Many seem to think that when the body is sick, it is simply
a sickness of the body alone, and the mind has nothing
to do with it. They do indeed allow that when actual
mental derangement occurs in connection with any disease
the mind is affected with the body; but they are prone to
lose sight of the fact in all ordinary cases of disease, and
yet it exists in these as really, though not to the same degree.
The influence of disease upon the mind is obvious to the
most careless and superficial observer, when he sees the
delirium produced by inflammation of the brain; but such
cases seem to him to stand out as glaring exceptions to what
he considers the great general fact—that the mind is independent
of the ailments of the body. Physicians themselves
too often overlook the influence of mind in their treatment
of disease, and the community generally have very inadequate
views of its extent and universality. There can not
be any sickness of the body, however slight, that does not
produce some effect upon the mind, and which is not
influenced either for good or for ill through mental impressions.
It is important in the management of the sick, not only
that this fact should be kept clearly and steadily in view by
the physician; but that it should be understood by the community,
so that the efforts of the physician may not be thwarted,
as they often are, by the attendants and friends of the sick,
when he aims to act upon bodily disease by impressions
made on the mind. And I refer not in this remark merely
to impressions of this kind where the attempt to produce
them is so palpable that the most careless observer would
perceive it, but to all those influences which the physician
is exerting upon the minds of the sick, in his daily intercourse
with them. In truth, everything that he says and
does in the sick room, is to be regarded as really a medicine,
and producing as real if not as manifest effects upon the
state of the patient, as any of the drugs that he administers.
It will be profitable, then, to the general reader, as well as
to the medical man, to examine the influences which the
mind and the body exert upon each other in sickness, the
use which can be made of such influences in the cure of
disease, and the abuse to which they are liable from the
mismanagement of those who have the care of the sick.
Before doing this, however, it may be both interesting
and profitable to look at the connection which exists between
the body and the mind. There are various figures used to
illustrate this connection. The most common one is that
in which the mind is spoken of as dwelling in the body as
a habitation. In a certain sense this is true. This tabernacle
of flesh, as the Bible aptly terms it, is, in its present
state a habitation, which the mind is to leave in a short
time, to return to it, however, at length, rebuilt and refitted
in a more glorious, an incorruptible form, to dwell in it then
forever. But this illustration of the mysterious connection
of the mind with the body is but a partial one—it does not
express the extent nor the intimacy of that connection. The
mind is not a mere dweller put into this habitation. Its
union with it is not thus loose and easily severed. It is
bound to its every nerve and fibre, so that the least touch
of the body at any point affects the mind. Instead of being
put into the body, it has, being thus interlaced, as we may
say, fibre with fibre, grown with its growth, and strengthened
with its strength. In the feebleness of infancy the mind is
just as feeble as the body, and they both grow together up
to the vigor and firmness of manhood, and both decline
together in old age. So close is their union through all the
stages of life, and so equally is each affected by the joys
and sufferings of the other, that we might justly conclude
that at death, when the tabernacle crumbles into dust, the
mind falls with it never to rise again, had not a divine revelation
told us that, indissoluble as this connection appears
during life, almighty power will dissever it and release the
soul from the thousand ties that bind it to its habitation at
the very moment of its destruction. Were it not for this
assurance of our immortality, we could look forward in the
uncertain future to nothing but blank, drear annihilation, as
awaiting our minds, just as it does the minds of the brutes
that perish.
In our carefulness to avoid materialism, we are too apt
to look upon the mind and the body as two separate and
independent things. At death they do indeed become so,
but who of us knows that they would, were it not for the
fiat of the Almighty? Who knows that there is not a
necessity for the putting forth of his power in each individual
case at the time of death, to prevent the mind of
man from dying with his body, just as the mind of the brute
does with his? The very prevalent notion that the mind
is essentially indestructible, and that it is put into the body
as a separate thing, having the power of itself to leave the
body whenever it dies, rests on no substantial proof. That
it is destined thus to leave the body is quite another thing.
Materialists, of whom we are pained to say there are
many among believers in phrenology, though they flatly
deny it,[39] seem to think that the brain produces thought
pretty much as the liver makes bile or the stomach gastric
juice. This doctrine would be gratuitous, a mere supposition,
even if there were no Christian revelation to contradict
it. But while we discard all such anti-Christian and absurd
fantasies, we must not run to the other extreme, as some
good men have done. It must be admitted, that in this life
all the manifestations of mind are not only connected with,
but are dependent upon, a material organization. The
nature of this connection and dependence is of course a
mystery, but of its existence there is no doubt. So far as
injury is done to the brain and nervous system, just so far
are the manifestations or actions of the mind impaired.
And, on the other hand, moral causes, acting directly upon
the mind, affect through it the organization. And when
insanity results from moral causes thus acting, it is not a
direct effect, but an indirect one—the organization affected
by the mind is thrown into a diseased state, and reacts upon
the mind, influencing its manifestations. If the mind thus
acted upon were a spirit, separated from the body, the result
would be merely the feelings, which the motives applied
would naturally produce, and not the unnatural feelings of
insanity. It is not strictly proper then to speak of a ‘mind
diseased.’
Let me not be understood to mean that mental derangement
in every case is to be attributed to disease that leaves
such palpable traces that the dissecting knife would reveal
it if death were to take place. There are diseased operations
in the body, that are hidden from our view—so hidden,
that they not only leave no traces, but often develop no
characteristic bodily symptoms.
Although the principles above stated are often overlooked,
and sometimes doubted, or even denied, there are some
cases in which they stand out so plainly, that everybody
acknowledges for the time their truth. For example, if a
man, by a blow on his head, has a piece of his skull pressed
inward upon his brain, he becomes senseless, and, if he
arouse at all from his stupor, his mind is obviously in an
unnatural state. The surgeon raises the depressed bone,
and thus taking off the pressure from the brain, restores the
mind of the man to activity and sanity. In this case it is
plain to every one, that the mental manifestations were
suspended by a cause acting directly upon the material
organization, and that they were revived again by the
removal of this cause.
