GEN. III. SPEC. II. a A. Hypochondrias autalgica. may. J. J. Rous seau. may distinctly states as one of its causes among his own countrymen a lecture habituelle de Buchan”. Rousseau admitted that this was a powerful cause of Vapours. hypochondrias in respect to himself. "Having read", says Exemplified "he, a little on physiology I set about studying anatomy; from Viller- and passing in review the number and varied actions of the parts which compose my frame, I expected twenty times a day to feel them going wrong. Far from being astonished at finding myself dying, my astonishment was that I could live at all. I did not read the description of any disease which I did not imagine myself to be affected with and I am sure that if I had not been ill I must have become so from this fatal study. Finding in every complaint the symptoms of my own, I believed I had got them all, and thereby added another still more intolerable the fantasy of curing myself." Fancies en tertained by the patient Marcellus Trincavellius. : The whims that are sometimes seriously entertained under this variety of the disease, are so truly ludicrous that " to be grave exceeds all power of face." One thinks himself a giant, another a dwarf; one is as heavy as lead, another as light as a feather. Marcellus Donatus makes mention of a baker of Ferrara who thought himself a lump of butter, and durst not sit in the sun nor come near the fire for fear of being melted. They are all extremely timid, and their fears are exercised upon trifles, or are altogether groundless. Some suspect their nearest and dearest friends of designing to poison them: others dare not be alone in the dark lest they should be attacked with ghosts or hobgoblins. They dare not go over a bridge or near a pool, rock or steep hill, lest they should be tempted to hang, drown, or precipitate themselves: and if they come to a place where a robbery or a murder has been committed, they instantly fear they are suspected. Trincavellius had a patient that for three years together could not be persuaded but that he had killed a man, and at length sunk into a confirmed melancholy, and made away with himself for fear of the gallows *. * Consil. xi. Lib. I. GEN. III. Vapours. It is a melancholy reflection that the wisest and best of mankind are as open to this affliction as the weakest, and perhaps more so. Pascal himself was at one time chondrias so hallucinated with hypochondrism, as to believe that autalgica. he was always on the verge of an abyss into which he was in danger of falling. And under the influence of this terror, he would never sit down till a chair was placed on that side of him on which he thought he saw it, and thus proved the floor to be substantial. tremens, what. It is frequently induced by too free a use of spirituous Often inliquors, the stomach and other digestive organs being excess of duced by an hereby debilitated and almost paralysed; and where this spirituous is the case the disease is apt to terminate in that exhaust- liquors. ed state of the nervous system generally, and delirious condition of the brain, which by some writers has been called delirium tremens; in which the mind and body Delirium exhibit equal feebleness, combined with a high degree of irritability, and the patient often falls a sacrifice in a few days: previous to which, he is worn out with convulsive struggles, succeeded by a cold and general perspiration; the pulse increases in rapidity and becomes thready, and the twitching of the tendons subsides into a tremour that spreads over the whole body; the countenance is pale and anxious, the patient mutters with incessant rapidity, and the DELIRIUM is constant, though easily interrupted by questions addressed to him. In one case, says Mr. Blake, who has given a good description of the complaint, the mind was so diseased that the patient after being desired to put out his tongue, continued for nearly half an hour to push it out and draw it in alternately in quick succession whenever I looked towards him*. If before this extremity takes place a sound and refreshing sleep creep gradually over the frame, the irritability subsides, a healthful quiescence succeeds to general commotion, and the mind and the body become by degrees re-invigorated. Under the SECOND VARIETY we meet with a totally dis- 6 A. Hypo Edin. Med. and Surg. Journal. Oct. 1823. p. 501. chondrias. pertæsa. Weariness of life. GEN. III. В А. Нуро- pertæsa. Weariness of life. Ascribed by men chiefly. This account not strictly correct: occasion ally. Common origin an ill-advised retirement tinct set of morbid feelings and ideas; for the patient is here oppressed with a general listlessness and disgust; an irksomeness and weariness of life, often without any specific reason whatever. This is the melancholia Anglica of Sauvages, who describes it as common to our own countrymen; under the attack of which, says he, "languid, sorrowful, tired of remedies of every kind, they settle their affairs, make their wills, take leave of their friends by letters, and then put an end to their lives by hanging, poison, or some other means: exhibiting a wish to die, not from insanity or severe grief, but tranquilly from a mere tædium vitæ, or irksomeness of existence." This may occasionally be the case; but by far the greater number of suicides in our own country proceed, not from hypochondrism, but a despondency produced by though true real losses, and belong, therefore, as I have already observed, to the genus empathéma. Yet this miserable upshot occurs in a few instances from the feeling, or rather the want of feeling here assigned: the perpetrators of the horrid deed being generally those