FOOTNOTES:
[40] Annual Report of the McLean Asylum, 1843.
[41] A Discourse on the Influence of Diseases on the Intellectual and Moral Powers, by Joseph M. Smith, M. D., Professor of the Theory and Practice of Physic, and Clinical Medicine.
[42] The following very interesting account of this experiment is taken from an article on the treatment of lunatics, in the London Quarterly.
It was during the reign of terror, and while all France labored under a new form of insanity, that the idea was first conceived of setting loose madmen from their bonds. The good and wise physician, Pinel, seems to have been struck with the injustice of keeping the patients chained in the dungeons of Bicetre, while so many hundreds of his countrymen, more mischievously distracted than many of them, were at large to work the bloody frolics of the revolutionary frenzy. There were at that time upwards of 300 maniacs chained in the loathsome cells of the horrible Bedlam of France. Pinel formed the resolution of setting them free from their strict restraint, and he entreated permission of the Commune to that effect. Struck with the novelty of the enterprise, at that time a sufficient recommendation before any assembly in France, the Commune listened to the proposal, and deputed one of their body, the notorious Couthon, to accompany the physician to the spot, and judge of the propriety of carrying his undertaking into effect. They were received by a confused noise—the yells and vociferations of some hundreds of madmen, mixed with the sounds of their clanking chains, echoing through the damp and dreary vaults of the prison. Couthon turned away with horror, but he permitted Pinel to pursue his enterprise. The philanthropist resolved speedily to liberate fifty of the number by way of experiment, and began by unchaining twelve of the most violent. The account of his proceeding has been recorded by his nephew, Sclyion Pinel, in a lively narrative, which was read before the Academy of Sciences. The first man set at liberty was an English captain. He had been forty years in chains, and his history was forgotten by himself and all the world. His keepers approached him with dread; he had killed one of their comrades by a blow with his manacles. Pinel entered his cell unattended, and accosted him in a kind and confiding manner, and told him that it was designed to give him the liberty of walking abroad, on condition that he would put on a waistcoat that might confine his arms. The madman appeared to disbelieve; but he obeyed. His chains were removed, and the door of the cell was left open. Many times he raised himself and fell back; his limbs gave way; they had been ironed forty years. At length he was able to stand and to stalk to the door of his dark cell, and to gaze, with exclamations of wonder and delight, at the beautiful sky. He spent the day in the enjoyment of his newly-acquired privilege; he was no more in bonds; and during the two years of his farther detention at Bicetre, assisted in managing the house. The next man liberated was a soldier, a private in the French guards, who had been ten years in chains, and was an object of general fear. His case had been one of acute mania, occasioned by intemperance—a disorder which often subsides in a short time under abstinence from intoxicating drinks unless kept up, as in this case, by improper treatment. When set at liberty, this man willingly assisted Pinel in breaking the chains of his fellow prisoners; he became immediately calm, and even kind and attentive, and was ever afterwards the devoted friend of his deliverer. In an adjoining cell there were three Prussian soldiers, who had been many years in chains and darkness; through grief and despair they had sunk into a state of stupor and fatuity, the frequent result of similar treatment; they refused to be removed. Near to them was an old priest, harmless and patient, who fancied himself to be the Savior of the world. When taunted by the keepers, who used to tell him that, if he was Christ, he could break the heavy chains that loaded his hands, he replied with solemn dignity, Frustra tentaris Dominum tuum. After his release he got rid of his illusion, and recovered the soundness of his mind. Within a few days Pinel liberated fifty-three maniacs from their imprisonment. The result was beyond his hopes. Tranquility and harmony succeeded to tumult and disorder, and even the most ferocious madmen became more tractable. This took place in 1792; and the example of Pinel was followed in various parts of France.
CHAPTER XVI.
INFLUENCE OF HOPE IN THE TREATMENT OF DISEASE.
I remember well that Dr. Jackson of Boston used to remark to the students, that the medical profession is, from the nature of its duties, a cheerful profession. The physician has so much to do with suffering, disease, and death, that this assertion would at first view seem to be erroneous. But when it is considered that in the great majority of cases he is able to effect a cure, that in those which terminate in death he can generally give relief to suffering from time to time, and thus at least smooth the passage to the tomb, and that the number of sick whose diseases he can neither palliate nor cure is exceedingly small, we can see why it is that the physician is ordinarily so cheerful a man in his daily intercourse. The impressions of most persons on this subject are wrong, and for very obvious reasons. Out of their own immediate circle of relations and friends, they hear only of the severe cases of disease, and often only of those in which death is the result, and know but little, perhaps nothing, of the multitude of cases, here and there in every part of the community, which end in recovery.
Sometimes, it is true, sad cases occur which cast a gloom over the path of the physician; but then the gloom is soon dissipated by the successful issue of other cases which he had reason to fear would have a fatal termination. Sometimes, too, unfortunate cases come in clusters, and the physician is for the time obliged to see so much of suffering and death, and the sorrows of bereavement, that in his sadness he is ready to regret that he ever adopted such a profession. But this happens only occasionally. It is a mere coincidence, and it is but momentary. Events soon take their ordinary current, and he has his usual amount of success, and resumes his wonted air of cheerfulness and hope.
The results of the skilful and judicious practice of medicine are such then as to make hope, and not despondency, to characterize the prevailing cast of the physician’s mind. And so it should be. For hope stimulates to action—steady, clear-minded action—while despondency is prone to inaction, and leads to no efforts except those which are hurried, fitful and confused. I do not mean that the physician should in any case blind himself to the dangers which it presents, and let a vain hope lull him into security. This error should be as carefully avoided as the opposite one, committed by those who see difficulty and danger in almost every case, magnifying every bad symptom, and imagining some which have no existence. The hope of the physician should be an intelligent hope. It should be based upon just and definite conclusions. It should be discriminating, and should be varied in its degree according to the character of each individual case.
Every medicine that is given should be administered by the hand of hope. The prospect, at least of relief, and generally of recovery, should be held up to the mind of the patient. Remedies should be given to effect some definite object, and the physician should hope to a greater or less degree that they will do so. Hope may thus be indulged in relation to the different stages of a case, without regard to the final event of it, which may be so distant and so clouded in doubt that no calculations can be made in regard to it. And the physician may direct the attention of the patient to these same points, and thus give variety to the hope which he excites in his mind. This in many cases is much better than to come to him every day with the simple expression of the hope that he will at length recover. In the tedium of his confinement, if it be a long one, he soon tires of looking far ahead to the bright fields of convalescence, but finds relief in the little spots lighted up of hope by the way—the oases thus made in the desert of sickness.