Essays on partial derangement of the mind in supposed connexion with religion

Front matter

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^ Henn} ^ the gift or his daughter.

Edith Agnes Salter

chapter i. National Education .... 1 17

Composition of the Austrian Empire— Public Instruction— Variety of Schools— Elementary Schools— Infant Schools— Superior Primary Schools— Repetition Schools— Effects of Austrian Instruction- Religious Education— Statistical Tables— Influence of race upon Education— Schools of Utility— Their Statistics— School of Mining at Schemnitz — Polytechnic Institutions.

CHAPTER II. Intermediate Instruction . . . 18 27

Gymnasiums — Character of their Education — Programme of the Course — Number of Gymnasiums in Austria — Lyceums — Theresianum Academy ; its Instruction, Objects, and Effects — Military Education — Statistical Tables of General Education in Austria.

chapter iii. Superior Instruction ..... 28 58

Universities — University of Vienna ; its origin, foundation, and early history — Van Swieten— Four Faculties — Philosophical Course — Lecturers and Professors — Theological Course — Law Studies — Faculty of Vienna ; its early history — Division of Medical profession — Education of Doctors of Medicine and Surgery — Comparison with similar

CONTENTS.

PAGES

instruction in this country — Character of Austrian Lectures and Lecturers — Physiology — Anatomy — Anatomical Museum — Botany — Dental Surgery — Public Museums, that for Mineralogy — Cabinet of Natural History — Examination of Students — Number of medical men in Vienna,

CHAPTER IV. General Practitioners, Pharmacy, and Apothecaries 59 — 75

Surgeon-barbers — Their education — Disabilities under which they labour — Present condition of Pharmacy in Austria — Price of medicines — The Pharmacy department — The Gremium laws — Regulations of Apothecaries — Pharmaceutical education — Master Apothecaries — Doctors of Chemistry — Regulations concerning the dispensing of medicines — Regulations between Apothecaries and Practitioners — Pharmacopoeias — Comparison with Great Britain — Surgical Gremiums — Their privileges and organization.

CHAPTER V. Present State of Science in Vienna . . . 76 119

Character of the Austrian students — Amusement in Vienna — The Elysium — State of science in the capital — "Want of an academy — Comparison between the labouring classes of Austria and Great Britain — The Danube Society — Leopold Academy — Efforts of Leibnitz to establish an Academy in Vienna — Klopstock — Hell — Von Hess — Petition of Viennese Literati in 1827 — Its neglect — Efforts of Littrow — Gall and Mohs — Literary Societies — Present condition of Literature, and General Literary Statistics — State of the Arts- Mechanics' Institute.

CHAPTER VI. The Great General Hospital . . . 120 138

Introductory remarks— The situation of Vienna— The Allgemeine Krankenhaus— Its erection— Position— Objects— Division— Officers- Government — Supports-Reception of patients— Diseases— Typhus- Its Pathology— Opinions of Rokitansky.

CONTENTS. V

PAGES

CHAPTER VII. Public Clinical Instruction . . . 139 — 166

Clinical instruction — Its advantages — The Medical Clinique for Surgeons —The Surgical Clinique — Operators' Institute — Its intention and statistics — The Ophthalmic School of Vienna — Its origin and celebrity — The men who flourished in it — Their writings and operations — Labours of Beer — The Ophthalmic Clinique — Its history — Advantages — Education of Oculists — Museum — Practice and operations of Rosas.

CHAPTER VIII. The Young School of Vienna, Auscultation, and

Pathological Anatomy 167 — 184

Private Clinique of Skoda — Diseases of the Chest — Mode of instruction — Experiments and opinions of the Professor — Consonance — Stethoscopic phenomenon — School of Pathology — Pathological Museum — Its preparations — Professor Rokitansky — His private course and peculiar opinions.

CHAPTER IX. On Syphilis 185—194

The Syphilitic wards — Their statistics— Description of the disease in Austria — Its peculiarities — Condyloma — The female wards — Treatment — The non-mercurial plan — Scharlievo — Its history, and writers.

CHAPTER X. The Lunatic Asylum 195 — 200

The Irrenthurm — Its situation — Wards — Improper treatment of the insane— Comparison with that at Prague— The Lazareth— Asylum at Ybbs — Statistics of Insane in Lower Austria.

