Two classes of causes—those which act upon the mind, and those which act upon the body. Insanity always, strictly speaking, a disease of the organization. Too much disposition to look to some one thing as the cause. Tables of causes in Hospital reports. Form of the insanity not necessarily indicative of its cause, or of the character of the patient. Causes of insanity. Indulgence of passions. Wrong views of life. Exclusive and prolonged attention to one subject. Insanity rare among savages, and those under despotic governments. Great prevalence in this country. Religious excitement. Debilitated system predisposing to insanity. Intemperance. Children seldom insane, though very liable to temporary derangement in sickness. Foundation of insanity, however, often laid in childhood. Forms and signs of insanity. Cases in which the disease comes on slowly. Monomania. Moral insanity. Treatment of the insane. Change produced by Pinel. Advantages of Retreats or Hospitals. 1. Removal of patient from the associations under which his insanity originated. 2. Judicious medical treatment. 3. Better mental and moral management than can have among his friends. Mistakes of friends of the insane in their management. Reasons why insane apt to dislike their nearest friends most. Helplessness of insane poor. Duty of the State in regard to them. Legal relations of insanity. Absurd and inconsistent opinions and practices of our courts of justice. Professional evidence in France, and in this country, when prisoner suspected of insanity. Insane often been executed. Plea of insanity. Importance of preventing the acts for which the insane are brought before our courts as criminals. Laws deficient at this point. Necessity of a commission of lunacy.
CHAPTER XVI.
INFLUENCE OF HOPE IN THE TREATMENT OF DISEASE,
Physician’s employment a cheerful one. Contrary opinion quite prevalent, but erroneous. Cases in which he can neither cure nor palliate few. Prevailing cast of physician’s mind, therefore, hopeful. Hope should always be based on intelligent grounds. Hope in the different stages of a case. Seldom should all hope be given up—even in apparently desperate cases recovery sometimes occurs. Interesting case. Hope a cordial—as necessary as the cordial draught, and as improper to withhold it. Giving false assurances wrong. Often done by quacks and quackish physicians. Views and feelings of patients in regard to prospect of death often misunderstood. Extinction of all hope of recovery not commonly desirable in cases certain to be fatal. This extinction of hope not essential to perfect resignation. Influence of collateral circumstances upon the manner in which death is met. Occasional pauses in the onward progress of fatal chronic disease. Duty of the physician in regard to the hope awakened at such times. Supposed salutary moral influence of the certain expectation of death. Tendency to hope in consumptive patients. Curability of consumption.
CHAPTER XVII.
TRUTH IN OUR INTERCOURSE WITH THE SICK,
Variety of opinion and practice on this subject. Percival’s views in his Medical Ethics. Advocates falsehood. Object of this chapter to present the practical considerations bearing on this subject, illustrating them with cases. 1. Knowledge concealed from the patient by falsehood it is wrong to assume would certainly do him harm if communicated to him. 2. Deception as commonly practised generally fails to be carried out. Case of the deceived child. 3. The discovery of the deception, when it takes place, has a worse effect on the patient than a full statement of the truth could produce. 4. Destruction of confidence occasioned by discovered deception injurious to the persons deceived. Children. The insane. Detected deception not only increases insanity, but modifies it. 5. General effect of deception, extending beyond the individual on whom it is practised. General distrust of the veracity of physicians. 6. If adopted as a common rule that deception is sometimes proper, the object of the deception would be defeated. 7. If the door for deception be once opened there is no limit. Though proper sometimes to withhold the truth, wrong to put falsehood in its place. Enquiries of the sick not always to be directly and fully answered. Too definite opinions often given by physicians.