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fulness, insufferable uncertainty of mind and unsteadiness of purpose, then we have the disease pure and complete. It is, no doubt, frequently accompanied with symptoms indicating considerable derangement of the functions of other parts of the body but these are merely accidental complications, arising solely from the unequal distribution of nervous influence, necessarily consequent upon a morbid action going on in some part of the brain whence that influence is derived; and therefore, in attempting to determine the seat of the disease, we ought not to suffer ourselves to be misled either by the frequency of their appearance or their apparent urgency. Dyspeptic symptoms, for example, so generally accompany or follow an attack of Hypochondriasis, that many writers regard the mental despondency as the direct result of the dyspepsia. But an attentive examination demonstrates that Hypochondriasis may occur, not only without any concomitant dyspeptic symptoms, but without any other organ than the brain being at all affected; and, vice versa, that dyspepsia may occur without any hypochondriacal affection of the mind necessarily following its attack. This fact, indeed, constitutes the great diagnostic mark between the two diseases. Dyspepsia, being simply a disease of the stomach, is known by the presence of symptoms indicating disorder of the digestive functions, but without any inordinate affection of the mind. Hypochondriasis, on the other hand, being a disease of the brain, is known only by the presence of symptoms indicating a morbid state of the functions of that organ, while those indicative of deranged digestion are often very slight, and not unfrequently altogether wanting.

That the manifestation of the mind is the only function necessarily affected in Hypochondriasis is still further evident from the acknowledged difficulty of distinguishing between it and melancholia; and, if our view of the former is correct, then both diseases must be affections of the same organs and of the same functions, and, consequently, as symptoms are nothing more than deranged functions, both must of neces

sity show many symptoms in common; and hence the very natural source of the perplexity, and hence why, as Dr Cullen states, it is often impossible to distinguish between them. He adds, that when it can be effected, "it is chiefly by dys

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pepsia being always present in hypochondriasis, and often "absent in melancholia."* But if, as we have already shown, dyspepsia is merely a common complication of Hypochon. driasis, and not necessary to its existence, it follows, that it may be absent or present in the one disease as well as in the other; and hence its occasional presence in Hypochondriasis can afford no just ground, either for distinguishing that from any other disease, or for assigning to it a different seat. That this is really the case is evident from Dr Cullen himself, who states also, that Hypochondriasis often exists" with few or "only slight symptoms of dyspepsia; and even though the "latter be attending, they seem to be rather the effects of "the general temperament, than of any primary or local "affection of the stomach." Here Dr C. distinctly acquits Hypochondriasis of being a stomachic affection, and affords something like a reversal of his own diagnosis,-thus showing how strongly facts concur in proving Hypochondriasis to have the same corporeal seat as melancholia, and in prov. ing that seat to be the brain. This conclusion is, in fact, so irresistible, that Dr Cullen's candour leads him, in another place, to" acknowledge, that he is at a loss to determine "how, in all cases, Hypochondriasis and Melancholia may be "distinguished from one another, whilst the same tempera"ment is common to both."+ Had their seats, however, been in different parts of the body, different functions must have suffered, and different symptoms must have appeared, which would have led at once to as easy and perspicuous a distinction as that already shown to exist between these and dyspepsia. Another circumstance, which might have led a reflecting

Culleni Synopsis Nosol. G. LXIV. + Cullen's Practice, § 1586.

mind to the discovery of the cerebral seat of Hypochondriasis, if it had not been for the soporific influence of established error, is the ever-changing and innumerable host of secondary symptoms which accompanies it. The celebrated Sydenham aptly declares, that the shapes of Proteus, or the colours of the cameleon, are not more numerous and inconstant than the forms of hypochondriacal disorder; and Dr Whyt represents it as simulating all other maladies; and Villermay again speaks of it annoying the patient, " depuis la plante des pieds, jusqu'au bout des ongles, jusqu'à l'extremité des cheveux." The obvious inference to be drawn from this is, that the disease must have its seat in some part of the body which is intimately connected with and exerts a strong influence over all other parts. Now, the brain alone can be such an organ. It alone is the fountain of nervous energy, and to it alone all sensations, from the soles of the feet to the tips of the fingers, are referable, and it alone has a constant sympathy with the state of all other parts; it alone, therefore, can be the seat of a disease whose influence extends over all other organs.

