ADYNAMIJE. 395 



it likewise proves an useful remedy in the hypochondriasis. 

 However, in the latter case, as I shall explain presently, it is 

 still a more useful remedy by its operation upon the mind than 

 by that upon the body. 



MCCXLIII. It is now proper that we proceed to consider 

 the most important article of our practice in this disease, and 

 which is, to consider the treatment of the mind ; an affection of 

 which sometimes attends dyspepsia, but is always the chief cir- 

 cumstance in hypochondriasis. What I am to suggest here 

 will apply to both diseases ; but it is the hypochondriasis that I 

 am to keep most constantly in view. 



MCCXLIV. The management of the mind in hypochon- 

 driacs is often nice and difficult. The firm persuasion that gen- 

 erally prevails in such patients, does not allow their feelings to 

 be treated as imaginary, nor their apprehension of danger to be 

 considered as groundless, though the physician may be per- 

 suaded that it is the case in both respects. Such patients, 

 therefore, are not to be treated either by raillery or by reason- 

 ing. We are very often led to reason such persons out of their 

 fears ; but it is a fact that reasoning has no power in this case : 

 they may be convinced, but the direction of their mind is too 

 powerful. The same thought occurs to them at every moment ; 

 nay, there is nothing more provoking and offensive to them than 

 these attempts to cure their feelings. I never almost tried this 

 reasoning without repenting it. I have lost my patients alto- 

 gether by showing to them the false foundations of their fears. 

 They must be drawn from their own thoughts, from their own 

 affairs, entirely by artifice and stratagem."" 



It is said to be the manner of hypochondriacs to change often 

 their physician, and indeed they often do it consistently ; for a 

 physician who does not admit the reality of the disease, cannot 

 be supposed to take much pains to cure it, or to avert the dan- 

 ger of which he entertains no apprehension. 



If, in any case, the pious fraud of a placebo be allowable, it 

 seems to be in treating hypochondriacs ; who, anxious for relief, 

 are fond of medicines, and, though often disappointed, will still 

 take every new drug that can be proposed to them. 



MCCXLV. As it is the nature of man to indulge every pre- 

 sent emotion, so the hypochondriac cherishes his fears ; and, 



