Physic and fiction

PHYSIC AND FICTION

PHYSIC AND FICTION

BY

S. SQUIRE SPRIGGE

AUTHOR OF 'ODD ISSUES,* ' LIFE
OF THOMAS WAKLEY *

(\ 4/-

HODDER AND STOUGHTON
LIMITED LONDON

K

r^

-^ o o

PREFACE

There are questions whose medical bearing is
as obvious as their general importance, though
answers to them cannot be dictated by medicine.
Such questions are these, for example, to mention
three that have received and will receive discus-
sion : — Whether health certificates are necessary
for eugenic marriages ; Whether the profession
of medicine is unduly or sufficiently controlled ;
Whether secret poisoning is on the increase. It
may be easier to come to conclusions upon these,
and similar debateable matters, if some of the
reasons for and against prevalent views are
set out.

I have gone to well-known stories to illustrate
certain of those views. Most of the books quoted
are many years old, but they are ones with which
every one may be familiar, while any expression
of opinion in them shows the long estabhshment
of the methods of thought.

Four chapters in their original form appeared in
the Cornhill Magazine, and parts of others in
the Nineteenth Century and After, the Contempo-
rary Review, the English Review, and the Burlington
Magazine. I wish to thank the respective editors
for permission to include these chapters here.

o. o. o*

Stoke Green,
Buckinghamshire, Oct. i, 1921.

CONTENTS

CHAPTER I
MEDICAL PRIESTCRAFT

PAGE

The Universality of Medicine — The Distrust and Faith of the
Public — The Development of General and Medical Edu-
cation— Podsnap and a Parable — The Prospects under a
Ministry of Health — The Question of Legal Protection . i

CHAPTER H

THE OLD-FASHIONED DOCTOR

What is Old- Fashioned? — Early and Late Greek Medicine —
Mediaeval Mysticism — Harvey and Lister — The Pre-Lis-
terian Leaders — Cause and Effect: the Prevention of
Malaria 27

CHAPTER HI

MEDICINE IN FICTION

The Novelist and the Medical Profession — The Treatment of
Disease in Fiction — The Popularity of Phthisis and
Malaria — Charles Brockden Brown — Dickens and
Thackeray on Fever — An Unsuccessful Competition . . 53

CHAPTER IV

THE MEDICINE OF DICKENS AND A NOTE
ON 'DR. GOODENOUGH'

Dickens as a Neurologist — A Pathologist in the Street— The

Death of Krook — Dickens and Thackeray as Social

Observers — The Church, Law and Medicine — Who was

Dr. Goodenough ? 89

ix

X PHYSIC AND FICTION

CHAPTER V

'THEY ALL LIVED HAPPY EVER AFTER'

PAGE

Marriage as an Individual^ a Social and a Racial AJfair —
Fairy Stories— Medical Inspection and Marriage Settle-
ments—Heredity and Disease — Mendelism and Marriage
—The Maligned Jukes 120

CHAPTER VI

PRIZES AND PERFORMANCES

The Significance of Prizes— The Real Professional Race— The
Race illustrated by Medicine — Some Figures from Three
Great Hospitals 14S

CHAPTER Vn

SOME PUBLIC DEVELOPMENTS OF
MEDICINE

Medical Standards after the War— The Ministry of Health —
The Great Ideals of Ninety Years Ago — Disraeli, Gaskell,
Kingsley and Dickens as Sanitarians — The Modern
Outlook of Medicine 176

CHAPTER VHI

THE PATHOLOGIST IN THE STREET

The Artist, Novelist, and Doctor Abroad — Snapshot Pathology
and Pavement Diagnosis — Modern Cosmetic Surgery —
Victor Hugo atul Sheridan Lefanu 201

CHAPTER IX
MEDICINE IN ART

L'Art tt la Mcdecine — Plague as a Favourite Subject —
Emerods and Mice — The Value of Pictures to Pathology
— ''Bernini's Enigma'' — fane, John, and the Faticiulla
d'Ansio — Incredible Pictures and Credible Stories , . 225

CONTENTS xi

CHAPTER X

COMFORTABLE WORDS ABOUT POISONING

OLD CASES

PAGE

Where Truth beggars Fiction — The Case of Mary Blandy,

John Donellan^ and John Tawell 248

CHAPTER XI

COMFORTABLE WORDS ABOUT POISONING:
MODERN DEVELOPMENTS

Four Medical Miscreants — Bacteriological Poisoning . . 268

CHAPTER XH

PRIMORDIAL AND OTHER STUFF

The Survival of Personality — Ether as the Primordial Matter
— The Position of Professional Thought — Mysticism and
the Law — ''Phenomena of Materialisation^ — Thomas
Vaughan — Medicine as Counsellor 286

CHAPTER I

MEDICAL PRIESTCRAFT

The Universality of Medicine — The Distrust and Faith of the
Public — The Development of General and Medical Educa-
tion— Podsnap and a Parable — The Prospects under a
Ministry of Health — The Question of Legal Protection.

The importance and universality of medical inter-
ests which had become of late years obvious to the
public, if only because of the amount of legislation
inspired by the desire to save life and preserve
health, are now recognised in the institution of
a Ministry of Health. The Children's Bill, the
Registration of Midwives, the Inspection of School
Children, the various Public Health Acts, Acts to
ensure purity of food, the Factory Acts, Quaran-
tine legislation, even the Licensing Act, suggest
themselves at once as measures having a distinctly
medical bearing, and the arguments employed
within and without Parliament in their discussion
could all have found inspiration in medical text-
books. Numerous public orders for the notifica-
tion of diseases, and certain national movements
for combating them, have emphasised the world's
dependence upon right medical guidance. It has,
as a result, been borne in upon us that every phase
of life, every art and science, every calling and
career, every edifice and exploit, every crisis and

A

2 PHYSIC AND FICTION

catastrophe, may be viewed from a medical stand-
point ; and while members of the medical profes-
sion may be inclined to regard existence too
exclusively from this standpoint, all, whether
specially interested, or assisted only by general
intelligence, or, perchance, hampered by a want of
imagination, are bound to keep the medical factor
in remembrance. And, through the magnificence
of the unknown, those who know least about
therapeutics give them the most excited attention ;
wherefore the majority of the questions asked by
the public of doctors may receive the flat ' yea '
or ' nay ' which is the only possible reply, but
which forces medicine into an unsought position
of popishness.

The prominence of medicine in men's thoughts
grew during the War, and is now even more marked.
It may be realised that this position, however
flattering, is not without its present drawbacks for
the medical practitioner, but it is one of enormous
promise for the world ; the drawbacks, as far as
the medical practitioner is concerned, are of small
consequence in comparison with the promise, and
will disappear as knowledge progresses. Where
medicine is made to pontificate, the leaders, in
giving advice, must take risks that never before
offered themselves, but with the discussion of this
advice will come the revelation to the pubhc that
there are sense and method behind medical science.
That, at any rate, is the comfortable behef here
adopted. The interest in medicine that is now

MEDICAL PRIESTCRAFT 3

shown compulsorily, reluctantly, or even with too
great alacrity, by the public will be replaced, in
no short time (I think), by some general under-
standing of the aims of hygiene, and by common
consent to take all steps to maintain a high stan-
dard of health.

Criticism of the professed expert will then be
enlightened, and will keep medical counsel authori-
tative where it is asked for ; resistance to what is
undisputed in scientific opinion will be held by
society at large to be a menace to public safety,
and will be excused rather out of toleration for
ignorance than out of respect for the manifesta-
tion of independence. It should be possible to
avoid the bitterness and foolishness of making
martyrs, by ensuring that enactments, made in
behalf of public health, are capable of popular ex-
planation. We are far from such a state of things
now, and narrow and timid spirits among medical
men, either afraid of or intolerant of public judg-
ment, invite unquestioning acquiescence in their
plerophories ; but we are none the less approach-
ing the day when familiarity with the principles of
health will be the propertj/ of all educated com-
munities, and when most communities will be
educated at least to such a point that the majority
will be able to sift gross and palpable falsehood
from the proven truth, and thus to advance
irresistibly the doctrines of right judgment.

What are the drawbacks to-day for the medical

4 PHYSIC AND FICTION

practitioner, the disappearance of which is prophe-
sied in the near future ? They are the distrust of
the pubhc and the unreasoning faith of the pubhc,
for these are the things which lead to disappoint-
ment when impossible events do not take place,
and to want of appreciation when great deeds have
been accomplished. From this situation there
arises a sense of irritation which is none the less
real because both parties feel that their variance
is unreasonable. The medical man longs to say :
Such a thing is so because it is so, and no purpose
is served by my disputing with persons who cannot
follow my arguments ; but the most arrogant of
his species know that this position cannot be taken
up in the twentieth century, though it might have
been pardonable two hundred years ago. The
layman would like to say : Such a thing is not so
because many occurrences disagree with the pro-
position ; but only the very self-satisfied can
assume this front towards a sincere worker in what
after all must be a special line of learning in many
cases, however general the interests involved.

The distrust of the medical man is as old as the
world, and the same may be said of the unreason-
ing faith in him, but while both will cease when the
aims and principles of medicine are better esti-
mated, both have been increased by the great
advance in general knowledge due to the spread of
education, together with the stronger enlighten-
ment of the public as regards hygiene. The in-
creasing wisdom of the public has led to more

MEDICAL PRIESTCRAFT 5

questions being asked, but not, as yet, to a parallel
comprehension of the answers. The science of
medicine progressed as quickly as, if not more
quickly than, any other branch of human know-
ledge during the last strenuous century, but its
strides forward have not been taken at their proper
worth by those who are outside the actual struggle.
There is nothing surprising in this. Some of us
have attended a race-meeting of motor-cars or
bicycles, and have found how impossible it is to
guess which is the winning competitor owing to
the ' lapping ' that may take place on a circular
course, and to the working of time handicaps
which we have understood only imperfectly. We
have been unable to beheve that the car or cycle
which is leading as it passes us is not the winner,
and, on having our impressions corrected, have
felt a little impatient of the methods employed.
We wish that we could see all the competitors
started side by side at the same time, off the same
mark, to race their fifty miles on a straight track.
That would be a race which we could understand ;
we could see how each competitor stood at a given
point, and could recognise the winner without
having to be told of non-apparent conditions which
are determining the destination of the prizes.

It is an unfortunate fact that the meaning of
much progress which has taken place in medical
science is lost upon those who are not actually
taking part in the struggle, or who are not aware of
the handicaps or allowances under which the work

6 PHYSIC AND FICTION

is being done, or of its exact object. This breeds
annoyance. A large number of intelligent people
say, Where is the progress of medicine ? People
still die of pneumonia, and medical science has not
come to an agreement as to a routine of thera-
peutics. Cancer is on the increase, and much of the
work that is being done in connection with it has
no direct bearing on treatment. Influenza has
recently decimated populations, and we are told
that its causal agent or agents being still unproven,
medicine cannot propose a specific remedy, but
must content itself with the treatment of symptoms
which may be due to the malign presence of germs
not peculiar to influenza. Instances might be
multiphed where the pubUc, not wholly under-
standing the conditions of the race between
science and disease, have been unable to appre-
hend how far medicine is gaining in the struggle.
Such information as is supplied to the public is
very generally supplied in an unassimilable form,
the language for necessary reasons of precision
being highly technical. For example, the publi-
cation of the proceedings at the numerous inter-
national congresses having some hygienic or sani-
tary reason should help to make a very large body
of readers aware of what is being done in the
medical world, but the debaters cannot argue with
one another if they do not understand thoroughly
each other's positions, and this can, of course, only
be secured by the rigid use of scientific terms.
As more and more of the grammar of preventive

MEDICAL PRIESTCRAFT 7

medicine becomes familiar knowledge, it will be
more and more easy for all to perceive what the
professional expert is talking about ; but for the
present the public is puzzled, alike by the appar-
ent long-windedness of the discussions and by
lack of immediate reform, following upon any
recommendations made by the general resolutions
of the congresses. It finds medicine not only
wordy but unpractical, not perceiving that all
which a congress can possibly accomplish is to
place before Governments the expert opinion,
leaving the Governments, whether of their own
initiative or in deference to popular wish, to give
effect to the opinion by legislation.

These circumstances are bound to affect medicine
nearly, because the spectators of the race between
science and disease cannot be disinterested, and
when they miss the significance of important stages
in the contest they do not pause before allotting
the blame. And it is a disagreeable fact that
things may appear worse as they are growing
better ; medicine may be more shrewdly criticised
as the time gets nearer when its work will be more
highly prized. All men in all times have been
deeply concerned about their healths ; and all
men in all times have had some knowledge of
medicine derived from personal experiences, well-
founded tradition, and an elementary sense of
logic. Though profoundly anxious to be cured, the
public was formerly prepared to leave the processes
to be employed in the hands of medicine men who

8 PHYSIC AND FICTION

knew the secrets of nature. It is all to the good
that this position is changed, but for the time being
there are some who miss the old attitude of un-
questioning deference. The silliness of those who
harbour such a regret is not so surprising as their
short-sightedness. The expansion of learning that
has taken place in medicine has been going on in
all other branches of knowledge, whether nearly
allied to medicine or not ; but the doctor has not
been prompt to note the general advance or to
read in it the promise of the future. Where the
sciences more directly ancillary to medicine are
concerned, the old boundaries between them and
medicine have been removed, so that no man can
say exactly where chemistry stops and where
physiology begins, what familiarity with electricity
rightly appertains to the medical man's calling, or
what knowledge of physics or of statistics should
be presupposed in a medical practitioner. Not
only has the medical student much to learn, but
his status is altered when he has learned it. In-
stead of occupying one of the three peaks where-
from the exponents of the only learned professions
— divinity, medicine, and law — looked down on
the unlettered masses, the medical man is now
classed with other practical workers who have an
equal claim with him to be considered men of
science. Such persons will not revere the practice
of medicine as something too learned or too
mysterious for their grasp, although they may
respect it because of its scientific aims. They will

MEDICAL PRIESTCRAFT 9

be critical, and it is right and fair that they should
be, but for the time being the profession of medi-
cine is often put into an awkward position thereby.

A medical man is not necessarily as good a
chemist as a pure chemist, or as resourceful an
electrician as a pure electrician, or as versed in the
controversies of Darwinians, Neo-Mendelians, and
others as the pure biologist, or as astute a statisti-
cian as an actuary ; at the same time his chemistry,
his electricity, his biology, and his mathematics
have to be brought into action not in the ideal or
exact conditions of laboratory or workshop, and
not in accordance with well-argued theory, but in
all sorts of environments, in all sorts of conditions,
and on subjects in all sorts of moods. The
pathology of the sick man is complicated not only
by his individual physiology and psychology but
by those of his medical man ; and physio-psycho-
pathology, with two personalities involved, forms
a difficult analytical study, as Cornelia Blimber has
shown once and for all. Exact results cannot
always be expected, the laws of averages and the
deductions of mathematical probabilities must be
set off against individual successes and failures,
and though it would be too sweeping to say that
the only way of estimating the progress of scientific
medicine consists in showing that vital statistics
improve steadily, yet figures, properly corrected
and properly used, form the most valuable testi-
mony to advancement.

This compound of certainties' and uncertainties.

10 PHYSIC AND FICTION

this science based on other sciences, this art in the
practice of which intuition and genius can play as
great a part as they can in music, has been placed
on a more secure footing by the institution of the
Ministry of Health whose executive officers are the
doctors of the country. The result is that the cry
of medical priestcraft has been raised, and will be
raised still louder if any Government inquires into
the results of unquahfied medical practice, as many
Governments have been urged to do.

Hitherto the relations between medicine and the
State have been hmited, and the need for such
inquiry has not been as obvious as has the incon-
venience that would ensue upon it. But to-day
Parhament must give hearing to measures of
reform demanded by the Ministry of Health, and
ere long the hcence of unquahfied medical practice
will come under consideration . When this happens
scientific medicine must be prepared for the accu-
sation that its followers exercise ' the arts used by
ambitious and worldly priests to impose upon the
multitude.' The whole meaning of what is being
done in medicine escapes the intelligence of those
who join in this cry of medical priestcraft. But
it is unwise of medicine to provoke attack through
seeking unnecessary protection, and careless of
its disciples not to perceive the grounds upon
which attack can be based.

There is no doubt that a large section of the
public views the opinion of scientific medicine with
suspicion. The indisputable services of medicine

MEDICAL PRIESTCRAFT ii

during the War have led to some revision of opinions
and change of bias, but there is still a belief, fairly
widespread, that those who pursue medicine as a
calling desire to enslave the minds of their fellow-
citizens. The critics of medicine are in revolt
against the edicts of hygiene, considering them
intolerable because founded on principles which
appear to be so disputable, which are so disputed,
and which, it is admitted, are not in all instances
very stable. Having pointed out the failure of
medicine to cure cancer or to prevent appendicitis,
they proceed to argue thus : A hundred years ago
bleeding was an almost universal procedure ; now
bleeding is discountenanced entirely by medical
men as a general mode of therapy, though in par-
ticular cases it is still employed. More recently
Koch, or rather his too sanguine followers, pro-
claimed tuberculin as a panacea for tuberculosis, a
view that was very generally adopted, to be very
generally discarded and again to gather adherents.
If such right-about-turns can be made, why should
not their like be made again ? The question can
only be answered by admitting that medicine is
fallible, and the answer is a very conclusive one.
Medicine is not as yet an exact science. Results
sometimes appear to justify means without it being
possible to determine the intervening processes ;
and means which ought to lead in certain direc-
tions, by failure of intervening processes give no
determined results. All this cannot be denied.
But what is not sufficiently appreciated is that

12 PHYSIC AND FICTION

medicine is advancing all along the line towards
the position of an exact science, while losing Uttle
of its claims to be an art, and that the risk of any
generally wrong therapeutic measure being thrust
upon the pubhc decreases steadily year by year.
Individual medical men will make, and must make,
individual errors, and if one of these has a com-
manding personality he will for a time attract
disciples ; but, since modern methods of medical
research began to be put into practice, the oppor-
tunity for a wrong or even an empirical scheme of
therapeutics being adopted by medical men as a
body has become very small. Granted that in
all instances a logical sequence cannot be found in
the cause and treatment of disease — here the
cause, there the treatment, and in a third place the
relation of treatment to cause or cause to treat-
ment cannot be stated ; on the other hand, it
must also be granted that the elements of uncer-
tainty which excuse empiricism are being analysed
away. Bright light is being thrown upon etiology
everywhere, clinical procedure has been vastly
improved, and the whole course of medicine has
been along various upward paths to a plateau of
logic and exactness. The awkward questions
which can be put grow less numerous ; their
answers become easier. And this partly because
doctors have fewer gaps in their knowledge, but
particularly because a right appreciation of service
is growing apace, and the public questions are
much better directed.

MEDICAL PRIESTCRAFT 13

Medicine, an art as well as a science, like other
arts, must live often unacclaimed, content to bear
the coldness of the uninitiated, if only those who
do know will welcome the attempts that are being
made, and will recognise the honesty of conviction
by which they are inspired. Podsnap will not
do this. Podsnap was a plain man, and while he
is a precious burlesque in the manner of his plain-
ness, in essential he is with us in crowds. Such a
plain man says in regard to pictorial art, ' I know
nothing of pictures, but I know what I Hke,' and
means to imply by his words that he is a shrewd
critic, one that is honest and free from prejudice.
He is, of course, nothing of the sort. His un-
trained eye is interfering with his judgments all
the time, preventing him from grasping the effect
of colour fully or the appeal of line accurately, and
forcing him to approve only the mediocre work
where the qualities are unable to give any challenge.
He is best pleased with what demands least com-
prehension, though he would not allow this, but
would rely on his admiration of the faithful
rendering of some accessory to prove him to be a
critic with high standards, who will not tolerate
any shirking of difficulties. The art of medicine
has to undergo the ordeal of such criticism from
plain men, and the result is that much of the
medical achievement that is praised by the public
is of small account in reality, while the finer aims
of medicine pass unregarded. ' I know what I
want,' says the plain man ; ' I want my doctor to

14 PHYSIC AND FICTION

tell me what 's the matter and make me better.
I want to get value for my money.' Nothing
could appear more reasonable, and if only his
wishes could be granted in all cases, he would be
right to complain if they were not granted in his
own. Unfortunately this precision in result can
scarcely be reached. There must as yet be an
average number of unprecise diagnoses, owing to
scientific defaults, and these lead to tentative treat-
ments— to say nothing of the percentage of error.
But as it is certain that in a far larger number of
instances than was the case, say, fifty years ago,
the precision is approached, the sense of grievance
on the part of the public is ungenerous. Or it
is founded upon a too hasty contemplation of the
complicated relations between the doctor and the
patient. A carpenter can make (let us say) a set
of shelves to fit a certain corner for a certain sum
of money. He acts on definite instructions as to
number of shelves and thickness and material of
board ; the shape of the corner dictates limits
which he can ascertain with a foot-rule ; the wood
is a rigid substance not varying in size or shape
after it has been cut. But such carpentry does not
always give satisfaction. The instructions may
not have been definite enough. For example, the
order may be for six shelves without specification
as to their distance from each other, and the custo-
mer having intended the intervening spaces to
become gradually larger from above downwards
may find that the carpenter has made the spaces

MEDICAL PRIESTCRAFT 15

equidistant. Or mahogany may have been em-
ployed instead of walnut ; or five pounds may
have been charged instead of three pounds ten.
The frailty of man is recognised in such situations
by the rendering of a detailed estimate before the
contract is entered upon, and it is an everyday
experience that where this precaution has not been
observed misunderstandings may arise, apart from
all questions of deliberate extortion or deliberate
shirking of obligation. Now let us suppose that
no written evidence of the terms of the contract
existed ; and, further, that the corner was not
always the same shape, so that it might change its
angles after measurement either on its own account
or on account of a general shifting of the building ;
and, further yet, that the wood was not constant,
becoming circular when cut square, or thin when
cut thick — in face of such fluctuations how difficult
it would be for the carpenter to make the shelves
with any certainty of a satisfactory result !