Take another example. A man of strong and clear
mind becomes deranged, and at length arrives at perfect
idiocy. He goes down to the grave in this condition. No
one supposes that in such a case the mind is affected independently
of the body, but the mental state is of course
attributed to bodily disease; and affection fondly, and we
may say rationally, cherishes the expectation, that when
the mind shall be freed from this tabernacle of flesh, it will
emerge from its long night of darkness, and possess again
its faculties in full, just as the man who lies senseless from
pressure upon the brain, is restored to mental activity when
that pressure is taken off by the trephine and elevator of
the surgeon.
Now what is true of the cases that we have cited is true
in every case—all mental aberration, however slight it may
be, results from the connection of the mind with the body,
and would not occur without this connection. It is the
product of some impression made upon the material organization,
either directly, or indirectly through the mind. This
impression may be momentary and evanescent, or it may
produce a real change of structure. It would be interesting
to enlarge upon these points, but it is not necessary
for our purpose.
We speak of the brain as the seat of the mind, or soul.
If we mean by this simply, that this is the great central
organ of that system in the body (the nervous system)
through which the mind acts upon external things, and is
acted upon by them, it is correct so to speak. But if we
mean to localize the mind, as sitting there, and especially
if we fix upon some one part of the brain, as Descartes did
upon the pineal gland (a body smaller than a pea) as the
seat, the throne of the mind, the illustration is an erroneous
one. The mind acts upon the whole body, through all the
parts of the nervous system, and each portion of that system
has its own peculiar offices to perform in obedience to the
mind. This is as true of the brain as it is of the rest of
the nervous system. This organ is a complex one, and the
different parts have their different offices. This we know
in regard to some of these parts, and we can justly presume
it in regard to others. And we do this without adopting
the fanciful ideas of phrenologists in locating the different
faculties of the mind.
While the brain is the great central organ of the nervous
system, by which the mind imparts and receives impressions,
there are other parts of that same system which seem to
bear some other relation to the mind than that by which
they transmit these impressions to and from the mind
through the brain, as the nerves ordinarily do. They seem
to have a connection with the mind independent of the
direct agency of the brain, and for aught we know they
have such a connection. When the mind is affected by
any passion, either of the cheerful or the depressing kind,
its sensible effects upon the body are not observable chiefly in
the brain, but in the region of the heart and the other organs
adjacent to it. The thrill of joy is felt there, and grief produces
there its sensation of oppression, prompting the occasional
sigh to relieve it.
Such facts as these led an eminent French physiologist,
Bichat, to adopt the theory, that while the intellectual functions
have their seat in the brain, the moral sentiments have
theirs in the ganglionic system of nerves, (as it is called,)
which has certain great nervous centres in the region of
the heart, stomach, &c.
I will not stop to expose the fallacy of this plausible
theory. It is sufficient for my purpose simply to advert to
the fact, that the moral sentiments of the mind or soul are
manifested more in that part of the body than in the brain.
The very language of the affections, and the gestures which
accompany the utterance of that language, or supply its
place when feeling is too big for utterance, are in consonance
with this fact. We speak of the heart, and we
place the hand upon the heart when the moral sentiments
are in lively action. And when feeling is so great as to be
overpowering, or when the attempt is made to suppress it,
there is with the load which is felt at the heart, a sensation
of choking, (no word expresses it so well as this homely
one,) preventing utterance; and then when it finds vent, it
seems as if there was a gushing forth from the heart, not
merely figuratively, but from the material heart that is
throbbing in our bosoms.
The fact which I have been illustrating shows the force
of such expressions in the Bible as ‘bowels of compassion,’
‘bowels did yearn,’ &c. It throws some light also on the
influence of grief upon the stomach, and on the depression
of spirits which so sorely afflicts the dyspeptic.
It gives but a faint idea, then, of the all-pervading connection
of the mind with the body, to suppose the mind to
be locked up in some chamber of the brain, there receiving
by the nerves messages from every quarter, and sending
forth messages in return by the same media. There is no
evidence of the existence of one great central point of
attachment for the mind, but the ties of its connection with
the body are multiplied and diffused. It is not merely,
therefore, positive disease existing in the brain that affects
the mind. Disorder of mind is infinitely modified by the
different seats and modes of disease in different portions of
the nervous system, as well as in different parts of the brain
itself. I speak not now of palpable insanity alone, but of
all the various states of mind occurring in sickness.
One of the most common and prominent characteristics
of the state of mind in sickness, is weakness. The weakness
of body caused by disease is generally accompanied by
a corresponding debility of mind. When Cassius speaks of
Cæsar, as asking, ‘give me some drink, Titinius, as a sick
girl,’ you see something more than weakness of muscle—the
giant mind of the mighty Cæsar is prostrated to effeminacy.
And as weakness of muscle is attended with unsteady,
irregular, and sometimes even spasmodic action of its fibres,
so it is with weakness of mind. Its efforts are fitful, and it is
easily thrown off from its balance. A feeble man tottering
along, occasionally resting upon his staff, or taking hold of
a post or a fence, is thrown down by the gentlest touch, or
by stumbling over even a slight obstacle, that he chances
not to see so as to avoid or guard against it. And in the
tedious journey of sickness, mind and body totter along in
their feebleness together, and either is exceedingly liable to
fall. And if the one fall, the other is pulled down with it.