VI CONTENTS.

PAGES

Chapter XI. Midwifery And The L.ying-in Hospital . . 201 — 225

The Geb'iranstalt— Its tendency— Origin and erection— Division— Receptions— Their classification— The secrecy of the establishment— Its arrangement — Terms of admission — Illegitimacy — Its causes, consequences, and rewards — Comparison with legitimacy— Statistical tables of illegitimacy— The Obstetric Clinique for Accoucheurs— That for midwives— Viennese midwifery— Puerperal fever— Its mortality —The ProfessorB— Works of Boer— Obstetric education— Table of receptions — Statistics of deliveries — Births and operations — Monstrosities.

CHAPTER XII. The Foundling Hospital .... 226 — 236

Its situation — Objects — Mortality — Statistics — Diseases — The Zuzel — Cost of reception — Income — The Vaccinating Institute — The wetnursing establishment — Generat Statistics of the Allgemeine Krankenhnus.

CHAPTER XIII. The Veterinary Institution, and Josephinum

The Veterinary Institution — Its programme of study — Its education — different descriptions of— Variety of practitioners — Josephinum Military Academy — Description of the institution — Its erection — Character of its education — Hospital — Cliniques — Ophthalmic Clinique of Professor J'ager — Its recommendation — Statistics — Peculiarities of its treatment — The cure of Pannus — Egyptian Ophthalmia — Dr. Jager's private course — His operations for cataract, Reclination, Depression, DistisBion, Dislaceration, and Extraction — Artificial pupil — Josephinum Anatomical [Museum — Wax preparations — Austrian Army Surgeons.

CHAPTER XIV. Homoeopathy, Poor Laws, and minor Hospitals

of Vienna 271—297

Present state of Homoeopathy in Vienna— Trial of its powers in 182S— Hospital of the Sitters of Charity— Homeopathic treatment of Cholera

CONTENTS. VU

PAGES

— Statistical records of the system — Poor-law system — Society of Noble Ladies — Poor-houses and Poor-law Hospitals — Orphan House — Statistics of Poor-law Hospitals— The Burgher Hospital — Institution of the Merciful Brothers — Hospitals for Clergy, Jews, and Criminals — Commercial Hospital — Institution of the SiBters of Elizabeth — Deaf and Dumb Asylum — Blind Asylum — Hospital for Children — Orthopedic Institution — General table of Hospital Statistics. ]

CHAPTER XV. General and Medical Statistics of the Austrian

Austrian, Sanatory Institutions — Division of medical men — The office of Protomedicus — District Physicians and Surgeons — Distribution of the Austrian Practitioners — Their proportion to the population — General Poor-law system — Medical Police — General mortality in the Austrian States — Statistical Tables — Coroners' InquestB — Quarantine and Sanatory regulations — Inoculation — Syphilitic diseases — Regulations concerning Scharlievo — General Hospital statistics of Austria — Military Hospitals — Deaf and Dumb Institutions — Midwifery and Foundling Hospital statistics — Tables of Crime.

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ESSAYS

ON PARTIAL DERANGEMENT OF THE MIND,

IN SUPPOSED CONNEXION WITH RELIGION.

By the late John Cheyne, M.D., F.R.S.E., M.K.I.A., Physician-General to hii

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-til-

Jk0

ESSAYS

ON

PARTIAL DERANGEMENT OF THE MIND

IN SUPPOSED CONNEXION

WITH

RELIGION.

II V THE LATE

JOHN CHEYNE, M.D. F.R.S.E. M.R.I.A.

Physician-General to His Majesty's Forces in Ireland, &r. &c.

WITtl A PORTRAIT, AND AUTOBIOGRAPHICAL SKETCH OF THE AUTHOR.

DUBLIN : WILLIAM CURRY, JUN. AND COMPANY,

LONGMAN, BROWN, AND CO. LONDON.

FRASER AND CO. EDINBURGH.

CONTENTS.

Pnjre

Preface . 4S

ESSAY I.

Introduction . . 47

ESSAY II.

On false percep*'ons and supposed denionism fiO

ESSAY III.

On disorder of the mind, confined to a single facult) 7S

ESSAY IV.

Of a disordered state of the affections . . . 1-1

ESSAY V.