I do not draw, in an obvious and perhaps un-
necessary little parable, any close parallel between
the public and the customer, the patient and the
material, or the doctor and the carpenter, but
some of the questions at issue between the public
and the doctor are exactly illustrated by the diffi-
culties in which a carpenter would be placed, in
the imaginary case of all his instructions being
vague or open to error, and all his conditions of
labour mutable. It is not humanly possible to
be certain in any diagnosis, if by diagnosis we

i6 PHYSIC AND FICTION

mean an estimate of a person's exact condition of
suffering. Yet no treatment can be considered as
wholly appropriate, or indicated in such a way
that no other treatment or modification of treat-
ment is possible, while a single element of doubt
exists in diagnosis. A shelf cannot be cut to fit
a certain corner if the measurements of the corner
are uncertain and unstable. A medical diagnosis
has to be made by a fallible man upon evidence
supplied by other falhble men, and to arrive at the
sum of error with which a diagnosis may begin, all
that the doctor may not himself detect has to be
added to all that may be wittingly or unwittingly
concealed from him by the patient or other wit-
nesses. Temperament and environment of various
sorts have to be taken into account, as well as
general physical health, before this diagnosis is
arrived at, and from the welter of speculations,
vague or precise, a scheme of therapeutics has to
be evolved, and a prognosis or guess at the future
history of the disease and its result to the patient
has to be given. The treatment commences, being
based upon personal and traditional experience in
such matters — in other words, being based upon a
law of averages, with an eye to idiosyncrasies.
The inexactness is obvious. Informed in a hap-
hazard degree, and controlling tactics to some
extent by theoretical considerations' the doctor's
course towards his end is also inexact. The human
body cannot be treated either as a test-tube or a
plank ; and procedures, analogous to those which

MEDICAL PRIESTCRAFT 17

the chemist or the cabinet-maker employs, and
having their origin in knowledge gained from
laboratories or workshops, when they succeed, do
so by processes the whole of which are not yet
known to science.

A diagnosis, a prognosis, and a plan of treatment
regarded from this point of view form matters of
deeper difficulty than many plain men think. This
is the veritable demand upon the doctor. He is
asked for the application of the general prin-
ciples of medicine, for full memory of what he
has himself learned in practice, and for a catholic
power of drawing upon analogies, as they are
furnished, and often only vaguely furnished, by
sciences allied to his own. It is not surprising
that the more experienced the doctor is, the more
deep do the difficulties seem. Yet in the large
majority of cases the doctor is right. The ob-
servation of symptoms, attention to the law of
averages, and allowance for individual circum-
stances guide him to a correct estimate alike of
the present state of the patient, of his future
changes and chances, and of the best way to secure
that those changes and chances shall be fortunate.
But remembering that every part of the body is
dependent upon all the other parts to some extent,
so that at any moment a local condition may
produce a general disturbance, or a general con-
dition may modify a local manifestation — remem-
bering these things in addition to all the other
reasons for uncertainty which have been enumer-

B

i8 PHYSIC AND FICTION

ated, it becomes easy to see that the doctor ardently
desired by Podsnap, who simply says what is wrong
and how it should be righted, cannot be forthcom-
ing in every event. When the terms of the con-
tract cannot be arrived at, when the wood alters
its shape, when the corner alters its contours, and
when the ruler is not always true, the shelves run
a risk of not fitting.

But in a steadity increasing number of cases
medical knowledge is getting ahead of disease, and
when this is more widely recognised, a public which
now regards the doctor as ineffective because he
cannot perform miracles, will allot him right regard
for what he can do. Medicine must always present
difficulties when it is considered as a science. Ob-
viously its study is hampered by the fact that it is
founded upon a group of sciences and that none of
them can be held to be exactly applied. Medicine
without chemistry is unthinkable, yet medical men
are not necessarily great chemists. On the con-
trary, too rigid an adherence to the principles of
chemistry may lead the physiologist into error, for
the body is not a test-tube, and vital processes
must not be expected to occur as they do in vitro.
Simple principles of physics underlie anatomical
action, but faulty movement cannot be remedied
with any certainty by mere carpentry, for every
factor in that action is susceptible to many and
comphcated influences. As a carpenter, as an
electrician, as a botanist, as a chemist, and even as
a biologist the medical man may often be doubt-

MEDICAL PRIESTCRAFT 19

fully regarded by special workers in those callings ;
but he has to rely upon the general principles laid
down by these special workers, and to adapt them
so that they may find a place in one flexible and
ill-defined scheme. The medical practitioner has
therefore two sets of critics : those who demand
from him guaranteed results in individual cases,
and consider that his occupation is a shifty one if
he cannot meet their requirements ; and scientific
men, of more than one branch, who see in him a
struggler in a medley of sciences, eternally com-
pelled to make allowances for compensating or
disturbing influences which ought to be eliminated
in all careful experiments. And all of the critics
may have as good a general education as the medical
man, who cannot, as he did in the fifteenth and
sixteenth century, take up any position of superior
learning with them and stifle comment by pooh-
poohing, even though he knows that the detraction
of his calling emanates from ignorance or mis-
understanding. And so we see that the spread of
education, though it has done so much for the
cause of medicine, has produced a sort of dilemma
for medical men. It has deprived them of any
exalted platform from which they can preach by
raising a large number of persons to the same
educational level as the doctor. This we need not
regret. But at the same time no large spread of
knowledge and intelligence has resulted which
would secure for the doctor general sympathy in
the daily problems of his work.

20 PHYSIC AND FICTION

Doctors are a much criticised class of citizens.
Tliey are not so universally disliked as house-
agents, they are not so universally mistrusted as
dairymeU; but, despite the sincere and frequent
eulogium which they receive for their self-sacrifice
and accomphshment, they are regarded in the mass
with lukewarm respect as the exponents of an
unsatisfactory branch of learning ; magical skill
is credited to a few, boundless admiration is
expressed for the mechanical dexterity required in
certain operations, but the collective efficiency of
medical men was never more called in question
than it is now. And never with less reason. The
education of the public which has conduced so
much to this state of affairs will, as time goes on,
be itself the remedy. This is inevitable, the intru-
sion of the medical factor in so many questions
of pubHc interest compelhng an increasing number
of thoughtful men to solve a certain number of
medical problems for themselves, or to co-operate
with medical men in their solution. The sanitary
service has already produced great results in this
direction in England. The appointment of medi-
cal officers of health to many of the counties, to the
big boroughs, and to associated groups of sanitary
authorities, the whole time of these officials being
given to their administrative duties, has been the
means already of informing many hundreds of
laymen as to the aims of and the procedure in
preventive medicine. Water-borne and air-borne
contamination, the segregation of infectious persons

MEDICAL PRIESTCRAFT 2i

and the value of the notification of such cases at a
central bureau, the cost of hospital administration,
the risks of improper housing, the terrible effects
of adulterated food — these matters are now dis-
cussed all over the country, and the members of
the sanitary authority and their medical officers
mutually inform each other at the debates. If the
authority looks to the medical officer for strictly
medical guidance, the medical officer on his side
has to learn to give the reason for the advice which
he tenders, and so becomes famiUar with the
points which laymen, many of them as well edu-
cated and as capable as himself, find hard to
understand.

The War has brought a wider diffusion of sanitary
sense, and a quickened avowal of the public debt
to medicine. The arrival of the Ministry of Health
has sohdified the medical status and should lead
from now onward to an expansion of the medical
services of the country, devised so manifestly for
the public good that no cry of class preferment or
priestcraft will find a loud echo. Especially will
it be the duty of the Ministry of Health to see
that a spirit of give-and-take prevails. There
are sanitary authorities whose members show no
desire to learn, and medical officers of health who
have not the gift of explanation ; there are sani-
tary authorities whose members treat the medical
officer of health as a servant only and not as an
adviser, and there are medical officers of health
who lose sight of the fact that they owe allegiance

22 PHYSIC AND FICTION

to their authorities ; there are sanitary authorities
whose members are corrupt, and there may be
medical officers of health who play into their
hands, but there is no recorded case. In spite of
the fact that the relations between the sanitary
authorities and the medical officers of health are
not always harmonious, the Sanitary Acts are an
effective instrument for the instruction of the
public in preventive medicine, and are bound to
have a growing influence in this same direction.
The Midwives Act has taught many persons the
handicap to which medical practice has to submit
when weighted by every conceivable opposition to
scientific principles ; and the working of this Act
having proved quite unsatisfactory, a Depart-
mental Committee appointed by the Privy Coun-
cil has inquired recently into its defaults. As the
shortcomings found in the Act were exactly what
many medical men pointed out that they would be,
the recommendations of the Committee followed
the anticipated direction. This should strengthen
the medical position, and prove that the profes-
sional protest against certain provisions in and
omissions from the Act were uttered in no trade-
union spirit, but were in accordance with public
pohcy. Here again the medical man and the
pubHc are learning to understand each other. But
no recent legislation has had so sure a tendency in
this direction as the Act for the medical inspection
of school children, which to some extent hnks the
advance of the nation in education with its

MEDICAL PRIESTCRAFT 23

physical advance. The passing of the Act was
itself complete testimony that the popular wish
was all in favour of a hygienic upbringing for
children, and when the work is in full swing every
schoolroom will be an opportunity for the display
of clinical wisdom, and every educational authority
will perforce have to learn something of the diffi-
culties of medicine. Lastly, the granting of a
charter of incorporation to the Medical Research
Council has formed at the same time a fine recogni-
tion of medical science and a practical bond be-
tween the nation and the doctor. The pioneers
of medical thought, in association with selected
laymen, can through this Council meet the rulers
of the country face to face.

Social movements are playing a similar part.
A large number of persons are now engaged in
practical philanthropy, and their labours have
very generally a medical basis, compelling them to
acquire knowledge of many of the circumstances
which complicate the practice of medicine. The
national societies for the prevention of tubercu-
losis and the control of venereal diseases, all
schemes for the feeding of school children or for
the provision of economical canteens, all move-
ments for the help of nursing mothers or for their
education and assistance in bringing up the
nurslings, all the systematic visiting of the poor
that is now being done with the object of instilling
the principles of sanitation — the hst of similar
philanthropic endeavour might be lengthened —

24 PHYSIC AND FICTION

have one certain result : they let those concerned
into the secrets of many medical embarrassments.
Drawing-rooms discuss these and cognate themes,
such as the alleged physical deterioration of the
race, heredity and Mendelism, and the arguments
for and against total suppression of alcohol, and the
notification of venereal disease. Such discussions
sooner or later get upon a medical basis, or at any
rate have to take into account the medical factor,
and lead consequently to the familiarising of the
public with medicine. For example, a desire to
fit the Mendelian theories and expectations to real
life, and to take discussions of Mendelism into
realms beyond the grower of the pea and the
breeder of the Andalusian fowl, will set a student
of these theories tracing pedigrees in his country-
side. His original object in his house-to-house
visitation of the peasants will be, perchance, to
find out if the blue-eyed parents have bred blue-
eyed children, or if the lineage of a hammer-toed
family conforms to Mendelian notation, but one
outcome of his researches must be a first-hand
knowledge of the shortcomings of labourers'
cottages. The inevitable result of this will be a
far more sympathetic and intelligent view of the
work of the medical profession, and probably even
a general opinion that, all things considered,
doctors do not do their work badly.

When this position is reached, will the pubhc,
and will the medical profession, have anything to
gain from changes in the laws of the country by

MEDICAL PRIESTCRAFT 25

which medical practice is made strictly illegal
in the hands of those without a degree or a dip-
loma ? The affirmative answer is not so clearly
indicated as might be expected. For all pro-
tected industries are confessedly weak to the
extent of their protection. At any rate, such
changes as are made must be made not with
the wish to uphold the privileges of a class,
but with the intent to protect the pubhc, and,
further, with the wish to elicit who is able, not
being a doctor, to render none the less service
in certain directions. By as much as the public
is able to appreciate the real aims of medicine,
by so much will the cry of medical priestcraft
be a feeble one in face of coming reforms. It is
inevitable that the cry should be raised. Not only
will those usually to be found in revolt against
accepted principles be irritated at any further
control of quackery, which they will regard as an
attempt to define more strictly the limits to their
freedom ; but sentimental people will take the
opportunity of saying that already the medical
profession consists of a too protected class. These
excitable folk are not numerous, but some of them
are honest and none of them is silent ; they will
take pains to make their beUef heard that medical
men use their privileges to cloak their enormities,
and that no legislation can be required which does
not start with the abolition of the Medical Acts.
This will put them out of court.

The universahty of medical interests has be-

26 PHYSIC AND FICTION

come of late years obvious to the public ; the
estabHshment of the Ministry of Health is the
sohd result of the newer outlook ; and the spread
of education will lead to more widely diffused
sympathy with medical aims, closing the mouths
which clamour in ignorance rather than in malice,
in soft-heartedness rather than in accuracy, for
the disestablishment of a non-existent medical
priestcraft.

CHAPTER II

THE OLD-FASHIONED DOCTOR

What is Old-Fashioned ? — Early and Late Greek Medicine —
Mediaeval Mysticism — Harvey and Lister— The Pre-Listerian
Leaders — Cause and Effect : the Prevention of Malaria.

That the calling of medicine and the growth of
religions have been associated in the evolving
stages of various civilisations is common know-
ledge, though the parallel between the medicine-
man and the priest has been too closely instituted.
Sir Chfford Allbutt has pointed out that there is
no sign in the Homeric poems of the subordination
of medicine to religion, while in many cases the
priest seems to have been either an oracular
medium or a court magician, without being a
practical therapeutist.

The development of general education, coincid-
ing with remarkable medical progress, has rendered
the estabhshment of a medical priestcraft to-day
impossible ; the absence of sanctity from medical
legislation has been abundantly evident to an in-
structed community. Further, those who would,
on high and low grounds ahke, be considered the
willing supporters of medical priestcraft — who
would like again to see a special class of sorcerers
segregated from the community and entrusted

87

28 PHYSIC AND FICTION

by it with the discharge of duties on which the
pubhc safety and welfare are believed to depend —
have never, of late years, manifested any feeling
save total disinclination towards the assumption
of class privileges. The mysteries of the leaders
of medical thought have been steadily revealed to
the world, and the only intrusion that is resented
is the intrusion of those who criticise the medical
profession without taking the trouble to use proper
sources of information, or to investigate the real
meaning of what they condemn. A medical man
must issue orders sometimes without being called
upon to explain them to all and any, for otherwise
the funeral might precede the diagnosis. And,
under the direction of higher powers than he him-
self possesses individually, namely those of the
collective wisdom of medicine, he employs a ritual
sometimes whose beneficial action may be clear
to him, but whose logicality he cannot wholly
estimate. But, as years go on, the empirical ritual
wanes under experience of its unsoundness, or
waxes to become scientific procedure as new dis-
coveries point to its logical basis. In either event
there is a diminution of sacerdotal character.
This may be illustrated aptly by the position of
the doctor in the mid- Victorian era, when medical
pronouncements were delivered more oracularly.

For the last quarter of a century in the obituary
notices of a good many physicians and surgeons,
all of whom were well known in their day, and
some of whom will hold an undoubted place in the

THE OLD-FASHIONED DOCTOR 29

historic roll of medicine, the phrases have occurred
that with such an one ' a type of an older school '
or ' one of the last of the old-fashioned doctors *
has gone, or ' a Unk with the past ' has been
snapped ; but as the past is a period of unhmited
retrospect, and as what is old-fashioned is the
subject of opinions which themselves are the sub-
ject of changes, the meaning which it is intended
to convey is not clear.

What is not old, what is old, and what is very
old indeed, are matters of relativity in every de-
partment of hfe, but the epithet old-fashioned, as
commonly used, does seem to put a term to the
period of antiquity, and to suggest that, by com-
parison with the length of time which might have
been brought into discussion, the range to be con-
sidered is brief. So when the old-fashioned doctor
is spoken of, while we imply that he is one whose
methods are out of immediate date, we also imply
that those methods have distinct affinity with the
procedures of our time. That is the significance
of the familiar phrases quoted. No one would
allude to Galen as old-fashioned ; and when leaping
the vast gulf between classical and mediaeval
culture, we come to Paracelsus, Linacre, and
Vesalius, the epithet old-fashioned remains inap-
pHcable. We are still too far away from them in
thought as well as in date to call them old-fashioned ;
but it is the difference in mental approach, not the
difference in the calendar, which counts, for cychcal
recurrences of thought may render the oldest series

30 PHYSIC AND FICTION

of observation pertinent to existing conditions,
just as we may at any moment witness a bias of
taste, tm'ning an apron of leaves into a modish
smnmer confection.

The position which medicine in connection with
the study of natural science had reached in the
time of the Ptolemies is comparable to its position
in the eighteenth century — nothing between those
dates counting much in a large sense. Along
certain clinical paths, for this reason, it would be
correct, despite what has just been said, to bring
Hippocrates into line with the practice of to-day
by caUing him old-fashioned. In that glorious
and curious stage of the world's learning, illustrated
and mocked by Rabelais, many valuable thera-
peutic additions were made, but the scientific
thinkers were less ready for the doctrine of the
circulation of the blood than they would have been
nearly two thousand years earher in history. When
at the end of the sixteenth century Harvey arrived
with his grand discovery, he had hard work to con-
vince his own colleagues that he was right ; he
might have found it easier to discuss the mechanics
of the circulation with the great anatomists of
Alexandria than with any of the uromaniacs and
alembists who gained the ridiculing attention of
the Abstractor of the Quintessence (see Pantagniel,
Bk. 4, ch. 7). The anatomy of Vesahus was, no
doubt, ahead of that of Herophilus — Vesahus is
a really great figure — but, nevertheless, three
hundred years before the Christian era such men

THE OLD-FASHIONED DOCTOR 31

as Herophilus and Euclid would have been readier
for scientiiic conviction of the value of Harvey's
discovery than were many of Harvey's contem-
poraries ; for anatomy and physics had not at the
earher date been defiled by superstition or daubed
with mysticism.

A thing, then, is not old-fashioned wholly by
reason of its date ; rather, the old-fashioned thing
may be defined as that which we accept in the
main, but whose revision in detail is needed for
conformity to modern standards. Generally,
therefore, it will be of a fashion which has been
superseded recently. But when a great pause
occurs in the pursuit of knowledge, we may get a
later fructification of ideas, sown centuries earlier,
and summoned accidentally to maturity, accident
having checked their development. (Recall the
fact that about 2000 years went by between the
discovery of the burning-glass and the arrival of
the microscope.) And as old ideas undergo re-
surrection, those who toiled to give shape to them
earn promotion as old-fashioned and not oblivion
as obsolete, which is an entirely different thing.

The old-fashioned doctor is one who has lost by
the passage of years intimate touch with modern
developments but not his philosophic insight into
his calling, where he is the heir to a long lineage of
experience and research. He knows that many
truths when enunciated have escaped attention or
been buried under irrelevancies, and he can console
himself with the assurance that the essentials, to

32 PHYSIC AND FICTION

which he holds as tenaciously as do his successors,
are the things that count for the good of mankind.
But every now and then he gets a shock ; for every
now and then, in the drawn-out story of intellectual
progress, there comes a discovery, sudden even
though presaged, which revolutionises contem-
porary thought and changes the whole situation
for the group of workers involved. A new essen-
tial is added, when, as far as the profession of
medicine is concerned, all those who are unable to
carry on their work in accordance with the dis-
covery, and in association with its relations to
their theory and technique, will become not so
much old-fashioned as obsolete. But a man,
finding himself in this plight, will be obsolete only
in such measure as his previous equipment enables
him, or does not enable him, to adapt the teachings
of the old essentials to the differences entailed by
the new essential.

The discovery of the circulation of the blood
produced this situation. It rendered obsolete in
their practice those who did not accept the truth ;
it did not deprive them of their valuable knowledge,
but it left them dependent on empiricism instead
of on reasoning, when dealing with pathological
conditions. And what the discovery of the cir-
culation of the blood did for the leaders of medicine
in the sixteenth century, the discoveries of Pasteur
and Lister did for the leaders of medicine in the
middle of the nineteenth century. And if in one
way the revolution of thought produced was not

THE OLD-FASHIONED DOCTOR 33

so striking, in another it was farther reaching. In
the first case we were deahng with the works of
a paddle-steamer, and in the second with the multi-
farious and involved machinery of a Dreadnought ;
for the medicine of the nineteenth century during
that interval of 250 years between Harvey and
Lister, had inherited the learning and assimilated
the knowledge of chemistry, physiology, and
morphology brought to the common stock by such
men as Pare, Scheele, Laennec and Hunter
(especially the last) , so that the system which had
to be revised to suit the teachings of Lister was a
scientific one, where practice had been tried and
found good — in many directions it has not been
changed — but where ignorance of etiology Kmited
the therapy and shut out preventive treatment
save of a speculative character.

Pasteur's work of discovery was to a great extent
the expression of the achievements of chemistry
used with penetrating insight into meanings and
connections which had hitherto escaped notice.
His range of experiment was very great, but human
diseases did not at the beginning, or at any time
exactly, form the objects of his investigations.
Lister was an enormous discoverer quite inde-
pendently of Pasteur. He had got on the right
track when Pasteur's work came as a revelation to
him, buttressing his ideas and indicating their
working out. Pasteur both inspired and con-
firmed Lister, so that, sure of the soundness of his
theories and convinced by rigid testing of the huge

c

34 PHYSIC AND FICTION

value of his technique, he was able not only to
announce, but to insist upon, the radical nature of
his message.

Now a typical old-fashioned doctor, in accord-
ance with what has been suggested earlier, would
be a man a little preceding Lister, and one who
was a master of their common science, and an
intellectual leader, what time Lister was making
good as a hospital surgeon. Such a man would
be of the generation of Lister's immediate seniors
and immediate teachers ; out of what this man
taught, or transmitted from still older masters.
Lister became the able surgeon that he was, and
acquired as a pupil the base upon which he could
found his researches.

Lister, as has been said, was an enormous dis-
coverer, and as such, a very unusual man in
medicine ; but he was also a typical example of
the man who founds brave departures from a
secure base, commencing his excursions over sur-
veyed country. If we may judge from the easy
way in which any new ' cure ' of cancer or tuber-
culosis can obtain a vogue, it is generally believed
that in medicine fundamental discoveries may
arrive at any time. Practically this does not
occur. What does occur is the addition, sometimes
quite dramatic and remarkable, and sometimes
apparently unimportant and consequently un-
remarkable, of some new piece of knowledge to
knowledge that has been tried and proven. But
if the new discovery is a really wide-ranging one —

THE OLD-FASHIONED DOCTOR 35

if it is what we have termed ' an essential ' — the
sum that is done is not one of addition but of
multiphcation ; it is not the case of adding i to
99 and making the total 100, it is the case of adding
I to 99, and then finding that the presence of the
I has so activated the 99 that the total is a milhon
instead of 100.

