When Sir William Osler made his valedictory address to the University of Pennsylvania in 1889, he chose the subject “Aequanimitas.” He said, “In the physician or surgeon no quality takes rank with imperturbability.” Then he defined the word: “Imperturbability means coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, immobility, impassiveness, or, to use an old and expressive word, phlegm.” He was doubtful that it could be acquired except by inheritance and he thought that some of his students, “owing to congenital defects,” might never be able to acquire it. He counseled, nevertheless, that education with practice and experience might help to attain imperturbability in fair measure. The doctor, Osier felt, should develop an “inscrutable face by education of his nerve centers.” In concluding this discussion of imperturbability he said:
“Cultivate, then, gentlemen, such a judicious measure of obtuseness as will enable you to meet the exigencies of practice with firmness and courage without, at the same time, hardening the human heart by which we live.”
The mental equivalent to imperturbability, which Osler called “a bodily endowment,” is a calm equanimity. He considered that one of the first essentials in securing a good equanimity is “not to expect too much of the people amongst whom you dwell.” Osler recognized that prosperity is an aid to equanimity and enables us to hear with composure the misfortunes of our neighbors.
One wonders what Sir William Osler might have said had he had available in 1889 such aids to imperturbability and equanimity as have come with the new tranquilizing drugs. This is in the nature of a medical revolution. Ten years hence statistics of institutions for the mentally disturbed and for the alcoholic may indicate the results of an administration of these and other new remedies that are bound to come. Already the great progress that has been made is an indication of the future.
At a recent meeting of the Society of Biologic Psychiatry, the president, Dr. Harold E. Himwich, said, “A few short years ago it would have been impossible to read a paper on the new tranquilizing drugs but now we know that Chlorpromazine and Reserpine are valuable in the treatment of disturbed psychotic patients.” Since that paper was read, other drugs have been added to the list, notably Frenquel, Miltown, and Equanil. These are the drugs that affect the brain. Both Reserpine and Chlorpromazine depress the hypothalamic mechanisms, particularly that part concerned with the patterns for emergency, for fight, and flight. Chlorpromazine depresses not only these mechanisms but also the sympathetic and parasympathetic nervous systems. Other research has indicated that chlorpromazine prevents the awakening, alerting, or arousal reaction producing what is in effect a pharmacologic lobotomy. Frenquel, according to Dr. Himwich, depresses neither the hypothalamus nor the activating system and is still a potent tranquilizing drug.