SPECIES II. ALUSIA HYPOCHONDRIAS. Wypochondrism. Low Spirits. GLOOMY IDEAS OF REAL LIFE; DEJECTED SPIRITS; SPEC. II. specific THE term HYPOCHONDRIAS is taken from the anatomical GEN. III. compound hypochondria, to which region the disease was Explanaformerly supposed to be altogether confined. Hypochon- tion of the drias is here used instead of hypochondriasis, the common term. name, because, as already observed on various occasions, iasis as a termination is limited, nearly with this single exception, to denote in the medical vocabulary a peculiar family of cutaneous diseases, as pityriasis, psoriasis, ichthyiasis, and many others. The author has felt the less difficulty in proposing this change, as hypochondriasis is of comparatively modern invention, and is not to be met with in the Greek or Latin writers; by whom the complaint is usually alluded to or described as a species of melancholy, or rather as a disease of the melancholic temperament. Diocles. It constitutes the third sort or species of this malady How explained by described by Galen, and which he regards as connected Galen in with a peculiar state of the stomach; though, from its his contromental symptoms, he does not incline to contemplate it very with as Diocles, a contemporary physician of reputation, had done in his Book on Gastric Affections, as a simple disease of this organ. The controversy has been in different The controtimes continued to our own day; and it does not seem to versy not yet settled. SPEC. II. Alusia drias. GEN. III. be even yet universally settled whether hypochondrias should be regarded as a mental or a dyspeptic malady. Hypochon- M. Esquirol, and M. de Villermay*, contemplate it in the latter light, M. Georget† and M. Falret, though a pupil of M. Esquirol, refer it in every instance to the brain as its primary seat‡. In Pinel the disease seems to be included under aliénation mentale, and its different varieties to be distributed, though without particular remark, amidst the five species into which he has divided that genus. Hypochondrism. Low spirits. How arranged by Pinel. Close resemblance to some varieties of genuine melancholy; and may originate from like causes, The present species bears so near a resemblance to several of the varieties of genuine melancholy as to be often distinguishable from them with great difficulty; and the more so as it is no uncommon thing for hypochondrias to terminate in melancholy, or for melancholy to be combined with hypochondrias §. Both may be the result of a predisposing constitution, or may be primarily induced by accidental causes where no such constitution exists and the predisposition and the accidental causes of the one may become those of the other: for the temperament known by the common name of melancholic, and characterized by a lean and dry corporeal texture, small and rigid muscles, a sallow skin, brownish-yellow complexion, little relieved by redness of any kind, deepblack and coarse hair, eyes sunk in hollow sockets, large prominent veins, especially in the hands and arms, with a tendency to solitude and private musing, is a common precursor of both. And in like manner a sedentary life of any kind, and especially severe study protracted to a late hour in the night, and rarely relieved by social intercourse, exercise, or nugatory amusements; a debauched and dissolute habit, or excesses in eating and drinking, may become causes of either of these maladies, from accessory circumstances that cannot be traced out even where the predisponent temperament does not seem to Traité des Maladies Nerveuses, &c. + Sur la Folie-Physiologie du Cerveau. De l'Hypochondrie et du Suicide, &c. Svo. Paris, 1822. $ Falret, de l'Hypochondrie, &c. ut suprà passim. GEN. III. SPEC. II. exist. But it is very justly observed by Sir A. Crichton that even in those "whose health is much deranged, Alusia true melancholy seldom arises, except mental causes of Hypochongrief and distress join themselves to the corporeal ones: Hypochonand this constitutes one of the characters which distin- drism. Low drias. guishes melancholia vera from hypochondriasis. The spirits. former may be said to be always excited by mental causes, character. Descriptive and consists in various phænomena of grief, despondency, and despair; whereas the latter most commonly arises from corporeal causes, and its mental phænomena consist of erroneous ideas entertained about the patient's own make or body "*. causes. The corporeal causes are usually a diseased condition Ordinary of one or more of the digestive organs, and especially, as corporeal we shall presently have to observe, a displacement of some part of the colon. It is also not unfrequently a result of the sudden cessation of some periodical or other habitual discharge, as that of an issue, or of a hemorrhoidal flux, a chronic ulcer, or some external eruption. The melancholy man seldom lives long, and his disorder often commences in the meridian of life. He frequently terminates his days by violence, or