This is what happened to biology seventy years
ago when the ardour, pertinacity and open mind
of Darwin gave to the world the Origin of Species.
Previous biological knowledge had to be viewed
from a new standpoint — not all of it scrapped, for
much of it was strengthened ; an immeasurable
vista of research was opened up, and the values of
detached pieces of observation were readjusted in
a surprising manner as they conformed to the new
teaching. That teaching was not immediately or
wholly accepted, Huxley, its famous apostle, him-
self making important reservations. But those
who denied its main deductions, because in this or
that direction the story was incomplete or faltering,
became obsolete if they fought for their increduhty.
They were old-fashioned if, admitting that ' there
must be something in it,' they continued their
researches, prepared to take Darwin's work into
account where they could appreciate it.

So in medicine. Lister was born in 1827 ^^^>
reaching the ripe age of eighty-five, did not die till
191 2, and if any date can be fixed for the announce-
ment of his discoveries, which were ahke the result
of solid grounding, intense apphcation, and imagin-

36 PHYSIC AND FICTION

ation, he may be said to have delivered his message
in the year i860. For a quarter of a century he
added to it and modified it, while a faithful band
of adherents developed his teaching and applied it
in new directions. During this time there grew
up with Koch, to mention one among the most
prominent, the great bacteriologists of the seven-
ties and eighties, who revealed the immense future
of preventive medicine by tracing the causes of
separate infections. Quite soon the interconnec-
tion between physiology, chemistry, and the trans-
formed pathology was arrived at, and the whole
framework of a new medicine was erected.

Now consider the leaders of the medical profes-
sion at that time, that is to say, in the third quarter
of the nineteenth century. Among the physicians
Sir William Jenner was the most prominent, though
Sir William Gull was equally well known. Among
the surgeons — thinking only in terms of London —
Paget, Savory, and Holmes may be mentioned as
particularly noticeable. The first of these was
slightly older than Lister, the last two were his
contemporaries. Sir William Jenner was born in
1815, Sir William Gull in 1816, Sir James Paget in
1 8 14, while William Savory and Timothy Holmes
were born respectively in 1825 and 1826. These
men were truly great physicians and truly great
surgeons. They were the representatives of the
best academic and clinical learning when Lister
introduced the antiseptic doctrines, and when the
significance of bacteriology became manifest. They

THE OLD-FASHIONED DOCTOR 37

counted in the vast rise of general scientific know-
ledge which marked the mid- Victorian era, and
the inter-play of special branches of learning was
manifest to them. The teachings of Darwin and
Huxley, himself a medical man, were accepted by
them, and the fact that the normal relations be-
tween all organisms involve systematic biological
reciprocity was plain to them.

The names of these five men are brought forward
as typical exponents of medical thought at the
time when Lister's work had to be taken into
account — revising, as it did, all theory and all
practice — not because a dozen others, with names
as well or better known, and with claims as high
or higher, could not have been mentioned, and not
because London is the only centre from which
medical light was, or is, diffused, but because those
particular five represent exceptionally well the
natural divisions of professional leadership. Jenner
had shown the potentialities that lay in clinical
observation when, unassisted by bacteriology, he
had distinguished between typhus and typhoid.
Gull, relying also on clinical experience, was the
pathologist who first drew attention to myxoedema,
calling it ' a cretinoid state supervening in adult
life.' Ord and Greenwood, of more or less the
same generation, extended these researches, and
it was left to younger men, Victor Horsley and
Professor G. R. Murray, to work out the causation
and determine the treatment under which what
was previously an incurable complaint has become

38 PHYSIC AND FICTION

tractable. Sir James Paget was a surgical saint ;
he held the tenets in which he was bred with de-
votion, and he enlarged those tenets by fervent
and widening appHcation of them for the enlighten-
ment of those who should follow. When only a
student he discovered the cause of trichinosis by
the intelligent use of the microscope, and through
his devotion to surgical pathology he helped to
bridge the gap between Hunter and Lister.

Timothy Holmes was a scholar. He arrived in
London after a brilHant career in double schools at
Cambridge, took the fellowship of the Royal College
of Surgeons of England without sitting for the
lower diploma, and while still a junior assistant
surgeon at St. George's Hospital was so confessed
a scientific and literary authority that he was able
to gather around him a brilliant staff of expert
writers, and produce the leading System of Surgery.
In a treatise of his own, dealing with the rupture
of one of the viscera, he stated that the patient's
best chance of life would follow the opening of the
abdomen and the sewing up of the rent. When
he wrote thus the operation was almost necessarily
fatal, owing to the difficulty of preventing the
patient from succumbing to general septic in-
fection. None the less Holmes did make converts
on the ground that those who escaped infection
would live, and would probably form a larger
percentage of survivors from the injury than those
who were left to the unaided efforts of nature.
Then came the Listerian teaching, and hard on it

THE OLD-FASHIONED DOCTOR 39

followed the ability to open the abdomen without
any necessarily fatal result to the patient. Holmes
lived to perform the particular operation twenty
years after he had indicated that it was the right
procedure, though contra-indicated by its risks to
the patient.

Savory was the most important surgeon in the
country to hold out openly against the Listerian
treatment, and as late as 1879, ^-t a meeting of the
British Medical Association, he declared the dis-
trust that he was feeling. In his earlier days, at
St. Bartholomew's Hospital, he was a highly suc-
cessful teacher, and his care and skill at operations
were notorious. He declared against Listerism
when it had been largely accepted as gospel, but
he was afterwards elected President of the Royal
College of Surgeons of England, the fact being that,
far more than he himself knew, he was in accord
with the antiseptic school. The results which he
brought forward of successes obtained without the
aid of Lister's technique were so many proofs that
by preventive care he could produce conditions
where antiseptics were less needed, and to that ex-
tent he was actually ahead of the leading which he
deprecated, and was pointing to the goal of asepsis.

In the regions of speciahsm the same position
obtained. Men born in or around the thirties,
who enjoyed the leading professional positions in
their specialities, found themselves left behind by
the rapid developments ensuing on or coincident
with Lister's discoveries. In neurology Sir John

40 PHYSIC AND FICTION

Russell Reynolds affords a typical example. The
son of an Oxford scholar and grandson of a Court
ph3^sician, his medical career was largely dictated
by his close alliance with his brilliant teacher,
Marshall Hall, the discoverer of the reflex functions
of the spinal cord. Reynolds disliked the name
of speciaHst, and indeed, while still a young man,
edited a general System of Medicine on the pattern
adopted by Holmes in his System of Surgery. But
it is as a neurologist that Reynolds will best be
known, and it is as a neurologist that he suffered
from his date. He appeared at a transition period,
when order was just discernible forming itself out
of chaos, and he was largely responsible for that
order. Five or six years before the paths of
microscopical investigation had been made plain
by Lockhart Clarke, Reynolds was working at the
clinical aspect of diseases of the nervous system,
and perfecting the knowledge and proving the
surmises of Marshall Hall. Later a flood of light
was to be thrown on these subjects by the philo-
sophical lore, the research, and the clinical teach-
ings of Hughlings Jackson, Bastian, Ferrier,
Gowers and Buzzard ; but during the interval the
lamp was held aloft by Reynolds, and the fact was
admitted by his election to the Presidency of the
Royal College of Physicians of London. He
laboured at his subject, he interested as well as
instructed others, he made things plain so that his
successors could start with ease where he left off,
and he rescued the manifestations of hysteria and

THE OLD-FASHIONED DOCTOR 41

epileptoid conditions from the curious, uncanny
kind of mystery in which they were shrouded, and
showed them to the whole profession as simple
results of causes and effect. These were great
accomplishments, and Reynolds, denuded of
official dignity, his prestige as a writer, his reputa-
tion as a lecturer, and his claims upon the public
as a general physician, would still remain secure
of his place as a pioneer in the science of medicine.
But the theories and practice of prevention which
followed upon Lister's work he could only acquiesce
in ; he could take no part in their elucidation.

In aural surgery Sir WiUiam Dalby was similarly
placed. Like Reynolds he allowed personal suc-
cession to the clientele of a famous senior to dictate
his speciality for him, for he became assistant to
that singular man, James Hinton, who some sixty
or seventy years ago had an enormous practice as
an aural surgeon in Saville Row. During the
twenty years between 1875 and 1895 Dalby's
opinion was sought from all parts of the kingdom.
He published a series of lectures on diseases and
injuries of the ear, and wrote articles on the same
subject in Holmes's System oj Surgery and Quain's
Dictionary oj Medicine, while his Short Contribu-
tions to Aural Surgery ran through three editions,
and deserved its popularity by wide practical in-
formation and pleasant writing. He was not in
any sense a good operating surgeon, and found
himself in an unstable phght after the enunciation
of Listerian doctrines and the perfection of the

42 PHYSIC AND FICTION

methods of administering anaesthetics. He was
embarrassed as a man of science by the date of
his active work. He was the main hnk between
the periods of non-operative and operative aural
work, but was not equipped for active participation
in the cranial surgery made possible by Lister.

These men form a representative group, for
which many names equally apposite could have
been substituted, of the scientific leaders in surgery
and medicine whom the introduction of Listerism
immediately rendered old-fashioned, while it rested
with them to adapt their personal and academic
equipment to the new essential if they did not
intend to become obsolete. They all gave in their
adherence, four with deliberation and one un-
wittingly, protesting his unbehef while really
showing important conformity in some regards ;
for Savory had recognised that sepsis must be
abolished, without appreciating that to establish
the cause of sepsis would make such successes as
he himself had recorded not a personal affair, but
an orderly technique for all.

But the position was very difficult for such men
and for all who could be compared with them in
wisdom or standing. They were in the van, but
although they might estimate at its proper value
the significance of Lister's work, it was still im-
possible for them in many directions to do more
than speed that work by verbal advocacy. Coeval
though they were with Lister, he had worked in-
tensively and for many years with his theory before

THE OLD-FASHIONED DOCTOR 43

him and his special faith within him, and when he
declared his results his technique was imperfect.
He could not teach by written or spoken word
what his entire message was, and in frequent details
he was not certain himself what it was. His con-
temporaries, and, for that matter, a good many of
his juniors, who were unready for the great revolu-
tion even while they supported it, had in most
cases not the training which would enable them to
put the new doctrine to actual proof. Lister had
taught himself, and was instructing the whole
scientific world junior to him, but there was no one
to teach the men of Lister's age or just senior to
him, who had left the lecture-room and bench too
long to remain flexible when the famous work at
Glasgow and Edinburgh began. Physicians, and
surgeons in particular — for it is to surgeons the
words mostly apply — brought up in the older
school, though they faced manfully the difficulties
of unfamiliar procedure, and though they might be
insistent upon Listerian practice in theory and
word, never became great exponents of the prac-
tice ; Listerism was necessarily a thing that in its
carrying out required personal experience, though
in its exposition it could be accepted all along the
line. Few leading surgeons, however, in the last
quarter of the nineteenth century contested the
truth of Listerian teaching, and those who did
found no disciples. The rest, having a grand
heritage of surgery behind them and a great work
to do at the institutions with which they were

44 PHYSIC AND FICTION

connected, and at the academies and corporations
whose leading posts they filled, welcomed the
vastly extended scope of operative treatment and
preventive medicine held out.

But while they gave in adherence to the ad-
vanced school, it was inevitable that in their
public utterances they should more than occasion-
ally point out that things which they had done in
their day, before the discovery of antiseptics, and
things they still were doing, were confirmed by
the Listerian doctrines. They laid stress upon
old cHnical methods to show that, although they
had been without many of the facilities which the
young men now possessed, they had been able, if
by more haphazard methods, to make great dis-
coveries, such as those enumerated, and to arrive
cUnically at many identical conclusions. And
this explains to some extent why, in their bio-
graphical sketches, much stress is laid on the
personalities, and occasionally the whimsicalities,
of the departed leaders. They made their mark
by their idiosyncrasies, and by insisting on them.
Being often without a broad theory for the causa-
tion of conditions whose symptoms and signifi-
cance they recognised unerringly, they trusted to
individual acumen to obtain information and to
individual experience for indications as to the best
method of fighting the pathological foe. Then, in
their teaching, they were bound to use dogma as
a general reason. They would lay stress on the
value of this or that drug, and the promise of this

THE OLD-FASHIONED DOCTOR 45

or that procedure, because they had found them
valuable in this or that case. Thus they became
associated in the minds of their juniors with
routines that seemed little removed from fads, and
their lovable eccentricities were allowed to obscure
the fact, the amazing fact, that unaided by the
further knowledge that we now have of the origins
of disease, they were able to treat successfully the
conditions.

The following passages are from an obituary
notice which appeared in the Lancet of the late
Dr. Lloyd Roberts, who was also bom in the
thirties, and who continued in practice, or at any
rate in touch with medicine, until the end of his
more than eighty years.

* Any Manchester man could fill a book with
tales, true and untrue, that have been told about
Lloyd Roberts, and if he had died in his zenith
thirty years ago, his biography would have had a
large sale. Hospital work done, he was to be
found by mid-day standing — always standing —
compact, alert, close-cropped, by his consulting-
room fire. There was a glass of milk warming
in the fender, and amongst the instruments on the
mantelpiece there were walnuts, which he cracked
at intervals with explosive violence. These served
for lunch. Then there was the bowl in which all
the filthy lucre he received must be washed before
he would put it in his pocket en route for the
bank. Lloyd, as he was universally known (pro-
nounced " Lide "), never appeared to belong to

46 PHYSIC AND FICTION

any particular age or generation. He used to say
that he was not a consultant but " a general
"fepeciahst with a leaning towards women," and his
definition of gynaecology as " anything either
curable or lucrative " has become a classic. A
born healer, it did people good merely to see him.
. . . Quite free from illusions, his advice to young
friends was sometimes startling. " If you want
to be on the staff of a hospital, lad, pretend you 're
a fool till you 're on it." " There are two ways of
getting on ; you can be clever or you can be
kind ; now, you can always be kind." " You
can't alter that, so there 's no use a-bothering."
" Always take off your overcoat in a patient's
house. If you are only there a few minutes they
will feel you are not in a hurry." . . . Lloyd
Roberts drove daily to the end of his life from
Brought on to his rooms in St. John St., Man-
chester, as he had done for half a century. He
always came in an old-fashioned brougham, the
horse or horses being good, and many will remem-
ber the little figure with the blue serge jacket, top
hat jauntily perched on back of head, and plaid
rug thrown over his shoulders on cold days, peering
from the centre of the back seat that he might miss
nothing either on the road to the hospital, the book
shop, two silversmiths' shops and a chemist's shop
— his five regular places of call.'

Lloyd Roberts was a great provincial physician
and gynaecologist, but modern preventive medi-
cine arrived too late for him to do more than

THE OLD-FASHIONED DOCTOR 47

admit the advances that were taking place. His
old-fashioned habits and colloquialisms became
the things about which his world talked, yet there
was not in the country a better practitioner.
He was the very type of doctor dear to the novelist.
Smollett, Scott, and Reade have all drawn him,
George Ehot and TroUope have been inspired by
his sort.

The grand thing that happened to medicine
seventy years ago was the opening up of a bound-
less scheme of prevention by the identification of
causes. On this followed wide and special develop-
ments of treatment, but here we must be careful
not to underrate the therapeutic prescience and
achievements of the older men — the long historic
roll of medical protagonists.

What the Listerian methods did in the first
instance for surgery, bacteriology did, and is doing,
for every department of healing ; it is making
prevention the object of the doctor.

In medicine pure the story of malaria forms a
very good example of this. In the first years of
the Victorian era there was published a remarkably
eloquent treatise on medicine by Sir Thomas
Watson. Watson, one of the numerous scholars
who have adorned St. John's College, Cambridge,
was physician to King's College Hospital and was
appointed Professor of Medicine in the school in
1836. He was elected President of the Royal
College of Physicians of London in 1862 and held
office for five years. Between these dates he

48 PHYSIC AND FICTION

published a series of clinical lectures, covering the
whole practice of medicine, which he had delivered
at the medical school. A section of this admirable
book was devoted to malaria, in those days be-
heved to be a miasmic disease ; but there is not a
word in Watson's essay, if we read it alongside with
the latest treatise on malaria, that is not informing
as to symptomatology and sound as to treatment.
The types of malaria are carefully separated, as,
indeed, they had been separated by Hippocrates,
though modern work has here enabled classifica-
tion to be much more useful as well as elaborate ;
the phenomena of the attacks are minutely de-
scribed ; the historical, geographical, and chmatic
information is full and derived from unquestionable
sources ; and the treatment of the sick is sound and
based on a practical knowledge of the quahties of
quinine. But the cause of the spread of malaria
being unknown — though something very near the
truth had been guessed at more than once — not a
word could be said about prevention. No doubt,
with the famous revelation of Manson and Ross,
treatment of the individual cases has advanced in
many ways, but the world-importance of their
contribution to medicine Res in the fact that a
disease, supposed to owe its origin and spread to
telluric and climatic circumstances lying beyond
the limits of human activity, is found to be pre-
ventable now that we know its cause. The great
difference between the teaching of Hippocrates
and Watson and the teaching of to-day is that

THE OLD-FASHIONED DOCTOR 49

we now know the etiology, while with them it was
a matter of speculation. With regard to treat-
ment, Hippocrates suggested none, and Sir Thomas
Watson, with limitations, that which we now
follow, but he could give only empiric reasons for
his advice. The periodicity of the paroxysms
eluded exact demonstration until the microscope
began to play its effective part and until every
pathologist was aware of the existence of blood
parasites. But for years physicians used much
speculation upon the hot and cold phenomena in
relation to the etiology of malaria, and in their
guesses were themselves now hot and now cold.
Those who attributed the sequence to an unex-
plained fermentation of the blood may be described
as lukewarm ; those who thought the phenomena
were due to a general law of the universe by which
night follows day, rain follows drought, and winter
summer, were very cold ; while the one or two who
hazarded the guess that insects might carry the
infection were very warm indeed. These philo-
sophers, if they had remembered that most
occurrences in nature have predisposing or con-
comitant reasons as well as one predominating
cause, might have laid down for certain the rules
for prevention of malaria without having micro-
scopic proof of their wisdom. Lancisi, for example,
asked : ' Cur juxta paludes noctu praesertim
indormientes magis quam vigilantes laedantur ? '
He and others knew that the victims of malaria
were those who slept out in the neighbourhood

D

50 PHYSIC AND FICTION

of certain damp but drying areas, and if they had
put this knowledge alongside of the observation
that certain insects would breed well in such
areas, and would bite at night, the discovery of the
peccant mosquito might have been made years
ago. But the notion of a mysterious miasma had
too forceful an appeal.

The belief that disease is something dispensed
as a punishment to a sinning world by an outraged
God was the main reason why the medical man
looked no further than a miasma for the cause of
malaria. Undoubtedly religious superstition has
always been ready to impute impiety or blasphemy
to research work. An Italian surgeon at the end
of the sixteenth century invented a method for the
replacing of noses, these organs at that time being
not infrequently destroyed by accidents of war,
and being sometimes removed by legal mutilation.
Tagliacozzi's method, which contains the basis of
much of the cosmetic surgery performed on behalf
of sufferers in the recent War, was severely repro-
bated at the time of its invention by the strict
religionists on the ground that he was tampering
with God's handiwork ; nor must we find the view
too ridiculous when we recall that in the nine-
teenth century Sir James Simpson was reproved
from pulpits for employing the new drug, chloro-
form, to alleviate the pangs of childbirth, because
St. John had said, * a woman when she is in travail
hath sorrow.' Also, if religion did impede the
course of medicine, the religious houses, by acting

THE OLD-FASHIONED DOCTOR 51

as the only centres of learning, must have furthered
its aims. In the case of malaria, for example, the
Church was largely responsible for the popularisa-
tion of what still remains the standard remedy.
There are several versions of the story how cin-
chona was introduced into Europe, but that
directly associated with the Spanish viceroy's
lady, the Countess de Cinchon, who was said to
have been cured of the fever by the drug at Lima
about the year 1638, accounts most plausibly for
the three popular names of the remedy — cinchona,
Peruvian bark, and Jesuit's bark. The latter
appellation was derived from the fact that, being
a Catholic, the Countess either sold or gave the
secret of the cure to the Jesuits, through whom
civiHsation obtained its benefits.

The old-fashioned doctor is the man who has
learned what to do without, sometimes, at any rate,
the opportunity of learning why he does it. It is
his devotion and sagacity that we should admire ;
these virtues remain and are aggravated by any
gaps in his technique.

Medicine is a torch race, to quote Moore's jingle :

' 'Tis like a torch race such as they

Of Greece performed in ages gone.
When the fleet youths, in long array,
Passed the bright torch triumphant on.'

But they who pass on the torch in the team race
of medicine do not necessarily drop out of the race.
Out-paced they will be — that is in the scheme of
the race ; but for some time after they have

52 PHYSIC AND FICTION

handed over the torch they can keep in touch with
their successors and help them to victory by en-
couragement and counsel, advising them to spare
their breath down such and such an incline, or
warning them out of personal experience that the
flame will falter if the torch be not carried at the
right angle.

CHAPTER III

MEDICINE IN FICTION

The Novelist and the Medical Profession — The Treatment of
Disease in Fiction — The Popularity of Phthisis and Malaria —
Charles Brockden Brown — Dickens and Thackeray on Fever
— An Unsuccessful Competition.

The references to fiction which have aheady been
made render a confession of frequent and pro-
miscuous novel reading unnecessary, nor does the
habit need apology save in one direction. It is
sadly apparent that the novehsts referred to are
all old friends ; their claims have been so engross-
ing that I have made no new friends with the
same intimacy.

The connection between physic and fiction has
many bearings. For nearly two hundred years in
this country contemporary life has been recorded
in stories — some good, some not so good, but the
literary value of particular novels is not in ques-
tion. In these stories the medical profession is
described at different epochs, and we can gather the
esteem in which it has been held by society during
its evolution from empiricism to science. Further,
medical episodes are employed in the machinery of
many narratives, and from these can be gauged to
some extent how far medical technique is under-

53

54 PHYSIC AND FICTION

stood by those who would interpret it for the
information of the pubhc.

