SOME APPLICATIONS OF PHYSIOLOGY TO MEDICINE: III.--BLOOD PRESSURE AND HEART ACTION IN SLEEP AND DREAMS: Their Relation to Haemorrhages, Angina, and Sudden Death
Authors: J. A. MacWilliam
Journal: BMJ (1923)

inseparable from it.In it the patient does not merely complain of altered sensations and feelinigs, but has gone a stage further and translated these into terms of definite disease, from which he is certain he is suffering, and his conduct is modified accordingly.Maniy patients have an idea that they may have syphilis or cancer, or ulcer of the stomach, and consult their doctor on this account.But this in itself does not constitute hypochondriasis, for after adequate examination and explanation they may be con- vinced that their fears are groundless.It is the person with the fixed idea, unalterable by argument, that he has some definite disease and will not therefore take food, or only certain foods, and will not touch other persons for fear of contaminating them, or will not walk lest he suddenly drops down dead from heart disease, or who spends his time constantly examining some part of his body which he considers diseased, or conistantly washes alnd changes his lilnen because he thinks he is verminlous-that is the true hypochondriac.It is in some cases a truly terrible affec- tion, and is often as incurable as a case of chronic delusional insanity.Tratumatic Netiroses.It would take too long to discuss traumatic neuroses in all their aspects, complicated and increased as they have been by the NVorkmen's Compensation Act, but a few words are necessary.No signs or symptoms are found in tllese cases differing from those mentioned in my previous remarks.The manifestations may be those of malingering, of hysteria, of neurasthenia, of hypochondriasis, or even of tr ue -melancholia.The only peculiarity is that after trauma it sometimes happens that there is a mixture of hysteria and neurasthenia with some malingering.According to legal decisions hysteria and neurasthenia (including, of course, hypochondriasis and melancholia) are psychical or physical changes and have to be compensated.But malingering, being pure fraud, gets no compensation, and the great difficulty is to prove that the case is one of pure malingering.Somptimes the doctor can discover this himself, but at other times it can only be proved by outside evidence.For instance, a man after injury may have paraplegia, not organic, as it does not conform to this, but a;pparently hysterical.If, how- ever, there is evidence that when not under observation so far as the man knows he is seen to walk and run in a perfectly normal manner he is an obvious fraud.Psychical shock producing neurasthenia may occur with- out physical injury.A lady in a tramicar saw a following car approaching too rapidly and thought the guard would be killed, but beyond a very slight impact of the cars nothing happened.But the lady got out of the car in a state of fright, fainted, and was afterwards at home sufferinlg from profound neurasthenia for weeks, and wasgiven heavy damages at the assizes.Again, a man is in very great danger owing to an alarming accident, say, of a falling crane crushing him to death; perhaps ho escapes with a bruised foot which soon But this hypothesis has to be revised in view of Leonard * A communlication on this subject was made to the Internationlal