1801 - Philippe Pinel in France, takes over the Bicêtre insane asylum and forbids the use of chains and shackles. He removes patients from dungeons, provides them with sunny rooms, and also allows them to exercise on the grounds.
Philippe Pinel was the son of a barber surgeon of small means who practiced in St.-Paul-Cap-de-Joux, a village between Castres and Toulouse. His mother, Élisabeth Dupuy, came from a family that had since the seventeenth century produced a number of physicians, apothecaries, and surgeons. Despite this medical heritage, Pinel's early education, first at the Collège de Lavaur and then at the Collège de l'Esquille in Toulouse, was an essentially literary one; he was greatly influenced by the encyclopaedists, particularly Jean-Jacques Rousseau (1712-1778). Having decided upon a career in religion, he enrolled in the Faculty of Theology at Toulouse in July 1767; in April 1770, however, he left it for the Faculty of Medicine, from which he received the M.D. on December 21, 1773. Simultaneously with his medical training, Pinel studied mathematics, an interest that is apparent in his medical writings.
In 1774 Pinel went to Montpellier, where for four years he frequented the medical schools and hospitals, and became acquainted with the vitalistic school of François Boissiers Sauvages de Lacroix (1706-1767), Théophile de Bordeu (1722-1776), and Paul Joseph Barthez (1734-1806), also studying under Gabriel-François Venel (1723-1775).
He there began to formulate and practice what he later recommended to his students: "Take written notes at the sickbed and record the entire course of severe illness." He supported himself by giving mathematics lessons, conducting a private anatomy course, and writing theses for rich students. He also met the chemist Jean-Antoine-Claude Chaptal (1756-1832) who later acknowledged Pinel's influence upon his intellectual development. In 1777 Pinel presented two iatromechanical papers, on the application of mathematics to human anatomy, to the Société Royale des Sciences de Montpellier; he was named a corresponding member in July that year.
In 1778 Pinel went to Paris. He carried with him letters of recommendation to the geometer Jacques Couin, who advised him to give up medicine and devote himself to exact sciences. He visited libraries and hospitals, particularly Pierre Joseph Desault's (1744-1795) service at the Hôtel-Dieu and frequented the salon of Mme Helvétius, (widow of Claude-Adrien Helvétius, 1715-1771) into which he had been introduced by Pierre Jean Georges Cabanis (1757-1808), and where he met Benjamin Franklin (1706-1790). Mme Helvétius's house in Auteuil was a gathering place for the school later called idéologues, and Pinel became acquainted with the sensational doctrines of John Locke (1632-1704) and Étienne Bonnot de Condillac (1715-1780), which strongly influenced his work. As a graduate of Toulouse, however, he was unable to practice medicine in the capital.
In 1784 Pinel became editor of the Gazette de santé, in which he published a number of articles chiefly concerned with hygiene and mental disorders. In 1785 he translated William Cullen's First Lines of the Practice of Physic and three volumes of the Philosophical Transactions of the Royal Society of London into French. He also wrote articles on medicine for the daily Journal de Paris and, in 1788, published a new edition of Giorgio Baglivi's (1668-1707) Opera omnia, which had first been published in Lyon in 1704.
Pinel commenced his work of systematic observation and recording of case stories when he was advisory physician to the private sanatorium of the master joiner (Tischlermeister) Jacques Belhomme in Paris.
Work he undertook on the mechanics of bones, joints and the jaw in this period was widely acclaimed and he was appointed to a position at the Jardin des Plantes. At this time he also began visiting privately confined mental patients, after a friend of him in 1785 went mad and ran into the countryside, where he was eaten by wolves. From that time Pinel devoted his time to mental illness, and in 1792 he became the chief physician at Bicêtre, the Paris asylum for the incurable insane men. There he found appalling conditions, with patients being chained to the walls - many of whom had been restrained for 30 to 40 years - treated like beasts, and put on display to the public, who paid admission to see them.
Pinel is remembered as the tempered man of the revolution, taking no active part, but devoted himself to attempting to aid those who had been proscribed, among them the philosopher Marie-Jean-Antoine-Nicolas de Caritat, marquis de Condorcet (1743-1794), an advocate of educational reform and one of the major Revolutionary formulators of the ideas of the indefinite perfectibility of mankind.
As professor of medicine, Pinel was obliged to attend the execution of Louis XVI. This shocking experience he reported in a letter to Louis’ brother on the same day, January 21, 1793.
On August 25, 1793, at the instance of his friends Pierre Jean Georges Cabanis (1757-1808) and Michel-Augustin Thouret (1748-1810), he was appointed médecin des infirmeries of the Hospice de Bicêtre, where he was able to begin implementing his ideas on the humane treatment of the insane (he had previously been a frequent visitor at the Belhomme nursing home for the mentally ill, but had been unable to convince the director - who was primarily concerned with making a profit - to accept hi therapeutic notion). At the Bicêtre Pinel had the chains removed from his patients, an event commemorated in both paintings and popular prints.