On insanity in supposed connexion with religion 131

ESSAY VI.

On the constitution of man, upright, fallen, and regenerate 149

CONTENTS.

Page

ESSAY VII.

ESSAY VIII.

On faith .... 188

ESSAY IX.

On love to God, charity, and hardness of heart . 206

ESSAY X.

On hope . . , 235

ESSAY XI.

On the presence and absence of devotional feeling 249

AUTOBIOGRAPHICAL SKETCH.

A succinct account, such as I am about to give, of the life of a physician who, without much literary or general scientific information, attained confidence and consideration, may suggest useful hints to the junior members of the medical profession to whom it is addressed.

The particulars of my birth, parentage, and education may soon be told.

I was born on the third of February, 1777, in Leith, where my father, John Cheyne, practised medicine and surgery. He was a man of great cheerfulness, benevolence, good sense, and singleness of mind. He would visit the poor as promptly as the rich, and his half-crown was as freely given to those who had no means of procuring food, as his prescription.

B

& AUTOBIOGRAPHICAL SKETCH.

My father succeeded his uncle, John Cheyne, a kindred spirit, who had acquired the name of " the friend of the poor." Of my great grandfather 1 know little, but that he and his family were devoted to the Stuarts, to whose agents they had lent considerable sums of money, which were never returned ; and that his portrait by Sir John Medina still hangs in the hall of the College of Surgeons of Edinburgh, of which he was a member, as were also my father and grandfather.

My mother was the daughter of Mr. William Edmonstone, Fellow of the Royal College of Surgeons, and of his wife Cecilia Bayne, sister to William Bayne, who was mortally wounded in Lord Rodney's great battle, while in command of the Alfred seventy-four-gun ship, and was the senior of the three captains to whom a monument was erected in Westminster Abbey. This Cecilia Bayne was daughter of Alexander Bayne, Professor of Scots Law in the University of Edinburgh, whose life appears in the " Penny Cyclopaedia," and who is noticed in DTsraeli's

" Calamities of Authors." My mother was an ambitious woman, of honourable principles, constantly stimulating her children to exertion, and intently occupied with their advancement in life.

By the advice of one of my father's friends, I was, after passing four years at the Grammar School of Leith, sent to the High School of Edinburgh in my tenth year, and at once placed

under the care of Dr. , the Rector, or

head master, for whose class I was in no respect prepared. In consequence of this ill-advised step I was very unhappy, being unable to keep up with many of my companions, and I often feigned sickness and submitted to take medicine that I might be kept from school. Dr. , doubtless a very eminent master, was a vain man, and so passionate as to inspire his scholars with the utmost terror; when he found that we had been idle he would flog a whole form till he became pale and breathless and unable to proceed, and then he would throw himself into his chair, rail at our base ingratitude, and magnify his own merit, till the paroxysm ended in a conviction that he was the most learned, wise, and virtuous man of his age. Certain it is, that my impatience to escape from his rule knew no bounds, and that during my whole life he has continued to preside over a great portion of my uneasy dreams.

Soon after I left the High School I was placed under the care of a clergyman of the Episcopal Church of Scotland, a good scholar, but an idle and dissipated man. Both master and pupil had more relish for frivolous talk than for Homer or Virgil ; and as he did not exact careful preparation, I did not read much for him ; so that, although I went to him daily for two years, little was added to my knowledge of Greek or Latin.

In my thirteenth year I began to attend my father's poor patients : I was sent to ascertain that they were supplied with medicines, to bleed them, dress their wounds, and report upon their condition. In this way I acquired an early acquaintance with diseases ; and my success in treating them seems to me to have arisen more from my knowledge of their expression, than from any other qualification that I possessed.

Before I reached my sixteenth year I had begun to attend medical lectures in the University of Edinburgh ; and in this premature commencement of my professional studies, which was the second false step in my education, there was nothing apparently incongruous, as I had then attained full growth, and had the appearance of a young man of eighteen or nineteen. Dining at a boarding-house every day with several medical students, who were qualifying themselves for the Doctorate, I found that I was as well acquainted with medical subjects as most of them, and therefore I unhappily resolved upon presenting myself for examination by the professors when they did. By attending a club, of which the members alternately examined each other in anatomy, physiology, theory and practice of physic, &c, and by the assistance of Mr. Candlish, a celebrated grinder of that day, my superficial knowledge of Latin and of medical science was made to answer the end in view : I passed my examination without difficulty, and obtained a medical degree in June, 1795.