That all subjects are the artist's province has
been proclaimed over and over again, but there are
some provinces which, as history just now has
shown, and is showing, may belong to owners who
cannot rule them. Medicine is such in the novelist's
hand. Allowed to run its own extravagant course,
the medical episode is thoroughly helpful to the
story-teller ; coerce that episode in the most
reasonable manner, ask it to conform in its salient
features to true pathology, and often it becomes of
less use to the narrative. This is the reason why
so much fun has been expended over the medicine of
fiction, and it is also the reason why some of this
fun has been cheap. Critical persons have taken
it for granted that whatever is undisciplined is
wrong — a harsh and stupid doctrine to apply to
feats of imagination.

The proper attitude to be assumed in respect of
the treatment of medicine in fiction seems to be
fairly well defined. Where the author has in any
way insisted on the accuracy of his science — where
he writes as one having authority, and calls all men
to witness, either in so many words or by his
general assumptions, that he is a learned and sound
expositor — it is certainly fair that he should be
reproached for any lapses from the truth ; but
where the author has introduced a medical episode
for the mere sake of helping his story along, it is
not necessarily sound criticism to blame him for

MEDICINE IN FICTION 55

faiiltiness of detail. Imagine calling Balzac to
order because the murder of Maulincour by the
terrible Ferragus is not to be explained by text-
books on toxicology. The author may be true to
the scheme of his story even while he is untrue to
the teaching of the medical text-books. This is
how it comes about that some of our very best
novels contain bad medicine, while some of the
silhest contain good medicine. Whether the
author of the former is to be praised as an artistic
writer, or the author of the latter is to be credited
with valuable accuracy, depends upon the rules of
criticism adopted ; and these ought to be applied
with appreciation of what the aim of the author has
been. If the author has plumed himself upon the
preciseness of his medical knowledge, he should be
judged by the correctness of his display ; if he has
made the action of his story depend upon a chain
of medical circumstances in such a way that unless
the chain holds the story collapses, he invites us
to test that chain link by link. But such a use of
medicine in fiction is rare ; as a rule it is no great
contradiction of the author's pretences if a mistake
in therapeutic or pathological detail occurs. And
it makes small difference to the position of medi-
cine in the public eye that signs rightly attributable
to one poison are transferred by a novelist to
another, that the symptoms of a tropical disease
are burlesqued or the terrors of a fever magnified.
The reader knows that the therapeutics in such
matters will be in real liie under the conduct of

56 PHYSIC AND FICTION

those who know, and his feelings towards the
medical profession are not altered one way or
another by details in respect of which accuracy can
never be his practical concern.

But when medicine enters in a larger manner into
a story, and when the relations of the medical
profession to the public are presumably expounded
in a book, it is very important, both to the medical
profession and to the public, that the author should
be accurate. And he generally is nothing of the
kind. The novelist never seems to have the
slightest knowledge of the professional medical life.
He is ready enough to credit the members of the
medical profession with many shining virtues and
equally ready to darken their reputation with
calumny, the unfortunate result being to leave upon
the public mind the impression that the average
medical man is not an average member of society.
The idea which the public might well derive from
reading many novels is that to call in a doctor is
an extraordinarily fluky proceeding, as the medical
profession is divided sharply into heroes and
knaves. The heroes lead a strenuous hfe, succour-
ing the sick in desperate circumstances and refus-
ing fees ; operating at the briefest notice when a
hair's breadth to the right or left in the making of
an incision would be certain death to the patient.
The knaves murder, cozen, and keep bogus sana-
toriums. They vivisect for pleasure, their
humanity is dead within their breasts, and they
pass existences that are a standing reproach to the

MEDICINE IN FICTION 57

law of the land. Now undoubtedly either sort of
description of the medical Hfe, whether the roseate
glow of eulogy or the green cast of detraction is
employed, does no good to any one. As far as the
public is concerned, it cannot be useful that they
should have doubts whether their doctor is a saint
or a sinner, a knave or a hero. Medical men, for
their part, may smile at errors in the medical
details of novels, but they are uneasy under indis-
criminate laudation of the nobility of their careers,
and grow positively restive at some of the allega-
tions concerning their criminal habits.

The time has surely arrived when we may expect
that the novelist who aims at recording contempor-
ary manners will take the trouble to ascertain
what are the professional standards in medicine,
what is the usual course of the successful man, and
what the machinery, legal and ethical, which
confines the medical career within certain bounds.
The part which his hospital work plays in the life
of the consultant physician and surgeon certainly
varies, but it varies only within limits, and those
could be readily ascertained by the novelist, who
too frequently seems to confuse the honorary staff
of the charity with the resident officers of the same
institution. There are general hospitals which
may have medical schools attached to them, and
special hospitals which, not possessing the range
of material necessary for use in chnical training,
only play an ancillary role in medical education.
These points ought to be remembered, even though

58 PHYSIC AND FICTION

the picture of the great speciahst in brain disease,
passing from bed to bed in his world-famous ward,
surrounded by a crowd of enthusiastic students, to
whom he discourses with elegant brutahty, has to
be suppressed. Intelligent internes, again, do not
reverse the treatment of their superiors, and, by
saving life with brilliant unorthodoxy, succeed at
once to lucrative practices in Harley Street ; no
great consulting position was ever won in this way.
Nurses in hospitals have to do as they are told ;
the devoted young woman who remains by a
sufferer's pillow hour after hour and day after day
till she wins a hand-to-hand fight with fate and
secures by her importunity the hfe of her patient —
she is a figment ; for in the hospitals all nurses
go to their meals and their beds at stated times.
Heaven knows, the work of both house-surgeons
and hospital nurses is hard enough : the time
allotted for their meals is scant, the hours of their
labour are long, and much of the routine of their
work is hard — physically as well as mentaUy hard.
They do not deserve ridicule, and it makes them
ridiculous to describe their share in the organisa-
tion of a hospital so untruthfully as has been done ;
while the misstatements give the pubhc a totally
wrong view of institutions which, with extreme
difficulty, derive their support from the public
purse. The callousness of hospital nurses has
more than once formed the subject of newspaper
comment, and the views of the critics of hospital
dispensation have been, I make no doubt, largely

MEDICINE IN FICTION 59

derived from the impressions of patients who,
fooled by fiction, have thought that a broken leg
or a scalp-wound would entitle the sufferer to the
exclusive possession night and day of a soft- voiced
ministering angel, and who have resented their
particular angel going to her tea.

If the harm that may be done by the burlesque
descriptions of hospital life which have appeared
in various popular novels is more easily realised,
I am not sure that it is greater than the harm done
by the perpetual suggestion that the venal or
criminal doctor is easy to find. Mr. Matthew
Finsbury, the seal collector, who, as set out in
Stevenson's best manner, took deep thought on
this point, came to an opposite conclusion ; yet
there makes a regular appearance in fiction the
doctor who is ready at a price to violate every
article of the Decalogue separately or in permuta-
tion and combination. Why is this ? It is because
a large number of the public, who are sufficiently
well educated to perceive in some sense the qualities
good and bad in the sensational novel, are still
in ignorance as to the aims of medicine, scientific
and sociological. They still believe, when the
novelist bids them, that a medical student is
necessarily an expert toxicologist ; that to immure
the sane subject in a lunatic asylum is a safe and
simple proceeding ; that nurses are often the
mistresses of doctors ; that in many diseases the
withholding of a dose or an injection will inevitably
cause death (these latter two notions pave the way

6o PHYSIC AND FICTION

to frequent situations) ; and that familiarity with
sorrow produces greed and callousness. It is
suggested to intending novelists that these things
are all untrue ; that the very occasional episodes
on which statements of the sort are grounded do
not warrant the general conclusions ; that the
time has come when they should not be said ; and,
further, that it will be good business — if a vulgar
appeal to profits may be pardoned — to forgo
certain easy effects that can be obtained by mis-
representing medicine. Scott, George Ehot and
Stevenson spoke nobly on the side of the medical
profession ; I beheve that modern novehsts who
follow them here will not go unrewarded. Good
novelists do not wish always to write for the
ignorant, and the ignorant are, or soon will be, the
only persons to be thrilled by patent falsehoods.
In them the slanders confirm wrong impressions
and so do harm.

The more usual employment of medicine in
fiction takes no count of professional questions, but
consists of the narration of a medical episode in the
story. For one book which ahudes to the pro-
fession of medicine as a profession, there are
twenty in which a medical event occurs, being
introduced not to illustrate the habits of the pro-
fession of medicine, but to fulfil the exigencies of
the plot. Some of these instances of the use of
medicine are thoroughly good ; some, a smaller
quantity, are bad ; for the most part they display
the partial knowledge of a writer who has got up

MEDICINE IN FICTION 6i

his subject conscientiously, and who lays unneces-
sary stress upon a symptom without knowing the
secondary part which that symptom may play in
diagnosis or as an indication for treatment. Some-
times the author shows real pathological grip,
while often the effect of a disease upon the be-
haviour and morals of its victim is well portrayed.
Most of the instances of such employment of
medicine in fiction fall into two general classes:
(i) where the disease or accident is an episode,
and (2) where the disease is a part of the drawing
of some character whose attitude towards life is
swayed by the condition. This is a rough division,
and corresponds with the equally rough division
into two classes of the science of medicine, which
has to be made in all medical practice and literature,
these two classes being (i) medicine proper — the
innere Medizin of the German, and (2) surgery.
It will be found that among the invalids of fiction
the purely medical cases will be described mainly
from a temperamental point of view, surgical
cases being introduced as episodes. And we see
at once how natural it is that poisoning should
have attractions for the novelist. Poisoning cases,
while really belonging to the class of violent
accident, being in this way comparable to a surgi-
cal catastrophe, appear to belong to the class of
medicine proper ; that is to say, that while they
are as truly casualties as the sprained ankle of the
heroine or the sword wound of the hero, they
usually pretend to be manifestations of systemic

62 PHYSIC AND FICTION

disease, producing the symptoms of typhoid fever,
of meningitis, of epilepsj^ and so on. The novelist
who uses the crime of poisoning is able to defend
any obscurity of his own by reference to the
notorious obscurity of such cases in real life,
and this is a consoling feeling for a conscientious
writer. I think we now have a rough guide for the
appraisement of the use of medicine in fiction.

Where the episode plays no other part in the
narrative than to assist in the evolution of the
plot, it cannot matter greatly whether the details
are correct, and their incorrectness may prove a
positive virtue. It is general belief that crime, as
it appears at]the cinema, leads to imitation ; if this
be so, it is well that the episodes in sensational
novels should not form accurate recipes for murder.

To cavil at mistakes in the novehst's surgery
is often unfair, as they are usually mistakes in an
episode not necessarily affecting the story as a
whole ; but we may have to ask from the author,
if his book is to be credible and symmetrical, that
his ' internal medicine ' should be accurate, for
the behaviour of his sick characters ought to be
in accordance with their diseases. I am making,
therefore, no comments upon the surgery of the
novelist, because, in the instances that occur to
me most readily, inaccuracy does not much matter
— it does no public harm, does not spoil the tale,
and should not be made the subject of serious
discussion. When a well-known writer, one of the
' best-sellers,' mixed up in his surgical allusions

MEDICINE IN FICTION 63

an organ of reproduction with one of excretion,
he did not make his story less probable, though,
incidentally, few things could have done this. But
the use of medicine proper in fiction may call for
more serious consideration.

In medicine proper, most of the diseases whose
name is not too difficult to spell or too cacophonous
to pronounce, whose associations are not revolting,
and whose details are in the least familiar or are
capable of explanation, have been used by story-
tellers of different grades. It is obvious that no
attempt can be made to review such a mass of
material, and I propose only to illustrate the
uses of medicine in fiction by calling to mind the
way in which certain common diseases have been
employed in the course of their art by great or
successful writers.

The incidence of an epidemic is a social occasion
of enormous importance ; it cannot be viewed
from the medical side alone, but must be regarded
by every conscientious writer as having public
significance. It seems to me clumsy to introduce
an epidemic into a novel to kill off — say — one
person, but if the epidemic is well and truthfully
described, an allegation of bad art cannot be lightly
made. There are well-known and justly popular
novels into which battles have been introduced
merely, it would seem, to wound a hero ; while
dams have burst and villages been submerged to
afford some one in a lower valley a chance of
distinction. But we demand that the battle of

64 PHYSIC AND FICTION

fiction should follow the lines of the battle of fact ;
and that the flood should run down the valley and
not up the mountain. About such fundamentals
we feel that a novelist should be right. The public
is not famihar with epidemiology as it is with
popular history and elementary physics, and has
not the same sense, therefore, of the necessity for
accuracy, but this does not absolve the novehst
from care. It is a laudable fact that many novel-
ists have taken special trouble over their descrip-
tions of epidemics.

It is the methods employed in fiction for deal-
ing with internal medicine that may call for
criticism. In the groundwork the novelist is sure
to be weak, and this is only what might be ex-
pected. Disquisitions on general pathology have
no obvious place in fiction. The story of inflam-
mation, the circumstances of the destruction and
the repair of tissues, the conditions which actuate
hypertrophy, dystrophy and atrophy, the relations
of micro-organisms to disease, haemolysis, the pre-
cipitins, the opsonins and so forth, may become
material for the novelist in the future ; indeed, we
may be certain that sooner or later books will be
written for popular use in which the problems of
general pathology will be put out in such popular
ways as may return the best reward in cash. But
that will be a great change from any employment
of medicine in fiction that we have seen as yet.
When Sir Rider Haggard wrote his brilliant de-
fence of vaccination, Dy. Theme, in the guise of a

MEDICINE IN FICTION 65

novel, he made himself aware of the arguments in
favour of prophylactic inoculation and produced
a story of episode. He did not discuss in his pages
the pathology of vaccination. If he had done so
he would have been incomprehensible to those
whom he was addressing. I can quite see that
in the future, perhaps in the near future,
there may be so large a class of readers pos-
sessing a scientific equipment, that a novehst
who enters upon a pathological disquisition
will be as practical in his writing as a novehst
is nowadays who discusses at first hand, or
through the medium of his characters, psy-
chological and theological subtleties, the in-
testines of a motor-car, or the mechanics of
a flying-machine. For the present, however,
general pathology can hardly enter into the schemes
of any novelist's work.

But most particular diseases have been illus-
trated by novehsts, and most accidents and surgi-
cal catastrophes. Death by all conceivable forms
of violence has fallen in their pages upon all con-
ceivable sort of people, but in a proportion of cases
so vast that the remainder is negligible, the surgical
episode is a mere detail in the story — a character
has to be checked in his career, or removed from
the scene, and physical violence of some kind or
another, the result of accident or of crime, is em-
ployed to give probability to the modifications of
the drama. Accuracy, however commendable, is
not necessary in an episode hke this ; it may be

66 PHYSIC AND FICTION

preferable, but sometimes the dramatic force is
increased by a little mendacity.

A general disease much used by novelists is
malaria. Sometimes malaria removes an indi-
vidual, and in that case the accuracy with which
symptoms are rendered is not of prime concern ;
sometimes we are told how the disease falls upon
populations, and here it is of importance that the
medical picture should be correct. Several writers
of fiction have dealt with malaria under different
names. Guiltless of any knowledge of the part
played by the mosquito in the spread of the disease,
they have none the less been able to show with
accuracy the probable environment of a malarious
population, and the effects upon physique and
morale of what the Anglo-Indian until recently
called ' a touch of fever.' The episode of the Valley
of Eden in Martin Chuzzlewit, drawn with exuber-
ant picturesqueness and biting humour as it is, is
on the whole an accurate description of a malarious
community. There never has been any place
quite as Dickens portrayed the Valley of Eden ;
he has used the same almost unbounded exaggera-
tion in bringing this gruesome strand before us
that he employed in drawing elaborate personages,
for no one was ever quite so infernally impish as
Quilp, so gorgeously benevolent as the Cheeryble
Brothers, so silly as Mr. Dombey, or such a
beast as Uriah Heep. But these personages are
sublimated types, and are accepted as such ; and
in the same way Eden may be accepted as a sub-

MEDICINE IN FICTION 67

limated type of a malarious settlement, and so pass
as accurate enough. The malaria which attacked
the inhabitants of this valley was of a continuous
form, but when they got rid of it they remained
in the same place some three months more without
experiencing a recurrence, nor do we learn of any
later manifestation of symptoms on arrival in
England. It is easy enough to criticise the Eden
episode in detail, but in general spirit it is a mas-
terly piece of writing, accurate enough, and display-
ing in a vivid manner the hopelessness which falls
upon a people that abides, and strives to live, under
the shadow of death. The effect of his illness
upon Martin plays a definite part in the alteration
of his character, which is very useful for the story,
but medical experience does not support the view
that illness often leaves a chastening effect upon
man ; seldom indeed is it that any one is rendered
less selfish thereby. Contrast with this the use
of malaria in two popular novels, where the disease
is employed to remove the heroines — and merely
to remove them. I refer to Henry James's
Daisy Miller and Marion Crawford's Mr. Isaacs.
Daisy Miller was a doomed character from the
start. It was impossible not to feel that this gay
and clever young rebel would become an admirably
picturesque and pathetic person if she died quickly
and neatly, and Henry James, most learned of
all novehsts in seeing when such effects can be
obtained, kills her in the space of a week of ' Roman
fever.' Her attack was without intermission, ap-

68 PHYSIC AND FICTION

parently without complications, but with deUrium
from the beginning. Now this is not a very con-
vincing chnical picture. Katharine Westonhaugh,
the heroine of Mr. Isaacs, died of ' Indian jungle
fever ' in much the same space of time — that is,
in a week or ten days. She speaks clearly and
easily from first to last, but has no recognisable
sort of fever. It is my belief that Marion Crawford
intended to kill her by an accident in the hunt
which preceded her illness, but, seeing how very
dignified a figure she had cut throughout the book,
he felt that mauling by a tiger was an untidy way
of disposing of her. There is a form of malaria,
designated bj/ the French acces pernicieux, which
may end either in delirium and coma, or in collapse,
running its fatal course in a few days. These cases
occur in Africa, not India, for the most part ; but
I find such criticism laboured. In all three cases
malaria is well handled ; in the first it appears as
an epidemic under a picturesque guise, in the
others as a piece of narrative machinery.

Cholera and plague both put in appearances in
novels. There are two well-known descriptions of
cholera in popular fiction. The best is Charles
Kingsley's account, in Two Years Ago, of the
cholera of 1854 as it fell upon a poor community.
Aberalva is a picturesque fishing village in the west
country, the amenities of which are much disturbed
by the sudden advent from the sea of Tom Thurnall,
an energetic medical man who has been wrecked
off the coast. Having had experience of cholera

MEDICINE IN FICTION 69

in various out-of-the-way places, he makes up his
mind that Aberalva will be visited in the course of
the coming summer. Kingsley gives a very good
account of the dirt of the place, of the pig-headed-
ness of the people, and of the way in which Thur-
nall rubbed them all the wrong way by poking
about in their backyards and showing them ordin-
ary water animalculae under the microscope.
The cholera does come, and a flamboyant account
of the progress of the disease and the mixture of
panic and obstinacy with which it was received
will be found in this admirable novel. It is
cheering to think that the Ministry of Health no
longer deserves the fun which Kingsley poked at
the General Board of Health of 1854 ; nor is there
any longer truth in Kingsley's dictum that ' Local
Government signifies in plain English, leaving a
few to destroy themselves and the many, by the
unchecked exercise of the virtues of pride and
ignorance, stupidity and stinginess.' The work
of Simon, Chadwick, and Buchanan was already
beginning to bear fruit when these bitter words
were written, but Kingsley was an emotional man,
used to creating valuable effects by powerful
appeals which came from his heart and not from
his reason, and there is no doubt that he beheved
that the message which he was delivering was
sorely needed. The modern novel which essays
to arraign the pubUc health dispensation of this
country will require more accurate knowledge than
Kingsley possessed if it is to carry any weight,

70 PHYSIC AND FICTION

while the abuse will have to be levelled at the
pubUc rather than at the Ministry of Health. And
even so this abuse will have to be discreetly apphed,
for many communities are nowadays very wide-
awake to what can be done for them by a well
administered sanitary service, as is shown by what
happened in Suffolk in the autumn of 1910. An
outbreak of pneumonic plague among the popula-
tion was found to be due to an epizootic attacking
the rodents in the district, and inquiry pointed to
two ominous things — first, that there had been
probably other human cases than the four fatalities
which first attracted the attention of the health
authorities ; and second, that the area of the epi-
zootic was ill-defined, and that conditions favoured
the spread of plague among rats. There was no
panic ; natural and reasonable apprehension led to
active co-operation between the population and the
local sanitary authorities, who were advised through-
out by the Local Government Board. It was some
time before it was possible to say that all danger of
a spread of the disease among the human population
had disappeared, but the steps needed to prevent
developments were taken, and proved successful.

The terrific mortality and unrelenting march of
an epidemic of plague has made this disease a
favourite one with writers of romance from Homer
and vSophocles, through Boccaccio, down to to-day.
Everybody will remember the picturesque and
effective account of the Great Plague of London
in Harrison Ainswortli's Old St. Paul's. Ains-

MEDICINE IN FICTION 71

worth was a conscientious author, and clearly had
consulted the authorities before writing his descrip-
tion. In the preface to the first edition of his
work he says that he has followed closely a rare
narrative, which he attributed to Defoe, entitled
Preparations against the Plague both of Soul and
Body. I have never seen the book, but all the
historical background to Old St. Paul's can be
found in Defoe's Diary oj the Plague. The
maniacal behaviour of Solomon Eagle, the murder-
ous inclinations of some of the plague-nurses, the
roaring trade done by quacks, the blasphemous
orgies of the half-terrified, half-defiant loose-livers
— all this, which is so effective in Ainsworth's
romance, finds a place in the Diary, and, moreover,
is all historically sound. Defoe's consummate
and particular literary skill led him to tell the story
of the plague as though he had been an eye-witness,
when in truth he was only six years old in the
terrible year of its occurrence. But his chronicle
is essentially accurate, for he had access to genuine
diaries of the time, to Dr. Hodges's Loimologia, to
Vincent's God's Terrible Voice in the City, and
notably to the Collection of the Bills of Mortality for
1665 ; while seniors in his family or among his
acquaintances would have certainly narrated their
personal experiences before him. The famous
Diary has patent exaggerations, and not being
written until Defoe was sixty years of age, he could
not refer doubtful passages to those who had given
him personal information ; but the story of the

72 PHYSIC AND FICTION

epidemic is trustworthy, and Ainsworth, by track-
ing Defoe closely, achieved success.

