4:30 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



perversion of sensation in the patient's various organs has led to 

 perversion of their functions ; for the same emaciation and the same 

 disorder of nutrition may likewise be seen in persons who have fallen 

 into a state of permanent mental depression, as a result of objective 

 conditions, and who feel no morbid sensations in the organs which 

 ultimately become diseased. Moreover, the very improper way in 

 which hypochondriacs often live, and their immoderate use of medi- 

 cines, contribute a great deal toward the development of a cachectic 

 condition. 



Hypochondriasis always runs a chronic course. The cases in 

 which peculiar causes, acting upon a constitutionally timid and im- 

 aginative person, induce a transitory belief that he is ill, or a fear 

 that he is about to be ill, are not to be regarded as genuine hypo- 

 chondriasis. Recovery is not uncommon. More frequently the dis- 

 ease persists throughout He, with varying intensity. It rarely termi- 

 nates fatally, although there have been instances where the patient 

 died of marasmus and exhaustion. 



TREATMENT. It is useless to dispute with a hypochondriac, and 

 to try to convince him of the error of his ideas. The only way to cure 

 the patient is to rid him of his morbid sensations. For this purpose it 

 is necessary, in the first place, to correct any existing derangement of 

 the system which, as we have said, is often the exciting cause of the 

 disease, and which would cause a feeling of illness in a sane person. 

 The necessary therapeutic measures vary according to the peculiarity 

 of the case. The benefit often derived from the springs of Karlsbad, 

 Marienbad, and Kissingen, in the treatment of this affection, are, no 

 doubt, mainly due to the beneficial effect exerted by these waters upon 

 diseases of the gastric organs, which so frequently prove a source of 

 hypochondriasis. In other instances, preparations of iron will be ap- 

 propriate, while the springs will do harm. In others, again, sea-bath- 

 ing and cold foot-baths are to be used. We must be cautious in the 

 employment of the drastic cathartics, although they can seldom be 

 dispensed with altogether, and although they usually afford the patient 

 a temporary relief; and, above all, we must distinctly warn the patient 

 against over-dosing himself, a practice to which hypochondriacs are 

 very prone. This likewise applies to the use of carminatives, fo* 

 which the patients nearly always earnestly beg. The object of tlu 

 psychical treatment, as Romberg aptly says, should be diversion of 

 the attention from the sensory to the motor and intellectual spheres. 

 This object will not be attained in educated patients by ordering them 

 to take long walks, to saw wood, to practise gymnastics, and to occupy 

 themselves in other mechanical pursuits, because the attention of the 

 patient is not diverted, by such actions, out of the sphere of sensation. 



