Steel is a doubtful medicine. Where the head is chiefly affected„ it is sure to do harm. And even in cases in which we may conceive that some chalybeate water, as that of Tunbridge, or some chemical preparation of steel, may be employed, it will be necessary to discontinue their use for some time, on the first approach or return ofthe affection of the head. When the spasm affects the voluntary muscles l of the body, the trial of steel is indicated, and its use appears sometimes considera bly to contribute to the prevention of the return of dyspeptic symptoms and of pain in the stomach, as well as to the general tone and strength.
The spasms about the hypochondria very frequently cannot be relieved with out opium, and in this case also the solid form of it is the best, as it is applied con stantly by gradual solution to the parts immediately affected, and produces much less injury to the stomach and to the sys tem than if given in a fluid state. Yet in neither way should we have recourse to it but when impelled by the supreme com mand of dire necessity ; for at best it is but a temporary remedy, and the irrita bility generally returns with augmenta tion from its use. In cases of less ex tremity, the fetid gums, in the form of pills, camphor, xther, and Hoffman's anodyne liquor, will be often found high ]y serviceable, and will prove innocent of the baneful effects of opium. Flatulency is often much relieved by increasing the muscular action of the stomach and in testines; and mustard, horse-radish, and other such stimuli, are useful, either in the forms in which they are served at table, or the mustard-seed may be taken whole, orthe officinal and other prepara tions of horse-radish may be employed. In cases of sick-head-ache opium must, as much as possible, be avoided ; to in crease the power of the stomach and re gulate the bowels are here the principal objects.
With regard to external remedies, blisters and other applications, soliciting a discharge, are commonly very unneces sary torments, and are very seldom just ly applicable. Frictions on the hypo chondria with volatile liniments often give very consiclerablerelief Cold bath ing has been advised, but generally seems to disagree with persons Of a seden tary constitution, especiallrif advanced in years.
Upon air and exercise much has been written ; and some things have been writ ten erroneously. The air of large cities is indisputably injurous to all debilitated invalids; and to hypochondriacs a pure air is peculiarly to be recommended. Yet seclusion is so baneful, that the good ef fects of a purer air will be more than counterbalanced, if an hypochondriac shut himself up constantly by his fire-side in his country study, or retire from society into indolence and apathy. Cold piercing winds are severely felt, and should be avoided : at the same time the propriety of hypochondriacs accustoming them selves to bear tile open air as much as cir cumstances will allow, must ever be im pressed upon them : and proper warmth of clothing, particularly about the feet, must be worn.
Exercise, short of fatigue, is essential ; and even a little fatigue must be endured by those, who, from long sedentary occu pation, have lost the habit of exertion ; riding on horesback, or in a carriage, sailing, rowing, are all useful ; also mode rate walking, bowling, or working with a spade in the garden, and other exercise out of doors attended with some labour. It is to be observed, however, of sick head-ache, that its attacks are frequently induced by the motion of a carriage,boat, or ship, and that exercise on toot or horseback is best for such invalids : fric tion about the hypochondria with a flannel . or flesh-brush is often serviceable, and to be recommended, when the debility of the patient prevents other kinds of mus cular action. The military exercise, as practised by our volunteers for a short time every day, is also, where it can be adopted, of very high advantage.
The plan of diet in this disease is a point of much delicacy and management: the same mode will seldom answer for any two distinct cases. In general, the
patient is to be nourished with whatever aliment he can digest, and an equal and uniform reservation as to spices is by no means necessary, provided that they seem to improve rather than to injure digestion ; his appetite for a moderate quantity of almost any variety of food is to be indulged, provided no derangement of the stomach ensue from it, and the juvantia and Ledentia are to be made out from observation in each case ; vinegar and native vegetable acid commonly are prejudicial, yet very frequently ripe fruit is beneficial. In general every thing that is oily or empyreumatic must be avoided: mustard, horse-radish, and the like, are often useful in the prevention of flatulen cy! sometimes in long cases of hypochon driasis, where vomiting has been a tire some symptom, the yolks of eggs boiled hard have been digested, and the vomit ing in a short space of time has ceased: in these cases it is probable that the stomach is in an habitual state of contraction, as it has been sometimes actually found on dissection, and mustard or horse-radish, by increasing its muscular action, would have been injurious, whilst any easily di gestible substance nearly solid, from not occupying much space, would be retain ed, and gradually distend the stomach, or, from causing the muscular effort produc ed in vomiting to cease, give opportunity to the stomach to recover its natural di mensious ; eggs, however, prepared in any way that has been contrived, will not always agree, even when this state of stomach is to be suspected ; but will at times be almost immediately rejected, or produce much disturbance, when a small quantity of gelatinous or mucilagi nous food, or even of light meat, will be digested It is by no means justifiable to prohibit light suppers peremptorily ; since, in point of theory, we know that digestion and the absorption of chyle proceed more regularly (luring sleep than at any other time ; and, in point of fact, we know equally that hypochondriacs are often benefitted by tight suppers. Thus much is certain, that the meals should always be light and sparing, and consequently frequent; and that, if suppers be indulged at all, the hour of dinner should be much earlier than is customary in the present day.
With respect to drinks, malt-liquor ought but seldom to be allowed. Soda water, with wine, commonly forms a most excellent beverage. It is rarely proper to require any large quantity of diluting drink to be taken. Coffee generally agrees better than tea ; and sometimes cocoa, or even chocolate, if its oily quality do not offend the stomach, is very proper for breakfast, or in the forenoon.
Opium, for the mere purpose of pro curing sleep, should never be allowed. Much, in this respect, is to be accom plished by regularity in the hours of ris ing and going•to bed, and especially by opposing all propensity to sleep in the day time.
The in i ad i n hy pochondriasis cannot be properly regulated without the best ef forts of the patient himself, but he will for the most part be induced to use them, on the representation of a medical man of intelligence and good humour, that it is impossible for him to accomplish any plan he has in view, and that he must al ways be a burthen to himself and his con nections, till lie makes the search after cheerfulness and health his primary pur suit ; he must make himself alive to the scene which passes before him, and his family may commonly be instructed in some methods of divesting his attention from dismal„Atilfttinn,S On himself, and from unremitting application to any fa vourite tope, and gently to remind him of the harm lie is about to do himself, when he seems ready to give way to any excess of passion. His resort to public places will be beneficial, when he can be brought to attend to what is going for ward there, and by such attentions his pursuit of health will daily become less irksome and laborious ; and by the same means he must be brought to unbend big mind in the society of his equals, and to attend to the proper times of exercise, food, and rest.