GEN. III. SPEC. II. Medical when such a symptom, therefore, occurs, we have reason to suspect the cause of the disease to be produced by Alusia Hysome derangement of the colon in respect to position. pochondrias. HypochonUnder the operation of such a cause the art of medicine drism. Low can do but little: temporary ease, however, may be ob- spirits. tained by the pressure of a belt broad enough to sup- treatment. port the whole of the lower belly; and it is possible that How to be the intestine may gradually right itself under a course of palliated. the warmer tonics, as columbo, canella alba, and cassummuniar, or lose its morbid irritability by habit. But these are rare terminations; for more generally the displacement increases, and the disease itself gains ground and becomes more incurable. Disease often re lieved by mariscal rrhage, hemo or leeches applied to the anus. to be re whenever suddenly Congestions from weakness of vascular action in one or more of the abdominal viscera, are a frequent result of the present complaint, and not unfrequently a primary cause: and hence we may see why the bleeding piles should be serviceable in so many instances as to obtain from Alberti the name of medicina hypochondriacorum *, and why leeches repeatedly applied to the anus, as recommended Chronie discharges by Schoenheyder, should often have a like beneficial effect. This is of the greatest importance where the newed discase has been preceded by a periodical flow of blood from the hemorrhoidal veins and should point out to us obstructed. the necessity of renewing any other discharge or external irritation to which the system may have been accustomed. Opium is a very doubtful medicine, though strongly Opium recommended by Deidier and other respectable writers; and readily had recourse to by hypochondriacs themselves to relieve their distressful sensations. Dr. Cullen asserts peremptorily that he has always found a frequent use of opiates pernicious in hypochondriacs ‡ and in many instances in which I have myself been tempted to employ it, I have been compelled to withhold its further use from its doing more mischief than good. It has often, in such doubtful. Dissert. de Hæmorrhoidibus. Halle. 1716. + Act. Soc. Med. Hafn. 1. p. 313. GEN. III. Alusia Hypochondrias. Hypochon cases, been exchanged for other sedatives, but rarely with any decided advantage. Exercise of all kinds should be encouraged in every drism. Low modification of the disease, but especially exercise on horseback, though it is seldom in the first and third variety we can succeed in getting a patient to try it. The diet should be governed by the principles already laid down for treating indigestion. spirits. Exercise, especially on horseback. Moral management. In the autalgic variety sometimes necessary to humour the prevailing fancy. Exemplified. In the MORAL MANAGEMENT, assiduous kindness and consoling conversation produce a deeper effect than they seem to do. Loquacity is always hurtful, but a talent for cheerful discourse, intermixed with interesting and amusing anecdotes, frequently draws away the patient's attention from himself, and becomes a most useful palliative. In the autalgic variety, in which he is perpetually haunted with a feeling of some dreadful disease which exists no where but in his own fancy, the hallucination, when we possess his confidence, should be removed by a candid statement of the fact, and, if necessary, friendly expostulation: but the moment we find the prepossession is too strong to be removed by argument, it is better to humour the conceit and to pretend to prescribe for it. It is sometimes necessary, indeed, for the hypochondriac is often possessed of great cunning, to drop all pretensions whatever, and to put him in good earnest upon a course of medicines for a disease we know he is as free from as ourselves. Thus a firm belief that he has an inveterate itch is a common delusion with a patient of this kind, and it will be often found impossible to persuade him that he is cured till his whole body has been repeatedly rubbed over with sulphur or hellebore ointment. I had lately under my care a special pleader of considerable eminence, who in the course of this affection would have it that he had the pox. I at first argued the point with him day after day, but to no purpose; he felt certain that he should never be well till he was not only salivated, but had used tonic injections for a gleet which he said accompanied it, though he had no discharge whatever. It was in vain to deceive him by supposititious medicines, for he was a man of con GEN. III. SPEC. II. Alusia Hy siderable learning, and well acquainted with medical preparations, and I hence allowed him his heart's desire; he rubbed in mercurial ointment every night, and for an in- pochondrias. jection used a solution of zinc. In a week he persuaded drism. Low himself he was well, and begged permission to desist from spirits. a