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.

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 diarrhoea, 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.

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 foetus 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]

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 Croesus 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 Croesus!’ and from that moment he was able to speak.