cataract-the trump of the wild bee, hanging on the pendent blossom of the honeysuckle-the mid-air carol of the lark-the hoarse caw of the rook-the silent heron, moveless as a statue on the margin of the lake-or, the piercing scream of the cormorant, as it wheels from its eyry on the naked rock amid the waste of waters, are objects far more likely to attract the attention of the hypochondriac, than the turmoil, the spectacles, and the tumults of towns and cities. The former sooth, the latter irritates his feelings. In dyspepsia, the harbinger of hypochondriasis, the blood circulates languidly through the extreme vessels, thence its stagnation in the larger; its defect of arterialization, and the consequent imperfect stimulus which it affords to the brain.i "You must rise early," said I, whilst prescribing for a fashionable hypochondriac; "run up the broad walk in the Regent's-park, and brush off the dew on Primrose-hill. You will then lose your blue devils, and eat a hearty breakfast on your return." He gazed at me for a minute and replied, "How, my dear doctor, can that be effected? You know that if one lives in the world, he must conform to its customs. I dine at half-past seven o'clock and feel drowsy after dinner, during, I presume, the progress of digestion; but that passes off; tea is brought in at ten, I am aroused; on retiring to bed, in vain do I court the drowsy god, until the morning peeps in between my curtains. How can I then rise?" There was much truth in this remark; and it is to be lamented that the tyranny of fashion obliges the higher classes to bring the heaviest meal of the day so closely upon the hour of repose. There is a wide difference between retiring to rest with an empty stomach, and one overloaded with many varieties of indigestible food, rendered still more so by the feverish excitement, caused by a more than salutary allowance of wine. The intimate connexion of digestion with sleep is such, that the physician is culpable who does not point out the error into which society has lately fallen with respect to these matters. The chief object of sleep is to restore exhausted power; so that the person may awake invigorated, and capable of again returning with refreshed energy to the performance of all the duties of life. But can this be expected, when the irritation of heavy, undigested food is present to disturb the soundness of our repose, by causing flatulence and pressure upon the plexus of nerves connected with the stomach? The funetions of the brain and nerves are deranged even by the sudden and repeated interruptions of sleep which the irritation of indigestion causes; for in health, the transition from sound sleep to waking is almost as gradual as its approach. The effects of such a condition are nightmare, horrific dreams, feverish delirium, and all the train of evils consequent upon their influence. If this is the effect of the habits of the present day, in relation to food and sleep on healthy individuals, how much more severely must it be felt by those in whom the nervous system is already in a morbid condition. I shall venture no opinion upon the cause of dreams. The poet says, 66 cum prostrata sopore, Urget membra quies, et mens sine pondere ludit."-PETR. |