farther use of the remedies; a permission which was treatment. readily granted him. Moral in the second variety, or tædium vitæ. A return to suits: past pur or new pur suits engaged in with great Country sports: duties. In the second variety, or tædium vitæ, where the time Treatment seems to hang intolerably heavy on the patient's hands, from his having in a mistaken search after happiness, relinquished a life of constant excitement and activity for the fancied delights of rural retirement and quiet, the best and most radical cure would be a return to the situation that has been so unfortunately abandoned: but if this cannot be accomplished the patient must be put into a train of pursuits of some other kind. If he be fond of the sports of the country, he should weary himself in the day time with hunting or shooting, or even horse-racing rather vigour. than be hypochondriacal from idleness; and spend his evenings in the bustle of dinner-parties, or cards. And if he be capacified for higher and more useful occupations, let him plunge headlong into the public concerns of the or a routine parish and its neighbourhood, become a member of its of public select vestries, a trustee of the highways, or a magistrate of the district. The habit of excitement must for some time be maintained, though it be afterwards let down. by degrees and the intermediate steps are of no great importance so far as they answer their purpose. We are not at present arguing the case upon a principle of ethics or of religion; but merely upon a principle of moral medicine. Yet I have often known persons of the above description broken in by degrees to a love of domestic above in quiet, for which they were by no means fitted when they various first entered upon it: and who, with a love of domestic quiet, have settled also, as a soberer stage of life has advanced, and reflection has gained ground upon them, into a love of strict moral order, and the higher duties of a conscientious Christian, to which at one time they seemed as little disposed. Happy re sult of the cases. GENUS IV. APHELXIA. Rebery. INACTIVITY OF THE ATTENTION TO THE IMPRESSIONS GEN. IV. Origin of the generic term. Subject al most new to medicine. Means of our be coming acquainted with an ex ternal world; external APHELXIA is derived from apéλxw "abstraho, retraho, avoco, abduco"; and is in use among the Greek writers. The subject is almost if not altogether new to nosology, and has seldom been dipt into by physiologists. Dr. Darwin occasionally touches upon it in various parts of his "Zoonomia", and Dr. Crichton in his " Inquiry into the Nature of Mental derangement", and it is well described and illustrated by La Bruyere in his " Characters"; but it yet remains to be analyzed and reduced to a nosological method, and examined in a pathological view. A few leading ideas upon this subject have already been thrown out by the author in his comment upon the present definition in the volume of Nosology; and of these he will avail himself in treating of it more at large. In order to our becoming acquainted with the existence of surrounding objects, or of an external world, as it is called by psychologists, three things are necessary: sound external senses; a secretion of the nervous fluid, apparently under different modifications, whereby they tion of ner- are made capable of being roused or excited by the different objects addressed to them; and an exercise of the faculty of the faculty of attention to the impressions which are senses: due secre vous fluid: exercise of attention. thus produced. The will has, or ought to have, a power GEN. IV. of calling this, as well as every other faculty of the mind, Aphelxia. Revery. into a state of exertion or of allowing it to be indolent; Power of the and it is chiefly upon this want of power, or the same will in sumpower intensely exerted, that the phænomenon of revery attention: moning the depends; thus giving rise to the three following species Revery de pends upon this power intensely exerted, or wanted. characters. In the first of these, the attention is truant and does Distinctive not yield readily to the dictates of the will: in the second, it is rivetted at the instigation of the will itself to some particular theme unconnected with surrounding objects: and in the third, it has the consent of the will to relax itself, and give play to whatever trains of ideas are uppermost or most vivacious in the sensory. SPECIES I. APHELXIA SOCORS. Absence of Mind. TRUANT ATTENTION; WANDERING FANCY; VACANT OR VACILLATING COUNTENANCE. GEN. IV. THIS is an absence or vacuity of mind too common at schools and at church; over tasks and sermons; and there Illustrated. are few readers who have not frequently been sensible of it in some degree or other. In reading books in which we are totally uninterested, composed in a tedious and repulsive style, we are almost continually immersed in this species of revery. The will |