at the utmost never attains old age. The hypochondriac seldom becomes affected till after the meridian of life, and very generally continues to the stage of longevity. The common corporeal symptoms are a troublesome Diagnostics. flatulency in the stomach or bowels, acrid eructations, costiveness, a copious discharge of pale urine, spasmodic pains in the head and other parts of the body, giddiness, dimness of sight, palpitations, general sleeplessness, and an utter inability of fixing the attention upon any subject of importance, or engaging in any thing that demands vigour or courage. The mental feelings, and peculiar trains of ideas that haunt the imagination and overwhelm the judgment, exhibit an infinite diversity, and lay a foundation for the three following varieties: * Of Mental Derangement, Vol. 1. p. 235. a A. Hypochondrias autalgica. 7 Misanthropica. Vapours. Misanthrophy. Spleen. In the FIRST VARIETY, which is commonly distinguished by the name of VAPOURS, or LOW SPIRITS, the patient is tormented with a visionary or exaggerated sense Description. of pains or some concealed disease; a whimsical dislike of Vapours. Exemplified. Additional illustration. particular persons, places, or things; or groundless apprehensions of personal danger or poverty. Greding gives an account of a medical practitioner who applied to him for assistance, under an impression that his stomach was filled with frogs, which had been successively spawning ever since he had bathed, when a boy, in a pool in which he had perceived a few tadpoles. He had spent his life in trying to expel this imaginary evil, and had travelled to numerous places to consult the first physicians of the day upon his obstinate malady. It was in vain to attempt convincing him that the gurglings or borborygmi he heard were from extricated and erratic wind. He argued himself, says M. Greding, into a great passion in my presence, and asked me if I did not hear the frogs croak. I have at this moment under my care, a hypochondriac of about fifty years of age, who affords a sufficient proof that Moliere drew his Malade Imaginaire from nature, and hardly added an exaggerating touch. His profession is that of the law; his life has been uniformly regular, but far too sedentary and studious. Without having any one clearly marked corporeal affection, he is constantly dreading every disease in the bills of mortality, and complaining one after another of every organ in his body; to each of which he points in succession as its seat: especially the head, the heart, and the testes. He now suspects he is going to have a cataract, and now frightens himself with an apprehension of an involuntary seminal emission. It is rarely that I have left him half an hour, but I have a note to inform me of some symptom he had SPEC. II. a A. Hypo forgotten to mention, and I have often five or six of these in the course of the day. The last was to state that shortly after my visit he had had a discharge of three chondrias autalgica. drops of blood from the nose-a change which he thought Vapours. of great importance, and requiring immediate attention. His imaginary symptoms, however, soon disappear, provided they are listened to with gravity and pretended to be prescribed for; but not otherwise. Yet in disappearing they merely yield to others that can only be surmounted in like manner. His head is too much confused to allow him to engage in any serious study, even if it were prudent to recommend it to him: but on all common subjects he is perfectly clear, and will converse with shrewdness and a considerable extent of knowledge. His bowels are sluggish: his appetite not good though he eats sufficiently; his sleep is unquiet, but he has enough of it without opiates; his pulse is variable, sometimes hurrying on abruptly, and without any obvious cause to a hundred strokes in a minute, but often very little quicker than in a state of health. His tongue varies equally, and is irregularly clean, milky, and brownish, and then suddenly clean again. He is irritable in his temper, though he labours to be calm; and is so rooted to his chamber that it is difficult to drag him from it. He has now been ill about ten weeks, but it is during the winter, and the season is too severe and inclement for him to venture abroad. I look forward to his restoration in the spring from exercise, change of air, and a course of tonic medicines. I have not found him complain of dysphagia globosa, or that sense of suffocation from the feeling of a constringing ball in the throat which is so common to hysteric patients, and which, from its being often also traced in the present disease, has been called by Pechlin suffocatio hypochondriaca *; but his spirits are in a state of almost perpetual depression. A superficial and injudicious perusal of medical books, An injudicious perusal addressed to those who are not of the profession, has of medical been a frequent source of this affection. M. Viller * Lib. I. Obs. 31. books a fre quent cause. |