On the day after I obtained my degree, having previously passed an examination at Surgeons Hall, I left Edinburgh for Woolwich, the headquarters of the Royal Regiment of Artillery, in which corps I had received the appointment of assistant-surgeon. "With them I served in various parts of England till the end of 1797, when I obtained the local rank of surgeon, and accompanied a brigade of horse artillery, commanded by Lieutenant-Colonel, afterwards Sir Edward Howorth, to Ireland. With part of that brigade, commanded by Lord Bloomfield, I was present at the actions with the rebels which took place at Ross, Vinegar Hill, &c. in 1798. While I was assistant-surgeon and surgeon in the artillery, from 1795 to 1799, my time was spent in shooting, playing billiards, reading such books as the circulating library supplied, and in complete dissipation of time. In fact, I learned nothing but ease and propriety of behaviour. At last I became dissatisfied with my prospects, anxious to distinguish myself in my profession, and persuaded that unless I made a strenuous effort I must be content with a subordinate station, which my vanity would not have permitted me tamely to occupy. I therefore left the horse artillery and returned to Scotland in 1799, when I was appointed to the charge of the Ordnance Hospital in Leith Fort.

I now undertook to act as assistant to my father, whose practice, especially among the poor, was very extensive. From the cases which fell to my lot in our division of the business of the day, I selected the most interesting ; these I journalized, and when I foresaw that a disease would end unfavourably, I took measures to ensure permission to open the body. At this period I formed a friendship with Mr. afterwards Sir Charles Bell, who was occupied in the study of pathology, laying the foundation of future eminence. He opened most of the bodies which I obtained permission to dissect, taught me many things which I might not otherwise have learned, and confirmed my taste for distinction. As an example of diligence in study he could not be surpassed, and it was already manifest that he was a man of genius.

From this period, my object was very simple, and my plans were soon formed. I resolved, whenever I should think myself fit for the undertaking, to attempt to establish myself as a physician in a large city, and in the meanwhile to devote every leisure hour to the necessary preparation.

My attention was directed principally to the diseases of children, and to acute and epidemic diseases, which I had the fullest opportunity of studying. When a well-marked case occurred, or when an epidemic arose, I obtained the best monograph I could on the subject, and attentively compared it with the opinions of the most experienced of my professional brethren, whom I had frequent opportunities of meeting, and then I filled up my case-books. Thus, by means of observation, reading, and the experience of others, my mind was made up on the most important points of practice, and I acquired a facility of prescription, especially in acute diseases, which proved of great advantage to me, particularly in dispensary practice. With respect to chronic diseases, in addition to the assistance which I derived from books and observation, I obtained a mass of consultations, many of them written with great care by the most eminent physicians in Edinburgh during the middle and towards the end of the eighteenth century, which had been preserved by my granduncle, father, and grandfather.

I endeavoured to become acquainted with the characters of those who moved in the highest rank in the profession, and to discover the causes of their success ; and I ascertained that, although a man might acquire popularity by various means, he could not reckon upon preserving public favour unless he possessed the respect of his own profession ; that if he woidd effectually guard his own interests, he must in the first place attend to the interests of others ; hence, I was led carefully to study and liberally to construe that part of medical ethics which regulates the conduct of physicians towards each other.

The surgeons in Edinburgh during this period of my residence in Scotland were thrown into a state of disagreeable excitement by an attack which Dr. Gregory made on their connexion with the Royal Infirmary. Dr. Gregory assailed the system of attendance in a series of pamphlets written with great spirit and humour, and succeeded in effecting its overthrow. The angry feeling, which I saw at this time exhibited, was such as to lead me to resolve on avoiding professional disputes, and suffering injury rather than attempting to right myself, unless my character were likely to be endangered by forbearance. I have since shut my eyes and ears against some very obvious attempts which have been made to prove that I had acted ignorantly, and have lived to see my opponents become steady and useful friends.

