The affection of the mind in hypochon driasis is curable, or may be very much palliated, by due care and attention to the digestive process ; persons thus af fected are always disposed to view only the gloomy side of objects : according to the different circumstances and situa tions in life of each individual, he be comes oppressed with the fear of dis ease, of poverty, of death, of fatuity, of loss of memory, or has other ground less fears of misery awaiting him ; such paroxysms will sometimes occur seve ral times every day, and are often found to depend on indigestion and flatulency, which being removed by the means to be pointed out in the plan of treatment, these ideas of apprehended evils will gradually subside, or, at least, be very considerably diminished.
In all cases of this kind, whether of original affection of the primze vim, or symptomatic of chlorosis, or any other af fection, little good can be done, without unremitting attention to the regularity of evacuation from the bowels, which is essentially necessary to the subduing of acid, when habitually formed in the stomach, and towards gaining any ground in the removal of pain, flatulency, and every other dyspeptic symptom ; and the means of attempting to effect this re gularity in different persons, and in the same person at different times, must be exceedingly varied ; now and then a case occurs with an habitually lax state of the bowels, and only rhubarb is requisite as a purgative, joined with light aromatics, but commonly we have to contend with constipation, and rhubarb by itself does mischief. When the stomach and bow els are loaded and foul, powerful doses of mercurial purgatives are occasionally necessary, particularly in those whose are full, and whose ener gies are considerable. When this state of the system is indicated by labouring action of the heart, which is perceived by the patient, or by vertigo, depending upon repletion of the blood.vessels, it is to be relieved by cupping : and if the secretion of the bile be deficient or irre gular, the repetition of a grain of calo mel daily, or every other day, for a week or two, persisted in, will be frequently found of great utility.
Yet it often happens that the bile, though duly secreted, is an insufficient stimulus to the intestines, either from its being neutralized by the acid which pass es from the stomach to the duodenum, or from the bowels being in a state too per manently torpid to be excited by it. In such cases the repeated use of calomel, as a stimulus to the liver, cannot fail to be injurious : the intestinal canal itself should be chiefly attended to, and pur gatives of a liquid kind, or those easily rendered liquid, should be employed in its stead. About a tea-spoonful of the tincture of senna, rendered more grateful to the stomach by the admixture of a lit tle tinct. of lavend. or of ginger, and ta ken at bed-time, without any admixture of water, will often cause a more easy night's rest, and operate mildly in the mornin„ ; this is very useful in prevent ing the necessity of the too frequent re petition of more bulky or violent cathar tics. On the same principle, elcctuary of senna and the various domestic prepa rations of that drug and of other mild las.
atives have their uses; for it is allays to be remembered, that violent!,pog;ing is not the intention to be accoMplished, but only permanent regularity of evacuation. The aid of clysters should sometimes be obtained, particularly when there ap pears to be a large collection of indurat ed faces in the colon : this is sometimes evident from a hardness in the track of this intestine, which may be felt in the umbilical and left iliac regions; and this congestion alone has not unfrequently produced strong hypochondriac symp toms.
Yet injections, too long and habitually indulged in, are, of themselves, apt to produce costiveness ; and are one grand cause of that constitutional constipation, to which a great part of the French na tion are so subject.
Aloes would be a convenient medicine, but that the diseased now under conside ration, from a general torpidity of alvine action, are peculiarly disposed to hm morrhoids ; a malady which is almost al ways increased, instead of being metto rated by aloetic purgatives. Magnesia is seldom useful, whether alone or in com bination. Calcareous earths often pro duce febrile heat, and augment the impe diments to digestion. In some cases, however, of very chronic acidity, and when the bowels are tolerably free, con siderable advantage may be derived from lime-water prepared with oyster-shells, as a purer form of calcareous earth than that which is dug out of a chalk-pit, and from bark prepared with lime-water. The addition of natron, or aq. kali, to bark or other bitters, is sometimes advantageous, particularly if the case be complicated with glandular affection ; in the same manner soda-water is beneficial, and from the tonic power of the light carbonic acid it contains ; the good effect of ammonia taken into the stomach, may depend in some measure on its alkaline nature, but seems principally to be produced by its grateful stimulus, both in the form in which it is taken, and after it may have been combined into a neutral ammoniacal salt, by union with any acid it may meet with. Nothing, however, can be more capricious than the stomach in hypochon driacs, and in all those diseases where acidity habitually prevails ; it is particu larly to be noticed that vitrolic acid, with bark or without it, is often essentially useful, and this, where acidity in the sto mach is continual ; the utility of this acid is certainly in defiance of all chemical reasoning, and may depend upon its as tringency, whereby it probably prevents the secretion of acid fluid into the sto mach, or of such fluid as is ready to be come acid,' and in some measure on its power of preventing fermentation. To nics for the most part are necessary, but it is almost impossible to lay down any form of them to be pursued for any length of time ; the stomach is common ly soon disgusted with any individual preparations, and it is often very difficult to suit its variation of aptitude by the most judicious changes of medicine, which, however, must always be attempt ed, since there is not any case of disease which is so frequently aggravated by ne glect.