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functions of some parts of the body, in consequence of which we may, even after ascertaining what function is disordered, still be unable to say by what organ it is performed, and, consequently, what is the seat of the morbid cause ; and, secondly, the occasional occurrence of deranged functions, not from disease in their immediate organs, but from sympathy with remote parts. The first obstacle is, in fact, that which has so much retarded our medical knowledge of insanity, and for the effectual removal of which we are highly indebted to Phrenology; and nothing can demonstrate more clearly the importance of a sound physiology to the progress of medical science than the very fact, that the idea so long entertained, and still so generally received, of Hypochondriasis being an affection of the digestive viscera, arose solcly, logically, and consistently, from the equally erroneous, but long prevalent physiological notion of the passions having their seats in the same parts. In admitting this idea, the error lay, not in the inefficiency of the principle, or in the unsoundness of the inference deduced from the premises, but in absurdly regarding the premises themselves as physiologically true, when, as is now known, they were altogether without foundation; and, consequently, had it been known to our predecessors as it is now to us that the brain is the corporeal seat of the passions as well as of the intellect, the same principle which led them, in ignorance, to place the seat of melancholy, Hypochondriasis, and other mental affections, in the viscera of the abdomen, would, in knowledge, have led them as infallibly to place it where it really exists, in the encephalon, or brain. Besides, the functions of the brain, in so far as it is the seat of mental emotions, being now pretty accurately ascertained, this objection no longer applies to the study of the particular disease under consideration, and to which we mean at present exclusively to confine ourselves.
The second obstacle, when narrowly examined, proves to be equally groundless as the first. It may be thus illustrated
-Blindness sometimes arises from worms irritating the intestinal canal, and therefore here is an instance, it may be said, in which the seat of the disease is not in the eye or organ which executes the disturbed function of vision, but in a part widely distant, and in which, consequently, the mere knowledge of the deranged function does not lead to the true seat of the malady, and hence the principle is of no practical value. But there is a double fallacy in such reasoning; for in this, as in every other instance, the organ which performs the disturbed function is actually the only one that is invariably affected ; and blindness does not occur, except in consequence o a sympathetic, but not less real, morbid state of the eye or of the optic nerve, both of which are essential to vision. This morbid condition of these parts may no doubt result, In some cases, from worms in the intestinal canal ; but that it in does exist is perfectly undeniable. If it did not, why does not the same intestinal cause always produce the same effect upon vision ? for experience shews that it does not give rise to blindness in one out of a hundred cases. The only reason is, that in some constitutions the eye is naturally so irritable, and so susceptible of diseased action, that it suffers from such slight causes as in sounder constitutions would have been altogether without effect; and hence we are still authorised to hold, that in every disease in which vision is impaired or altered, the eye, or organ which executes the function, must of necessity be also disordered. This disorder may arise from external causes acting immediately upon the eye itself, or it may result from sympathy with remote parts, but still it must exist, and therefore it forms no exception to the principle above stated.
The second point of the fallacy is this :-If the blindness arises from sympathy with the irritation produced by worms, the latter being the cause, must necessarily exist first, and manifest their presence by symptoms indicating derangement of the digestive functions, and thus lead, by the very principle objected to, to the intestinal seat of the original malady, and to a treatment calculated to effect its cure, and, of course, also to remove the blindness, in so far as it has arisen from sympathy. Accordingly, such is actually the fact in nature. In the cases alluded to, worms first shew themselves by variable appetite, impaired digestion, irregular bowels, &c., and then the blindness supervenes. In short, it stands to reason to admit, that before we can ascribe blindness to the influence of intestinal worms, we must previously have had some symptoms or proof of their existence ; so that, even in the supposed exception, the principle contended for leads us straight to the true cause or seat of each disease.