On May 13, 1795, he became chief physician of the Hospice de la Salpêtrière, a post that he retained for the rest of his life. Here he was in charge of 5.000 pensioners, aged women, and chronically ill patients; there was a 600-bed ward for the mentally ill, a 250-bed infirmary for acutely ill patients, and, at first, a small infirmary for sick orphans. Pinel was eventually assisted in his work by Augustin-Jacob Landré-Beauvais (1772-1840) Jean Etienne Dominique Esquirol (1772-1840), and C. J. A. Schwilgué (1774-1808). At the Salpêtrière he did the same for the female insane, as he had done to the men at the Bicêtre.
On December 4, 1794, three years after the dissolution of the medical guilds and faculties by the Legislative Assembly, the Convention Nationale established three écoles de santé, and Pinel, upon the recommendation of Antoine Francois Fourcroy (1755-1809) and Thouret, was named adjunct professor of medical physics at the school in Paris. In 1795 he became professor of medical pathology, a chair that he held for twenty years. He was briefly dismissed from this position in 1822, with ten other professors, suspected of political liberalism, but reinstated as an honorary professor shortly thereafter.
Pinel was elected to the Académie des Sciences in 1804 and was a member of the Académie de Médecine from its founding in 1820. In addition to working in hospitals and teaching, Pinel often served as consulting physician, although he did not have the rich and influential patients that Baron Jean-Nicolas Corvisart de Marest (1755-1821) or Antoine Portal (1742-1832) had.
Although he is properly considered one of the founders of psychiatry, Pinel's contemporaries regarded him as a master of internal medicine, a reputation based upon the authoritative classification of diseases that he set out in his Nosographie philosophique, published in 1798.Perhaps because of his interest in botany, Pinel was greatly interested in systematic classification of disease. His nosological work should be viewed in the context of the great eighteenth-century concern with classification, of which the works of Carl von Linné (1707-1783) are exemplary. Specifically medical classifications had been offered by William Cullen (1710-1790) and David Macbride (1726-1778), in 1769 and 1772, respectively, while Erasmus Darwin's (1731-1802) Zoonomia appeared in 1794-1796. Pinel was aware of the difficulties that his predecessors had faced, but he approached the task cheerfully, secure in his belief that a disease was "an indivisible whole from its commencement to its conclusion, a regular ensemble of characteristic symptoms."
Pinel composed the Nosographie as a textbook. It went through several editions, among which important variations may be found. Although the Nosographie was a notable success among Pinel’s students and disciplines, it also provoked a number of criticisms. François Joseph Victor Broussais (1772-1838), in particular, attacked Pinel's ideas in idiopathic fevers. Pinel chose to ignore his critics, however, and even forbade his followers to respond to them.
Pinel's system of classification was, of course, quite makeshift and grouped together many unrelated disorders, for example, under the classification of internal haemorrhage, he would have such diverse conditions as menorrhagia, haemoptysis, haematuria, haemorrhoids and aneurysms. Ha gave little attention to either autopsy findings or aetiology, relating his classification to clinical symptoms rather than morbid anatomy.
Pinel discarded the long-popular equation of mental illness with demoniacal possession, regarding mental illness as the result of excessive exposure to social and psychological stresses, and in some measure, of heredity and physiological damage. In Nosographie philosophique (1798) he distinguished various psychoses and described, among other phenomena, hallucination, withdrawal, and a variety of other symptoms. His classification of mental diseases retained the old divisions of such illnesses as manic, melancholic, demented, and idiotic, "for the time being," since medicine was not advanced enough for subtler distinctions.
In 1802 he published La Médecine Clinique which was based on his experiences at the Salpêtrière and in which he extended his previous book on classification and disease.
Pinel easily accepted new discoveries, including Corvisart's technique of sounding by percussion and the use of the stethoscope for mediate auscultation, introduced by René-Théophile-Hyacinthe Laënnec (1781-1826). Pinel created an inoculation clinic in his service at the Salpêtrière in 1799 and the first vaccination in Paris was given there in April 1800.
Pinel did away with such treatments as bleeding, purging, and blistering and favoured a therapy that included close and friendly contact with the patient, discussion of personal difficulties, and a program of purposeful activities. In his book Traité médico-philosophique sur l'aleniation mentale; ou la manie (1801; Medico-Philosophical Treatise on Mental Alienation or Mania) Pinel discusses his psychologically oriented approach.
Pinel's psychiatric therapeutics, his "traitement moral," represented the first attempt at individual psychotherapy. His treatment was marked by gentleness, understanding, and goodwill. He was opposed to violent methods - although he did not hesitate to employ the straitjacket or force-feeding when necessary. He recommended close medical attendance during convalescence, and he emphasized the need of hygiene, physical exercise, and a program of purposeful work for the patient. A number of Pinel's therapeutic procedures, including ergo therapy and the placement of the patient in a family group, anticipate modern psychiatric care.
