_MALADIES PRODUCED BY FEAR_
I
Unhappy invalids who must seek shelter in the hospital, and drag
themselves feebly through those long wards where quiet has reigned for
centuries, only broken by the sobs and cries of those poor wretches
who come to lie down within these walls, as in the common tomb of the
homeless!
How depressed they are when they leave their family and note the
sadness of the place, advance sighing towards an unfamiliar bed, while
around them they see all the ills which misery begets, and breathe the
oppressive air of that pity which has gathered them together!
The new-comers at once recognise those more dangerously ill, even
though they are at some distance, because the physicians stay longer
beside them, watching them, the assistants and nurses are occupied with
them. Then the bell for the viaticum rings; all who are able rise to
their feet; then the extreme unction--then the rattling in the throat
in the death-agony. And when at last they see the curtains drawn
around the bed, a low, trembling whisper passes the sad news from mouth
to mouth, to the most remote corners of the ward, beyond the dim rays
of the funeral torch shining in the night like the last flicker of life
in a body waxing cold for ever.
In their morning round the physicians find that the serious cases have
grown worse, while those who are better beg to be dismissed. But it
is in the women’s ward that similar sad circumstances cause the most
alarming effects. The physician who has the night-watch must walk up
and down the whole night, prescribing soothing draughts and cordials,
without his presence or his words of comfort preventing convulsive
attacks or fainting fits.
Many patients die in the hospitals from fear and depression who would
probably have recovered had they been tended in their own homes.
We must hope that thrift may so increase that the poorest working-man
may have a cleanly house in which he may be nursed by his family when
he falls ill, and that public benevolence may erect modest houses for
those unhappy ones in need of succour, where the patient may enjoy
efficacious scientific aid, and those comforts which the advance of
hygiene demands, and be spared the heart-rending sights and injurious
effects of the old hospitals.
II
The young physician, just beginning to practise, is astonished at
the remarkable things which his patients tell him with the utmost
confidence and in all good faith. Nearly all relate the story of their
illness, beginning with that circumstance which, in their opinion,
originated it. It is an innate tendency which spurs the human mind to
find an explanation for everything; and the reason of phenomena, which
is the foundation of science, is yet the cause of prejudices and the
most abundant source of error. If I were to mention the names of all
the maladies which are thought to be produced by fear, I should be
obliged to copy nearly the whole index of a pathological text-book, and
with small advantage to the reader, for the authors, after exhausting
their scientific matter, state empirically everything their patients
tell them, provided their affirmations bear an appearance of truth. I
shall only mention facts beyond doubt, or those least controversial,
supporting them by examples taken from the most reputed authors.
Chomel relates that a physician, after having performed the autopsy of
a man who had died from hydrophobia, was so overcome by the fear of
having infected himself, that he lost both appetite and sleep, felt a
horror of all liquids and a choking sensation in the throat when he
forced himself to drink. For three days he wandered through the streets
like one desperate. His colleagues and friends, believing it to be the
effect of imagination, made every effort to convince him of the fact,
and by keeping him with them, they succeeded in ridding him of the
ill-omened thought, and he recovered.
It is an incomprehensible phenomenon, but yet admitted by all medical
writers, that fear may of itself give rise to phenomena exactly
resembling those of hydrophobic infection. A celebrated physician,
Bosquillon, believed that fear alone was the cause of hydrophobia and
not the bite or the saliva of the dog.
Dubois tells of two brothers who were bitten by a mad dog. One had
to leave at once for America, and thought no more about it. When he
returned twenty years afterwards, he heard through some thoughtless
person that his brother had died of hydrophobia, and was so agitated
by the news that he fell ill and died, showing all the symptoms of
rabies. Medical works are full of instances of persons bitten by dogs,
who only developed hydrophobic symptoms after being incautiously told
that the dog was mad. It is often impossible even for the physician to
distinguish hypochondriac hydrophobia from true rabies; even the manner
of death is no guide, for tetanic contractions of the respiratory
organs appear also in hypochondriac hydrophobia.
The physician can often save these patients, if he knows how to exert
authority and to make use of means to convince the sufferer that he has
nothing to fear.
The story is told of a physician who was called to a female patient
infected with actual rabies, after his colleagues had declared that
she was incurable. He examined her attentively, then kissed her on
the mouth to prove to her that she was not hydrophobic. The patient
recovered.
More especially during epidemics does fear play havoc. From the most
remote antiquity physicians have observed that the timid die more
easily. Giorgio Baglivi, in his celebrated book 'Praxis Medica,’[34]
describing the effects of an earthquake which took place in Rome in
1703, says that although not a single person was killed, several
died of fever through fear, many women miscarried, and all bedridden
invalids grew worse. Larrey had already noticed that on the fields of
battle and in the lazarets soldiers belonging to the conquered army
succumbed more easily to their wounds, while the victors more speedily
recovered. This was confirmed in the war of 1870.
[34] Baglivi: _Praxis Medica_, liber. i, cap. xiv. s. 5.
