UYPOCHONDRIASIS. 



429 



disease, but sticks to a belief in one, and cannot be dissuaded from it. 

 He is not like other patients, satisfied with simply complaining of pain, 

 oppression, or fever ; partly, because he really feels worse than other 

 people, and, in part, because he is convinced that the doctor " makes 

 light of his sufferings." Hence he exaggerates, and often exhibits the 

 utmost fluency in description of his infinite suffering. In spite of the 

 severity of these imaginary symptoms, however, they by no means 

 despair of recovery; hence hypochondriacs seldom attempt suicide, 

 and never weary of seeking fresh medical advice and of trying new 

 treatment. Sometimes their hopes are so much in the ascendant, and 

 are so productive of happiness to them, that, for a while, in spite of 

 their sense of illness, they are cheerful and in even high spirits. Such 

 intervals, however, are usually very brief, and occur most frequently 

 immediately after the engagement of a new medical man or the con> 

 mencement of a new " cure." The old mood very soon returns. The 

 false realizations of their sensations, and the erroneous ideas of the pa- 

 tients as to the condition of their own bodies, which we sometimes see 

 in hypochondriasis, are a genuine delirium. Like other insane ideas in 

 other forms of psychical disorder, this proceeds from morbid bias of 

 the mind, and is to be regarded as an attempt to clear it ( G-riesinger). 

 Hallucinations " sensations originating inwardly " also arise in hy- 

 pochondriasis, owing to this sense of illness, and to the attempts of 

 the patient to account for it. Thus the idea that the heart is stand- 

 ing still, or that a limb is withered, or that the body is putrefying, 

 although it is not the result of a genuine sensation incorrectly inter- 

 preted, yet it is so vivid that the patients cannot distinguish it from 

 an impression actually furnished by the senses ; and they really believe 

 they can feel that the heart does not beat, that the skin is dried up, or 

 that they can smell the putrid emanations from then* body. In spite 

 of their mental aberration and morbid fancies, most hypochondriacs are 

 able to transact their business, and to take care of their house and 

 family ; and this is the reason why hypochondriasis, usually, has not 

 been regarded as a disease of the mind, being looked upon rather as a 

 nervous disorder, a custom with which we have complied. In the 

 worst forms of the disease, the patient loses all interest lor matters 

 which do not bear upon the state of his health. He becomes ab- 

 stracted, forgetful, and negligent of his affairs, gives himself no further 

 concern about his family, and often remains idle in his bed for years. 

 It is often a long time before his nutritive condition begins to suffer. 

 Gradually, however, especially in bad cases, the patient grows thin, 

 and acquires a sickly appearance, and derangement of the secretory 

 and digestive functions arises. We are not at liberty to account for this 

 emaciation and the other nutritive disorders, by supposing that the 