The account of one of the several and severe
epidemics of plague which in the seventeenth
century fell on Naples, as given in John Inglesant,
is a briUiant piece of writing. Here we have the
appalUng state of a plague-stricken city standing
out in contrast with the beauty of the South
Italian climate and the wonderful colour of the sea
and the sky. The dead are lying in the streets,
which are still decorated for some popular festival ;
business is at a stand, for the houses are full of
infection, but a terrible restlessness drives every
lazy NeapoHtan here and there. This restlessness
has often been noticeable in epidemics, and no-
where, perhaps, would it be more obvious than
among an unstable superstitious people hke that
of Southern Italy. In London during the Great
Plague this restlessness was counteracted by the
drastic orders confining the inhabitants of a plague-
stricken house to that house — orders which terribly
added to the horror and destructiveness of the
disease. Another novelist who has used an
epidemic of plague with striking success is that
singular writer, Charles Brockden Brown, who
never could have been very readable, and who has
now, I think, fallen into complete oblivion. But
there is much in Brown that is fine. He had a
great eye for a situation, a thorough and whole-
some interest in psychological problems, and
a powerful as well as a cultivated pen. In many

MEDICINE IN FICTION 73

ways he deserves better of posterity than the scant
reference which he obtains in such phrases as ' the
successful copyist of Godwin ' or ' the father of the
American novel.' Brown was born in Philadelphia
in 1771, and was twenty-two years old when the
plague fell upon that city. He had therefore been
an eyewitness of the scenes which he describes in
his best-known novel, Arthur Mervyn, and there
are two or three chapters in this book which bring
home to the imagination of the dullest what a
plague-smitten community really suffers. Plague
has been well treated by novelists.

In regional diseases it is natural that little use
should be made of disorders of the stomach, liver,
kidney, and spleen. Their manifestations would
not make polite reading, so the novelists seldom
hit below the belt. Many dyspeptics cross the
novehst's stage, but the victims of indigestion are
nearly always subsidiary characters furnishing food
for ridicule. Disease of the liver is rarely alluded
to, save as a sort of label for retired Indian civiHans
or half-pay colonels, where the disease has become
a convention, no more hke any pathological entity
than the effigy on a Macedonian coin resembles
a horse. Diseases of the spleen are unmentioned
as such, and I have not come across any description
of malaria where the association of the disease
with splenic symptoms has been mentioned.
There hes here an opportunity for the novelist, as
the malarious spleen is a cause of sudden death
sometimes from a trivial accident, and this

74 PHYSIC AND FICTION

method of killing off a superfluous Indian villain
has, as far as I know, not been exploited. A
certain proportion of the fits that terminate bad
careers in novels are presumably renal in origin,
and in this way novelists do not omit to mention
disorders of the kidney, though they do so un-
wittingly. The heart disease of fiction is usually
angina pectoris. Diseases of the lungs are very
commonly introduced ; indeed, the disease, par
excellence, of fiction is phthisis. It is unusual for
the symptoms either of heart disease or phthisis
to be particularly well described, but there are
one or two notable exceptions to this rule.

Heart disease almost always plays the part of an
accident, that is, it intervenes suddenly in the
course of a narrative, and incapacitates or cancels
characters whose activity is embarrassing. Its
typical employment is exemplified in such novels
as The Moonstone , and perhaps Armadale — and
would that more such novels were written nowa-
days. In both instances the victims were dear
ladies, no longer young, who had to be removed
by something not painful, not revolting, and out
of deference to their breeding and gentiUty, not
vulgar. There is a story of a teacher and a
mother which is not new but in this connection
may bear repeating. The teacher, in response to
an enlightened view of her duties, taught her class
in simple terms some simple things about the
physiology of their bodies. Later in the day the
mother of one of the pupils arrived to request the

MEDICINE IN FICTION 75

teacher not to instruct her daughter in regard to
her insides, ' for it frightens the child — besides,
it 's rude.' Out of respect, I imagine, for pubhc
delicacy of this sort arose the feehng that heart
disease was one of the few really refined ways in
which nice old people might die, just as phthisis
was the proper way for good young people to
finish. The diaphragm was the line of demarca-
tion ; and all characters bom in a good social
position, or drawn for us in a sympathetic manner,
had to be afflicted above that line. Thus heart
and lung disease are frequently employed.

The heart disease of fiction is commonly a polite
sort of disease, and has few or no premonitory
symptoms ; it is found out suddenly by the doctor,
who issues the warning that at any moment the
victim may fall down dead ; and sure enough, at
the right moment, down he or she falls. Such
patients have no dropsies or unpleasant complica-
tions, though they may suffer from anginous
spasms. It is a purely novel-writer's disease, and
is preluded almost invariably with that visit to
the doctor to receive the unexpected verdict which
has been described over and over again in novels,
but which for obvious reasons happens but rarely
in real life. One novel, however, occurs to my
mind in which a definite description of cardiac
disease is given accurately — Une Vie, by Guy de
Maupassant. Here, it may be remembered, the
unlucky heroine's mother, the Baroness Adelaide
les Perthius des Vauds, has a heart disease to

76 PHYSIC AND FICTION

which she alludes frequently as ' mon hyper-
trophic,' and the symptoms of hypertrophy with
subsequent dilatation of the heart are given
perfectly. The baroness is a heavy and short-
winded woman, who slept stertorously, walked
with difficulty, and sat down every few paces
during her self-imposed tasks of exercise. We
learn when the book opens that she has suffered
from cardiac symptoms for some ten years, so
that it is perfectly right that the failure of the
heart to do its work should have begun. And with
the physical decay has also arrived the inevitable
moral feebleness of a starved brain. Forced to
lead the life of a half-suffocated cabbage, the
unfortunate woman spends her time weeping over
sentimental romances and re-reading the letters
which later reveal her to her daughter as the
possessor of a poor past. On the occasion of her
daughter's wedding she deputes to her husband the
delicate task of breaking to their child the meaning
of the responsibilities of marriage, with the result
that the young couple make a horrible start in
their joint life. The next year sees the end of her
resistance to her disease ; compensation fails,
she becomes dropsical, is unable to walk un-
supported, is troubled with dyspnoea, ages in six
months more than she had done in the preceding
ten years ; falls into unconsciousness, and dies.
This is a vivid pathological picture.

Phthisis has been frequently used to account for
the disappearance from the scene of j'oung women

MEDICINE IN FICTION 77

in an agreeable and sometimes in a very prompt
manner. It is in the older novels always fatal and
usually hereditary, and we must remember here
that opposite views are the outcome of completely
modern work. In hereditary cases the fatal seeds
germinate on exposure to a draught in a ball-
room, or symptoms supervene upon amatory
disappointment — two perfectly correct observa-
tions as far as they go.

One of the most carefully drawn descriptions of
phthisis is in TJie Portrait oj a Lady, where Ralph
Tuckett in the course of a very long story gradu-
ally dies of a chronic form of the disease. It was
inevitable that when Henry James elected to make
his male protagonist a pulmonary subject he should
present to us a correct picture, but the accu-
racy is superficial. Ralph Tuckett comes on the
scene at the beginning of the book already in
broken health, and his appearance, as drawn for us,
is an admirable etching of admitted invalidism.
The delicacy, the frailty, the licence in dress and
manner are all indicated with sure strokes, and
we have before us a man who has established the
right by his physical disabilities to lounge, even
to slouch, and to wear what is most comfortable
to him ; at the same time the slow and gentle
nature of his malady makes him no distressing
companion. True to his oft-enunciated theory
of how a story should be told, Henry James never
tells us himself what Ralph Tuckett's feehngs
were ; we are left to ascertain them from the sick

78 PHYSIC AND FICTION

man's actions or from the way in which he strikes
other people. The most luminous account of
these feehngs is given by Ralph's father. Tliis old
and sickly man says of his son, who has when the
story opens been an invalid for three years : ' It
affects his mind and colours his way of looking at
things ; he seems to feel as if he had never had a
chance. But it 's almost entirely theoretical, you
know ; it doesn't seem to affect his spirits. I have
hardly ever seen him when he isn't cheerful.'
This, taken with the description of Ralph's appear-
ance, makes up a good chnical picture of the chronic
phthisical subject in the days when practical
physicians ordered rest and wintering abroad for
the condition, though the temperament revealed by
the patient is morejoften associated with acute than
with chronic cases. Ralph had his bad days and his
good days, his bad seasons and his good seasons ; but
throughout a long book he goes steadily downhill,
as he would have done in real life — the life of the
seventies, before bacteriology and modern thera-
peutics had changed our views and our proceed-
ings. From the modern point of view Ralph's
illness is no longer very probable, for medical men
would have dealt more actively, and probably
quite successfully, with so chronic a form of the
disease occurring in a wealthy subject able to
carry out any prescribed routine. He had been
ill three years seriously when the book opens.
Some years — two or three — later, we find him
starting to winter in Corfu. He remained there a

MEDICINE IN FICTION 79

year, and on his return he had become ' an acci-
dental cohesion of relaxed angles ... he shambled
and stumbled and shuffled in a manner that de-
noted great physical helplessness.' Two years and
a half later than this he is described as very far
gone indeed, and another season goes by before the
actual end comes. The story cannot get on
without him, for while it is every whit as much
Ralph's portrait that is being drawn as the
heroine's, Henry James wants the help of Ralph
in depicting Claire. Now Claire's adventures are
compUcated, and take some years to come to any
head, so that Ralph is kept an improbable time,
about ten years, as a dying man. Otherwise he
is a good bedside study.

Compare all this with the abrupt tuberculosis
which struck down David Copperfield's child-wife,
and we get a very good example of the other way
of using medicine, i.e. as an episode to help the
plot and not with any desire either to study the
course of a disease or its influence upon character.
Henry James gives us a cause of the disease which
would have been accepted at the date when the book
was written, the progress, the exacerbations, and
the conclusion are all suppHed in a logical manner,
the actions and moods of the subject being made
to fit well with the particular disease and its vari-
able nature. Dickens has tied his hero up to a
young woman with whom he can do nothing, so
he slays her, and slays her by a ladyhke form of
consumption, with no distressing symptoms.

8o PHYSIC AND FICTION

Lassitude and emaciation set in and kill her in a
few weeks. Dickens, whose ideas of fevers and
their infectivity are so crudely displayed in the
sickness and death of little Johnnie Harmon,
could make his medicine a true and fairly accurate
background of a picture if he chose, as we have
already seen, and was also well aware of the
feelings invoked by sickness and the changes of
behaviour that it induces. But he was not
attempting anything of the sort in deahng with
Dora's case, and I have the personal feeling that
he removed Dora from the scene because he
altered his mind as to the construction of his story,
as was probably the case with the orphan in Our
Mutual Friend. At the same time it must be allowed
that cases like Dora's case have occurred. The
course of acute tuberculosis may be very rapid
and attended with few distressing symptoms until
the end. Dickens does not give any details of the
illness, but he may have been aiming at a descrip-
tion of what at the time the book was written was
called ' galloping consumption.'

Charles Reade used medicine a good deal in his
full-blooded bumptious stories, and although his
sense of omniscience betrayed him into many
mischievous errors, he was sound in some of his
important conclusions. He has in the justly
popular novel, Foul Play, written by himself and
Dion Boucicault, a remarkable case of phthisis.
The heroine has the disease, and, considering it
irremediable, spares her father the shock of learn-

MEDICINE IN FICTION 8i

ing what she has discovered for herself. If he
knows that she has spitting of blood he will at once
know that she is doomed, inasmuch as her mother
was a phthisical subject. But circumstances —
and circumstances of a truly sensational kind —
lead to this young lady being left on a desert island,
where she has to sleep in a hastily constructed log
shelter and labour all day beneath the sky in
accordance with the habits of brave castaways.
She puts on weight, increases from strength to
strength, and utterly loses her tuberculous infec-
tion. This book was written in 1868, and at that
time few save George Bodington, the first to advo-
cate the open-air treatment of tuberculosis, would
have believed the episode possible. Bodington's
book was written in 1840, but his teachings were
coldly received, and by 1868 were forgotten. To
many medical men, in a book teeming with im-
possibilities, the episode of Helen Rolleston's
recovery may have seemed the least credible ; we
now see not only its possibility, but its extreme
probabiUty.

Among general or systemic diseases a certain
amount of play is made with fevers, but the patho-
gnomonic symptoms are rarely given in sufficient
detail to enable us to make a diagnosis. I cannot
recall any case in what may be called a standard
novel where an accurate study of scarlet fever or
of typhoid fever occurs, and the zymotics are
generally and indifferently used to remove super-
fluous persons. During the evolution of that

82 PHYSIC AND FICTION

magnificent muddle, Our Mutual Friend, Dickens
in all probability changed his mind more than once,
and when he decided to get rid of the Boffins'
adopted orphan he did it with great celerity by
fever. The orphan had spots which came out on
his chest. They were very red and large, and he
caught them from some other children. So the
orphan was driven to the Children's Hospital, where
he was nursed in a general ward, and died shortly
afterwards, conscious to the last, and bequeathing
toys (and infection) to his room-mates, and a kiss
to ' the boofer lady.' Fevers seldom receive closer
observation than that given to them by the greatest
romancer in our language, but Thackeray knew a
surer way of treating them, having a different
object in view. Dickens was out to create sym-
pathetic interest. It is perfectly easy to say that
he was sentimentally inaccurate, but it will be a
bad day for human nature when the abounding
grace of Mrs. Boffin's charity fails to draw from
the reader its tribute of tears because for the
minute the great writer, who was also a great
sanitary reformer, forgot that contagious and
spotty things, whatever their names, ought not to
be nursed in the general wards of hospitals.
Thackeray, in describing the epidemic of small-pox
which falls so suddenly and with such appalling
results upon Castlewood, is not attempting to
enlist our sympathies with the sick : he designs
only to show us how people behaved in such
circumstances in the reign of Queen Anne. The

MEDICINE IN FICTION 83

epidemic is brought before us in Esmond in a vivid
manner, the baldness of phrase being, of course,
studied ; especially effective in the simplicity of
wording is the description of the panic that was
produced in the era before vaccination by this
terrible and disfiguring scourge of populations.
Neither Parson Tusher nor Lord Castlewood takes
any shame to himself for frank terror, while the
mortahty that ensues in the little community goes
far to justify their attitude. The progress of the
attacks sustained by Henry Esmond and Lady
Castlewood is not reported at any length, but,
save for the remarkably brief incubation in the
former case, an accurate clinical picture is drawn
both of symptoms and sequelae, while the little
touch which tells that the gracious and graceful
lady's nose remained swelled and red for a con-
siderable period is truly of Thackeray.

Nervous diseases are largely employed by
novelists, but few of them describe any definite
pathological condition, so that it is impossible, as
a rule, to say that the subject under consideration
is the victim of spastic paralysis, locomotor ataxy,
progressive muscular atrophy, pseudohypertrophic
paralysis, paralysis agitans, or any other disease
or symptom-complex. The nervous diseases,
which are recognised by medicine to have a dis-
tinguishing morbid anatomy, are lumped together
in the novehst's mind as the fevers are, and this
perhaps is just as well. The diagnosis of these
diseases, one from the other, is not easy in real

84 PHYSIC AND FICTION

life, and to attribute a mixture of physical signs
to a character in fiction is in many instances to
give to the imaginary patient much of the medley
of disabilities which the patient in real life would
have complained of. And just as the zymotics are
largely used as a good method of removing ob-
noxious persons, so nervous diseases have their
generic employment — thej^ are used by the novelist
as an hereditary curse. The perfectly correct
service that thus is demanded of them makes the
inaccuracy of the description of any particular
case of no consequence.

It must be remembered that behind the mani-
festations of cerebral or spinal lesions there is
frequently an origin tying in the defaults of some
other organs or tissues ; paralysis, for example,
commonly occurring as a sequel of cardiac or renal
disease. The apoplectic fit, aphasia, agraphia,
the withered arm, and so on, have all been intro-
duced by novelists into their stories, and often
there is evidence that this has been done with close
observation. In Monte Chrisfo an aphasic subject
is dramatically depicted. Indeed, it has always
seemed curious to me that Dumas should have
been the author of the chapters in Monte Christo
where old Noirtier makes his will. The will-
making powers of the aphasic, and the methods
by which, where the subject is also agraphic, his
wishes ought to be communicated to his lawyer or
his friends — these things make up a very difficult
and delicate matter of legal medicine, and we

MEDICINE IN FICTION 85

should hardly have expected the chronicler of
Joseph Balsamo's fantasticalities to indicate a
practical and valuable way out of forensic diffi-
culties. But this is done by Dumas. The kind
of sufferer that Noirtier was is clearly shown — he
was an instance of aphasia where the intellectual
faculties are unimpaired. Other circumstances in
the case do not agree with his being a sufferer from
pure aphasia, but what Dumas brings out is that
there is in him no disturbance of the emotional
faculties, no perversion of the judgment or affec-
tions, and no diminished firmness of intention.
This last is a touch not in accordance with accepted
medicine, as I believe it is generally allowed that
most aphasic subjects are greedy of suggestions,
and Noirtier's paralysis was so profound and
general that he should have been a malleable
person. He could understand spoken and written
language, but had motor aphasia together with
very complete bilateral paralysis, and could not
communicate his wishes in any way save by moving
his eyelids. He had only these, and truly eloquent
eyes, with which to transmit his intentions and
desires to his notary, so that the pathology is not
impeccable, for we can hardly imagine a lesion
whose effects are so complete and disastrous, while
leaving the reason unimpaired. None the less the
aphasic subject who is perfectly able to make a
will is a well-recognised person, and the method
devised by Dumas for eliciting the testator's
wishes through the medium of a dictionary is one

86 PHYSIC AND FICTION

which nowadays would be employed in such cases.
It has been precisely recommended in some authori-
tative articles on the subject, which is a scientific
triumph for the great romancer.

Into other regions of neurology I will not follow
the novehst, but a protest is wanted against a
certain common way of using insanity to punish
ill-doers — if it cannot be dropped because it is
stale, will the fact that it is also silly lead to its
surcease ? We must all be familiar with the
sudden overthrow of reason that occurs in ill-
behaving characters. The wretches become insane
in a moment. This catastrophe generally comes
at the end of the book or play, and mainly afflicts
villains whose schemes have miscarried piecemeal ;
their anxiety increases with their terrific but futile
efforts to ward off the approaching Nemesis ; then
some wholly unexpected disaster meets them,
reason totters on its throne, and they fall with a
crash, to be picked up insane. Various situations
lead to this kind of fit — the diamonds kept by a
thief in reserve, to secure flight when the worst has
come to the worst, at that exact juncture prove
to be false or to have been stolen by a confederate ;
the mistress, hitherto the loving accomplice, deserts
the failing fortunes of him who has sinned for her ;
the fatal rectitude of a wife or a son closes un-
wittingly the last avenue of a swindler's escape.
The victims get purple, grasp their collar-studs,
burst into horrid laughter, tumble to earth, and
are picked up gibbering lunatics who for many

MEDICINE IN FICTION 87

years after may be seen in an asylum going through
some pantomime reminiscent of the crowning cata-
strophe. Who first invented this kind of thing I
have no idea ; it is founded on no known pathology,
but novehsts and dramatists believe in the force
of its public appeal.

Most of the diseases which find a place in a
dictionary of medicine have been alluded to by
some novelist or other at some time or other. My
selection of books offering examples of medical
knowledge has been purposely brief, for I did not
desire to essay the impossible task of reviewing in
detail the pathology of fiction. The attempt has
been to show that medicine has certain claims
upon the novelist, and to suggest that if he dis-
regards them he may be called to order, and should
be so dealt with if he affects or protests a know-
ledge which he is without. He should not tell false
social history by misdescribing professional life.
But it is not necessary for him to spoil the machin-
ery or balance of his story by unnecessary medical
accuracy.

I remember once to have written a solution of
a murder mystery in a magazine competition.
The story setting out the puzzle was excellently
written for its purpose. It contained all the in-
formation necessary to fasten the crime upon the
guilty person, but little or none of this evidence
lay upon the surface, while the false scents were
distributed seductively. Some week or two later
the winning solution was published, and point after

88 PHYSIC AND FICTION

point, as I had taken them up, this solution took
them up — until the closing sentence. Then the
murder was allotted to one criminal only, while
I had given her a partner, because I knew that it
was impossible physically for a woman unaided to
do what the story demanded of her. Shortly
afterwards I met the editor of the magazine, and
told him that the successful answer to his recent
competition postulated an impossibility, having
regard to the respective ages and fighting-weights
of the murderess and her victim, and to all the
other circumstances. He was good enough to say
that my forensic medicine was probably sound,
but that my special training was unfortunate from
the story-teller's point of view. Now my solution,
which contained no medical impossibihty, was
clumsy compared with that furnished by the prize-
winner. This was far the neater story, for to
bring a second criminal upon the scene, as I felt
constrained to do, required large hberties in the
way of coincidence. It struck me then that the
episode furnished a good example of the difficulty
of introducing accurate medicine into a story of
episode.

CHAPTER IV

THE MEDICINE OF DICKENS, AND A NOTE
ON 'DR. GOODENOUGH'

Dickens as a Neurologist— A Pathologist in the Street— The
Death of Krook — Dickens and Thackeray as Social Observers
— The Church, Law and Medicine — Who was Dr. Good-
enough ?

In the previous chapter I essayed to show that the
use of medicine by novelists followed certain tracks.
The conclusions which I have invited are briefly as
follows : that the medical episode as an assistance
to the working out of the plot was often well em-
ployed by the experienced novelist ; that in such
use of medicine pathological accuracy, though de-
sirable, was only material if the author himself
claimed scientific correctness ; that the masters
of fiction had often drawn excellent hkenesses of
the diseased subject, and had illustrated correctly
the influence of disease upon communities, though
they were not exempt from the commission of pro-
found or comical errors ; and that only in the
rarest cases was any knowledge shown of the life
led by the medical man — of the nature of his
successes or the reason of his failures, of the
significance attaching to his quahfications, or of
the usual steps in his professional career.
Though some of the statements may be chal-

89

90 PHYSIC AND FICTION

lenged, the truth of the conclusions is rather ob-
vious ; but every one sufficiently interested in the
questions can point out that I have omitted this
or that striking example of the use of medicine in
the novels of so and so. Well, I knew that the
examples which I had selected to prove my points
were chosen arbitrarily, but how otherwise could a
choice be made ? The writers whose books are
quoted are thoroughly well known, and many of
the books must, I think, remain as permanent
adornments of our hterature ; but other writers,
as great or greater, are not alluded to. Scores of
diseases which have been described in novels,
written both by those writers whom I cited and
those whom I omitted, were not brought into dis-
cussion ; and it was obvious that any particular
examples which I gave could be paralleled by
others which might seem more to the point in con-
nection with a particular disease, or more typical
of an individual author's genius, than those which
I hit upon. Such a subject as the use of medicine
in fiction, even within the narrow limitations set
to myself — viz. that only well-known novelists
writing in English or French would be quoted —
must be completely outside the scope of a chapter,
if all the available evidence upon which any
general conclusions are to be arrived at has to be
quoted. For such a task a large book would be
required, and I would not write such a book even
if I had the knowledge and skill to write it very
well ; for I do not think that it would repay the

THE MEDICINE OF DICKENS 91

trouble of reading. Too many examples of the
same episode, too many repetitions of villainy
with the same object and of virtue with the same
reward, would be the result of the compilation.
The use of medicine in the novels of Charles Dickens
is in itself an ample subject for consideration — too
large a subject, it may be seen, for this essay, if
anything like the thoroughness postulated by a
hard critic be expected.