The guide, therefore, of these two travellers in this journey,
must see to it, that all obstacles in the way of either be
removed or avoided, that no rude hand be permitted to
touch them, and that all those supports be supplied on the
way which either can best use.
The mental weakness which disease occasions, is often
exhibited to the physician under affecting circumstances.
Minds that have been able to grasp the most difficult and
abstruse subjects return, in the debility of sickness, to the
simplest ideas—those which are both common and precious
to the child, the man, the angel, and to God himself. The
‘strong meat’ is turned from, for the ‘milk of babes.’ I
remember one of lofty intellect, fading away with consumption,
who well exemplified this remark. Her aged father
was reading to her a chapter in one of the epistles of Paul.
‘It is good,’ said she, ‘but I cannot understand it now. It
bewilders me. Something more simple—something from
the Apostle John is better for my poor feeble mind.’
The mind, weakened by disease, is easily disturbed and
agitated, except in those cases in which disease blunts the
sensibilities. Derangement of mind is often the product of
mere weakness, under increase of excitement, without any
fresh accession of local disease. A familiar illustration of
this you may see in fever. Very often there is mental
derangement only during the paroxysm of fever, the mind
being quite clear in the remissions. Especially is this the
case with children, whose sensibilities and sympathies are
in so much more lively a state than those of the adult.
Slight causes, therefore, which would produce little or no
effect upon the mind of one in firm health, may affect
strongly the mind of a sick man. A single example will
suffice. The patient was sick with typhus fever. He had
been very much deranged, and great care had been taken
to guard against any excitement, which might act injuriously
upon him. He was now getting better, and his mind
had become calm and clear, though still, like his body, it
was very weak. A friend came in one morning as usual
to inquire about him. He knew that all visitors had been
prohibited from going into the sick room, but he wished
very much to see his friend, and, as he had an opportunity,
he looked in through the door, as it chanced to be a little
open. The dull eye of the sick man saw him dimly, and
he at once became as much affected as if he had seen a
dreadful vision. His distempered fancy conjured up ideas
of a painful character, which remained upon his mind for a
week, and endangered as well as delayed his convalescence.
This incident leads me to remark that physicians find
great difficulty in securing a due degree of quietness in the
sick room. I use the word quietness in its widest sense.
I do not mean the avoidance of noise merely, but of all
improper excitement. Visiting is generally a nuisance
in the chamber of sickness. Multitudes of lives are continually
sacrificed to curiosity and mistaken kindness. The
tattling circles that gather round the fireside of the sick
room, and retail their mixtures of medical lore, and slander,
and hair-breadth escapes, and wonderful cures, often inflict
torture upon the shattered nerves of the poor patient, and
that torture sometimes, I have not a doubt, ends in death,
when a recovery might otherwise have taken place.
No one should enter the sick room from curiosity or from
a mere vague desire to do good. Nothing but the actual
prospect of doing good should prompt him to go there.
Indeed, everything which interferes with the proper quiet
of the sick should be most scrupulously avoided. It should
always be remembered, that in many cases of disease, mental
excitement may do as much harm as the excitement
produced by stimulating medicines. And it is as much the
business of the physician to direct in the management of
this matter, as in the administration of remedies; for it has
as real, if not as great a bearing on the recovery of the
patient. Indeed, sometimes it is vastly more important
than all the medicine that is given in the case. I call to
mind a case which illustrates this last remark so strikingly,
that I will state it as briefly as possible. A patient was
taken sick, with some important business pressing upon his
attention at the time of the attack. He was persuaded to
dismiss it entirely from his thoughts for the time. He was
soon relieved by the remedies that were used, and he was
in a fair way for a recovery. He was, however, in such a
state, that it was very important that he should be kept
from all excitement, and as I saw that he was disposed to
do the business now with some friend, whom he wished to
have called in for the purpose, I told him and his family in
plain terms the risk which he would run if he should pursue
this course. He however disregarded my injunctions,
and the consequence was that in the evening of the same
day he was very sick, and in a few days died from disease
in the brain, which was clearly induced by the mental excitement.
If he had followed my directions as scrupulously
in regard to this point as he did in regard to the medicines
which were given, recovery instead of death would probably
have been the result.
Some in their anxiety to secure the quiet of the sick, go
to an extreme, and give almost the silence of the grave to
every sick room. They institute a sort of prison discipline,
and shut out both the light of heaven and all cheerfulness
of intercourse. The very means which they take to produce
quietness, the stealthy step and the whisper, are apt to
disturb the patient more than noise or excitement would do.
Discretion should be exercised by the physician, and the
friends of the patient should rely on him to direct this part
of the management of the case, as well as that which is
strictly medical. He must judge as to the degree and kind
of excitement appropriate to the case, and direct in its
application, for the same reason that he should, in a case of
disease of the eye, direct as to the amount of light which
should be admitted to it.
It is often very difficult to carry out these principles,
especially in families that have but a small number of apartments.
The fear of giving offense, too, very often opens the
door wide for visitors, against the most positive injunctions
of the physician. To obviate this difficulty, I have in some
few cases put upon the door a card, forbidding this kind of
intrusion—an expedient which I have found to be very successful.
One case was that of a clergyman’s family. So
many were sick, that the house was a perfect hospital. A
large portion of the parish poured in of course, to offer their
sympathy and their services. Most of these persons did
more harm than good. I attempted to remedy the evil by
directions to the nurses, and by conversation with individuals,
but in vain. At length I put up a card on the door
of the house, to this effect: ‘Visitors are requested to go
directly into the parlor. No one is to enter the sick rooms
but those who have the care of the sick. No talking in the
entry.’ This effected the desired change at once. I introduce
this case simply to show the difficulties which exist on
this point, especially in country towns, and the very plain
remedy which can be applied. There is no reason why a
universal rule should not be adopted in every case in which
it is deemed necessary by the physician.
