HYPOCHONDRIASIS.
Accepting Gower's definition of hypochondriasis as a morbid state of the nervous system in which there is mental depression due to erroneous ideas of such bodily ailments as might conceivably be present, the line may be drawn between it and insanity with somatic delusions, though the tendency of most modern writers is towards regarding every case of hypochondriasis as a form of melancholia.
Owing to the danger of suicide in the graver type of hypochondriasis, the borderland between it and insanity having been already passed, the only treatment available in most cases will consist in removal to a properly equipped asylum.
The treatment of the minor forms of hypochondriasis is often most unsatisfactory and disheartening. The physician haying satisfied him self by thorough and painstaking examinations that there is no organic disease present, finds himself placed in a difficulty. If he obeys his instinct and proceeds to impress upon his patient the view that his symptoms are purely imaginary, and if he makes light of his suffering, he only aggravates matters by causing him still further to concentrate all his faculties upon his abnormal feelings; this drives him to seek the advice of one physician after another till all his morbid sensations become intensified, with the result that he crosses the line dividing the sane from the insane condition.
is in the !Ugliest interest of such a patient that the humane physician should cntlea? our to secure his complete and whole-hearted confidence by a thorough and sympathetic investigation of his complaints, after Avhich he may be able to explain to him the nature of the neurosis and to convince him of the absence of any organic disease without falling into the common mistake of arguing him out of his abnormal sensations. Any departure from the typically healthy standard should be corrected; thus insomnia, dyspepsia, constipation, anemia, or other disordered condition should by appropriate treatinent be remedied.
Exercise in the open air, especially if carried out in the company of others, boating, bathing, fishing, golf, or any active amusement in which the patient's mind is lifted off his sensations, will do more than physic. Travel, if the patient's means permit of it, if nut, when possible, a com plete change of employment may he advised. Resorting to spas, hydro pathics or places where invalids congregate often does harm; the patient returns somewhat improved, but with new combinations of sensations derived from comparing notes with his suffering brethren who flock about most health resorts. As a rule, anything which insures a complete change of habits and of thought is likely to be followed by benefit. _Massage is often beneficial, and static electricity in some cases proves useful.
The treatment, whilst mainly moral and psycho-therapcutical, need not necessarily exclude drugs, though officious prescribing is to be dis countenanced for the same reasons which should deter the physician from writing out an elaborate diet table. A drug which will diminish the excitability of the sensory terminals will do no harm, and may effect some good, as in the management of hysteria. Valerian is the most suitable; a pill containing a grain of each of the valerianates of zinc, iron and quinine is the best routine, and the addition of asafoetida is often bene ficial. As in hysteria, strychnine is usually harmful. The valerianates may be alternated by a mixture containing 3 to 5 grs. Antipyrine with 5 wins. liquid extract of Coca, but narcotics including alcohol should be always avoith (I; the co, aine, naal)bia, alcohol and chloral habits are especially liable to become developed in such patients.