Fear alone may develop all the symptoms of a pestilential malady,
even when the epidemic causes are totally wanting. Just recently, in
one of his works on hysteria and hypochondria, Jolly relates the case
of a patient of his, a lady in Strasburg, who received the news of
the death of a relative from cholera in a distant country. She was
very much frightened, and imagined that she herself was attacked by
it. She lost her appetite and suffered for eight days from violent
attacks of diarrhœa, and only after convincing her that there was
not a single case of cholera in Strasburg, and that she was a prey to
her own imagination, was it possible to allay the serious intestinal
disturbances produced by fear. As soon as a report of cholera spreads
through a town, all hypochondriacs feel worse.
Physicians who have described the dreadful spectacle of the lazarets
during epidemics, mention the great number who die victims to fear, in
many of whom the symptoms of the plague had not even appeared. Some
have died suddenly from the fear of being taken to the lazaret, others
have committed suicide, as we are told the cowardly have been seen
to do in battle, who, terrified at the sight of death, or weary of
suffering, have placed their chin on the muzzle of their gun and blown
out their brains.
What horror we should feel could we read year by year the story of
those who have succumbed to nostalgia, grief, humiliation; in misery,
winter-cold, or want of food! Of men who have died hopelessly in the
snow or lost in the sands of the desert, of others who have been
shipwrecked and thrown upon the rocks, and whom a little courage might
have saved; of men who have languished in gloomy prisons, in lonely
monasteries or in exile, and who have died rather of mental than of
bodily suffering.
III
Maladies which have their origin in fear must be distinguished from
those morbid conditions which are suddenly aggravated by the effect of
a strong emotion.
There are many who, when they receive a fright, become for the first
time aware of some infirmity, which then increases so rapidly as to
endanger their life.
Lamarre tells the following fact.[35] A lady, seventy-five years
of age, had suffered for about ten years from defective action of
the valves of the heart without this disease having hindered her
housewifely activity. Dr. Lamarre, who was her physician from 1865
to 1870, was called a few times to her. The hypertrophy of the heart
sufficiently counterbalanced the defect of the valves, and the pulse
was regular.
When the Franco-Prussian war broke out in 1870, her sons agreed to keep
her in ignorance of it, lest she should be afraid, she having already
witnessed the plundering of her father’s house by the Prussians in
1815. They succeeded easily in keeping all news of national disasters
from her, for they lived isolated in the country, and their mother read
no newspapers.
[35] Ed. Lamarre: _Contribution à l’étude du rôle du système nerveux
dans les affections du cœur_. Paris, 1882, p. 99.
On September 4, 1870, she suddenly heard of the defeats of the
French, and of the march of the German army upon Paris. It was such
a terrible shock to her that her face became livid, and she scarcely
had the strength to cry, as she pressed her hand to her heart, 'I am
suffocating--I am suffocating!’ Three-quarters of an hour later she
died in her sons’ arms.
The movements which she made with hands and face till the last moment,
and the great irregularity of the pulse, caused Dr. Lamarre to abandon
the idea of apoplexy, and accept as the cause of decease a nervous
perturbation of the heart brought on by violent mental agitation.
Pinel, one of the greatest celebrities in the domain of mental
diseases, always began the examination of a patient by asking him
whether he had not had some fright or some great vexation. In the study
of every nervous malady great importance must always be attributed
to the investigation of the moral causes. The vivid impression of a
strong emotion may produce the same effects as a blow on the head
or some physical shock. There are men who, through fear, have lost
consciousness, sight, or speech; others, still more sensitive, have
remained for a long time paralytic, unable to move legs or arms, and
have lost all sensibility. Some remain for a long time sleepless,
others fall into a sort of exaltation resembling the outbreak of mental
disease, many lose their appetite, or are afflicted with articular
diseases, and in some the nervous system suffers such a shock as to
cause violent fever.
Dr. Kohts, in his account of the maladies caused by fright during the
siege of Strasburg in 1870, gives a minute description of the cases of
_paralysis agitans_ and of convulsions which he observed. The tremor
and singing in the ears arose suddenly, often lasting for months,
and even for life in very nervous persons, as is also the case in
catalepsy, paralysis, and aphasy.
Leyden considers fright as one cause of myelitis. Likewise, in
sclerosis of the arteries, cardiac hypertrophy, fright may produce
hemiplegy. Berger instances two cases of perfectly healthy persons
who, immediately after a fright, were attacked by paraplegy, with
accompanying insensibility, without any serious anatomical injury, for
the phenomena rapidly disappeared.
It is often said, and with good reason, that children should not be
allowed to witness an epileptic fit, for the fright and emotion which
they suffer may prove dangerous, causing later a similar attack in
themselves. However difficult it may be to comprehend such a thing, it
is yet admitted by all. Quite recently Eulenburg and Berger saw two
old men, the one seventy, the other sixty-five years of age, who had
an epileptic fit immediately after such a fright, although they had
never had one before, nor were they predisposed to it. Romberg gives an
instance of a boy, ten years old, who was frightened in the morning by
a dog, and in the evening had an attack of St. Vitus’s dance.