After passing nine years in the study of pathology and in the practice of medicine, I resolved upon leaving Scotland, and instituted inquiries in several parts of England without discovering any situation which promised to suit me. I was more anxious for an opportunity of distinguishing myself than of securing a large income, and with that view I offered my services to the late Dr. Rollo, surgeon-general to the artillery, who some years before wished to establish a school of clinical medicine at Woolwich for the instruction of the medical officers of the artillery, then a numerous body. I proposed to give clinical instruction to the junior officers of the establishment ; and all I asked in return was the rank, pay, and allowances of a physician to the forces. But my application came too late — disappointment and disease had quenched Dr. Rollo's zeal for the improvement of the department over which he had presided with great ability, and I never received an answer to my application.

About this time I was furnished with a very particular account of the state of the medical community in Dublin, which probably made the deeper impression upon me, as it came from one who was not aware of my intended removal from Scotland. 1 immediately prepared myself for a visit to Dublin, whither I went in the latter end of March, 1 809, leaving Mrs. Cheyne in Antrim with her father, the Rev. Dr. Macartney, vicar of that parish.

I soon determined upon remaining in Dublin, in which city I found the profession respected. This was chiefly owing to the eminent physicians who had flourished there during the preceding fifty years. Dr. Smith, remarkable for his munificence ; Sir Nathaniel Barry, whom Mr. Grattan once characterised to me as the most accomplished gentleman he had ever known ; Dr. Quin ; Dr. Plunkett, the witty, accomplished, and amiable brother of the Lord Chancellor ; Dr. Perceval, distinguished for scientific knowledge, but more so for his philanthropy : the memory also of M 'Bride, Cleghorn, and Purcell, was still cherished by many. Moreover, I soon discovered that the field was extensive, and the labourers liberally rewarded. The physicians whom I found in the confidence of the public were mostly of the school of Cullen : they were possessed of good general information, but chiefly relied on the accuracy of their symptomatology ; they had paid but little attention to morbid anatomy. Much of the purely medical practice of Dublin was passing into the hands of the surgeons, who, although certainly less skilful in the treatment of acute diseases, were better acquainted with the nature and tendency of the organic lesions. In this state of things I discerned good grounds of hope: I was sufficiently well acquainted with acute diseases, and, thanks to Sir C. Bell, I had acquired a taste for pathology.

In the latter end of 1809 I took my position as a candidate for public favour in Dublin, where I had passed the summer, neither expecting nor indeed wishing for rapid advancement : what is easily acquired is little valued, and not unfrequently soon lost. I had a few friends, who being much dissatisfied with my apparent apathy, and the obscurity in which I lived, wished me to go into company, and even to give entertainments to those who had it in their power to advance my interests; and so much was I urged to this course, that at last I reluctantly yielded to their importunities ; but as my circumstances did not admit of my providing entertainments with comfort to myself, I refused to repeat the injudicious experiment. True it is, that my friends could derive but little encouragement from my apparent progress — from the 9th of November,

1810, to the 4th of May, 1811, a period of nearly six months, I received only three guineas; but then I felt that prejudices against me were giving way, and that I was beginning to be regarded with good-will by some of the most respectable of my professional brethren, who, in the latter end of

1811, procured for me the situation of Physician to the Meath Hospital.

This was for me a very important step : for although the old Meath Hospital was a small, mean, and gloomy building, yet my colleague, Dr. Egan, was much esteemed, and among the six surgeons to that hospital, there were at least three who stood high in their profession; moreover, the officers of that hospital are elected by the members of the medical board, who thus placed me on their own level. My situation, therefwe, not only afforded me an opportunity of evincing attention and knowledge of disease, but it was the best attestation which I could have obtained of competency to perform the duties of an hospital physician. What I most required was to be sufficiently accredited.

During the late war the College of Surgeons had become an extensive nurseiy for the supply of medical officers to the army and navy ; and about this time the directors of the School of Surgery thought it expedient to add to their other professorships one of the practice of physic. My attendance upon the Meath Hospital procured my election to this office : my lectures at the College of Surgeons, which were very full on the subject of military medicine, were attended by nearly all the surgeons and assistant-surgeons in the garrison, to whom they were free. These lectures, of which I delivered five courses, and my duties at the Meath Hospital, the seat of a crowded dispensary in which I daily prescribed for all the medical patients, occupied whatever time could be spared from practice now increasing as rapidly as my friends could wish. In 1812 my fees amounted to £472.

