MEDICAL NOTES.

Auckland Star, Volume LXIV, Issue 261, 4 November 1933, Page 10 (Supplement)

MEDICAL NOTES.

UNDEFINED DISEASES. THE "MAEADE IMAGINAIRE," DOCTORS' DIFFICULT PROBLEM.

(By PERITUS.)

In a country having no leisured class it is surprising to find a number of men and women who come under the heading of hypochondriacs, that is, nervous, sensitive people who experience all the discomforts and some of the pains of the sick, yet have no definite physical disease. They are able (unintentionally be it said) to create symptoms of illness, even to plant a pain in any part of the body, and to remain unconvinced when assured that the pain is not real. The faith-healer has many successful cases of this kind by falling in with the imagination of the patient, and suggesting means for the relief of the trouble. The means may be as fictional as the disease, but to' agree with the error has often a better effect than frankly deriding it. Hysterical lameness and paralysis, nervous habits and deranged functions, are often relieved or altogether banished by a few doses of impressive nonsense. The ordinary doctor has been trained in science,' is accustomed to look for proof appealing to his reason, to evidence to be recognised by his senses, and when the malade imaginaire cannot produce anything like this the doctor feels unable to be a party to what he believes to be a fraud, not that his patient is fraudulent, but the patient's senses are.

Chasing His Health. The patient is usually extremely anxious about his health; he takes the greatest care of himself, and is equally afraid of cold winds and indigestible food. He is equally afraid of not sleeping well, or of sleeping too soundly, and every chance variation in the performance of natural functions may, to his way of thinking, portend terrible disease. That time after time he escapes the disease he has dreaded affords him no comfort, for no sooner has some symptom passed away than another looms in its stead. Sometimes his attention is fixed upon one particular organ—heart, stomach, lungs, liver or kidney—and his intense interest in the behaviour of that organ is enough to put it out of action. If an emphatic adviser drives his attention away from one part of his body, quickly ho fixes on another. Ho usually wanders from one doctor to some other of whose cleverness he has heard reports, and his questions naturally let loose a flood of description which this "new" doctor has little chance of checking until the "invalid" runs down. A London specialist used to say that such a patient "passes his time in chasing his health, which is always contriving to elude his grasp." The most annoying feature of these cases is not only that a really serious symptom may be missed, but that behind all the camouflage of fiction there may hide a solid lump of fact wholly disregarded by both patient and adviser. There is no such thing as normal conduct in any organ. The varying circumstance of each day are reflected in the unconscious action of the body, and only a gross peculiarity or definite suffering should call up the medical staff. It takes longer to prove a healthy man (with a mental kink) perfectly sound than to diagnose disease from' a symptom or chain of symptoms.

Difficulty of Treatment. Imaginary disease may prove a harmless peculiarity attached to life, the sufferer carrying no more than a pale, strained anxious look, and lacking any interest in matters unassociated with health, or it may drift into true melancholia and mental inefficiency, and if this happens the physical condition may improve wonderfully. There is sometimes a substratum of functional disorder which gives rise to ill-directed alarm; for instance, neglect of bowel regularity may produce flatulence and palpitation of the heart, and the patient fixes on the 1 heart as the organ which is defective. ! The sufferer in most cases has a strong desire to live, and this impels him to seek attention and treatment; his endless search for a cure for something which does not exist. Ridicule is useless, so is prescribing for one symptom after another. Full occupation, under supervision, and a good tonic may work wonders. A "hobby" is of no value, because it may be neglected to devote time to examine symptoms, and "think things." Some of these poor fellows are humorously pathetic. One has "a worm in his head," another has "something creeping in his opine," a third brings something on a sheet of glass, and

says, "this is the trouble out of my nose." Most of them are thin, and are abstainers. Many have been unwilling to waste medical fees, and have used advice in unrelated driblets. Some had parted with their teeth, appendix, tonsils, and, if females, some other parts also. They, may be studying vitamins, or "higher thought," and just now, they may be "on a diet," or using an electric machine, a new "patent" or a system of exercises, or "cutting out tea" or "avoiding fats and sugars," or "sleeping with the head of the bod to the north," or carrying a "charm," or drinking oceans of milk or living on green leaves, or having only one meal a day, or pinning faith to the doctrine of "little and often" in feeding. There may be no harm in these things, but they are hard on housekeepers and play havoc with what we choose to call a "natural life." i

Cure of Love. Perhaps the best cure of all is for the patient to fall in love with a robust young woman "with no nonsense about her." , Up to the age of 40 tlic hardening process of camp life may go far towards preventing hypochondria, and personal records of the war confirm this. Familiarity with wounds and death, facing' all things most repugnant to the sensitive, had one of two effects, it turned the fearful shrinking creature into a man, or made another case of "shell shock." After 40 the nervous health-seeking case is generally incurable unless the anxiety can be converted into a determined carelessness, in which disease and death are accepted as the common lot, to be calmly accepted but never watched for, awaited but not invited.