The length of many of the novels of Dickens,
their multiplicity of episode and the vast quantity
of characters introduced, make it certain that no
one reader of his works would select, in illustration
of any text or in support of any thesis, exactly the
same passages that another reader, equally his
admirer, would decide to rely upon, in proving
any point.

I have taken my examples of the use of medicine
almost wholly from the long novels, and I know
that I have not exhausted the mine. But I have
been surprised at the amount of medicine contained
in those works of Dickens which I have recently
consulted, and in particular I have been surprised
at his knowledge of the professional medical life of
his day. Here he is ahead of most Enghsh writers,
save those who happen also to have been medical
men ; while it is evidence of the wide area over
which his kind and fantastic genius ranged, that
this particular knowledge would not be claimed
readily for him, so hidden away is it in the rami-
fications of his romances, so trifling are the things

92 PHYSIC AND FICTION

which display it, and so subordinate are the
characters whose behaviour prove it.

But the medicine in Dickens's novels is nearly all
of one large category. Who are the sick people in
these novels is a question to which no certain
answer can be given ; for many characters go
through his books, without a hint of physical
suffering, who are so warped and twisted that they
conform to no real standard of health, the deformi-
ties being as marked in their bodies as in their minds.
It is in descriptions of mental disease that Dickens
revels, but it is especially difficult to determine
whether a particular person is definitely a lunatic,
or merely an eccentric, or the victim of some ob-
session or self-delusion, utterly spoiling his or her
intellectual balance.

Mrs. Nickleby's unnamed admirer is, with due
allowance made for the deliberate exaggeration of
the comic side of lunacy, a fair picture. There
may never have been a lunatic exactly like him,
amorous failings taking as a rule a much more
unpleasant shape ; but there is no reason why a
certificated patient should not behave in much the
way that this elderly lover behaved ; he would
also have behaved in other ways, of a sort which
Dickens would never have allowed himself to
hint at.

Smike is an accurate and even terrible picture
of the half-witted subject ; hunger, humiliation
and pain have broken his spirit, and the association
with his condition of what is apparently chronic

THE MEDICINE OF DICKENS 93

phthisis is plausible. But can Smike be considered
madder than either Squeers or his daughter
Fanny ? And was not Newman Noggs in his
long - cherished revenge nearly as mad as the
Lothario hi small-clothes ?

The senihty of the ' Father of the Marshalsea,'
of old Chuffey who could only be recalled to life
by Anthony Chuzzlewit's voice, and of Grand-
mother Smallweed who required the stimulus of a
blow from a cushion to arouse her ; the rehgious
madness of Lord George Gordon ; and the con-
genital idiocy of Barnaby Rudge, and the weak-
mindedness of Mr. Dick — are all well dehneated.
But it is difficult to say that the characters, vary-
ing as they do m their manifestations of madness,
and in the depth and seriousness of their delusions,
are much more mentally unbalanced than Quilp,
or even Mrs. Clennam. Barnaby Rudge is an
interesting character, medically speaking, because
in his case Dickens shows belief in the pheno-
menon known as telegony. Barnaby is born
with a bloody mark upon his wrist owing to
his mother a few days before his birth having
clutched the wrist of his murderous father in
her terror.

Edgar Allan Poe, criticising the episode in a
review, pointed out that this was probably a slip
on Dickens's part, who intended to make the
murderer clutch the wife's wrist. Poe's surmise
is shrewd ; but in either event the result belongs,
as far as Barnaby is concerned, to the realms of

94 PHYSIC AND FICTION

imagination, and not to any accepted occurrence
in heredity.

The difference immediately to be noted between
the characters whom Dickens labels definitely
as insane, and those whom he leaves us to label as
we choose, is that the latter are more monstrously
deformed.

Squeers, squat and dirty, with but one eye and
' the blank side of his face much wrinkled and
puckered up ' ; Fanny Squeers, with her harsh
voice and squint ; Quilp, ' so low in stature as to
be quite a dwarf, though his head and face were
large enough for the body of a giant ' ; Flintwich,
whose ' neck was so twisted that the knotted ends
of his white cravat usually dangled under one ear,'
and whose swollen and suffused features gave him
' a weird appearance of having hanged himself at
one time or other and of having ever since gone
about halter and all, exactly as some timely hand
had cut him down ' ; Noggs, * with goggle eyes,
whereof one was a fixture, a rubicund nose, a
cadaverous face,' who ' rubbed his hands slowly
over each other, cracking the joints of his fingers
and squeezing them into all possible distortions '
— all these people present the outward appearance
of well-marked types of mental defect or degener-
acy, and Dickens was intuitively right to make
them act in defiance of recognised standards of
reason. But not a doctor drawn in Dickens's
pages would have had this sound psychological
instinct. For none of them was learned, or a

THE MEDICINE OF DICKENS 95

lover of learning. Dickens had it from cultiva-
tion of his powers of observation as much as from
the intuition that distinguishes his genius.

As no one can say exactly where physiology ends
and psychology begins, the connecting hnks be-
tween psychology and medicine must often be
very close ; we know this now as a commonplace,
but fifty years ago it represented the teaching of
only advanced thinkers. To Mr. Chillip, Mr.
Jobling, and Sir Parker Peps such words would
have meant nothing. Psychological modes of
thought assist in the exposition of therapeutics,
and the merely materialist physician is nowadays
bound to fall behind in the ranks of his profession.
The medical men in Dickens's pages were all
materiaUsts — of this we may feel sure ; but
Dickens himself had a very close appreciation of
the union between physiology and psychology.
None of his medical men is ever described as
seeing any evidence of this union, and it often
happens that characters do not appear in his
books as definitely diseased people, requiring
medical attention, when they are really at least
half-mad. But Dickens makes them act madly
and justifies doing so, in many cases, by putting
their cranky intelligences into physical frames of
the sort which we now recognise as often accom-
panying degeneracy.

I have purposely dwelt upon Dickens's treat-
ment of the mentally unbalanced, because he
introduced these characters into every one of his

95 PHYSIC AND FICTION

books, and did so with skill and discrimination.
The picturesqueness of the unbalanced mind
appealed to him ; he felt towards the crazy and
unexpected sentiment and emotions of Mr. F.'s
aunt, Miss Havisham, or Mr. Dick as he felt
towards a weed-grown churchyard, the oozing
planks of a derehct wharf, or the sagging fagade
of a slum. The ruin he deplored ; the message of
ineffectiveness and even of terror conveyed he
recognised ; but the attraction of mystery was
the predominant emotion with him. The usual
diseases he described hardly at all, and when he
employed them in his narratives he did so merely
as an assistance to the story, taking httle pains to
obtain accurate information upon the symptoms
and pathological history. He was an unconscious
pathologist in the street, and he stored the memories
of quaint features, crooked anatomies, unbalanced
gestures and disordered gaits with the wonderful
accuracy and minuteness which he displayed in
recalling the buildings or the vistas. He did not
know, and did not desire to know, what actual
physical defects or mental lapses were pro-
ducing the noticeable things, any more than he
desired to know and differentiate between the
orders of architecture ; the mystery that lay
behind was a great part of the allurement, and
he would not have it dispelled. He would
not have been even interested to learn that
Mrs. Nickleby's case has been given in a text-
book as an example of ' psychasthenia, character-

THE MEDICINE OF DICKENS 97

ised by loss of conscious control of the verbal
stream.'

The only occasion when I remember Dickens
to have displayed any desire to justify the correct-
ness of his medicine is in connection with the
death of Krook. Krook was a drunkard who died
of spontaneous combustion, and the pathological
notes of his illness and death would not be accepted
as sound by any medical man.

For his account of the death of Krook he
will go bail, but takes no credit to himself in
having drawn, in Dick Swiveller, not only a
most laughable character, but a wonderful por-
trait of the feverish and irresponsible alcoholic
subject, the man who drinks to satisfy no craving
for drink, but simply to ensure that ' the fire of
soul is kindled at the taper of conviviality and the
wing ol friendship never moults a feather.' It is
these topers whom a good restricting influence
can entirely reform, and that Dick should find
moral and material salvation with his ' Marchion-
ess ' is a sound piece of medical history.

The death of Krook was dramatic, terrible,
picturesque and fitting, and as such should pass
free of ah criticism. Improbable it certainly was,
but this fact did not affect the story in any way.
It was an isolated, if highly unusual, event ; and
it does not seem to me that Dickens's use of spon-
taneous combustion was other than perfectly fair
in fiction. The story did not depend on Krook's
dying in this way ; it is not suggested that it was

G

98 PHYSIC AND FICTION

a usual form of death, and no one considers that
a novehst ought to be a pathologist. When, how-
ever, the book was published, Dickens took the
field in defence of his medical learning, resenting
some criticism by George Henry Lewes, who was
no pathologist and an inaccurate though learned
man. Dickens demolished Lewes, but convinced
no one ; and the verdict of medicine to-day is
that there is no such thing as spontaneous com-
bustion. But the occurrence was, in my opinion,
a legitimate episode in a novel, and Marryat used
it with some effect in Jacob Faithful, his best
novel in many respects. The public could not be
seriously misled, save such an unreasonable por-
tion of them as should essay to quote Dickens as
an ultimate scientific authority, while the warning
against drink and dirt conveyed by Krook's
dreadful end has a salutary object.

The medicine of the sick mind, of the disordered
intellect, and of unbalanced emotion, permeates
Dickens's novels ; of the named diseases he makes
little or no mention. When it was necessary for
his story to plan a murder by poison, or to remove
a superfluous character by a zymotic, he does not
specify the drug or the fever. He had some
knowledge as to the symptoms and course of pul-
monary tuberculosis, and was acquainted with the
general features of malaria, though he blundered
in several ways in his description of the malady.
The circumstances of the crimes with violence,
which are prominent in several works, do not

THE MEDICINE OF DICKENS 99

follow surgical rules, though he was never abso-
lutely wrong, that I can recall. But save in the
instance of Krook's death he never insisted that
he was absolutely right, being content to use
medicine as an aid to the plot and nothing more,
and beheving that he had drawn very little upon
it for the success of his romances. In truth his
books are replete with sound medical observation,
all the sounder because it had no conscious medical
impulse.

To pass to his treatment of the profession of
medicine as a profession we find it equally sound ;
but here, instead of being an unconscious and
imaginative philosopher, he is a gay and hbellous
reporter. He writes, with his characteristic
qualities of whimsicality and exaggeration, of the
general practitioner as he has met him. He is
not in the least flattering to medicine and
barely touches on the higher ideals of those who
practise it.

No doctor plays more than a very subsidiary part
in the big romances, and no stress is laid upon the
display by any one of them of fine intellectual or
moral qualities. Allan Woodcourt, the young
surgeon who marries Esther Summerson, is the
single exception that occurs to me of this general
rule, and the presentment is quite unconvincing
and uninteresting. But if there are no stagey
medical heroes, so there are no stagey medical
villains. Dickens gives us the doctors whom he
knew, the general practitioners whom he had

100 PHYSIC AND FICTION

observed about their business. He drew them in
a spirit of amiable if extensive caricature, and the
few Hues devoted to them give a very fair picture
of several types of early and mid-Victorian family
doctors. Sir Parker Peps in Domhey and Son, and
the unnamed surgeon in Little Dorrit, are the two
principal portraits of the consultant class drawn by
Dickens. The first is a comical libel upon any
individual physician, and 3/et the character has
many happy points. We may be permitted to
wonder how the Parker Peps of the first chapter,
where he is a celebrated obstetrician, has developed
into the general consultant by the time he stands
at little Paul's deathbed. The transformation is
an error in detail. Allowing for the fact that
elaborate speciaUsm is largely a thing of to-day,
still there is a mistake here ; for the practice of
midwifery was half a century ago, more than at
the present time, a thing apart. Thackeray
would not have made such an error. His fashion-
able pltysician, Dr. Firmin of Old Parr Street, is
among the meanest scoundrels in fiction, but he
arrived at a consultant position in Old Parr Street
through the help of fashionable friends and a
fashionable marriage, which at that date was
possible, and not by development from accoucheur,
which was impossible.

Thackeray indeed illustrated the social posi-
tion in a very precise manner, through the
mouth of that gallant old snob, Major Pen-
dennis.

THE MEDICINE OF DICKENS loi

' I dine at Firmin's house,' said the Major, ' who has
married into a good family, though he is only a doctor
and '

' And pray what was my husband ? ' cried Mrs.
Pendennis,

' Only a doctor, indeed ! ' calls out (Dr.) Goodenough.
' My dear creature, I have a great mind to give him the
scarlet fever this minute.'

' My father was a surgeon and apothecary, I have
heard,' says the widow's son.

' And what then ' (says the Major) ? ' And I should like
to know if a man of one of the most ancient families in
the kingdom — in the empire, begad, hasn't a right to
pursoo a learned, a useful, an honourable profession.
My brother John was '

' A medical practitioner ' (says Arthur Pendennis).

' Stuff, nonsense — no patience with these personalities,
begad. Fimiin is a doctor certainly — so are you — so
are others. But Firmin is a university man and a
gentleman. Firmin has travelled, Firmin is intimate
with some of the best people in England and has
married into one of the first families.'

The whole passage is illuminating in showing the
gulf which existed in the first half of the nineteenth
century between the general practitioner and his
consultant colleague. Major Pendennis does lip-
service to the dignity of medicine in the person of
his brother, but has a whole-hearted regard for the
social standing of the Old Parr Street consultant,
though it was due to everything but scientific
achievement.

Thackeray himself can be seen to have no
sympathy with the Major's attitude, though
recognising its existence. Dickens, judging by

102 PHYSIC AND FICTION

Sir Parker Peps, was ignorant of the class dis-
tinctions which at that time were very real,
though disappearing. Major Pendennis was repre-
senting, as he would, a Regency code of opinions,
but his creator was aware of the social rise of the
medical practitioner, which took shape under the
first Medical Act.

To return to medicine as portrayed by Dickens.
The unnamed distinguished practitioner whom
Mr. Merdle, the eminent financier and thief, con-
sulted with regard to his health, is a medical
Tulkinghorn — he keeps close watch on his patients,
preserves their secrets, commands their confidence,
and enjoys the power that he thus secures. This is
hinted at, not laboured over as it is in Mr. Tulking-
horn's case, but the impressions produced are
identical. We can see, in Mr. IMerdle's adviser,
the man of the world, knowing so much of the
seamy side that he is necessarily disillusioned, kind,
tolerant, and witty. At least I think I can see all
that, though vision is helped by only a few
sentences.

Dr. Bayham Badger, j\Ir. Chillip, Mr. Losberne
and Mr. Jobling are far more closely observed.
They may be taken as typical examples of Dickens'
attitude towards the general practitioner. It is
the attitude of Mr. Merdle's medical adviser —
critical and tolerant. Dr. Bayham Badger, ' Mrs.
Bayham Badger's third,' is a more or less fashion-
able doctor, and the sketch of the socially ambi-
tious middle-class man is distinct. This pink and

THE MEDICINE OF DICKENS 103

white crisp-looking gentleman, with a meek voice
and surprised eyes, was probably quite a successful
general practitioner, but he never could have had
any sense of the meaning of his profession, and
never could have desired to get more out of it than
a secure and, if possible, rising social position.
An ass and a sycophant, he may very well have
known the routine of his work, and would in all
circumstances have behaved with decorum. He
was a safe man.

Mr. Jobling was essentially an unsafe man. This
accomplice of knaves, the tout of Montague Tigg,
himself touted for by undertaker and nurse, be-
longed to an evil school. The amount of harm
that a corrupt practitioner can do, much of it
quite unconsciously, is indicated in Jobhng's
character. ' We know a few secrets of nature in
our profession, sir,' said Mr. Jobling. ' Of course
we do. We study for that ; we pass the Hall and
the College for that ; and we take our station in
society on that.' Note that Dickens knew the
regular double qualifications under which the
Enghsh doctor usually practised at the time ;
most novelists would have given Jobling some
impossible degree. But Jobhng took his own
station in society upon nothing so orthodox and
creditable as his diplomas. Whether he was a
skilled practitioner or not, his success was clearly
due to the fact that he was not nice in his morals,
and Iris unscrupulousness was a direct link in the
chain between Jonas Chuzzlewit and murder.

104 PHYSIC AND FICTION

Mr. Chillip, the meek and mild medical man who
officiated at the birth of David Copperfield, is an
excellent character as far as he goes ; we may well
consider him next, to obliterate the disagreeable
impression left upon us by Mr. Montague Tigg's
' Jobling, my dear fellow.' Mr. Chillip's profes-
sional life is duly observed. He moves in the
social scale that the village doctor would do, and
his kindness and amiability get success for him,
as they ought. His goodness and simplicity are
transparent, and in the sphere of life where his
path lay we may be sure that he was an ever-
pleasant as well as ever-present help in time of
trouble. The same may be said of fat Mr. Los-
berne, who ' splintered up ' — Dickens meant ' put
up in spHnts ' — Oliver Twist's arm, and who so
gaily dislodged Mr. Giles, butler and doer of the
deed, from the position of hero which he had
assumed.

The family medical adviser is referred to casu-
ally in nearly every novel, but the four selected
for mention are the most carefully drawn portraits.
Their sum total cannot be regarded as altogether
satisfactory. For all are ridiculous and one is
highly so. None is ever placed in any position
where the possession of high principles would be
tested, and one would certainly nave broken down
under the slightest test. But three are good
fellows, and it is not suggested that, within their
limitations, they do not all do their work efficiently.

The way, however, to see how far Dickens was

THE MEDICINE OF DICKENS 105

intending to be harsh to the medical profession as
a whole is to look for a moment at his treatment
of the other professions. The law, of which he had
some practical knowledge both as clerk and police
reporter, is lampooned throughout. The lawyers
are far more important to the stories than the
doctors are, and their record of villainy is pro-
digious. Sampson Brass and Uriah Heep are
first-class villains ; Vholes, Dodson, Fogg, Stryver,
and Pell are very unpleasant people ; Jaggers of
Little Britain, so burly and bullying, immersed in
court business of a criminal kind, has this in
common wdth Tulkinghorn of Lincoln's Inn, so
close and irresponsive, the silent depository of
family confidences — neither does anything from a
high motive, though I have a habit of hking them
both. Eugene Wrayburn, whimsical and fascinat-
ing, is an unconscious bounder ; Hiram Grewgious
and Perker are the best of a poor lot morally ; the
second is honest and competent, while the first is
a good man.

The Church is condemned otherwise — it is hardly
ever mentioned in the books at all as a social or
useful force. Think of what this means. These
lengthy and compHcated romances, containing
over two thousand characters, and for the most
part dealing with contemporary hfe — though the
phases of that hfe and the individuals who hve it
may be rendered by a teeming imagination in
terms of cubism rather than of photography —
contain, as far as I can remember, only one clergy-

io6 PHYSIC AND FICTION

man worth recording for his virtues. Quite a
large proportion of the names in any dictionary
of Dickens's characters would fall under the head-
ings of unfortunate, poor, sick, crazy or bad. Yet
in how few instances do the ministrations of
religion, as proffered by the ordained representa-
tives, play any part in the drama. The chapter
at Cloisterham and its breezy boring minor canon,
Mr. Crisparkle, play no part in the tremendous
dramas about them, and the bishop who dined
with Mr. Merdle to meet the Barnacles is a jokelet.
Oliver Twist went through his terrible association
with crime of the meanest as well as gravest sort
on the spot where, later, Mackonochie and Stanton
became part and parcel of daily life, and where
the seeds that they have sown bear copious harvest
on unpromising soil. No hint is given by Dickens
of any sympathy from the clergy with those who
had strayed from the fold. True, the Church at
the accession of Queen Victoria was not active in
the spheres in which Sikes, Nancy, Fagin and John
Dawkins moved ; but it is surprising that neither
did Dickens's imagination prompt him to describe
the servant of God working in such a blasted vine-
yard, nor did his magnificent sense of justice move
him, so far as I remember, to urge the Church to
carry on some work of reclamation. I recall no
passages of the sort in his works. The Reverend
Frank Milvey, ' officially accessible to every
blundering old woman who had incoherence to
bestow upon him . . . expensively educated and

THE MEDICINE OF DICKENS 107

wretchedly paid,' who toiled all day and night
' out Holloway direction,' stands out as a very
St. Francis in an imaginary world where no others
compete with him for canonisation. Compared
with Dickens's treatment of the legal profession,
which he manhandled bitterly, riotously and with
gorgeous humour, and with his treatment of the
clerical profession, which for practical purposes he
ignored, I find his qualified regard for medicine
complimentary.

If none of Dickens's medical men stays much in
our memories, the exact contrary may be said of
his students and his nurses. Sairey Gamp and
Betsy Prig, Bob Sawyer and Benjamin Allen are
as well known as Micawber, Pecksniff, Sydney
Carton and Mr. Pickwick himself. They come, I
think, within the scope of a consideration of
medicine in Dickens.

With regard to the nurses, Dickens drew what he
had seen, reported what he had heard, and helped
a public, rocking with mirth, to appreciate the
existence in its midst of a dangerous scandal.

