Hypochondrium

“ Cold water, snow or ice applied to the right hypochondrium may act as a check to the hemorrhage. Unless in purely traumatic cases in an otherwise healthy liver, a recovery is at best temporary, and the already degenerate liver is liable to relapse at any moment. In horses and dogs, therefore, recovery is by no means an unmixed good. ”

“ A patient of the writer, who is subject to attacks of this kind in the right hypochondrium, will bear with her whole weight on some hard object as each paroxysm comes on, or insist that some one shall press with his fists into the painful neighborhood with such force that the skin is often found bruised and discolored. ”

“ If you lay bare, and examine the parts about the abdomen, you will fancy that none of the entrails and intestines remain, and that the hypochondrium is forcibly drawn upwards. The skin is parched in the last extreme, the pulse slender, dense, and hard. The heat on the first application of the hand seems faint, but soon afterwards feels acrid and pungent. While, therefore, any of the natural moisture remains, the fever is only hectic; but when the humidity runs the risk of being altogether consumed, a true marasmus is formed. ”

“ It is obvious that, when the temperaments of those two prime organs combine together, the whole body is affected accordingly. The humid and hot liver, less than the hot and dry, renders the hypochondrium shaggy ”

“ Pain on percussion of the right hypochondrium would be an additional feature.
Treatment can rarely be adopted because of the uncertainty of the diagnosis. It would proceed on general principles, antithermics, eliminants, antiseptics, and counter-irritants being resorted to as the conditions seem to demand. Alkaline laxatives and diuretics, salicylates of soda or potash, and guarded doses of sulphuric ether to solicit the action of the pancreas, might be resorted to. The disorder of the liver would require attention along the lines indicated under catarrh of that organ. ”

“ 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 ”

“ But, should it be preternaturally changed as to both these qualities, persons so affected will be readily seized with putrid diseases and disorders from bad humours; and more particularly if the humidity be much increased, and the heat but little, they will be liable to cacochymies. In the humid and cold, the hypochondrium is free from hairs, but the blood is pituitous, the veins contracted, and the whole body in like manner, unless changed by the heart to the opposite state. The cold and dry renders the blood scanty, the veins of the body contracted, and the body colder ”

“ 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.") ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ Mitochondrial transport is reversibly modulated by sequential activation of D2R and D1R receptors As shown in Figures 1 and 2, we found that both D2R and D1R are expressed in the same hippocampal neurons. Since dopamine, which stimulates both D1R and D2R, blocks mitochondrial movement, a D2R-dependent ‘stop’ signal must predominate over a D1R-mediated ‘go’ signal. We wished to determine whether the effect of D2R activation was reversible, and whether inhibited mitochondria could be re-induced to move by subsequent activation of D1R within the same neuron. ”

“ 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 ”

“ For instance, if we run fast, then the muscle cells in our legs burn up a good deal of sugar-fuel, and throw the waste gas, or smoke, into the blood. This is pumped by the heart all over the body, in a few seconds. When this carbon dioxid reaches the breathing centre in the medulla, it stirs it up to send promptly a message to the lungs to breathe faster and deeper, while, at the same time, it calls upon the circulation centre close to it, to stir up the heart and make it beat harder and faster, so as to give the muscles more {227}blood to work with. ”

“ In typical hypochondria more readily than in hysteria the patient may be led from one set of symptoms to another, the particulars of which he will detail in obedience to questions that are put to him, these symptoms not unusually partaking of the absurd and impossible. In hypochondria are absent those distinctive symptoms which in nearly all cases of hysteria appear in greater or less number, such as convulsions, paralysis, contracture, aphonia, hysterical joints, and the like. In hypochondria is present the groundless fear of disease without these outward manifestations of disease. ”

“ There is not the slightest doubt that the course of this metabolism, as well as the inter-relations of the cells of a particular organ, is only imaginable under the supposition that the metabolism of the whole organism is regulated in the most precise way, not only quantitatively, but also qualitatively. We are bound to imagine that, in the work of the cells, the same stages of decomposition recur regularly, and that it is at a quite definite stage that the by-products of metabolism are passed by the cells into the lymph channels, and so into the blood system. ”

“ Hypochondria and hysteria, as neurasthenia and hysteria, are sometimes united in the same subject; one sometimes begets the other, but they have certain points of distinction. Hypochondria more frequently passes into real organic disease than does hysteria; it is more frequently associated with organic disease than is hysteria. Hypochondria is in the majority of cases a true insanity, while hysteria can only be regarded as such in the special instances which have been discussed. ”

“ 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 ”

“ 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.) ”

“ 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. ”

“ Addition of SKF38393 failed to restore mitochondrial movement without washing out the bromocriptine, the D2R agonist (data not shown) . In this experiment, we employed a red fluorescent protein, which allowed us to acquire images continuously every 10 seconds over a period of 4 hours without any observable phototoxicity (Movies S13-S16) . To illustrate this result, we present the data as kymographs (Fig. 6) . This experiment demonstrates unambiguously that mitochondrial movement can be reversibly modulated by differential activation of the two dopamine receptor subtypes. ”

“ File:Pone.0002804.g005SKF38393, a D1R agonist, promotes axonal transport of mitochondria in hippocampal neurons, whereas SCH23390, a D1R antagonist inhibits mitochondrial transport (A–F) .A–B and D–E. Mean speeds (μm/min) of individual mitochondria before and after treatment with SKF38393 (33 μM; A,B) or SCH23390 (55 μM; D,E) . Pie chart insets show the percentage of stationary (red) , oscillatory (blue) , and directionally moving (green) mitochondria in all pooled experiments in the initial (a) and final (b) 15 minutes of imaging. ”

“ 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 ”

“ This gland is now known to manufacture and pour out into the blood a hormone which is a regulator of metabolism. When it is produced in normal amounts, the metabolism goes on at the rate that we find in healthy people. If the gland is inactive and does not secrete enough of the hormone, there is a reduction in the metabolism. Since this implies a lowering of the vigor of the life processes, we might expect it to have important effects. The most marked of these are in the nervous system. Persons whose thyroid glands are relatively inactive are mentally sluggish ”