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driasis there is nothing material or organic or real, and that the only lesion is that of the understanding.'

We have thus taken a rapid review of the most remarkable opinions that have been held by medical men of different ages, climates, and countries, respecting the nature, seat, or proximate cause of hypochondriacal disease. The diversity and discrepancy of these opinions may be traced to the besetting sin of professional writers, that of confining their vision to one part only of a subject, to the exclusion of every other : hence it is that they magnify and exaggerate one fact or object, and neglect and disparage all the rest.

Now what is the real and simple truth? M. Brachet will tell us:

“ It is quite true,” says he, " that the functions of the stomach, liver, spleen, heart, &c., are more or less disturbed ; that the digestion is usually much deranged; that an unhealthy chyle may be formed and supplied to the circulating fluids; that the nerves are deeply affected; and, finally, that the brain and the imagination are truly and essentially implicated. All this exists in Hypochondriasis; there cannot be a doubt about the matter. But not one of these things taken singly, and apart from the rest, constitutes the disease in question. Every author, we verily believe, has truly seen what he has described; but his mind, biassed either by the direction of his studies, or by the tone of the ruling doctrines of his day, has adopted one train of thought to the more or less complete exclusion of every other. Thus the opinions as to the nature and seat of Hypochondriasis have been humoral during the long reign of Humorism; organic, when Solidism was dominant; nervous, when so much importance was attached to the physiology of the nerves; and at length cerebral, in the eyes of those men whose special attention has been engaged more particularly in the study of mental disorders. Now each and all of these doctrines are true; at least partially 80. The error lies only in their generalisation, in the attempt to reduce to a narrow spot phenomena whose sphere of exhibition is a wide circle. Not one of the theories that has been broached, however absurd and ridiculous it may now seem, was entirely destitute of considerable probability; and for this reasonbecause they were all based on a series of observed facts and phenomena. It was only the extravagant extension, which was sought to be given to it, that rendered the opinion faulty, by making it too exclusive. It is to the multiplicity of opinions deduced from similar facts that Galen alluded to, when he said that in our economy there is nothing absolute, rigorous, and necessary, and that the same cause may produce different effects on different individuals : Nihil in corpore animato planè est."

Having now sufficiently considered the much-vexed question as to the cause of Hypochondriasis, we proceed to a more satisfactory and important topic, that of its treatment. Fortunately on this point there is far less discrepancy and dissension:

Concidunt venti, fugiuntque nubes,
Et minax

ponto

Unda recumbit. Hippocrates has not said much respecting treatment. From various passages of his writings we are led to infer that he recommended an occasional emetic, the moderate use of purgatives, along with a temperate diet and regular exercise. Celsus advises residence in the country, travelling about, gymnastic games-especially playing at ball and fencingreading aloud, bathing, and friction after it-temperance in, but not ab. stinence from, venereal pleasures : concubitus vero neque nimis concupis.

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cendus, neque nimis pertimescendus est: rarus excitat corpus, frequens vero solvit. Cælius Aurelianus insists chiefly on the necessity of amusing the mind and distracting it from its gloomy apprehensions. He lays down very particular rules; and even descends to mention the trifling circumstance of whitening the patient's chamber, to excite more cheerful feelings. He reprobates the use of strong medicines : Vitandum probamus frequentem ei tariam medicuminum putationem, quæ fella deducere promittuntur, site ventris fluxus, sive urinalia. Etenim sitis extenditur, et solidioris cibi fastidium duplicatur, et corporis fortitudo minuitur; atque cibi accepti corrumpuntur, et omnis corporis materia adulterio medicaminum deterior fit, cùm habitudo omnis fuerit immutata, quod facere videmus eos qui sæpissime ac jugiter absynthiam, uloem, et colocynthidem dari probaverunt.

No writer, whether of ancient or of modern times, has discoursed more sagely on the treatment of Hypochondriasis than Galen. Fortunately, his therapeutics are not built upon, or deduced from, his humoral opinions ; he rises above the spirit of system, and is at once practical and philosophical. His principal remedies were frequent baths, a juicy and nutritious diet, and all sorts of active exercise, quæ non modo totum corpus exercent, verum etiam animum oblectare possint. It was only in obstinate cases that he had recourse to purgatives and other evacuants to discharge the atrabilis, which was supposed by him to play so important a part in the induction of the malady.

Passing over the practice of Aretæus, Paulus Ægineta, and Ætius, for they seem to have suggested nothing new, we come to the epoch of the Arabian physicians, who, besides being indefatigable commentators of the writings of Hippocrates and Galen, introduced that host of polypharmic formulæ, known under the names of elixirs, electuaries, pills, powders, troches, loochs, hiera, &c. Many of their antispasmodic and other reme. dies are, although simplified in their preparation, still retained in practice, in spite of the opposition of the unbelieving philosophism of the present day.

