Hypochondriasis

“ 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 ”

“ 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 ”

“ As in hysteria, too, the tenderness is a phenomenon so greatly affected by the mind, that, if we can divert the patient's attention for a moment, he will let us touch him anywhere, without noticing it at all.
It is a marked peculiarity of hypochondriasis that it is far more common in men than in women; a relation which is precisely the opposite to that which rules in neuralgia. Hypochondriasis is also pre-eminently a disease of adult middle life; it is scarcely ever seen in youth, except as the result of excessive masturbation acting on a temperament hereditarily predisposed to insanity. ”

“ HYPOCHONDRIACAL INSANITY differs only in degree from hypochondriasis, described on a subsequent page. It is an incurable manifestation of one type of the mental degenerations. It is slowly progressive, and often ends in dementia. It differs from hypochondriacal melancholia in being an evolution of mental defect or degeneration, and in the fact that the mental depression, which is usually of a mild, periodic, or impulsive form, is secondary to the other symptoms, and not, as in hypochondriacal melancholia, the mental condition out of which the hypochondriacal symptoms are evolved. ”

“ Hysteria is distinguished from hypochondriasis, as in the latter there are no retrograde motions of the alimentary canal, but simply a debility or inirritability of it, with distention and flatulency. It is distinguished from apepsia and cardialgia by there being nothing ejected from the stomach by the retrograde motions of it, or of the œsophagus. ”

“ The subjects of hypochondriasis are for the most part members of families in which hereditary predisposition to degradation of the nervous system is strong, or those who have suffered from morbid influences affecting this system during the earlier years of life. ”

“ 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 notoriously the fact that hypochondriasis especially affects the rich and idle classes; but it would be a great mistake to suppose that it never attacks the poor or the hard-worked: only, in the latter instances, it apparently needs, for it development, the existence of strong family tendencies to neurotic disease, and especially to insanity. ”

“ But in hypochondriasis it is not often that we are left, for any long time, to these means of diagnosis only; the special character of the disease is that the morbid sensations shift from one place to another, in a manner that is quite unlike that of the true neuralgias. The patient who to-day complains of the most severe gastralgia, or liver-pain, will to-morrow place all his sufferings in the cardiac region, or in the rectum, or will complain of a deep fixed pain within his head; and these changes are often most rapid and frequent. ”

“ Hypochondriasis is a still slighter form of mental derangement, and which is characterized by a preposterous anxiety and solicitude with regard to the patient's own health, which in these cases is often little if at all disturbed, with the exception of occasional uneasiness at the stomach, arising from flatulency and other effects of indigestion. This disorder in the state of the digestive function, is generally considered by the patient as the real and primary disease, though 99 times in 100 it is merely secondary, the result of torpor of the alimentary canal altogether. ”

“ 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.) ”

“ The physical symptoms of hypochondriasis are commonly those associated with impaired digestion and nutrition—namely, anæmia, dyspepsia, neurasthenia, constipation, flatulence, headache or a feeling of discomfort after using the brain, less appetite, slight loss of flesh, disordered sleep. ”

“ And were we as partial as we wish to be just, there would certainly be no reason for denying it. Hypochondriasis is an infirmity, not a fault. Lord Byron himself, when informed that such a one complained of being called hypochondriacal, replied somewhat to the following effect: "I can not conceive how a man in perfect good health can feel wounded by being told that he is hypochondriacal, since his face and his conduct refute the accusation. ”

“ Hypochondriasis is often handed down from one generation to another in its individual form, but it is also not unfrequently to be met with in an individual as the sole manifestation in him of a family tendency to insanity. In its most common form it is manifested by simple false belief as to the state of the health, the intellect being otherwise unaffected. ”

“ Hypochondriasis is not insanity, if by insanity we mean intellectual perversion dependent mainly or entirely on the state of the higher nervous centres. But it is closely allied to insanity in its phenomena, only that these are, as it were, manifested in a scattered form, unequally distributed over the whole central nervous system, and especially affecting the spinal sensory centres. ”

“ In the first rank stands Hypochondriasis, especially if accompanied by atony of the bowels, congestion of the abdominal vessels, constipation, hæmorrhoidal tendency, or determination of blood to any of the vital [185] organs. In such cases pure chalybeates would only augment the evil; whereas the saline chalybeates are of the greatest benefit. Chronic nervous affections, with or without cramps or spasms of stomach and bowels, are a class that derive great advantage from these waters. ”