The attendants on the sick often make a great mistake
in supposing the patient to be so fast asleep, or so stupid, as
to receive no impressions from their conversation. Often,
from this cause, he is obliged to hear what may do him
great harm. Amid the confused thoughts of his dreary bewildered
state of mind, the idea of his own death is conjured
up by some remark, to trouble and affright him.
Instead of getting the rest which his wearied body and mind so
much need, his nerves are disturbed by the hum of conversation,
and his mind is harrassed by a succession of dread
thoughts and visions, suggested by remarks, of which it is
supposed that he takes no cognizance.
Some, who are very cautious on these points in regard to
adults, never think of their application to children. Often,
for example, does the physician find, on entering the sick
room, those whom kindness and curiosity have assembled
there, talking loudly, while the mother is trying in vain to
soothe the troubled child by rocking the cradle as if for a
wager. Much, too, is often said in presence of sick children
that ought not to be, on the false supposition that they
do not understand what is said. Many a child is frightened
by horrid stories, and by gloomy comments upon his own
case. Visitors stand over him, and besides fretting him by
their staring, they say something, perhaps, of this sort.
‘Poor thing! how sick he looks! I don’t believe he can get
well.’ And then they go on to tell about some little child,
perhaps his playmate, that had died recently, and whom,
perhaps, he saw laid in his grave, and utter in his hearing,
with all due solemnity and sorrowfulness, the opinion that
he is affected much like him, and will probably die in the
same way; adding, by way of consolation to the poor mother,
that then they will be in heaven together. Children
have sensibilities and hopes and fears, like adults, and they
understand, even at a very tender age, enough about death
to be affected, and often very strongly, by this holding up
of its grim visage directly before them. The mind, and the
nervous system, by which the mind is connected with the
body, are as excitable in the child as in the adult, and the
avoidance of unnecessary alarm and excitement is as important
in the sickness of the one as in that of the other.
I cannot forbear here to notice one thing, which often
exerts a bad influence upon the mind of the child in sickness.
It is the habit which many people have of threatening
their children, when in health, with sending for the
doctor to bleed them, or to give them some bitter medicine, as
a punishment for their misdeeds. The inevitable tendency
of this is to increase the mental depression and agitation
which disease produces, by the gloomy associations which
are thus necessarily attached to sickness in the mind of the
child. The physician should never be held up as a bugbear
to children, but should uniformly be spoken of in their
presence in such terms, that when he visits them in sickness
they may rejoice to see him, both as a friend and as one
who is to bring them relief. There is no doubt that many
a child is seized with an ill-defined terror, when the physician
is called in, and thinks of him only as some dreadful
monster that cuts off children’s ears, and gashes their flesh
almost for sport. The effect of such a feeling on the weakened
and agitated nerves is always injurious and undoubtedly
is sometimes fatally so. One may get some adequate
idea of the feelings of children under such circumstances,
by imagining himself, in a state of weakness and disease, to
be visited by an incarnate demon, who has both the power
and the disposition to torment him.
I am anxious to impress most faithfully the mind of the
reader with the importance of giving rest to the mind in
sickness. I have already remarked on the extent and the
intimacy of the union between the mind and the body. It
is never to be forgotten in the chamber of sickness, that the
mind not only is not by itself, alone and independent, but
that it is not connected with sound nerves, but acts upon a
deranged body, and is acted upon by it, through the multitude
of nervous filaments, which, scattered everywhere, are
receiving impressions at every point, and transmitting them
to the mind. If, therefore, the mind, thus disturbed by disease,
be at the same time troubled by causes applied directly
to it, the result must be a reaction from the mind through
the nerves upon the disease itself. The mental and the
bodily irritations must increase each other. It is then just
as important to withhold all irritating causes from the mind,
as from the diseased organ. For example, if the brain be
inflamed, that inflammation may be aggravated as certainly
by exciting the mind, as it would be by the administration
of any stimulant to the body. In either case the same
result occurs—the brain is stimulated—the only difference
is in the channel through which it comes. And it is the
duty of the physician to shut out the irritation from one
channel, as much as from the other. When the eye is
inflamed, one part of the curative means is to exclude the
light, because the light, by exciting the nerve of sight, would
increase the inflammation. But the action of the mind is
as really connected with the brain and nervous system, as
the act of vision is with the eye; and therefore it must
be guarded against, in inflammation of the brain, as vision
is in inflammation of the eye. The same may be said, to
some extent, at least, of every other part as well as the brain,
for every organ is supplied with nerves connecting it with
the mind.
As an illustration of these remarks, I will introduce a
case, showing the influence of the irritation of passion upon
a diseased body. I refer to the death of John Hunter, who
has been often called the greatest anatomist and physiologist
of his age. “On October 16, 1793,” says his biographer,
“when in his usual state of health, he went to St.
George’s hospital, and, unexpectedly meeting with some
things that ruffled his temper, he allowed himself to give
way to passion; the heart became overloaded with blood,
the ossified aorta, not yielding to the effort of the heart, the
countenance became dark, angina pectoris immediately
ensued, and turning round to Dr. Robertson, one of the
physicians of the hospital, he was incapable of utterance,
and died.”
This, it is true, is an extraordinary case; but the result
of mental irritation in common cases of disease, though not
as great and as palpable as in this case, is nevertheless as
real. While it caused in the case of John Hunter a sudden
and final suspension of the heart’s action, it would, in
a man suffering from some inflammation, aggravate that
disease, by driving the blood too forcibly into the inflamed
part, and by making its irritable nerves partake of the general
excitement of the system. The effect might not be at
any moment very powerful, but if the irritation be repeated
or continued, although it may be vastly less in amount
than it was in the case of Hunter, the accumulative effect
of the excitement upon the disease would at length become
very great, perhaps destructive. And in certain low states
of disease, when, in the midst of great weakness, the nervous
system is in an extremely agitated condition—a condition,
in which little causes may produce powerful effects—a
comparatively slight irritation induced in the mind,
connected as it is with every trembling filament of that
nervous system, may overwhelm the very powers of life as
certainly, if not as suddenly, as did the strong passion of
Hunter, in overloading his diseased heart, and thus stopping
its action.