Of all the Arabian writers, none has been so celebrated as Avicenna, who was long the oracle of medicine in the schools, and shared the homage of its professors with the old man of Cos and the physician of Pergamus. The following remarks by our author, in reference to the neglect of pharmaceutical remedies by his countrymen of late years, are so entirely consonant with the opinions which we have always expressed in this Journal, that we have much pleasure in introducing them here to the notice of our readers. " I do not desire,” says he, “ to revive that heap of bizarre, and often very ridiculous, formulæ ; but I cannot help lamenting the other extreme into which we have fallen in the present day. It has landed us in such a famine, so to speak, of therapeutic resources, that people begin to enquire, when they read the clinical reports of some of our most able physicians, if medicine is now what it was before the time of Hippocratesthe contemplation of death, or the necrology of a cemetery. No where do we see any real efforts made to triumph over disease. Every exertion is made to determine most exactly the seat, extent, and form of a morbid alteration ; and when they have succeeded in this object, they seem to fancy that everything possible has been done. Such knowledge, we readily acknowledge, is very necessary; but it is assuredly not all that is required of a medical man. He must not stop short at the diagnosis of a disease ; he has then to proceed to a more important part still, the treatment of it. The old physicians acted in the very opposite manner; they neglected too much the diagnosis, and were altogether taken up with considering how to cure the disease they had to deal with. Their Materia Medica was cer. tainly encumbered with far too many formulæ ; and yet, we must confess, they often succeeded in obtaining a cure that could never be achieved by the use of gummed water ! To cure : there is the end, the only philanthropic, end of medicine; and he, who succeeds the best in this glorious endeavour, deserves most highly of humanity.”

Although Montanus, on one occasion, gave to a hypochondriacal patient the advice—which, by the bye, has often been very erroneously perverted into a precept of general application-fuge medicos et medicumina, et sana. beris, he expressly

recommends the use of warm aperients, as rhubarb and turpentine, of regular exercise, friction of the extremities, &c. Platerus ordered his patients to take before their meals a powder composed of coriander and aniseeds, cannella, fennel and balm. Rhodius, following the example of Rondelet, cured a patient by trepanning him! Another favou. rite remedy with this gentleman was the application of the cautery over the line of the coronal suture! Sanctorius insisted much on the use of a vegetable diet and of regular exercise. Baillou gives the sound advice that · hypochondriacal persons should eat little, but often, because their humours require to be continually renewed, in order that they may get rid of all acrimonies, and not generate any new ones by the fluids remaining too long within their vessels.' Zacchias trusted a great deal to the use of chalybeates, in conjunction with bathing. Burnet, in his Thesaurus Medicina, has collected together all the remedies that had been recommended by preceding writers : it is a compendium alike of regimen and therapeutics. Vieussens is in every respect a representative of the old humoral school. As he saw nothing in the disease but an impure and thickened blood and concrete state of the lymph, with engorgement of the abdoininal viscera, his chief remedies were various depuratives, evacuants, bleeding, and subsequently tonics. Sydenham, in our author's estimation, was certainly not so judicious a practitioner, at least in the treatment of Hypochondriasis, as his " reputation aussi colossale,” might justly have led us to expect. According to the English Hippocrates, the main indication is to restore to a healthy condition the blood which supplies the animal spirits; and as the ataxia or irregularity of these was supposed to induce, in course of time, an alteration in the circulating fluid, he recommended that bleeding and purgatives should be used in the first instance to lessen its quantity, and then that steel should be given to render tone both to the blood and to the animal spirits. If the patient was very weak, he began the use of chalybeates at once; and, during their administration, he exhibited no purgative medicines, but only gently soothing anodynes. He advised the application to the abdomen of a plaster of galbanum and castor; and, in some cases, administered medicated wines of gentian, absynthium, cinchona, &c. Horseback exercise and travelling were also favourite remedies with him.

Stahl, who considered that a stagnant state of the circulation of the vena portæ had so much to do with the disease, insists strongly on the

good effects to be obtained from promoting a hæmorrhoidal discharge by the application of leeches to the anus, and the use of aloetic medicines. Hoffman advises a similar treatment, more especially at the time of the spring and autumnal equinoxes. He lays down the following four therapeutic rules to guide the practitioner : 1. To evacuate the crude and windy matters ; 2. To dissipate the stagnant humours; 3. To appease the spasms; and 4. To fortify the nervous system. When health is once restored, he tells us thus how to preserve it: tunc enim optimum præsidium est nullo uti remedio, sed præcipuum sanationis punctum in mutatione ætatis, aeris, vita generis, victusque consistere fide experientia compertissimum est.

Dumoulin is reported to have said on his death bed, " I leave behind me three great physicians, diet, exercise, and water." Sauvages has laid down many judicious instructions, censuring those practitioners who trust exclusively either to mental or to physical remedies : the use of both ought always to be conjoined.

“ If,” says our candid author, “ he unnecessarily multiplied the species of Hypochondriasis-bilious, sanguineous, melancholic, pituitous, hysterical, asthmatic, phthisical, calculous, and tympanitic—he has shewn himself in matters of practice to be superior to many moderns, who seem to forget that the cure of the sick is the end and object of our science.”