Pinel was also concerned with the proper training of infirmary personnel and with the proper administration of an institution for the mentally ill. A generation of specialists in mental diseases, led by Jean Etienne Dominique Esquirol (1772-1840), was educated at the Salpêtrière and disseminated Pinel's ideas throughout Europe. He succeeded Pinel at the Salpêtrière.
Pinel was married in 1792 to Jeanne Vincent; of their three sons, one, Scipio, became a specialist in mental illness. Having been widowed in 1811, Pinel was married again in 1815, to Marie-Madeleine Jacquelin-Lavallée.
Pinel was life physician to Napoleon, but rejected the offer of becoming court physician, as this would take his efforts away from his work as a clinical physician, scientist and teacher.
He was made Chevalier of the Legion d’Honneur in 1804. A statue in his honour stands outside the Salpêtrière in Paris.
"The doors of Sainte-Pélagie opened but only for his short journey through Paris to Bicêtre, one of the worst prisons in the city. Yet Bicêtre housed criminal lunatics and had been under the benevolent superintendence of Philippe Pinel. In a rejection of the traditional and barbaric treatment of the mad, Pinel extended the revolutionary doctrine of liberty by unchaining them and treating their condition by "moral therapy". His patients were no longer to be feared, nor ridiculed, nor pitied, but understood. Moral therapy was the means by which the sane would enter the minds of the mad and endeavour to lead them. In the year of Sade's arrest Pinel had published his ideas in his Traité médico-philosophique sur l'aléniation mentale; ou la manie (1801). His theory, quickly taken up in England and elsewhere, was a perfect match for the contemporary climate of romantic sensibility and humanitarianism. Bolstered by a physiological science in the new fashion of phrenology, it marked the greatest transformation in the science of mentality since the middle ages."
Donald Thomas, The Marquis de Sade:
(In March 1803 the Marquis de Sade was moved from Sainte-Pélagie to Bicêtre)
For, in diseases of the mind, as well as in all other ailments, it is an art of no little importance to administer medicines properly: but, it is not an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them.
A Treatise on Insanity, Section 1. Translated by D. D. Davis.
In all public asylums as well as in prisons and hospitals, the surest, and, perhaps, the only method of securing health, good order, and good manners, is to carry into decided and habitual execution the natural law of bodily labour, so contributive and essential to human happiness.
A Treatise on Insanity, Section 94. Translated by D. D. Davis.
Laborious employment . . . is not a little calculated to divert the thoughts of lunatics from their usual morbid channel, to fix their attention upon more pleasing objects, and by exercise to strengthen the functions of the understanding.
A Treatise on Insanity, Section 94. Translated by D. D. Davis.
The consequences of great sorrow are among the most remarkable; they include a feeling of general listlessness, decline of muscular strength, loss of appetite, small pulse, tightening of the skin, pale face, cold extremities, very evident decline in the vital force of the heart and arteries, leading to an imaginary sense of fullness, a feeling of oppression and anxiety, laboured and slow respiration with sighs and sobs; an exhaustion of irritability and sensitivity sometimes so complete as to entail a more or less total torpor, a comatose state, or even catalepsy.
Philippe Pinel providing a synopsis of Sir Alexander Crichton's (1763-1856)An Inquiry into the Nature and Origin of Mental Derangement, . . .
Nosographie philosophique ou méthode de l'analyse appliquée à la
Recherches et observations sur le traitement moral des aliénés.
Traité médico-philosophique sur l'aléniation mentale ou la manie.
A Treatise on Insanity.
La médecine clinique rendue plus précise et plus exacte par
l'application de l'analyse, ou recueil et résultat d’observations
des maladies aigues faites à la Salpêtrière.
Resultats d'observations et construction des tables pour servir à
déterminer le degré de probailité de la guérison des aliénés.
Adynamie. Dictionnaire des sciences médicales, 1812, 1: 161-163.
Some works referred to or quoted from:
Sir Alexander Crichton:
F. J. V. Broussais:
Walther Riese (1890-1976)
Philippe Pinel (1745-1826), His Views on Human Nature and Disease, His Medical Thought.
Journal of Nervous and Mental Disease; Baltimore), October 1951, 114 no. 4: 313-323.
An Outline of a History of Ideas in Psychotherapy.
Bulletin of the History of Medicine, Baltimore, September-October 1951, 25, no. 5: 442-456.
The legacy of Philippe Pinel; an inquiry into thought on mental alienation New York, Springer Pub. Co., 1969.
Naissance de la clinique, une archéologie du regard médical. Paris, 1963.
E. H. Ackerknecht:
In the series Classics in Psychiatry. New York, Arno Press, 1976. Reprint of the 1888 edition published by Imprimeries Réunies, Paris.
Les pionniers de la psychiatrie française avant et après Pinel.
2 volumes. Paris, Baillière, 1930.
A history of French psychiatry from Jean Fernel (1497-1558) to the end of the 19th century, focused around the work of each pioneer. Semelaigne was the great grand nephew of Pinel.
Robert H. Curtis:
Philippe Pinel Links:
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