With regard to the students, Dickens also drew
what he had seen, and the injustice to medical
students lay in his attributing to students of
medicine all the loose habits of students in general,
and then typifying students in general by two
particularly special examples. It is the old but
none the less sound defence of those who would
explain the almost boundless exaggeration of some
of Dickens's characters to say that he drew types

io8 PHYSIC AND FICTION

not individuals. No one was ever so good as
the Golden Dustman, so fatuous in their ways
as Mr. Meagles and Mr. Podsnap, or so irrelevant
as Flora Flintwich and Mrs. Nickleby ; they are
the exposition of their failings. Bob Sawyer and
Benjamin Allen, who were suggested by Pierce
Egan's heroes, are the personification of deboshed
apprentices ; they are not portraits of students,
and certainly not of medical students. The ob-
servations from life made by Dickens in his youth
— he was only twenty-four when he wrote Pickwick
— were made in a humble stratum of society, where
one young man in training for his calling was much
like another. Dickens mixed up all the idle tyros
of any trade or calhng across whom he came, and
a good many of these were not embarking upon
any professional career, and presented the quint-
essence of their humour and raffishness by two
young men with the label of medical student
attached to them. By the time he was writing
Bleak House, that is to say some fifteen or sixteen
years after the publication of Pickwick, he knew
more ; and Richard Carstone, who entered the
medical profession under the tutelage of Mr. Bay-
ham Badger, in what was then quite the orthodox
manner, though a tragically inefficient person, was
no rowdy.

On the whole, I think Dickens treated medicine
well. He placed neither the science nor the prac-
titioner on any pedestal. But that he respected
medicine is indicated in several ways. He re-

THE MEDICINE OF DICKENS 109

frained from introducing into his books patho-
logical travesties, the result of the ill-digestion of
text-books. A great sensational novelist, he did
not once make a doctor play any leading part as
a villain. Lastly, he helped in a very pronounced
degree to rescue society from the ministrations of
the hopeless class into whose hands the calling of
nursing was committed. At the time of his earlier
writings our grandparents suffered much from the
nurse-hag. I think of their sorrows with fortitude
when I reflect that it is from their sorrows that we
derive Sairey Gamp and Betsy Prig. Society
owes Dickens a double debt for having buried the
nurse-hag under inextinguishable laughter.

A Note on ' Dr. Goodenough '

The character of Dr. Goodenough, reference to
which has been made just now, is often stated to
have been drawn from Dr. John EUiotson, the
famous physician at University College Hospital.
To a certain extent this may be the fact, but
curiously enough, because Dr. John EUiotson came
to professional grief and Dr. Firmin came to total
grief, the absurd statement has been printed that
Thackeray meant to delineate EUiotson by the
scoundrel Firmin. The story of the fall of Elliot-
son is not without its lessons to-day ; there is no
doubt that Thackeray considered him to be a
deeply wronged man.

In 1838 EUiotson was the senior physician on

no PHYSIC AND FICTION

the staff of University College Hospital, a staff
second to none in Europe for brilliancy, comprising
as it did Samuel Cooper, of the Surgical Dictionary ;
Liston, the most expert operator of his day, cer-
tainly the boldest and probably the most successful
surgeon London has ever seen ; Richard Quain,
the author of The Anatomy oj the Arteries and a
mine of pharmacological lore ; and Robert Cars-
well, of unequalled pathological knowledge. He
was co-professor at the medical school of University
College with these, with Robert Grant, the zoo-
logist, Huxley's predecessor as Fullerian Professor
at the Royal Institution ; and with Sharpey, the
profound physiologist, and the autocrat of the
elections of the Royal Society. In this splendid
company EUiotson more than held his own. A
comprehensive lecturer in the classroom, a most
acute physician in the wards, and an original, un-
conventional thinker in every capacity of life, he
was respected and admired by his colleagues, much
consulted by the pubUc, and immensely popular
with the students. Being such a man as he was,
the story of his connection with animal magnetism
and of his experiments in a kind of black art con-
ducted at University College Hospital forms one
of the most extraordinary pages in the medical
history of the century. Nor is that page rendered
less curious by the fact that Elhotson seems to
have acted in perfect good faith — to have been,
in fact, a dupe along the very lines where he might
have been expected to be a detective. But he

' DR. GOODENOUGH ' in

was vain of his readiness to learn. He had made
many valuable observations in the uses of drugs,
and he was wont to stimulate his classes by point-
ing out that in the domain of therapeutics the
student had open before him a virgin country
awaiting the explorer. For anatomy and surgery,
as then taught, appeared more or less finite sub-
jects. The enormous developments that physio-
logy and pathology would experience as a result
of the study of micro-organisms were not foreseen,
and Elliotson, a sanguine, imaginative man, sought
outlets for his inventive mind. As bad fortune
would have it, he came across a certain Baron
Dupotet, who had experimented in Paris with
mesmerism, and obtained permission for him to
make a trial of his methods of healing in the wards
of University College Hospital. EUiotson's own
association with these experiments was at first that
of an interested spectator. Avowedly on the look-
out for departures in therapeutics, Baron Dupotet's
claim to relieve, and in some cases cure, epilepsy
by the production of the mesmeric slumber seemed
to him to fall within the range of legitimate inquiry.
Had Elliotson stopped there, all would have been
well. Had he been content with a simple attempt
to benefit the sick, of whose desire to recover from
their diseases there could be no doubt, and whose
only collusion would consist in faithful obedience
to the physician's orders, no one would have ob-
jected ; at any rate, no one would have had a good
case on which to found their objections. But, un-

112 PHYSIC AND FICTION

fortunately for EUiotson, he was led to employ
mediums of whose good faith he had no proper
guarantee, and by their pretended powers and
revelations to see in mesmerism a new force for
good or ill in the world. Everything that is or
has been meant by Perkinism and animal magnet-
ism, transferred vision and exoneurism, seems to
have been put in practice by EUiotson in conjunc-
tion with his two mediums, Elizabeth and Jane
O'Key, while his initial intention to use the new
force, whatever that might be, in therapeutic
measures was entirely lost sight of. These two
hysterical girls being thrown into slumber were
invited to tell the time by watches applied to
their elbows or navels ; were asked questions as
to the proper medical treatment of themselves and
other patients ; and were apparently twisted into
convulsions by passes made at them at a distance
by EUiotson, or by contact with certain fluids or
metals which had been previously charged with
' magnetism ' by being held in Elliotson's hand.
The performance was mystical and inconclusive,
for no certain results were ever obtained. It,
moreover, showed a tendency to degenerate into
indecency, while the only therapeutic innovations
that resulted from it would have given effect to
the dangerous precedent of allowing patients to
prescribe for themselves, and even to interfere with
the prescriptions given by the medical staff to
fellow-sufferers, less marvellously gifted.

It was no wonder that the hospital authorities

'DR. GOODENOUGH' 113

were much exercised in their minds at ElUotson's
behaviour. Two camps were quickly formed.
The Governors were opposed to the continuance of
performances which were gaining the institution
much unfavourable notoriety and some ridicule.
Certain of the students, headed by Liston, sup-
ported the Governors' view. On the other hand,
EUiotson had a grand argument and a great follow-
ing. The argument was, of course, that all in-
novators are deemed mad or dishonest by their
slower-witted coevals, and that the impossibility
of to-day readily becomes the routine of to-
morrow ; the following consisted of the majority
of the students, who were personally attached to
EUiotson, who could bear witness to his wisdom
and sincerity in other things, who were con-
tent to beUeve what he believed, and who
were, moreover, fascinated by the atmosphere of
occultism. The ' hospital of all the talents,'
as it was called in recognition of the scientific
excellence of its staff, was thrown into absolute
disorder.

Thomas Wakley, the editor of the Lancet,
wrote in his paper, which by that time had become
a serious professional organ, that the solution to
the trouble lay entirely in the answer to the ques-
tion whether the O'Keys were or were not honest
and trustworthy. If they were trustworthy, then
EUiotson and Dupotet had made a discovery, but
he pointed out that the words of hysterical epi-
leptic young women, brought suddenly into pubUc

H

114 PHYSIC AND FICTION

notice, would not as a rule be considered worth
any attention at all. And if the O'Keys were
impostors, what were Dupotet and Elliotson ?
Clearly dupes or rogues. From this inference the
articles in the Lancet allowed no escape. Elliot-
son accepted the challenge with a willingness and
alacrity that certainly vouched for his good faith.
He offered to bring his mediums to Wakley's house
in Bedford Square, and there to exhibit their
powers of prophecy, transferred vision, clairvoy-
ance and extraordinary susceptibility to certain
metals and fluids. Accordingly, on i6th August
1838 a performance — for no other name describes
the proceedings — was given in the drawing-room
of 35 Bedford Square for the benefit of ten persons,
five chosen by Wakley and five invited by Elliot-
son. Among those invited by Elliotson to be
present was a Mr. Fernandez Clarke, for many
years a member of the staff of the Lancet, and the
author of some interesting autobiographical recol-
lections of the medical profession. Clarke was
regarded by both sides as a friend, for although he
was present by Elliotson's request, he was willing
to further Wakley's intent to probe the facts.
Accordingly, at a particular moment a test was
made of the honesty of one of the mediums, Eliza-
beth O'Key, by arrangement between Wakley
and Clarke. Of the girl it was alleged by EHiot-
son that she would fall into convulsions upon being
touched by a piece of nickel, but would remain
placid under contact with lead. Discs of these

'DR. GOODENOUGH' 115

two metals were then given by Elliotson, ' charged
with magnetism,' to Wakiey, who was seated in
front of the girl, a screen of pasteboard being set
between them. Wakiey immediately gave the
nickel, unperceived by EUiotson, to Clarke, who
put it in his pocket and walked to the other end
of the room, where he remained during the ex-
periment. Wakiey, now having nothing but the
lead in his possession, to which metal the medium
was supposed not to react, bent forward and
touched the girl's right hand. As he did so a
bystander by arrangement whispered audibly :
' Take care that you do not apply the nickel too
strongly.' Immediately the medium fell into
strong convulsions, much to the gratification of
EUiotson, who said that ' no metal but nickel had
ever produced these effects,' and that ' they pre-
sented a beautiful series of phenomena.' Wakiey
at once pointed out that no nickel had been used,
and upon Dr. Elhotson's indignant protest, Clarke
came forward and explained the trick that had
been played, and produced the nickel from his
own waistcoat pocket. Wakiey now said that his
point was made, and that the girl was proved an
impostor, but EUiotson was persistent that some
error had occurred. He considered it possible
that in some unexplained way ' the power of nickel
had been present.' The experiments were con-
sequently persevered in, both on that day and on
the foUowing day, with the result that the
behaviour of both the muddled mediums became

ii6 PHYSIC AND FICTION

entirely at variance with that which was expected
of them. Not only did they fall into convulsions
on contact with the unexciting lead, but they
remained impassive when rubbed with the influ-
ential nickel. They drank water which had been
mesmerised — this was ElUotson's word, and the
process consisted in the owner of the master mind
placing his finger in the fluid for a few minutes —
without a spasm, when it should have rendered
them rigid ; while water straight from the pump
produced opisthotonos. ' Mesmerised ' gold from
ElUotson's hands had no influence on them, while
sovereigns emanating from the trouser-pockets of
sceptics produced neurotic results of a marked
character.

Wakley denounced the whole thing in the
Lancet as a pitiable delusion. He made no reflec-
tions upon Elhotson, who was a personal friend
of his own, and had been a contributor to the
Lancet from the inception of the paper, but he told
the whole story of the experiments, when it be-
came clear that Elliotson had omitted proper
precautions, that his scientific experiments were
parlour jugglery indifferently stage-managed, and
that he himself had imported into the matter a
degree of personal interest which had unbalanced
him and unfitted him for the responsible position
of senior physician to University College Hospital
and teacher of medicine in the school. In Decem-
ber of the same year the Council of University
College passed a resolution to the effect that the

'DR. GOODENOUGH' 117

hospital committee were to hold themselves in-
structed to take such steps as they should deem
advisable to prevent the practice of mesmerism
or animal magnetism in future within the hospital.
Dr. ElUotson considered this resolution personally
offensive to himself, and at once lodged his resig-
nation of the posts of physician to the hospital
and lecturer to the medical school with the Council
of University College, at the same time making
an appeal to the students to demonstrate in his
favour against the hmitation which had been put
by the Council upon the range of legitimate scienti-
fic inquiry. The students at an excited meeting
and by a slender majority ratified the action of
the Council, resolving that they ' sincerely regretted
the circumstances which had necessarily led to
Dr. EUiotson's resignation.' On the same day
Dr. EUiotson's resignation was accepted by the
Council.

Elliotson did not die till thirty years after the
exposure, and in his obituary notice in the Lancet,
where much of the above story will be found, the
following testimony to his talents and personal
honour appear :

' He pursued it (his profession) as he did
everything he engaged in, consistently and ener-
getically. He was highly endowed mentally and
was a good scholar, being well acquainted with
ancient and modern languages. He was some-
what obstinate in his opinions and had too firm a
belief in what only appeared to be true. He has

ii8 PHYSIC AND FICTION

somewhat outlived the memory of the present
race of medical practitioners ; but he occupied in
his day a most important position, and this he
occupied worthily — he was entitled to it by his
talents and acquirements. Whatever were his
faults, and they were probably those due to an
enthusiastic temperament, it must be admitted
by all who regard his character without favour
and malevolence that he was a remarkable man.
He was an earnest reformer. He repudiated
authority when it attempted to interfere with the
progress of truth. He was in the front ranks of
those who opposed monopoly, and was consistent
in this at a time when that consistency would
have been fatal to a man less able and courageous.
The breath of slander has never ventured to
attack his private character. If he made enemies
he had the happy power of conciliating and making
friends ; and thousands of the pupils whom he in-
structed, and whom he endeared to him by a
genuine spirit of kindness, will do justice to his
memory as to one of the foremost men of our time ;
while they cannot help lamenting the great error
of his life which casts a shadow over his monument,
which without it would have been pure and
unsuUied.'

It is quite certain that Thackeray would never
have travestied such a man by taking him as the
model for Firmin, whose fall was the consequence
of a steady career of falsehood, but apart from
this we have remarkable proof that Thackeray

'DR. GOODENOUGH' 119

thought Elhotson to have been very badly treated.
In 1850, twelve years after Elliotson had resigned
his official position, Thackeray dedicated Pen-
dennis to him in warm words of appreciation
and gratitude. This seems to be the only ground
for the suggestion that he meant to portray
Elliotson in the sympathetic character of Dr.
Goodenough.

CHAPTER V
• THEY ALL LIVED HAPPY EVER AFTER '

Marriage as an Individual, a Social and a Racial Afifair —
Fairy Stories — Medical Inspection and Marriage Settlements
— Heredity and Disease — Mendelism and Marriage — The
Maligned Jukes.

' They all lived happy ever after ' is the one stock
phrase with which to close the fairy story — at
any rate that is the form in which the raconteur
is expected at the children's hour to sum up the
future for those lovely princesses, astute peasants,
virtuous youngest sons and spell-bound maidens,
whose joy-bells ring down the curtain. Grimm is
a regular employer of the formula, and with respect
to what followed upon such marriages as those of
Prince Vahant to the Sleeping Beauty, or of Prince
Charming to Cinderella or of Aladdin to the Princess
Badroulbadour, the words are always added in
personal narrative to show that the end has come —
not so much as a logical or artistic issue as to in-
form the children that there is no purpose to be
served by petitioning as to what happened in the
future either to the good people or to the bad ;
the marriage of the heroes and heroines having
brought happiness not only to themselves but to
every one else who remained aUve to witness it,
and a monotonous record of fehcity being not

120

' THEY ALL LIVED HAPPY EVER AFTER ' 121

worth reciting, the sooner the audience gets off to
bed the better. But did Cinderella, for example,
live happy ever afterwards ? Was her marriage
good for the race ? If the marriage made her un-
happy, but proved good for the race, did Cinder-
ella's unhappiness matter much ? What we reply
depends on how we regard marriage.

In a well-known compendium. Health mid Disease
in Relation to Marriage and the Married State, written
by a group of German authorities and edited by
Dr. S. Kaminer and Professor H. Senator of BerHn,^
Herr Rudolf Eberstadt, treating of the economic
importance of sanitary conditions in relation to
marriage, debates whether on legal and politico-
social grounds a contract of marriage ought not
to be made dependent upon the presentation of
proofs that the bodily health of the intending
partners is good, or that there is at least an absence
of diseases which may be a source of danger to
each other or to the future children. This is a
most important question, and if it should come to
be answered in any State by the general introduc-
tion of health certificates for marriage purposes
we should indeed be witnessing a far-reaching
departure in sociology. Already there are com-
munities subject to some such form of legislation.
A question can, however, be important without
being urgent ; the points involved may depend,

^ An abridged version of Itliis interesting work, translated into
English by Dr. J. Dulberg under the title of Marriage and Disease,
was published recently.

122 PHYSIC AND FICTION

for example, upon investigations not yet com-
pleted or upon conditions not yet realised, when
it is seen at once that to give an answer would be
premature ; and yet we may desire very much
that an answer should be given. Enthusiasts
reply before the time is ripe, and if they are fortu-
nately moved they may save their generation evolu-
tionary embarrassments, for their inspired lead
may conduct by a short cut to a destination which
otherwise could only have been reached by a
dreary tramping of the highway ; but, on the other
hand, if enthusiasts err in their intuitions they
may delay progress by their impetuosity, directing
into wrong courses energy that could be ill spared
— for the short cut which lures us from the highway
may land us in the bog. The question of how far
a certificate of health ought to be a compulsory
preliminary to marriage is exactly one where we
need to be careful about the guidance which we
follow. We ought to ensure as far as possible that
our conductor knows his way unfailingly, but such
security is rendered hard by the number of circum-
stances to be taken into account.

The claim made for medicine that her doctrines
should be consulted as a matter of course as a
preliminary to marriage is one that is just now
being pressed considerably by certain groups of
thinkers, and it is undoubted that a large number
of people, not even the majority of them belonging
to the medical profession, beUeve that all men and
women about to be married would do well to sub-

'THEY ALL LIVED HAPPY EVER AFTER ' 123

mit themselves to medical inspection as an in-
evitable preface to the joining of hands. To take
the opposite view is regarded by some of these
ardent spirits as a betrayal of eugenics, a crime
which must be especially hideous when perpetrated
by a medical man, but I am compelled to think
that the time has not yet come when the legalised
interference of the medical man in respect of
marriage designs would serve practical purposes
commensurate with its inconveniences.

Marriage may be regarded theoretically as an
individual, social or racial affair, according as the
contract has for its essential object the promotion
of the happiness of the pair concerned, consoHda-
tion in social poHtics, or the maintenance of the
race in good and improving health. But we have
to remember that whatever object any two persons
who are marrying may think is their essential one,
they must play their part, being married, as factors
in present society, and also as factors in the future
of the race. They cannot escape these responsi-
bihties. If two persons could decide that they
would belong to one class, and to one class only —
that is, that they would marry out of consideration
simply for personal happiness, social convenience,
or respect for eugenics — it would be feasible some-
times to assist them with a medical opinion as to
whether they were or were not fitted to belong to
the particular class selected ; but, even so, the
difficulties of civilised life might outweigh the
advantages of scientific correctness. Too many

124 PHYSIC AND FICTION

of the problems of heredity remain as yet unsolved,
and too much waste land lies between the terri-
tories of physiology and psychology, to make it
safe for medicine to undertake the task of even
saying whether the offspring of any particular pair
will be healthy ; any claim that is made for medi-
cine, either that by systematic examination of all
candidates for marriage a greater general happiness
would be obtained, or that a larger proportion of
unions fortunate for the State would be solemnised,
is bound to break down partially. Certain gross
tragedies, as unions where actual contagious dis-
ease might be propagated, would cease to occur,
but their cessation would not cause anything like
the general rise in physical condition that is be-
lieved ; while many couples who were able to pass
all physical tests successfully would continue to
be unhappy individuals and bad citizens, mainly
because of their unsuitable marriages, even though
each partner could pass an exhaustive medical
scrutiny.

This would be the case especially among the
upper classes, where command of money and the
habit of self-indulgence make marriage an easy
process, and where the environment should ensure
no physical unfitness. The typical mesalliance of
the lusty lord with the capering kitchen-maid —
the story of Cinderella over again — is a good ex-
ample of the union that would receive a medical
blessing, but that none the less contains no stable
element of happiness. It may be said that the

' THEY ALL LIVED HAPPY EVER AFTER ' 125

marriages of the upper classes — all of them,
whether of love or of convenience, whether suit-
able from a worldly point of view or the reverse —
count for very little in the history of races as a
whole, now that the world, at any rate those parts
of it which are civiHsed, is overcrowded. The rich
are now so small a fraction of the population. It
may also be said that the marriage of Cinderella
and Prince Charming is not typical among the
marriages of the upper classes, and that it is unfair
to urge that, because medical inspection would not
make such a marriage any greater success, medical
inspection can be of no use elsewhere. I am
putting this argument into the mouth of the
student of eugenics, and admit its force at once.
Where environment is elaborate, and where social
codes restrict the play of impulse, there are many
reasons for unhappiness in marriage which do not
prevail in simpler circles. These reasons so en-
tirely determine the destinies of those who are too
dependent upon the circumstances about them to
make any resistance, that the credit side of a good
match, from the hygienic point of view, may be
cancelled by the deficit in other directions. The
records of the Divorce Court prove this over and
over again.

I have alluded to Cinderella — consider her
marriage and that of the Sleeping Beauty with an
eye to eugenics, to racial developments and to
social circumstances. If medical advice had been
sought in these cases, all the evidence goes to show

126 PHYSIC AND FICTION

that the contract would have received ample
scientific blessing. The contracting parties were
young, ardent, good-looking people, mating by
inclination. To these advantages must be added
the fact that the dangers of over-specialisation in
breed were avoided in the case of a union between
the blue-blooded Prince Charming and the low-
born Cinderella. Prince Valiant and the Sleeping
Beauty presumably belonged to the same class in
society, and the medical man would possibly have
submitted the history of her prolonged trance to a
rigorous investigation, but as we learn that on the
signal of the Prince's embrace the whole life of the
palace resumed its normal course, it seems probable
that the Princess, when she awoke, awoke in good
health. From the point of view of eugenics these
marriages would have been considered very suit-
able, and the same may be said of the union be-
tween the plebeian Aladdin and the daughter of the
King of China — I forget if this marriage was ever
duly solemnised. But whether the marriages
would have been happy ones is not so certain.
Translated into terms of modern life, Badroul-
badour's mesalliance would have been fatal to
all family life, w^hile the other unions might well
have been unhappy, and sound physical health
would not have bridged the various gaps in the
dispositions of the contracting members. Cinder-
ella's husband would have found it difficult to
impose his wife upon his friends, and there would
have been perpetual trouble about her pretentious

'THEY ALL LIVED HAPPY EVER AFTER' 127

sisters ; the Sleeping Beauty's long segregation
from society would have made hci" an unfitting
mate for an adventurous spouse.