who having been acpursuits in tively engaged in the hey-day and meridian of life, have retired upon their fortunes with a view of enjoying them in quiet; but who unhappily find themselves fitted for any thing rather than for quiet; who have no taste for reading, reflection, or domestic tranquillity, and are too proud to return to the bustle of the world and the excitement of nicely balanced speculations. There is here a want of the habitual stimulus to a secretion of sensorial power; in consequence of which, the individual sinks into a state of low spirits and becomes unhappy. A like issue frequently follows upon a life devoted to all the pursuits of sensual gratification, in the course of which the individual has exhausted his stock of enjoyments, and worn out his powers of body and mind before he has reached little more than the midway of his existence. Every thing now palls upon his senses, and he has neither taste nor energy to engage in more rational pursuits. "A ride out in the morning, and a warm parlour and a pack of cards in the afternoon, are all that life affords," said a patient of from irritant those who are not qualified for quiet life. Dr. Darwin's to him, a man of polished manners, about fifty years of age. He got tired of these in a few months, and having no other resource, shot himself*. GEN. III. SPEC. II. Spleen. Burton has well described the state of mind of y A. Hypomany chondrias that are tormented with this most wretched malady+: misanthrobut still more so those affected with the THIRD VARIETY, pica. which is strikingly accompanied with peevishness, general Misanthromalevolence, and an abhorrence of mankind. "They are py soon tired with all things; they will now tarry, now be Description. gone; now in bed they will rise, now up, then go to bed; now pleased, and then again displeased; now they like, by and by dislike all, weary of all; sequitur nunc vivendi nunc moriendi cupido, saith Aurelianus: discontented, disquieted; upon every light occasion or no occasion object; often tempted to make away with themselves; they cannot die, they will not live: they complain, weep, lament, and think they lead a most miserable life: never was any man so bad. Every poor man they see is most fortunate in respect of them: every beggar that comes to the door is happier than they are; jealousy and suspicion are common symptoms in the misanthropic variety. They are testy, pettish, peevish, distrustful, apt to mistake, and ready to snarl upon every occasion, and without any cause, with their dearest friends. If they speak in jest the hypochondriac takes it in good carnest; if the smallest ceremony be accidentally omitted he is wounded to the quick. Every tale, discourse, whisper, or gesture he applies to himself. Or if the conversation be openly addressed to him, he is ready to misconstrue every word; and cannot endure that any man should look steadfastly at him, laugh, point the finger, cough or sneeze. Every question or movement works upon him, and is misinterpreted, and makes him alternately turn pale and red, and even sweat with distrust, fear, or anger." As in this species the body is more affected than in * Zoonom. Vol. iv. p. 90. Edit. 8vo. † Analysis of Melanch. Part. 1. Sect. u. i. 2. Lib. 1. Cap. v1. GEN. III. SPEC. II. Hypochondrism. Low spirits. Medical treatment. Remedial process. any other division of mental alienation, more may often Alusia Hybe accomplished by MEDICINE; though we must by no pochondrias. means be inattentive to moral discipline. The skin is very frequently cold and without a free secretion, and hence, general friction with rubefacients and the warmer diaphoretics have often been found serviceable. The digestive organs are almost always torpid, and several of them, especially the stomach and liver, secrete their respective fluids not only in too small, a quantity, but of an unhealthy quality, so as to be too viscid, too dilute, or morbidly stimulant. Some kind of acrimony, indeed, is almost always found in the stomach, and particularly that of acidity. And hence aperients, carminatives, and particularly the tonic plan which has already been recommended under LIMOSIS Dyspepsia, are manifestly called for, and will often be found serviceable. Warm diaphoretics. Warm ape and carmi rients, natives. Singular misplacement of the colon often found on dissection. Generally a result of debility, and hence often an effect. Tight pain in the epigastrium from this cause. Post-obit examinations have also frequently pointed out another local cause which otherwise we should little expect and that is a displacement of the transverse colon. M. Pinel, as we have already observed, regards this as a very common cause of insanity in all its forms: but there can be no question that it is a powerful and ready cause of the present species of mental alienation. M. Esquirol, who has found it as frequently as M. Pinel, tells us that this displacement sometimes consists in an oblique, and sometimes in a perpendicular direction of the intestine, so that its sinister extremity lies behind the pubes; whilst it has sometimes descended into the form of an inverted aorta even below the pubes and into the pelvis. No disease of the organization has been found in any instance, and hence the change of place must proceed from relaxation and debility alone, where the misposition is not connate; on which account it may, in some instances, be an effect, as it is certainly a cause in others. It is under these circumstances that we chiefly meet with that pain in the epigastrium to which we have already adverted, and which gives the feeling of a tight cord surrounding the body in the line of distress; and |