Hypochondria

“ Hypochondria is a species of torment which not only makes us unreasonably cross with the things of the present; not only fills us with groundless anxiety on the score of future misfortunes entirely of our own manufacture, but also leads to unmerited self-reproach for what we have done in the past. ”

“ In hypochondria the individual's thoughts are centred upon some supposed disease until a true delusional condition is developed; this does not often occur in hysteria. Hypochondria is seen with as great a frequency in the male as in the female, while hysteria prevails much more largely in the female sex. ”

“ But no doubt a more real help was his recurrence, as often as I chose, to his own youthful suffering from hypochondria, and his constantly repeated assurance that I not only would not and could not have hydrophobia from that out-dated dog-bite, but that I must also soon cease to have hypochondria. ”

“ We continue to remain powerless to cure hypochondria. We are able to soothe the sufferings of the hypochondriac, because we are able to deaden his microbe—kill it, we cannot. After more or less time the bacillus niger recovers his virulence, and the diseased individual retakes his momentary interrupted course towards the sombre land whence no traveller returns, and over whose doors are written those words of the great seer ”

“ Despite the plethora of materia scripta on the subject it makes sense to reprint Hill's Hypochondriasis, because it is indeed a "practical treatise" and because it offers the modern student of neoclassical literature a clear summary of the best thoughts that had been put forth on the subject, as well as an explanation of the causes, symptoms, and cures of this commonplace malady.
[Pg ii] No reader of seventeenth- and eighteenth-century English literature needs to be reminded of the interest of writers of the period in the condition—"disease" is too confining a term—hypochondriasis. ”

“ The cure or removal of hypochondriasis must be attempted by those medicines which are calculated to counteract occasional causes, and obviate the more urgent symptoms: hence gentle laxatives, acidulated and chalybeate waters, as also copious draughts of cold water, have often been productive of the best effects. Emollients, diluents, the cold-bath, Peruvian bark, and exercise, especially riding on horseback, if judiciously resorted to, have all been found of service.
Hypochondriac patients ought never to fast long; their diet should be solid and nourishing ”

“ Hypochondria consists of a mild form of insanity in which there is a tendency to exaggerate the various sensations of the body and their importance, their exaggeration being at times so great as to amount to actual delusion. All sorts of symptoms are dwelt upon, and the doctor is pestered to the extreme by the morbid fears of the patient. ”

“ You see, Sir, I am no hypochondriac, as my fool of a doctor wants to persuade me: a hypochondriac shudders at every breath of air, trembles when a door is open, and looks upon a window as the entrance of death. ”

“ In the first four sections almost every statement is commonplace and requires no commentary (for example, Hill's opening remark: "To call the Hypochondriasis a fanciful malady, is ignorant and cruel. It is a real, and a sad disease: an obstruction of the spleen by thickened and distempered blood; extending itself often to the liver, and other parts; and unhappily is in England very frequent: physick scarce knows one more fertile in ill; or more difficult of cure.") ”

“ The belief that hypochondriasis was a somatic condition persisted until [Pg iii] the second half of the seventeenth century at which time an innovation was made by Dr. Thomas Sydenham. In addition to showing that hypochondriasis and hysteria (thought previously by Sydenham to afflict women only) were the same disease, Sydenham noted that the external cause of both was a mental disturbance and not a physiological one. He also had a theory that the internal and immediate cause was a disorder of the animal spirits arising from a clot and resulting in pain, spasms, and bodily disorders. ”

“ Hypochondria inflamed not from retention of flatus, tension of the diaphragm, checked respiration, with dry orthopnœa, when no pus is formed, but when these complaints are connected with obstructed respiration; but more especially strong pains of the liver, heaviness of the spleen, and other phlegmasiæ and intense pains above the diaphragm, diseases connected with collections of humors,—all these diseases do not admit of resolution, if treated at first by medicine, but venesection holds the first place in conducting the treatment ”

