428 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



dilation all over the world. Now, although there is no doubt that the 

 reading of this kind of literature has often resulted in an attack of hy- 

 pochondriasis, yet persons free from any morbid predisposition may 

 read these books with impunity. An effect very much like that pro- 

 duced by reading popular medical books may arise from the exclusive 

 occupation of the mind with stories of disease and death, such as are apt 

 to be current in any region where an epidemic disease is prevailing. 

 Such impressions do no harm to the majority of people, but there are 

 a few who become hypochondriacs. It will be readily understood, 

 moreover, that the companionship of a hypochondriac is dangerous to 

 an individual of a hypochondriacal predisposition. 



SYMPTOMS AND COUESE. Hypochondriasis usually develops grad- 

 ually. At first, there is an indefinite sense of illness, which troubles 

 and oppresses the patient, but which does not as yet disturb his judg 

 ment or possess him completely. Nor are this restlessness and distress 

 usually permanent in the beginning. They generally cease at times, 

 and then reappear with somewhat increased intensity. The more pro- 

 foundly the disease takes root, so much the more assiduously does the 

 patient endeavor to discover the cause of his indisposition. He scru- 

 tinizes his tongue, his stools, his urine ; he counts his pulse and han- 

 dles Ins abdomen. Every trifling irregularity which he perceives, the 

 slightest irritation, the faintest coating of his tongue, a transient colic, 

 an insignificant cough, are all of the utmost importance in his eyes ; 

 not because he suffers more than any one else from such symptoms, 

 but because they seem to him to afford a clew to the nature of the 

 grave and obscure imaginary disease. To-day he may dread an apo- 

 plexy, to-morrow he may think that he has an ulcer of the stomach ; at 

 other times he may imagine his heart diseased, or that he is consump- 

 tive, or afflicted with some other serious malady of a character corre- 

 sponding to his sensations of distress. He studies all the " medical 

 advisers " and other books of " domestic medicine," but, instead of de- 

 riving comfort and aid from them, merely finds out new diseases, by 

 which he immediately imagines himself afflicted. As the disease gains 

 mastery over the patient, his belief as to his condition becomes more 

 and more biassed and incorrect. Argument is useless, as it cannot re- 

 lieve him of his feelings. A few hours only may have elapsed since 

 we last saw the patient. We then may have spared neither time nor 

 trouble in explaining to him that his condition was perfectly free from 

 danger, when a messenger arrives from him, begging us to come in 

 haste, that some serious change has taken place, and that his con- 

 dition has become a most critical one. In other instances, especially 

 when the patient really has some insignificant disorder, the hypo- 

 chondriac is not so apt to change his opinion as to the nature of hia 



