The Edinburgh Review of April, 1803, contains a review of Pinel's work, which deserves attention from the tone in which it is, for the most part, written. The Reviewer evidently thinks that England had very little to learn from France. The York Retreat had, indeed, been in active operation for some years, and the treatment pursued there might, no doubt, have borne comparison with that at the Bicêtre, but to speak of Great Britain as a whole having a decided superiority over other countries in its moral treatment of maniacs was rather absurd. The Reviewer regards Pinel as the first author on the Continent who is fully sensible of the advantage of such moral treatment, and then observes, "To medical readers in this country many of our author's remarks will appear neither new nor profound, and to none will his work appear complete.... It may be considered as a sketch of what has already been done, with some notices of what the author intends to do; though he seems frequently to wonder, with a smile of self-approbation, at what he thinks his own discoveries." And again: "Dr. Pinel is desirous that France should have some claim to a judicious treatment of the disease of the mind, the honour of which has hitherto been exclusively confined to England."
It is curious to find the Reviewer observing that Dr. Pinel appears to display very little sagacity and precision in saying that in some cases the brain is not affected. And again: "He conceives that the result of the examination of the periods of life most subject to insanity is alone sufficient to show how seldom it is owing to any organic affection of the brain or the cranium. But in this opinion there is some inconsistency. For he soon after states that in thirty-six dissections he found nothing more remarkable than in the brain of apoplectic and epileptic patients, or of persons who died from furor or convulsions. Now, this is a confession that some deviations from the natural and healthy appearances were observed; and this is all that is contended for, and all that the present limited state of our knowledge authorizes us to affirm." The Reviewer adds, no doubt with truth, "If no organic affections are said to have been discovered, in some few instances, we should not reason negatively from such dissections, perhaps cursorily and ignorantly made, and with instruments ill adapted to detect minute and apparently trivial deviations from the natural structure."
The following snarl is also noticeable:—"He informs us that he has studied with considerable attention the writings of Locke, Harris, Condillac, Smith, and Stewart; but the quotation of great names is not always the surest proof of an accurate acquaintance with their works, and we are inclined to think that there is some ground for doubt in the present instance."
The Reviewer is severe on Pinel's classification, which in the main has stood the test of all subsequent criticism to a remarkable degree. "It may," he says, "be entitled to the praise of ingenuity, but we doubt whether it is remarkable for its clearness and accuracy. Many of the distinctions seem absurd, and others not well founded. The several kinds of insanity are not distinct; they are only varieties of the same affection. All the symptoms mentioned under these five heads occur in the same patient. At different times he passes through all the gradations from furious phrenzy to complete fatuity." This criticism has, of course, great force as opposed to all symptomological classifications whatever, but not specially or mainly to Pinel's.
On the point whether madness can in certain cases be cured, Pinel's utterances are dismissed with downright contempt: "Instead of any new light being thrown upon this important question, or any new rules of conduct pointed out, our author gives a minute detail of two cases, where any ancient female of ordinary capacity could have decided as well as himself, and relates with laboured minuteness the contrary opinions of some eminent physicians on a late memorable occasion in this country." Pinel an old woman! It will probably be new to most, if not all, of our readers that this illustrious man was regarded in this light by the leading Review of our country, when his writings first became known amongst us. The review ends, after crediting Pinel with some merit, and commending his work as containing some profitable instruction, with the exceedingly kind and patronizing observation that "we are therefore inclined to make an indulgent allowance (!) for the imperfect execution of many parts of Dr. Pinel's essay, and to entertain hopes of further information from his diligence and discernment" (!!).
Insular conceit could surely scarcely go further. However, the Edinburgh Reviewer is forgotten and his name unknown; Pinel's name covered with glory, although not a popular hero; for when I made a pilgrimage to his grave in the great Paris cemetery, Père la Chaise, in 1878, I was a solitary visitor, while crowds flocked to others, including that of Thiers, which is in close proximity to it. I am glad to see it announced that the Société Médico-psychologique of Paris is about to erect—not too soon—a statue to his memory.
The bold proceeding, as it seemed in those days, of freeing the lunatics at the Bicêtre from their fetters, constitutes Pinel's title to honour—an honour of which no man will succeed in robbing him. He will be remembered when Dequin[138] is forgotten. Pinel, although his writings would have made him eminent as a physician had he never rendered his name illustrious in reference to the insane, did not, as a study of his life abundantly proves, liberate the patients at the Bicêtre from their chains in direct consequence of his medical knowledge of insanity, but mainly, if not entirely, from the compassion which he felt for their miserable condition. His knowledge, great before, was vastly increased after he had placed the patients in a more favourable state for medical observation; in fact, it is obvious that the opportunities of scientific research, and specially of observing the satisfactory progress of those labouring under the disease, were greatly augmented from the moment he introduced a humane system of treatment.
Had my sketch comprised France as well as England, I should have attempted to give a description of the work he performed in Paris. But I must not be tempted to go beyond my subject, and as a matter of fact the course of French and English reform in the treatment of the insane was entirely distinct and independent.[139]