Arguments like that just refuted have often been employed, and with the most pernicious effects, to shew that all the varieties of mental derangement have their seats in the chylopoetic or digestive viscera, and not in the brain or organ of mind. The attention has thereby been diverted from the investigation of the true causes, theory, and cure of insanity, and countless miseries have thus been heaped upon the beads of its unhappy victims. But the application of the same principle at once exposes their fallacy, and proves that insanity never arises from such causes, unless in individuals whose brains are, either from hereditary constitution or accidental circumstances, strongly predisposed to unhealthy action; and it shews, moreover, that diseased mind, like impaired vision and every other function, arises, in ninety-nine cases out of the hundred, from causes operating directly upon its material organ, the brain; and that, in a great majority of cases, the deranged digestion and other secondary ailments are the effect, instead of being the cause, of the disorder in the organs of the mind.
From the preceding observations it follows, that had our acquaintance with the functions or physiology of the brain been as complete as it is with many other less important organs, and had our inquiries and our practice been uniformly regulated by the principle which we have laid down as the sole foundation of a sure diagnosis and safe method of cure, no such diversity of opinion as now exists in regard to the nature of Hypochondriasis, and no such self-contradiction among the ablest and most esteemed authors, could possibly have occurred. We could not then have found such men as Dr Whyt, whose work on Nervous Diseases is still a standard treatise, in one place declaring Hypochondriasis and Hysteria to be affections of the same kind, the one having its seat in the alimentary canal and the other in the uterus, and subsequently, in another place, obliged, by opposing facts, to add, that they have not always their seats in these parts, but often arise from other unknown affections of the body, as if the discase could change its seat, and still be precisely the same, and manifest precisely the same kind of symptoms ! Neither could we have found an able physician and accurate observer like M. Louyer Villermay, who has lately written on this subject, involving himself, as he will presently be seen to do, in the most glaring contradictions, and cutting down his own opinions by the root with the sharp-pointed and unsparing edge of his own facts. Nor would Drs Gall, Spurzheim, Falret, Georget, and a few others, have been the only men, who, guided by a sound physiology and strict adherence to principle, have travelled over the same vast field of uncultivated inquiry, and alone advanced almost invariably consistent and useful opinions founded on the solid basis of consistent facts.
The importance of the leading principle being thus demonstrated, and the futility of the objections to which it is liable being exposed, we proceed to its practical application to the study of Hypochondriasis, and, first, to determine what function is the only one, a derangement of which invariably attends, and, therefore, we may say, alone constitutes Hypochondriasis. This point being ascertained, we naturally hold the organ by which that function is performed to be the seat of the disease.
Fortunately little difficulty attends the first branch of the inquiry; for, on perusing the delineations of the disease, as
given by the most experienced physicians, or on carefully examining the cases which come under our own observation, we find that all the symptoms, without exception, which are essential to its existence, point exclusively to the manifestation of the mind as the only function, a disturbance of which invariably attends its occurrence, and that even those writers who contend most strenuously for its abdominal seat never describe any series or combination of symptoms as indicative of Hypochondriasis, unless the mental uneasiness, the “ tristitia et metus ex causis non æquis” are also present.
Thus Dr Cullen, whose authority in description few will venture to dispute, characterizes the disease as a “ state of mind,” distinguished by a concurrence of the following circumstances :-Languor, listlessness, or want of resolution and activity, with respect to all undertakings; a disposition to seriousness and timidity; as to all future events, an apprehension of the worst 'or most unhappy state of them, and therefore often, upon slight grounds, an apprehension of great evil. From any unusual feeling, perhaps of the slightest kind, they apprehend great danger, and even death itself; and, in respect to all these feelings and apprehensions, there is commonly the most obstinate belief and persuasion.* In like manner, the celebrated Heberden, whose portraits of disease are such inimitably accurate copies from nature, sums up a similar description of Hypochondriasis, by likening it to the “ dream of a waking man, in which, although perfectly “ well, he seems to be sinking under the symptoms of every disease ; “and, although innocent, to be filled with remorse, as if guilty of
Such is a short summary of the only kind of symptoms invariably attending and truly constituting Hypochondriasis ; and if to these be added what Dr Willis calls 6 atrocious" headaches returning periodically, giddiness, obstinate watch
Cullen's Practice of Physic, & 1222. + Heberden's Commentarii de Morb. Hist. et Curat. p. 71.