But withholding irritation, and securing rest and quiet,
do not comprise all the physician’s duty in relation to the
mind, any more than they do in relation to the body of the
patient. He is sometimes to excite the mind to positive
action, for the same reasons that exciting medicines are
sometimes administered to the body; and he may thus
often exert, through the mind, a very happy influence upon
disease. This remedy, as I have already hinted, is to be
applied with discretion, according to the nature of each
case, and so as not to interfere with that rest, which I
have shown to be so necessary to the mind in the treatment
of disease. The excitement must, with some few
exceptions, be agreeable in character, in order that it may
produce a genial influence upon the nervous system. The
mode, the time and the degree of its application require the
exercise of discrimination, as much as the dose, and form,
and time of any stimulant or other medicine that is given
to the patient. The judgment and tact of the physician
are never more needed than upon such points as these.
Tissot, a French physician, relates an amusing case, showing
the utility of discrimination in regard to the kind of
mental stimulation to be applied. A lady was affected
with a lethargy, and many applications were used to rouse
her, but to no purpose. At length a person, who knew
that the love of money was the ruling passion of her soul,
put some French crowns into her hand. After a few
minutes she opened her eyes, and was soon entirely aroused
from her stupor.
The influence of the imagination upon the body is
familiar to every one. I will mention a few cases to show
its power.
Beddoes, an English physician of great enthusiasm, had
imbibed, among other new ideas, the notion that palsy could
be cured by inhaling nitrous oxide gas. He requested
that eminent chemist, Sir Humphrey Davy, to administer
the gas to one of his patients, and sent him to him for that
purpose. Sir Humphrey put the bulb of a thermometer
under the tongue of the paralytic, to ascertain the temperature
of the body, so that he might see whether it would be
at all affected by the inhalation of the gas. The sick man,
filled with faith from the assurances of the ardent Dr. Beddoes,
and supposing that the thermometer was the remedy,
declared at once that he felt better. Davy, desirous of seeing
how much imagination would do in such a case, then
told him that enough had been done for that time, and
directed him to come the next day. The application of
the thermometer was made from day to day in the same
way, and in a fortnight the man was cured.
When Perkins’ tractors were in vogue, Dr. Haygarth of
Bath, as I have stated in another chapter, had a pair of
wooden ones made of precisely the same shape with the
orthodox metallic ones, and contrived to color them so that
the deception should not be discovered. He then applied
them to quite a number of patients, with the same results
that followed the use of the genuine tractors, which cost five
guineas a pair. Pain was relieved as if by magic, and the
lame were made to walk. Their operation in these cases
is of course to be accounted for in the same way with the
operation of the thermometer in the case just related.
Some medical students determined to try the influence
of imagination upon a countryman who was going into
town to market. They met him one after the other, each
telling him how pale and sick he looked. At first, as he
felt perfectly well, he paid no regard to it, but after two or
three had thus accosted him, he began to think there must
be something the matter with him. By the influence of
imagination he soon began to feel badly, and to look really
pale. And as he still continued to meet persons, who
declared themselves struck with his peculiarly sickly and
ghastly appearance, he grew worse, and the result was that
he sickened and died.
I could cite numerous cases illustrative of the influence
of the imagination upon the condition of the body, but
these will suffice.
The physician has constant opportunities for making use
of the influence of mental association to much advantage
in the management of the sick. He does this almost insensibly
in his daily intercourse with his patients, exciting
trains of agreeable associations in their minds, varied to
suit the mental and moral character of each, thus aiding
materially the operation of his remedies.
Dr. Rush gives a striking instance of the influence of
association, which I will relate in his own words: “During
the time,” says he, “that I passed in a country school in
Cecil county, in Maryland, I often went on a holiday with
my schoolmates to see an eagle’s nest, upon the summit of
a dead tree in the neighborhood of the school, during the
time of the incubation of that bird. The daughter of the
farmer in whose field this tree stood, and with whom I
became acquainted, married and settled in this city about
forty years ago. In our occasional interviews, we now and
then spoke of the innocent haunts and rural pleasures of
our youth, and, among other things, of the eagle’s nest in
her father’s field. A few years ago I was called to visit this
woman, in consultation with a young physician, in the
lowest stage of a typhus fever. Upon entering the room I
caught her eye, and with a cheerful tone of voice said only,
the eagle’s nest. She seized my hand without being able to
speak, and discovered strong emotions of pleasure in her
countenance, probably from a sudden association of all her
early domestic connections and enjoyments with the words
I had uttered. From that time she began to recover. She
is now living, and seldom fails, when we meet, to salute me
with the echo of the eagle’s nest.”
It is important in the treatment of disease, to remove all
causes which awaken disagreeable associations in the minds
of the sick, for they often retard, and sometimes prevent
the recovery of the patient. It is as clearly the duty of the
physician to detect the causes of such associations, and to
remove them if possible, as it is to detect and remove the
material causes of any irritation or inflammation.
Dr. Rush mentions a case that came under his observation,
in which the influence of disagreeable associations
hindered the recovery of the patient. “A gentleman in
this city,” he says, “contracted a violent and dangerous
fever by gunning. After being cured of it, he did not get
well. His gun stood in the corner of his room, and being
constantly in sight, kept up in his mind the distressing
remembrance of his sickness and danger. Upon removing
it out of his room he soon recovered.”