Amidst such a variety of secondary symptoms, we have already seen that those which indicate derangement of the digestive functions are the most frequently met with; and, on the view of the disease being an affection of some part of the brain, this fact admits of an easy explanation. It is well known, for instance, that wounds and injuries of the brain often produce an immediate disturbance in the functions of the liver and stomach, giving rise to nausea, sickness, and vomiting. It is also well known that violent emotions, intense grief, unexpected bad news, or even a fit of anger, produce a sudden cessation and diminution of the digestive powers, and give rise to actual loathing and squeamishness. This is perfectly in harmony with the idea of Hypochondriasis being a mental affection, and having a cerebral seat, since we know that a regular supply of nervous influence is essential to the performance of the digestive process, and that whatever

interrupts this, whether momentary passion, continued grief, or hypochondriacal despondency, thereby diminishes the active powers of the stomach. That this effect results from the disturbance of the nervous influence coming to these organs from the brain, and not from the passions themselves having an abdominal seat, as was long supposed, is abundantly proved by the interesting and conclusive experiments of Drs Wilson Philip, Magendie, Breschet, and others, but of which our limits will allow us to state only the results.

1st, On dividing the pneumogastric nerve, which is the chief medium of communication between the brain and the stomach, and leaving the ends in contact, the process of digestion is a little retarded, but still goes on.

2d, When the divided ends are separated, or a portion of the nerve is excised, digestion ceases, or becomes exceedingly slow.

3d, A section or destruction of part of the spinal medulla, or a removal of a portion of the brain, is said to have the same effect.

4. 66 Every thing that diminishes the sum total of nervous "influence going to the stomach enfeebles proportionally the process of digestion in that organ."

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5th, Narcotics, administered so as to produce coma, equally diminish the power of digestion.

6th, When the process of digestion is stopt by the excision of the nerve, it is capable of being re-established by means of galvanism applied to the nerve.*

After contemplating these results, does it seem at all wonderful that cerebral or mental disease, or even undue exercise of brain, should give rise to dyspepsia? Baglivi, indeed, with great justness, assigns this very reason for the generally deficient digestive powers of literary men. Villermay also tells us, that "les personnes qui exercent beaucoup leur entendement "ont ordinairement les organes abdominaux faibles et tres sensibles; "il semble que l'activité mentale ait lieu au prejudice des fonctions

Medico-Chirurg. Review, No 16, p. 968.

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digestives. Un mauvais éstomac, dit Amatus, suit les gens de let"tres comme l'ombre suit le corps, et il est egalement vrai du moins "en general, que l'homme qui pense le plus est celui qui digere le plus mal."*-Dictionaire des Sciences Med. t. xxiii. p. 113.

The kind of secondary symptoms which occurs next in frequency, is that denoting disordered circulation, or a sympathetic affection of the heart. "You will not often find," says Dr Heberden, " any real disease of the heart itself, which gives "rise to more violent palpitations than Hypochondriasis, although "in the latter the heart remains sound and uninjured." This fact is equally consistent with the cerebral and equally at variance with the abdominal seat of the disease. We have not only daily instances of purely mental emotions influencing the circulating system through the medium of the nerves, and giving rise, in this way, to palpitations, fainting, and even death itself, but we know, that if the mental agitation continues to operate, the affection of the heart, which was at first sympathetic, and unaccompanied with organic change, will, after a time, terminate in irreparable lesion of struc

ture.

Thus, we are told by Desault and Corvisart, that at the commencement of the French revolution, when the public mind was in a state of insupportable anxiety and suspense, between dreadful realities and brilliant hopes, Hypochondriasis and other affections of the mind became extremely common, and that, being kept up for a length of time by the continued operation of their original causes, they gave rise in many, not only to sympathetic functional disorder, but also to actual organic disease of the circulating system. Keeping these facts in view, can we be surprised that hypochondriacal despondency, seated in the brain, should also disturb sympathetically the regular healthy action of the same important organs

Since writing the above, we have been consulted by a literary gentleman from America, whose health was greatly impaired in consequence of excessive mental application. Upon being asked if he was in the habit of studying soon after meals, he answered, that he dared not do so now ;" and assigned as the reason, the remarkable fact, that his digestion was as much under his command as his foot, for he could instantly stop it by intense thinking." Nor is this the only confirmation of the above view which we have lately met with.

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