In October, 1815, I was appointed by the Lord Lieutenant one of the physicians to the House of Industry, which lay at a distance of two miles from my house. I had there to visit daily upwards of seventy patients in acute diseases, most of these labouring under fever, of whom probably eight or ten demanded careful examination. As I had experienced and well-trained sick-nurses, who allowed nothing to escape their observation, the rest of the patients required only a glance of the eye ; so that the visit was always finished in little more than an hour. But I have ever experienced great fatigue from that stretch of mind which arises from going the round of an hospital. Then the walk to and fro occupied more than an hour, and I invariably reached home much exhausted : I therefore felt it necessary to resign my professorship at the College of Surgeons, as well as my charge of the Meath Hospital, that my private practice, which in 1816 yielded me £1710, might not suffer by the extent of my official duties.

When I received my appointment of Physician to the House of Industry, Dr. Edward Percival, who came to Dublin at the same time that I did, was one of the physicians to that establishment. We immediately resolved upon endeavouring to form a Clinical School and a Museum of Morbid Anatomy at the House of Industry, both of which objects it seemed we could, with the aid of the surgeons, accomplish without much difficulty. Within the precincts there was an extensive fever hospital, an hospital for chronic diseases, spacious wards and separate cells for lunatics, a large asylum for destitute children, and an immense number of paupers with constitutions in every stage of disorganization. Our plan also included digested annual reports of the diseases which fell under our observation, and this ultimately led to the publication of the Dublin Hospital Reports : but the plan failed. Dr. Edward Percival shortly after settled in Bath ; consequently I was left alone. The fever which ravaged Ireland for upwards of two years became epidemic in Dublin in 1817, and the House of Industry was converted into a depot for fever patients, of whom upwards of seven hundred were accommodated in that institution. And then in many of the wards dysentery afterwards broke out, and became the chief object of my solicitude, during the latter part of my connexion with the House of Industry.

Upon the death of Dr. Harvey, the Physician- General to the Army in Ireland, I applied without success for his situation. There were several applicants, whose claims the Lord Lieutenant found it not easy to adjust, and therefore he escaped from the difficulty by appointing Dr. Percival, who had not applied for the vacant office, but who, in point of character and standing, had a better title to the situation than any of those who were candidates for it. Dr. Percival accepted the office, on condition that the Lord Lieutenant would permit him to assume an assistant in the duty of attending the General Military Hospital. I was applied to by Dr. Percival to render him this assistance ; but in order to comply with his wishes I thought it necessary to resign my situation in the House of Industry. Indeed, I think I must have done so before long, as my practice was rapidly increasing, and the time required by my hospital duties was more than I could spare.

Dr. Percival soon afterwards resigned his office, upon which I was appointed to succeed him by Earl Talbot, then Lord Lieutenant of Ireland : my patent bore the date of October 7th, 1820. The situation of Physician-General, which was abolished in the end of 1833, was conceived, when I obtained it, to confer on the possessor the highest medical rank in Ireland ; and as my practice yielded £5000, which was about its annual average during the next ten years, I felt that I had fully attained the object of my ambition.

My constitution, naturally weak, was always injured by fatigue of body or anxiety of mind ; and hence before long I was obliged to circumscribe my practice, by refusing to go to a distance from Dublin, . or to undertake attendances in the country. I am convinced, had my health permitted me, that I could have added £1500 a year to my income.

By a good arrangement, punctuality, attention to the interests and feelings of my professional brethren, and prudence — the means which had apparently led to my advancement — I now tried to avoid those reverses to which professional life is ever subject.

As I was much more generally employed as a consulting than as an attending physician, I endeavoured to escape interruption in my chief line of business. I returned to my house at appointed times to form new engagements, but I left no account of my route when I set out from home. When I was tracked and obliged to yield to an unexpected requisition, the patient for whom I was sent was perhaps dead ; or he was dying and I was unable to leave him ; or the attack was over and he was again well, and my sole recompense was a complimentary speech ; or I was led to supersede the family physician engaged elsewhere, which gave rise to explanations, and to a negotiation to replace him in the attendance. In the meantime, disappointment to those patients and their medical friends who were waiting for me necessarily occurred, and thus a ruffle of the spirits, very unfavourable to the consideration of a difficult case, arose and continued for several hours.