“ Vapours are often complicated with diseases of the stomach, hystericks, melancholy. But in the true hypochondriasm, the valetudinary dyspepsy, and diseases of the digestive organs, seem rather a natural consequence and sequel of the lugubrious mental temperament: besides, in dyspepsy the mental perturbation is slight; it is also a far more universal disease than hypochondriasm, affecting equally both sexes; and the young as well as the old.
Hypochondriacks feel, or imagine they feel, all diseases; against these they combat with a thousand remedies, and exhaust the whole pharmaceutical rotine. ”

“ For example, the title page of the copy in the British Museum reads, Hypochondriasis; a Practical Treatise On the Nature and Cure of that Disorder, Commonly called the Hyp and the Hypo. The copy in the Royal Society of Medicine contains, among other additions, the words "by Sir John Hill" in pencil, and "8vo Lond. 1766," written in ink and probably a later addition.
[2] Melancholy, hypochondriasis, and the spleen were considered in the seventeenth and eighteenth centuries to be one complex condition, a malady rather than a malaise, which is but a symptom. ”

“ Hypochondria.—There are people who become hypochondriacal through their sympathy and concern for another person; the kind of sympathy which results therefrom is nothing but a disease. Thus there is also a Christian hypochondria, which afflicts those solitary, religiously-minded people who keep constantly before their eyes the sufferings and death of Christ. ”

“ No disease is more troublesome, either to the Patient or Physician, than hypochondriac Disorders; and it often happens, that, thro' the Fault of both, the Cure is either unnecessarily protracted, or totally frustrated ”

“ Modern popularizing of disease has distinctly increased the numbers of the hypochondriacs, or at any rate has made their fears more scientific. Brain tumor, gastric ulcer, appendicitis, tuberculosis, heart disease, cancer, syphilis,—often have I seen a hypochondriac run the gamut of all these deadly diseases and still retain his health. The faddy habits they form are the sustenance of those who start the varied forms of vegetarianism, chewing cults, fresh-air fiends, wet-grass fanatics, back-to-nature societies, and the mild lunacies of our (and every) age. ”

“ When you examine the patient, inquire into all particulars; first how the head is, and if there be no headache, nor heaviness in it; then examine if the hypochondria and sides be free of pain; for if the hypochondrium be painful, swelled, and unequal, with a sense of satiety, or if there be pain in the side, and, along with the pain, either cough, tormina, or belly-ache, if any of these symptoms be present in the hypochondrium, the bowels should be opened with clysters, and the patient should drink boiled hydromel in a hot state. ”

“ Air and exercise, as they are the best preservers of health, and greatest assistants in the cure of all long continued diseases, will have their full effect in this; but there requires some caution in the choice, and management of them. It is common to think the air of high grounds best; but experience near home shews otherwise: the Hypochondriac patient is always worse at Highgate even than in London. ”

“ Second, there is a special form of worry called by the old authors hypochondriacism, which essentially is fear about one's own health. The hypochondriac magnifies every flutter of his heart into heart disease, every stitch in his side into pleurisy, every cough into tuberculosis, every pain in the abdomen into cancer of the stomach, every headache into the possibility of brain tumor or insanity. He turns his gaze inward upon himself, and by so doing becomes aware of a host of sensations that otherwise stream along unnoticed. ”

“ This neurosis, too, has no psychic mechanism, but regularly influences the psychic life, so that among its regular manifestations we have anxious expectation, phobias, hyperesthesias to pain, and other symptoms. This anxiety neurosis, as I take it, certainly corresponds in part to the neurosis called hypochondria, which in some features resembles hysteria and neurasthenia. Yet in none of the earlier works can I consider the demarcation of this neurosis as correct, and moreover, I find that the usefulness of the name hypochondria is impaired by its close relation to the symptom of "nosophobia." ”