Some are much more readily affected by mental associations
than others. A gentleman in a stage coach was
observed to keep his cloak lying by his side, while he was
shivering with the cold. He was asked by one of his fellow
travellers why he did not put it on. He replied, ‘I have
just returned from a voyage, in which I was very sea-sick,
and while so I lay with that cloak wrapped around me.
Foolish as it may seem, I cannot put it on without renewing
the nausea.’
The various degrees and modes in which mental associations
appear in the sick room, require of course the exercise
of discretion and tact, in managing them to good purpose.
There is often much injury done by failure in this respect.
If, for example, the patient have great irritability of stomach,
and if some medicine which has been doing him good, at
length become exceedingly offensive to him, the continuance
of that medicine might do him essential harm, by the mere
influence of mental association; though, aside from this, it
may be still an exceedingly appropriate remedy for his
disease. Under such circumstances a change must be
made, or the patient will be injured, it may be fatally. It
will not do to call the patient whimsical, and to go right on
with the course. The mental association connected with
the medicine is practically one of the ingredients in it, and
as such has so modified its nature as to render it inappropriate
to the case.
The physician can often do much in curing disease by
diverting the mind of his patient. Disease is frequently
broken up by producing a new action in the system. This
is a principle in medical practice which is familiar to others,
as well as to the physician. And this change may sometimes
be brought about in the system, by a corresponding
change effected in the mind, especially in those cases where
the state of the mind is particularly influenced by the disease.
The husband of a poor woman, who in a feeble state
of health had fallen into a settled melancholy, broke his
thigh. The whole current of her thoughts and feelings was
now diverted into another channel, from her own sorrows
to the care of him and the relief of his pains, and she
recovered her sanity, and with it, for the most part, her
health, long before the fracture was united. The misfortune
of her husband was a severe remedy, but an effectual one.
A physician of my acquaintance some years since became
thoroughly impressed with the idea, that some symptoms
which he had, indicated the existence of an organic disease
which was certain to end fatally. At his request I made a
full examination of his case, and found the symptoms to be
purely of a nervous character. The expression of my
opinion relieved him for the time of his anxiety. But as
he brooded over his feelings when alone, the same idea
returned again. I examined him repeatedly with the same
result, but the comfort which he received from me was only
temporary. Knowing that he was paying his addresses to
a lady who was not only cheerful herself, but who had the
power of making every body else cheerful about her, I
recommended to him to be married at once, and told him
that if he would be, we never should hear any more about
his aneurism. My prescription was followed, and was
entirely successful. The idea, which had so long haunted
him like an evil spirit, was cast out never to return.
Every one is familiar with the fact, to which I have
already alluded, that dyspepsia has a depressing influence
upon the mind. And as the mental depression reacting
upon the disease aggravates it, anything which tends to
remove this depression assists materially in curing the disease.
Diversion of the mind from its habitual gloomy ideas
to cheerful thoughts and efforts, often exerts a great influence
in such cases. I will mention a single case illustrative
of this remark. A gentleman of high intellectual character,
who was sadly afflicted with the dyspepsia, visited his friend
Dr. Ives of New Haven, and placed himself under his care.
The Doctor saw at once that medicines would do but little
good in his case, so long as his mind remained in the same
condition, and occupied with the same thoughts; and that
a change there would go far to effect a corresponding one
in his bodily condition. He determined to produce this
change without the patient’s being aware of his intention,
as it in this way would be more effectually accomplished.
In one of his rides with him they alighted to pick some
wild flowers. He adroitly excited his friend’s curiosity in
regard to the structure and growth of the flowers, and
leading his mind on step by step, he did not stop till he had
fairly made him a student of botany without his knowing
it. The result was that he engaged in the study with great
enthusiasm, and followed it up for some time. He was
changed at once from a gloomy self-tormentor into an
ardent and cheerful seeker after knowledge in one of its
richest and fairest fields, and this change made his recovery
a rapid and easy one.
But it is not only in those cases in which the mind is
obviously affected, that the physician is to apply the principle
of which we have just been speaking. He can make
use of it with much profit in ordinary cases of disease, in
his intercourse with his patients from day to day. The
sick are prone to brood over their own complaints, and to
watch their sensations, and they need to have the mind
diverted to other subjects.
In this connection I will notice very briefly the influence
of change of scene upon the invalid. When the same
objects are seen by him from day to day, and he has the
same subjects of thought and conversation, these all act as
so many fastenings, or points of attachment, tending to
hold the disease in the same unvarying condition. But
take him away from them all, and set him free from this
discouraging and burdensome sameness, and let his thoughts
and feelings flow into other channels, and the change of
course favors the introduction of a new state of things,
bodily as well as mentally. The new objects that he sees
not only take off his attention from his diseased sensations,
but the new excitement that he feels, as he sees them one
after another, diffuses a refreshing and invigorating influence
throughout his system. And imagination lends her
aid in producing this effect. It seems to him that everything
is better than it was where he was so lately shut up
with the feeling almost of a prisoner—that the air is more
pure, the grass more green, the foliage of the trees more
dense and rich, and even the sun more cheerfully bright.
Something, it is true, is to be attributed to change of air
under such circumstances, but much less commonly than
to the influence of change of scene upon the mind.
The sick room, as every physician has frequent occasion
to witness, acquires after a time a monotony that is dreary
and painful to the confined invalid. Day after day he sees
the same furniture and same walls, every irregularity of
whose surface he becomes acquainted with, and he is forced
to seek for some variety even in the most trivial circumstances.