One of the most moving instances I have read about the influence of
fear on the organism is in the description of the voyage of a sailing
ship, so storm-tossed that one wonders how it could withstand the
hurricanes which burst upon it. When scurvy broke out on board, the
doctor noticed that the disease increased whenever the fear gained
ground that land might still be far off. In every fresh tempest several
died, and others were seized with the malady; and when at length the
captain died, in whom all had great faith, the number of patients
became five times greater.
IV
The passions have been divided by physicians into the exciting and the
depressing. This distinction cannot, I think, be maintained at the
present day, for we need only think of the effects we see produced
by fear to be convinced that this emotion, which may at first appear
exciting, becomes instead depressing in its paroxysms. The same may
be said of narcotics and depressive remedies, which, in small doses,
excite, but in larger doses depress.
Some phenomena, such as the growing grey of the hair, the immediate
transmission of a nervous malady from the mother to the fœtus under
the influence of fright, the possible death of sucklings a few hours
after the mother has suffered great fear, although the infant was not
present--all these are incomprehensible phenomena which we only admit
because trustworthy observers and physicians affirm that they have
witnessed them.
Michea, a celebrated physician, one of the most profound in knowledge
of mental diseases, used to write insulting anonymous letters to some
of his patients in order to cure them, and, he assures, with good
result in some hypochondriacal cases. The mind may be drawn off from
a fixed idea by preoccupying it with some danger. Physicians have
sometimes had recourse in hysterical cases to threats or a sudden
fright to check dangerous symptoms when all other remedies have proved
useless. Amann tells of an hysterical patient who suffered from tetanic
convulsions and trances, and whose father treated her with blows and
cured her.
It is a well-known fact that fear sobers the drunken and cures slight
nervous affections, but nothing can encourage the physician to raise
fear to the rank of a curative method, as it may be expected that in
the greater number of cases nervous diseases would be aggravated by
such treatment.
Less questionable is, perhaps, the efficacy of fear in subduing nervous
maladies acquired by simple imitation; in this case it is probable
that the greater ill, as the saying is, drives out the lesser. In old
books of medicine stories are found of psychic maladies which, under
the name of St. Vitus’s dance, or tarantism, affected entire provinces
with a morbid excitement. The first symptoms of this malady appeared
in Aix-la-Chapelle, then it broke out in Cologne, afterwards in Metz,
whence it spread along the Rhine. Artisans, peasants, rich and poor, in
hundreds left their families, dominated by an irresistible desire to
dance. Intoxicated with excitement, they performed frenzied contortions
as though possessed, until at last they sank exhausted to the ground
or became incurably insane.
In suchlike cases Boerhave had recourse without hesitation to fright
and violent emotion to prevent the patients giving way to their
inclination. The story is told that while he was physician of the
orphan asylum in Haarlem, he suppressed an epileptic epidemic by means
of fright. Seeing that epileptic fits were daily increasing among his
patients, he ordered a large brasier full of coals to be lighted in the
room, heated a number of pincers and tweezers red-hot, and then told
his little patients he had given orders that all those who had fits
should be burnt.
This inhuman method gave rise to repulsive applications in the
treatment of epilepsy, but cases of cure resulting are so exceptional
that they certainly do not counterbalance the aggravated sufferings
of those uselessly subjected to a cruel emotion. This notion, that
maladies produced by strong emotions may be cured by others equally
strong, is found in the oldest books on medicine. Pliny relates
that the blood of the gladiators used to be drunk as a cure for the
falling-sickness.[36]
[36] Plinii _Historia Naturalis_: 'Sanguinem quoque gladiatorum bibunt,
ut viventibus poculis, comitiales morbi; quod spectare facientes in
eadem arena feras quoque horror est.’ Lib. xxvii. p. 9, vol. viii.
We read miraculous stories of persons who suddenly became dumb, and of
others who have regained their speech; and, indeed, such occurrences
take place still, although they lose the dignity of the miraculous as
soon as they are studied in the infirmaries.
The following is a case recently described by Dr. Werner.[37] A
girl, thirteen years old, suffered a great fright by falling under a
carriage. She escaped with a slight scratch, but suddenly lost her
speech. Dr. Werner tried to cure her by various methods during thirteen
months, without any result. At last he had prescribed bromide of
potassium, when one day the girl threw herself into her mother’s arms
and said, in a laboured voice, 'Mamma, I shall speak again.’ After one
week she spoke as before.
Wiedemeister tells a story of a bride who, as she was taking leave
after the wedding breakfast, suddenly lost her speech and remained dumb
for several years, until, overcome with fear at the sight of a fire,
she cried out 'Fire! Fire!’ and from that time continued to speak.
Pausanias, too, relates that a youth recovered his speech in the fright
caused by the sight of a lion, and Herodotus, in his history, narrates
that the son of Crœsus was dumb, and that, at the taking of Sardes,
seeing a Persian with drawn sword about to kill his father, he cried
out, overcome with fright, 'Kill not Crœsus!’ and from that moment he
was able to speak.
[37] Kussmaul: _Die Störungen der Sprache_, p. 200.