“ Many decline to share the occupations and pleasures of others through fear of possible wet feet, drafts of air, exhaustion, or other calamity. Such tendencies, though falling short of hypochondria, pave the way for it, and, in any event, gradually narrow the sphere of usefulness and pleasure.
No part of the body is exempt from the fears of the hypochondriac, but he is prone to centre his attention upon the obscure and inaccessible organs. The anecdote is told of a physician who had a patient of this type—a robust woman who was never without a long list of ailments. ”

“ Hypochondria, to which intelligent and highly educated persons of sedentary habits brooding over their sensations are liable, especially if they are accustomed to read medical works and accounts of diseases and of their treatment, will do the same. ”

“ Impaired digestion with nervous symptoms—in which the morbid sensibility of the mind is apparently the greatest—is called hypochondria. This class of sufferers, whose bodily and mental ills and morbid fears are so chaotically interwoven, are deserving of much consideration. So numerous are their fears and so fertile are their reasons for the many changes they arbitrarily make in their efforts to get well or keep from getting worse, so obstinately sure are they of being always right—that we can but give them our sincerest pity. ”

“ No appeal to the reason is of any avail, and the hypochondriac idea so dominates his existence as to render him unable to perform the ordinary duties of life. In its most aggravated form hypochondriasis amounts to actual insanity, delusions arising as to the existence of living creatures in the intestines or brain, or to the effect that the body is materially changed ”

“ It is to be remembered, however, that mere debility is but seldom the cause of these nervous sufferings; and that the feelings of lassitude and exhaustion, the small pulse, cold extremities, cramps and spasms, so frequent among hypochondriacs, are generally symptoms or effects of congestion in the vessels of the liver and abdominal organs, giving rise to irritation in the nervous system, constipation, and morbid secretions. The classes of people who become hypochondriacal are those who have lived well, both in food and drink, and who have led an idle life, mental and bodily. ”

“ Hypochondria shows itself in a perpetual hunting after things that vex and annoy, and then brooding over them. The cause of it is an inward morbid discontent, often co-existing with a naturally restless temperament. In their extreme form, this discontent and this unrest lead to suicide. ”

“ It is best when wind passes without noise, but it is better that flatulence should pass even thus than that it should be retained; and when it does pass thus, it indicates either that the man is in pain or in delirium, unless he gives vent to the wind spontaneously. Pains in the hypochondria, and swellings, if recent, and not accompanied with inflammation, are relieved by borborygmi supervening in the hypochondrium, more especially if it pass off with faeces, urine, and wind ”

“ On arriving for the first time in a tropical climate, the stranger must be prepared to expect some trifling complaints, but temperance and discretion are his best directors. Above all things, let him be on his guard against the epidemic of new comers—hypochondriasis—as the greatest enemy to health and happiness, as the mildew that nips the bud of his new existence in its opening. But more let him guard against idleness, as the parent of hypochondriasis. It is essential to the enjoyment of a sound mind in a sound body that both be kept in constant exercise ”

“ Hypochondria, in its more aggravated forms, is a very common result of secret vice.
9. Phthisis, or consumption, is still more frequently produced by the cause we are considering, than any other disease I have mentioned. And we know well the history of this disease; that, though slow in its progress, the event is certain. In this climate, it is one of the most destructive scourges of our race. If the ordinary diseases slay their thousands, consumption slays its tens of thousands. ”

“ Few people are free from the distressing evils which hypochondria brings. They come at all times and are fed by the very flame which they themselves start. They are a dread of coming derangement caused by present disorder and bring about more suicides than any other one thing. ”

“ The results of treatment frequently assist our diagnosis in difficult cases. Almost any medicine will relieve the pains of the hypochondriac for a time, and it is generally far easier to do him good, temporarily, than it is to relieve a neuralgic patient; but, en revanche, every remedy is apt to lose its affect after a little while. The only chance of producing permanent benefit in hypochondriasis is by the judicious combination of remedies that remove symptoms (especially dyspepsia, flatulence, etc.) ”