“ Among the numerous debilitated persons who attend the out-patient rooms of our hospitals we every now and then encounter as typical a case of hypochondriasis as could be found even among the rich and gloomy old bachelors who haunt some of our London clubs. I have one such patient under my care now, who has been a repeated visitor at the Westminster Hospital during many years: he has had pseudo-neuralgic pains nearly everywhere at different times; but his most complaint has been of pain in the groin and scrotum of the right side. ”

“ The hallucinated individual projects, as it were, the things of his mind’s creation into the outer world, and accepts them as reality. He sees snakes where there is nothing to suggest them; sees a ghost where there is no shadow; believes that the taste of blood is constantly in his mouth.
There are possible hallucinations of every sense. Nonexistent objects are seen, touched, tasted, heard, or smelled.
Hypochondriasis is a state characterized by persistent ideas of non-existent physical disabilities. ”

“ Patients have very little energy or initiative and are often considered stupid and lazy. Hypochondriasis is at times noted and some severe cases become melancholic.
The Blood.—The red cell count averages in marked cases 2,500,000 to 3,000,000 red cells per cu. mm. The Hb. percentage is down in such cases to between 30 and 50. The color index is well below 1, except in certain rare cases, when the color index is that of pernicious anaemia, being above 1. These latter cases are very resistant to treatment and often show very few infecting worms notwithstanding the severity of the symptoms. ”

“ The prognosis of climacteric melancholia and hypochondriasis is not necessarily unfavorable. In a large proportion of cases sanity returns with the re-establishment of health. The treatment, in the absence of a positive diagnosis, must be expectant. Effort must be addressed to the removal of any possible cause. Hygienic measures fulfil all the indications for treatment in the disorder when it is caused by the change of life. Opium and alcohol must be employed with extreme care in view of the great danger of the formation of obstinate habits. ”

“ And its radical relationship to true insanity is strongly indicated by the fact that the sufferers from hypochondriasis are nearly, if not quite, always members of families in which distinct insanity has shown itself ”

“ Producing melancholy...." The literature of melancholy has been surveyed in part by C. A. Moore, "The English Malady," Backgrounds of English Literature 1700-1760 (Minneapolis, 1953) , pp. 179-235. In medical parlance, "hypochondria" means the soft parts of the body below the costal cartilages, and the singular form of the word, "hypochondrium," means the viscera situated in the hypochondria, i.e., the liver, gall bladder, and spleen. ”

“ The same time of the year always increases the disorder in those who have been before afflicted with it; and it is a truth must be confessed, that from its first attack the patient grows continually, though slowly, worse; unless a careful regimen prevent it.
The constitutions most liable to this obstruction are the lean, and dark complexioned; the grave and sedentary. Let such watch the first symptoms ”

“ 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. ”

“ SECT. VIII. The Medicine. 'Tis the ill fate of this disease, more than of all others to be misunderstood at first, and thence neglected; till the physician shakes his head at a few first questions. None steals so fatally upon the sufferer: its advances are by very slow degrees; but every day it grows more difficult of cure.
That this obstruction in the spleen is the true malady, the cases related by the antients, present observation, and the unerring testimonies of dissections leave no room to doubt. ”

“ 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 ”

“ These symptoms do not all appear in any one period of the disease, or in one case, but at one time or other all of them, as well as those which follow: the flesh becomes cold to the touch, though the patient does not himself perceive it; the limbs grow numbed and torpid, the breathing dull and slow, and the voice hollow ”

“ Being now thin, it mixes itself readily with the blood again, and brings on putrid fevers; destroys the substance of the spleen itself, or being thrown upon some other of the viscera, corrodes them, and leads on this way a swift and miserable death. If it fall upon the liver, its tender pulpy substance is soon destroyed, jaundices beyond the help of art first follow, then dropsies and all their train of misery ”

“ His food no more turns putrid on his stomach, but yields its healthful nourishment. The swelling after meals therefore vanishes; and with that goes the lowness, and anxiety, the difficult breath, and the distracting cholick: he can bear the approach of rainy weather without pain; he finds himself more apt for motion, and ready to take that exercise which is to be assistant in his cure; life seems no longer burthensome. His bowels get into the natural condition of health, and perform their office once at least a day ”

“ In the first place, no strong evacuating remedy must be given; for that, by carrying off the thinner parts of the juices, will tend to thicken the remainder; and certainly encrease the distemper. No acrid medicine must be directed, for that may act too hastily, dissolve the impacted matter at once, and let it loose, to the destruction of the sufferer; no antimonial, no mercurial, no martial preparation must be taken; in short, no chymistry: nature is the shop that heaven has set before us, and we must seek our medicine there. ”