“There, Doctor,” said an invalid playfully, “I
have made a little change, to-day. I have had the rocking-chair
put the other side of the fire-place, and the bureau
moved to that corner, and those phials on the shelf, you see,
have changed their places. My friends, Cologne and Camphor,
have gone to the other side of that vase, and those
drops (which, by the way, Doctor, I think that I have taken
so long that some change would be well) have their station
now quite at the other end of the shelf. And my good
grandmother, you see, looks down upon me from the other
side of the room. Variety is pleasing, Doctor, even within
a few yards square, when one can not get any farther.”
Even when the invalid is not confined to the sick chamber,
but has his rides and his walks, the monotony of every
day’s routine becomes a weariness. And no wonder that
an escape from this is so often so manifestly beneficial to
him.
But it is not merely the diversion of mind, attendant
upon change of scene, that benefits the invalid, but his
release from those mental associations, that have so tenaciously
connected themselves with his sickness, has an important
influence. The place where he has spent wearisome
days and nights of pain and restlessness and languor,
must necessarily have unpleasant associations connected
with it. These hinder, and in some cases even prevent
convalescence; and when he casts them off, he feels that
he has rid himself of a great burden, and as he goes on his
course with a light heart, a fresh impulse is given to the
vital powers of his body, making him to feel, as he says that
he does, like a new man.
The mind of the sick man sometimes gets into a fixed,
unvaried state, with one settled cast to its ideas. The tendency
of this is to make the diseased condition of body to
remain fixed also. It is important, therefore, to alter this
mental state—to break up this unvarying train of thought
and feeling. There are different ways of doing this in the
different cases that present, and the physician must judge
as to the most proper mode of effecting the object in each
case. I will give a few cases as illustrations.
A patient who had been very sick, but who had recovered
from the severity of her attack, and who was in a fair
way for getting well, remained precisely in the same condition
for some time. Her mind was in a fixed state of gloom,
marked by a perfectly unvaried expression of countenance.
Her friends had tried in every way to make her cheerful, but
it was in vain, for the simple reason that all their attempts
to do so were obvious. I knew that she had naturally a
lively sense of the ludicrous, and therefore, after getting her
somewhat off her guard by some incidental conversation, I
then, with an air of perfect carelessness, uttered something
which I thought would be very apt to hit her mirthfulness,
as the phrenologists term it. It did so, and a smile kindled
up at once upon her sad countenance. The spell was now
fairly broken. She speedily regained her wonted cheerfulness,
and the load being cast off, she went straight on in
the bright road of convalescence. In this case it was but
a small thing, after all, that turned the current of thought
and feeling, and the means which had already been used,
most persons would suppose, were much better calculated
to do it. All direct and palpable efforts to make the gloomy
invalid cheerful, are almost always unsuccessful; and yet it
is such efforts that are most commonly made use of by the
friends of the sick.
The course which was pursued in another case, was quite
a different one. The patient was a clergyman, who had
the impression strongly fastened upon his mind that he
should certainly die, and could not be made to admit by
the force of any reasoning, the possibility even of his recovery.
It was not an opinion founded upon evidence, but
it was a fixed state of mind, which was the product of the
disease. It was important to remove, if possible, this all-absorbing
thought, for it was reacting unfavorably upon
the disease itself. It could not be done by argument, nor
by speaking to him the words of hope; for it was not a conviction
of truth arrived at by any reasoning, but an impression
unaccountable, but strong and vivid. He did not think
that he should die, but he felt that he knew it. Some remedy,
then, different from either of these, was necessary. As
he was a man of stern, decided religious principle, I determined
to make a bold onset in that quarter. I told him
that God alone knew whether he would die or recover, and
that he was doing wrong—absolutely committing high-handed
sin, in setting himself up as knowing what God
only knows. This was the substance of what I said to
him, and it produced the desired effect. The impression
was dislodged from his mind, and though he occasionally
talked discouragingly of the result of his sickness, he never
said after that, that he knew that he should die.
One other case I will relate, in which the course taken
to destroy the diseased mental impression was of still a different
character. A patient, a gentleman of superior mental
and moral qualities, sent for me to inform me that he
had received a revelation, in which God had forbidden him
to eat or drink or sleep. The confidence which he manifested
in me by sending for me determined in my mind at
once the course to be pursued. I told him that I had also
had a revelation, which was quite as good as his, perhaps
better. ‘And,’ said I, assuming the air of calm authority
that expects submission as a matter of course, ‘you must
obey it.’ ‘What is your revelation,’ he inquired. ‘My
revelation,’ said I, ‘embraces all that is necessary in your
case. And in obedience to it you must continue to follow
my directions, and you must eat and drink and sleep as you
have done.’ I left him with my revelation fastened in his
mind, it having supplanted his altogether, and he immediately
ate and drank, and that night slept as well as he
usually did.
In chronic cases especially, the sick are often prevented
from recovering by the influence of unpleasant circumstances
in their situation, or in their relation to others
around them. The friends of the sick often get out of patience
with them in the tediousness of a long confinement.
Sometimes there is unkindness, and this to the weakened
mind and depressed spirits of the invalid, is often a burden
that cannot be borne. Some secret grief often neutralizes
the influence of medicine.
There is often great want of tact in managing the whims
and caprices of the sick. Many expect them to be as reasonable
in their notions and desires and feelings as if they
were well. It is unwarrantable and unjust to demand this
of a weakened and beclouded mind, and agitated nerves.