Of Whytt we are told that, while he accorded a proper degree of confidence to medicinal means, he never neglected to combine with their use a purely moral treatment. It is almost unnecessary to pursue this chronological notice of the therapeutics of Hypochondriasis any further; as we find an ever-recurring repetition of nearly the same remedies, till we reach the period when gastritism was the dominant genius of the schools. Fortunately this delusion has now nearly passed away, and physicians are beginning to imitate the practice of the good olden times, prescribing more for symptoms, and less for conjectural causes. Not many have adopted the Cerebro-pathic doctrines of Georget and Falret, who attach an almost exclusive, and therefore an undue, importance to moral and intellectual treatment. Not that we undervalue this part of hygienic regimen : far from it. We quite agree with Fontanelle that “ a physician has almost as much to do with the imagination of his patients as with their lungs or their livers ; and he must well understand how to treat their imagination, which demands particular specifics. A mere anatomist may dispense with eloquence; but a physician can scarcely do so. The one has only facts: to discover and present to the eye ; but the other, ever obliged to form conjectures on subjects often doubtful, requires also to base them on grounds that are solid, or which at least comfort and give assurance to the alarmed fancy. He must sometimes speak almost without any other object but to speak; as he has often the inisfortune to deal with men at those very times when they are most feeble and childish. This puerility prevails principally among the higher classes, and more especially in that section of them who often require rather to be amused than to be cured. In general, if he (the physician) has not the gift of ready speech, he will need almost that of miraculous healing to compensate for the want.”

This is all very well ; but we need not say that soft words will not cure many cases of Hypochondriasis. Much may be done by physical as well as by moral regimen and treatment. The intestinal and urinary secretions must be carefully and regularly attended to. If the patient be suhject to hæmorrhoidal discharge, this should generally be promoted rather than checked : hæmorrhoides, says Hippocrates, melancholiam et lienis morbos curant. Temperance and regularity should be peremptorily enjoined; moderation in sexual pleasures also is very necessary : quibus nervi dolent, Venus nocet. One of the most useful of all remedies is manual employment and bodily exercise. M. Reveillé-Parise tells us of a patient who had been recommended to take a sea-voyage for the cure of his malady. A friend had very considerately recommended him to read the philosophic works of Seneca on board, with the view of distracting and comforting his mind : “mais quel pauvre medecin de l'ame et du corps, en comparaison du travail des pompes et de cabestan!” he himself frankly confessed to his physician on his return.

Travelling, and change of air and scene, have been lauded since the days of Hippocrates : in morbis longis solum mutare debent, says the old Sage ; and Baglivi expresses the same thought in these words : evenit morbos peregrinatione desinere, qui antea nulli medicamini cedebant. This most accomplished physician-whose works we strongly recommend to the Sydenham Society to reprint–in another passage thus beautifully points out the soothing and sanative influences of a judicious hygienic regime on hypochondriacal patients : Et licet talium hominum morbi primo aspeciu perniciosi et incurabiles videntur, sanari tamen solent facile non quidem per nimiam remediorum copiam, sed aut per grata amicorum colloquia, aut per honesta ruris oblectamenta et equitationes frequenter, aut tandem per virendi normam a sagaci medico institutam.

In all cases, it is very necessary to attend to the state of the skin, to promote perspiration, and encourage an active circulation on the surface : hence the importance of shower or plunge bathing, and brisk friction with the horse-hair gloves, or a fiesh-brush, &c. The intimate connection between the cutaneous and the digestive organs has long been understood; and their diseases are often observed to alternate with each other.

Hypochondriasis has been known to cease very quickly, or even suddenly, on the breaking out of a cutaneous eruption. Reil says : nam subito exanthemata, ulcera &ca. oriuntur, et eodem momento morbus nerrosus præsens cessat.

Lorry expresses the same thought : sæpe scabies, impetigo, herpes erumpentes sanitatem retulere ; and Heine makes a similar remark in these words: attulit sæpe curati em scabies fæda, aut va numerosa ingens enata, vulde tumentium fluxus hæmorhoidum, atrabilis per superiora et inferioru rejectio. A sharp attack of the gout, as Stoll has remarked, has often been known to dissipate not only hypochondriasis, but even melancholy and mania : suborta arthritide sæpe curantur.

It has been remarked that hypochondrical patients are more than usually exempt from contagious and epidemic disorders : Hypochondriaci, says one of the old writers, inorbis contagiosis et epidemicis rarius corripiuntur ; nerri, ad spasmos efficiendos activi, sensu pro contagio carent ; si quondam efficiuntur, hypochondriasis cessat.

There are many other topics connected with the treatment of Hypochondriasis that we could wish to have alluded to, if our space had permitted. One word respecting the use of sedatives. Medical practitioners are often too timid in the administration of this class of inedicines in

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