Trifles light as air affect the sick strongly. The very grasshopper
is a burden to them. It is with the mind of a sick
man as it is with his senses. Noise troubles him—even
the motion of a rocking-chair, perhaps, or the swinging of
a foot, disturbs his sight, and through that sense disturbs his
mind. The darling child, whom he delights, when he is
well, to see running about playing his little pranks, must be
taken out of the room, because he makes his father’s head to
whirl and to ache. Thus easily is he disturbed through the
senses. Just so is it with his mind—it is as easily disturbed,
and circumstances, which would scarcely excite a passing
thought in health, now agitate and depress him. Disappointments,
that ordinarily would be felt but for a moment
and slightly, he can hardly brook now. Every mother has
often seen how easily her child is grieved by little things,
when mind as well as body is prostrated by sickness. And
she does not commonly get out of patience with it for its
seemingly unreasonable griefs, but soothes and quiets them.
It would be well if the attendants and friends of the sick
had more of that patience and forbearance, which are
prompted by a mother’s tenderness.
The sick often contract a strong feeling of dislike towards
some things, and sometimes towards individuals. They
may regret it, and see that it is unfounded and foolish, and
yet not be able to get rid of it. Some make the sick dislike
them by their very kindness, because it is so officious and
pains-taking. There is a tact in the good and judicious
nurse which dictates just what to do and how much, and
many of the attendants on the sick are sadly deficient in
this.
The fretfulness and impatience of contradiction, which
are so often the product of the nervousness of disease, are
generally not to be combatted, but to be borne with. The
considerations which I have already presented clearly show
the propriety of this maxim; and yet it is a maxim which
is very commonly neglected. Many a dispute about the
most trivial things is held between the patient and the attendant
or friend, when a little tact might have diverted the
weakened mind from the subject, without yielding in the
least anything, which pride of opinion or firmness would
prompt to hold fast to. I once heard a mother, a woman
of intelligence too, dispute with her sick daughter about the
number of crackers she had eaten during the day, each
maintaining her side of the question with as much zeal and
pertinacity, as if it were a matter of vital importance. The
result was that the patient was injuriously agitated by this
rencontre about nothing, and ended it by bursting into tears,
and the mother triumphed, as was her wont to do, by having
the last word. And this was a fair specimen of the
moral management of that patient during a long sickness.
It added vastly to her nervousness, and clouded a mind filled
with lofty, and refined, and tender sentiment, and made that
chamber a scene of painful exhibition of thought and feeling,
when a different management might have soothed her
agitated nerves, and left the sensitive chords of her soul to
respond clearly and harmoniously to the gentle touch of
friendship and love.
The patient often feels, and takes comfort in feeling, that
his temporary outbursts of fretfulness and impatience are
understood by his friends, as having no consonance with
the real feelings of his heart. A much respected patient,
of whose sickness I have many pleasant recollections, was
one day speaking to me of his sister in the highest terms of
eulogy. “Yet,” said he, “I scold at her, but I have no
business to do it. However, she understands it. She knows
that I am nervous, and that I am sometimes hardly myself
and she forgives it all.”
Let me not be understood to mean that all the notions
and caprices of the sick are to be yielded to as a matter of
course. I only object to an useless and injudicious warfare
with them. There should always be firmness exercised in
the management of the sick, but there should be no struggle
with them from mere pride of opinion, or a desire for
authority, or from want of a proper charity for their mental
weakness. They should never be directly opposed,
except it be distinctly and manifestly for their good.
One very common mistake in the mental management of
some chronic cases remains to be noticed. I refer to those
cases in which the nervous system is so deranged, as to
produce a variety of sensations of a deceptive character.
Such patients are generally laughed at as hypochondriacs,
and they are told by their friends, and sometimes even by
physicians, that these sensations are wholly imaginary.
This is not so. Some of their notions about them are mere
imaginations, it is true; but the sensations themselves are,
to some extent at least, real. Imagination may magnify
them, but it does not ordinarily create them. The wrong
ground which is so often taken in regard to such patients,
sometimes essentially retards their recovery. They feel
that they are trifled with, and they have but little confidence
in the judgment of those who deny that their sensations are
real, and therefore have but little if any in the remedies
which they administer to them. Besides, the mind of the
patient is disturbed continually by the disputes and consequent
ill feeling which such differences of opinion necessarily
engender, and this of course has a tendency to aggravate
the diseased condition.
As an illustration of these remarks, I will mention a single
case. The patient, who had long been an invalid, had,
among a great variety of sensations, a burning, twinging,
sometimes a pulling sensation, in the region of the stomach.
Her notion about it was that there was a cancer there, that
really pulled, and burned, and twinged. She had been assured
again and again that there was no cancer there, but
so little credit had been given to her account of her sensations
by those who had told her so, that she had on her part
given little credit to their knowledge of her case. I immediately
told her that I had no doubt that the nerves in that
part of the body were the seat of the sensations she described,
but that she was wrong in the disease which she fancied to
be the cause of those sensations. By taking this plain and
obviously proper ground with her as to the nature of her
case, making the true distinction between what was real
and what was imagined, she was induced to give up the
imaginary notion that was weighing down her spirits. This
view of her case, so consonant with the faithful report of
her own sensations from day to day, commended itself to
her common sense, and by inspiring confidence and hope,
did quite as much for her recovery as any other remedial
means that were used.
Among the great variety of topics which have suggested
themselves in connection with the subject of this chapter
I have selected those, the discussion and illustration of which
would most interest and profit the general reader. There
are two topics, however, of this character which require so
extended a notice, that I shall devote to each of them a
separate chapter. I refer to insanity, and the influence of
hope in the treatment of disease.
In concluding this chapter I remark, that the subject of
it demands of medical men a more distinct and thorough
attention than it commonly receives. The physician should
be something more than a mere doser of the body. Mental
influences are among the most important of our appliances
in the cure of disease. The physician, therefore, in
fulfilling his high vocation, should not only have a full
knowledge of mental philosophy, but he should aim to
acquire a practical skill in applying its principles to all the
ever varying phases, which the mind presents in its connection
with disease. The possession of this skill is one of
the most valuable endowments of the medical art.