In talking of compulsory medical inspection
before marriage — and it is only the case of legal
compulsion that is being considered — the case of
the upper classes is taken before the case of the
mass of the population on two grounds. First,
the upper classes would be likely to discharge
voluntarily a duty which could only be insisted
upon by the State as a general provision with the
greatest possible inconvenience, if any State were
to attempt to make medical inspection before
marriage compulsory ; secondly, the upper classes
are the people whose marriages are attended with
settlements, and the precaution shown by the pro-
vision of settlements between married persons is
quoted frequently as a precedent for similar caution
in the matter of physical health. The specious
comparison of medical inspection before marriage
with what is termed the parallel case of legal
settlements invites some comment. All prudent
parents, it is said, call in a lawyer to draw settle-
ments before marriage is entered upon, in order to
insure the material well-being of the young people
in the present and in the future ; surely, and with
even more reason, they should seek the advice of
the doctor to see that each young person brings to
the common lot a fair stock of physical well-being,
and a fair promise of respectable heritage for the
offspring. We are assuming that no marriage can

128 PHYSIC AND FICTION

occur without the production of health certificates ;
and we must compare tliis case with the case
where, owing to insistence on one side or the
other, no marriage can occur save upon the exe-
cution of certain legal documents.

Now all prudent parents do not insist upon
marriage settlements, or, rather, the marriage
settlements are only insisted upon in a com-
paratively few cases of property. I do not know
what the exact proportion of rich and compara-
tively rich persons in this country may be to the
rest of the population, but I know that the number
of these well-endowed persons is small. Probably
not more than one parent in ten thousand occupies
a position in which a settlement would be con-
sidered as an essential for the marriage of children.
And among these it will be further found on ex-
amination that the settlement is often the very
slightest sacrifice to an old-fashioned principle
of insurance, because the substantial position en-
joyed by the parent, being dependent upon annual
earnings and not upon any hoard, does not allow
of money in capital sums being parcelled out
among the children. The cases where settlements
are such an integral part of nuptial arrangements
that their recital might be included in the church
service without arousing any feeling of surprise
are those which may be termed gross cases of
property — cases where, whether the money settled
amount to £500 only or half a million sterling, the
sum is something that can be so absolutely spared

' THEY ALL LIVED HAPPY EVER AFTER ' 129

out of the common family wealth, that fairness
suggests a division should be made, and prudence
that 'twere well 'twere done legally.

These cases are far too exceptional, when we
take into consideration all the marriages that are
celebrated, for any general rule to be founded
upon them, and to draw from them the conclusion
that it is the custom of all prudent parents to
make marriage settlements upon their children is
misleading. The position has its physical analogue
when a medical investigation of the amount of
physical wealth, which it is proposed by the con-
tracting parties to bring into the common stock,
has to be made for reasons of the most elementary
caution — that is, in gross cases of suspicion where
there is distinct evidence of a profound blood-
poisoning, or of an unhealthy diathesis, or of one
of the few hereditary maladies. Such gross cases
of suspicion are comparable to gross cases of
property. Here the risks to be taken are so great,
that just as the prudent parent calls business
experts to his aid when he is confiding a daughter
to a man engaged in a highly speculative business,
so the prudent parent is right to forbid the marriage
unless the suitor can prove, despite report or
appearances, that he is bringing into physical
settlement the necessary stock of good health to
constitute a satisfactory trust. (I allude to the
situation as affecting the man adversely, but, of
course, the circumstances could be transposed.)
Where obvious reasons exist for doubting the

130 PHYSIC AND FICTION

good health of one or other of the contracting
parties medical opinion would be most valuable,
and an absolute veto of the marriage on medical
grounds might be highly reasonable. Put these
are gross cases of physical risk, and, as with gross
cases of property, their number in the aggregate
is small. And just as it would be an absurd,
boring, and grandmotherly piece of legislation to
enact that no people should be married unless
they could bring into the church with them, say,
three years' income in cash, so it would be an in-
tolerable piece of social bullying to legislate that
all intending couples must undergo some form of
medical inspection, merely because in gross cases
the opinion of a medical man is desirable, and
because perhaps in these cases a medical veto
might be the only means of averting a serious
tragedy.

Young men and young women are not to be con-
sidered criminally imprudent who marry without
any further provision than the income or wages
earned from day to day ; and a stock of health
which seems to be up to the average on each side
ought to be considered sufficient whereon to begin
married life. The medical certificate has been so
much put forward as an elementary precaution in
eugenics, and the idea has seemed to so many
medical men to be a sound one, that I am a httle
scared at my temerity in finding it a very unsound
one. But I can conceive it to be a mischievous
proceeding often, and a useless one generally, and

'THEY ALL LIVED HAPPY EVER AFTER' 131

Major Darwin, in an address to the Eugenic
Education Society, has warned his hearers to be
circumspect in seeking Government interference
in the regulation of marriages.

The special circumstances of the well-to-do
classes make it likely that without some measure
of good health on both sides a marriage will not
often take place, while those same circumstances
make it possible that a marriage which appears
imprudent hygienically shall be a nominal union
only. Also in the well-to-do classes, if their
marriages are going to be unsuccessful there will
be many factors at work to bring the misfortune
about, and to cause the unions to be failures from
the racial and sociological, as well as the individual
aspect, however healthy the contracting parties
may be. For these reasons medical inspection of
the candidates for marriage would serve no useful
purpose as a general rule in these classes, although
in a few cases, where the circumstances may be
fairly compared to those which in the case of
material wealth call for settlements, medical
inspection is wanted. And here it is sure to be
obtained quite frequently.

But what about the population at large ? What
about the people whose stock-in-trade is their
health, whose individual happiness and prosperity
largely depend upon their health, and, above all,
whose offspring are to form the bulk of our popu-
lation, and to do so much of the hard work of the
nation that their physical deterioration amounts

132 PHYSIC AND FICTION

to a national calamity ? Ought they to undergo
some form of medical inspection before their
marriages are sanctioned ? The answer often
given to this question is ' yes/ and the opinions
imphed thereby are becoming daily more pre-
valent. None the less, the answer is unsatis-
factory ; it is given too hastily, with the stories
of hereditary amentia, hereditary alcoholic pre-
disposition, hereditary mahgnant disease, and
hereditary tuberculosis too prominently in the
mind. It is an excellent thing that the world
should now be concerned in such terrible matters,
and that the medical man should find alhes, not
only in the biometrician and the sanitarian, but
in all the thinking public, in his attempts to settle
to some extent the boundaries of hereditary influ-
ences. But it would not be a good thing, either
for the medical profession or the public, if a
measure of safeguard were accepted which lulled
the general conscience without satisfying scientific
scrutiny. And I conceive of medical inspection
of persons about to be married, whatever the
social grade of the subjects, as being just such
a measure. It would wear the appearance of a
practical utility which it could not possess, or,
rather, which it does not at present possess. We
do not as yet know enough about the diseases
that are hereditary, nor can we predict with
sufficient surety what the result upon the future
generation will be of the marriage of those where
hereditary taint is possible, to make compulsory

' THEY ALL LIVED HAPPY EVER AFTER ' 133

medical inspection before marriage a trustworthy
guide. Much sound medical advice might often
be given to those about to marry, but in any par-
ticular case the chances of error would be large.
They would be large whether the rich or the poor
should be concerned, but in the latter case there
would be the added drawback that the machinery
for carrying out the inspection would be very
difficult to devise.

A debate on heredity, considered from its patho-
logical aspects, took place at the Royal Society of
Medicine in the autumn of 1908, and showed very
well the frail foundation upon which anything hke
an attempt to prophesy what would and would
not be the results to the race of the mating of
certain individuals, rested at that date.^ Nor does
it seem that more recent wisdom has placed us on
firmer ground. There are two principal diseases
which are beUeved widely to be hereditary, and
which, from their ruinous prevalence and terrible
consequences to the race, it is most important
should not be transmitted, viz. cancer and tuber-
culosis ; while of certain nervous affections much
the same might be said. The debate at the Royal
Society of Medicine was arranged to centre round
these diseases, and the late Sir William Gowers
dehvered an admirable address upon heredity in
nervous maladies. This famous neurologist found

1 The proceedings at this debate were published in April 1909,
in a volume — Heredity and Disease. (Messrs. Longmans, Green
& Co., 4to, 4s. 6d. net.)

134 PHYSIC AND FICTION

that there was evidence to prove the hereditary
nature of certain abiotrophies, of the nerve dis-
turbances in diabetes (perhaps), and of pseudo-
hypertrophic paralysis, a disorder that is especially
interesting because its hereditary behaviour is
suggestive of Mendelian characteristics. He also
detailed certain other maladies which begin later in
life, after the period of growth is over — Hunting-
ton's chorea, Marie's heredo-ataxy, and Thomsen's
disease — but all these conditions, save the first,
are sufficiently rare to be neglected in practical
deliberations upon eugenics, and in the present
state of our knowledge. Idiopathic epilepsy, that
is the convulsive disease which is not symptomatic
of cerebral mischief or trauma, appears to be
hereditary, but to what amount is not settled in
the absence of trustworthy statistics. Other
speakers in the debate added little to show that
the hereditary influences of nervous diseases had
further to be reckoned with. To the same debate
Dr. Bashford, then Director of the Laboratory of
the Imperial Cancer Research Fund, made a con-
tribution, the net result of which went to indicate
that malignant disease, which all the public knows
to be most distinctly hereditary, cannot be proved
to be anything of the sort. In speaking of cancer
we are in trouble from the beginning, because of
our ignorance of the etiology of the various condi-
tions which we call cancer ; we do not know how
far tumours, having the character of malignancy
in common, but otherwise differing in minute

'THEY ALL LIVED HAPPY EVER AFTER' 135

structure or clinical behaviour, can be all classed
in one category, so that a common origin may be
expected for them. If a classification by the
sweeping together of many of these conditions into
one order of disease is correct, it is reasonable to
look for one source of origin, but we are in a funda-
mental difficulty at once as to the directions in
which search for a cause should be made, because
we are not agreed whether cancer is a biological
fault, which could easily be transmissible, or is a
microbic disease, when hereditary qualities would
be more difficult of explanation. When the weight
of research leans towards the biological theory, the
view that cancer ought to be hereditary becomes
more logical. Conversely, when clinical facts point
the other wa}^ the hereditary theory is hardly
strong enough to form an argument for compulsory
health certificates.

All the world knows tuberculosis to be heredi-
tary, and here also some of the most recent w^orkers
are in accord in believing that the condition is
not hereditary at all. ' Certainly the evidence in
favour of an inherited predisposition,' said Dr.
Arthur Latham, in the course of the same instruc-
tive debate, ' is not sufficiently strong to make
me vary my practice of refusing to advise those
who have suffered from pulmonary tuberculosis,
and who have acquired a partial immunity in the
process of the arrest of the disease, to refrain from
marriage.' All observers do not agree with Dr.
Latham entirely, but all fair-minded medical men

136 PHYSIC AND FICTION

will allow that it is no longer correct to treat the
hereditary nature of tuberculosis as a dogma.

What, then, is left for the inspecting medical
man to do ? Of whom is he to say that this man
or that woman ought not to be married ? He
takes much, indeed, on himself if he says it of
persons with a family history of cancer or tuber-
culosis. Certain nervous diseases are hereditary,
though many marry with a family history of such
troubles and have children free from the taints.
There remain the obvious degenerates, the drunk-
ards, the imbeciles, and the victims of profound
blood-poisonings, like syphihs. These, of course,
should not be allowed to have children, but it
would not be easy to make legal regulations which
would prevent many of these undesirables from
mating. If we try to define a ' degenerate ' or a
' drunkard ' exactly, we shall see the numberless
compUcations that would arise in enforcing the
legal restraint to marriage.

Medical inspection before marriage would fail in
the upper strata of society as a means of securing
greater happiness to the contracting parties, no
less than as a means of improving either the
amenities of existence or the physique of future
generations ; and this because any good that it
might do would be outweighed by the force of the
environment in which these classes live. Medical
inspection before marriage in the lower strata, to
which the huge majority belong, would fail, not
only because of the impossibihty of enforcing it

' THEY ALL LIVED HAPPY EVER AFTER ' 137

legally upon the populace, but because, if it could
be enforced, medical men have no common stock
of knowledge, as yet, to guide them as to what
persons should be allowed to marry with a view
to the health of the resulting offspring.

Have we in the MendeHan theory, which appears
to be borne out in the transmission of pseudo-
hypertrophic paralysis, anything more certain
upon which the medical man can rely ? Some
think that we may have in MendeUsm a source of
definite assistance to the medical man who is asked
to give advice concerning an intended marriage,
but this opinion stands upon an insecure base.
The doctrines of Mendelism are so fascinating in
their details that it is inevitable that many should
anticipate great results from further work on
MendeHan hues. If the followers of Mendel are
right, and if in their theories we have the solution
of fundamental riddles of heredity, the questions
what are, and what are not, suitable marriages
will be attacked by them. It would not be fair to
expect that time to be soon, because of the number-
less forces of social environment which have to be
overcome before the principle of mating with an
eye to a sound posterity can be in the least general.
But at present the promise of Mendelism is so out
of all correspondence to the performance that it
is not easy to maintain gravity when some drawing-
room prophet foretells the swift disappearance of
disease, which must follow upon the breeding of
the human race in accordance with Mendelian

138 PHYSIC AND FICTION

principles. Many indeed do not keep grave, while
the seriousness of others has its origin in the
intention not to hinder the struggles of what may-
be a movement towards the light.

Undoubtedly, there are very many observers,
particularly among medical men, of the directions
in which Mendehsm would appear to be leading,
whose silence must not be taken as passive support,
but rather as a tribute to the gallantry of the
'leaders of a new movement. Everybody now
knows of one or other of the usual expositions of
Mendehan laws, so that there is no need to recall
the sequence of events if (say) a round-seeded pea
be crossed with an angular-seeded pea, self-fertilisa-
tion having been prevented. From such experi-
ments it can be proved that true breeds can be
established in certain circumstances, and that ill
stock will disappear in other circumstances. That
is something — nay, in theoretical discussion it is
a great deal, for a large class of thinkers have of
late adopted gloomy views on this very subject,
finding in the fact that man must be a mosaic of
the qualities of his ancestry a justification for be-
lieving that we are the irresponsible and helpless
puppets of our lineage. It is something, therefore,
to know that a pea-stick can be bred tall, or that
a pea-flower can be bred pink, but whether we are
at liberty to hold this something of importance in
human breeding is as yet very doubtful. It is
embarrassing that we never know, save by actual
individual experiment, what quahties for certain

'THEY ALL LIVED HAPPY EVER AFTER* 139

will respond to the Mendelian notation, nor whether
they will prove dominant or recessive in their
action. So that, while any application of Mendel-
ian principles to marriage means that medical or
scientific advice must be sought before a marriage
is contracted, and that the pedigrees of the in-
tending couples must be carefully scrutinised, we
do not know for what to look.

It is believed by some easy to ascertain many
ingredients of our composition which are trans-
mitted according to Mendelian principles, but as
far as disease is concerned — as far, that is, as the
medical voice could be raised in opposition to any
projected marriage — we come down to a few de-
formities, to a form of night- vision, and to pseudo-
hypertrophic paralysis. These latter two condi-
tions, being transmitted by the female but attack-
ing the male, suggest that sex is itself a Mendelian
characteristic, and that in the female, regarded as
the more perfect organisation, there is present a
something, namely, her femaleness, which counter-
acts the pathological factor. From regarding sex
as a Mendelian characteristic to a belief that the
future sex can be predicted is but a step, and in-
vestigations along this hne have been proceeding,
I believe. But the thing in Mendelian work which
gives it its greatest importance in considering all
questions of marriage is the demonstrated possi-
bility of avoiding the transmission in certain plants
of certain qualities by avoiding the contraction of
certain alhances. This is going to the very root

140 PHYSIC AND FICTION

of the matter, and if, contrary to the evidence as
yet before us, any practical rules as to the trans-
mission of human disease in general can be given
to medical men by the Mendehsts, the great con-
ception of some Mendelists as to their position in
eugenics might be realised. For observe that
marriages contracted upon perfected Mendelian
lines would cause a segregation of the unfit.

Those who study how to promote the improve-
ment of the breed as applied to man — of course
including woman — point naturally to the improper
or ill-assorted marriage as the cause of much de-
generation of the stock. The cry in cases where
obvious physical or moral defect is present is for
segregation of the unfortunate subjects as a method
of sterilising unfit persons. Murderers are steril-
ised effectually by capital punishment or life
sentences, and habitual criminals are sterilised for
long periods by their recurrent visits to penal
institutions. But society, which thus impedes the
fertihty of the murderer and the professional
burglar, subsidises insanity and other forms of
degeneracy to some extent by a bountiful supply
of philanthropic and State institutions, where
persons under skilful care are brought into a con-
dition sufficiently stable to warrant their treat-
ment as free agents, when thejammediately produce
a progeny of suspicious origin. But sterilisation,
whether partial or complete, and whether b}^ im-
prisonment or by anatomical treatment, is an
unthinkable remedy for possible hereditary ills in

'THEY ALL LIVED HAPPY EVER AFTER' 141

most cases, if only because of the uncertainty as
to the part played by heredity. If we consult the
most thoughtful of our modern biologists for any
leading in the matter, we find the number of con-
ditions which, in their opinion, would warrant the
imposition of compulsory sterility far smaller than
the number that is recommended by less scientific
authorities. The practical use of Mendelian
doctrines for the prevention of transmissible
disease as yet has no existence.

The case of the Juke family is always used as
an example of the ill wrought upon a nation or
humanity by the propagation and proliferation
of a bad stock. But the lurid interpretation of
the Juke pedigree has owed a good deal to imagin-
ation. This family was made the subject, some
forty years ago, of detailed investigation by
Mr. R. L. Dugdale, and his small book, which was
widely read at the time of issue, was republished
in 1910 with an introduction by Professor F. H.
Giddings. Owing to their striking nature, the
facts chronicled by Dugdale were seized upon for
the purpose of popular lecture and exposition, and
were not a little distorted in the process. How
distorted Dr. W. A. Brend showed recently in the
Lancet by reviewing the reprint of Dugdale's
monograph in the light of its introduction.

' Juke ' was the pseudonym given by Dugdale
to a family whose environment and lineage he
traced in some cases through seven generations.

142 PHYSIC AND FICTION

The pedigree started with one ' Max,' a descendant
of early Dutch settlers who was born between 1720
and 1740, and lived the life of a backwoodsman
in New York State, where backwoods then existed.
Two of his sons married two out of six sisters
named ' Juke,' and the descendants of five of these
sisters, to the number of 540, as well as 169 related
by marriage or cohabitation, were followed up,
709 in all. They were found to include criminals,
prostitutes, inebriates and paupers, as well as
respectable persons. Dugdale's original views,
says Dr. Brend, put forward in 1887, are fully in
accord with the modern tendency to attribute
ever-increasing importance to environment at the
expense of heredity. There is therefore consider-
able irony in the fact that the pedigree of the Jukes
should be so often quoted as supporting precisely
the opposite view. For this record of the Juke
family has been quoted over and over again as an
instance of the force of heredity in relation to
crime, inebriety and social degeneration. Eugen-
ists have dehghted to draw a moral from the sup-
posed story of the Jukes, and have often done so
in a prominent and inaccurate way, as the following
extract from the Lancet will show, written before
Dr. Brend's inspection of the facts appeared : —

' There is the famous Juke family. Ada Juke,
known as the " mother of criminals," left 1200
direct descendants, of whom nearly 1000 were
criminals, paupers, inebriates, insane or on the
streets. The cost to the State directly in con-

' THEY ALL LIVED HAPPY EVER AFTER ' 143

sequence of this inheritance was £260,000, while the
indirect loss cannot be estimated.' If the original
book is read, especially in the light of the real
figures and Professor Giddings's preface, the Juke
family will be seen to have been unfairly treated.
' The statistical summary shows,' says Dr. Brend,
' that of the 709 descendants of the five sisters and
those of " X " blood, there were 76 criminals, 142
who received out-door relief, and 64 in almshouses.
No special investigation into the number of ment-
ally deficient persons is recorded, but the tables
show only one person of Juke blood as insane,
and one idiotic. The inferences in respect of in-
heritance cannot be justified.' Professor Giddings
points out in the introduction that the book is in
no way a demonstration of hereditary criminality
or degeneracy, and that the author never made
any such claim for it ; though he did not see that
a series of recorded facts may always have a lesson
which the recorder has not sought to convey. But
a caution is uttered against mistaking coincidence
for correlation, which has clearly been needed, for,
wherever the facts appear to indicate the inherit-
ance of vicious tendency, they can be explained
as the result of continuous bad environment. On
the other hand, instances are quoted of children
of vicious parents who under the influence of a
new and good environment have become useful
members of society. ' Dugdale's general con-
clusion is,' says Dr. Brend, ' that, where the organ-
isation is structurally modified, heredity is the pre-

144 PHYSIC AND FICTION

ponderating factor in determining the career, a
proposition which may be taken as established.
In other cases the environment has more influence
than the heredity. Pauperism and crime are to
be overcome by training and education. The
investigation into the Juke pedigree provides
material for illustrating the fallacies which are
frequently made when dealing with a " family "
without having given a scientific definition to that
word. Usually deductions are based on the as-
sumption that a family consists of a number of
persons who have descended from a single pair
in a kind of ever-broadening stream. It is for-
gotten that were it not for the marriage of cousins
an individual of the seventh generation would have
64 ancestors of the first generation, all standing in
precisely the same relation to him. In the loose
statements made about the Juke family the out-,
side blood is always ignored, and the unfortunate
Ada is made responsible for all the criminals,
and this to an exaggerated number. In her de-
tailed biography she is described as being " tem-
perate and not criminal " ; the worst things against
her are that she was a harlot before marriage and
was not industrious. Similar descriptions apply
to most of her children. It is by those who married
into the third and fourth generations that the
worst strains seem to have been introduced. An
interesting instance is given in the case of Bell,
the second sister. Her three eldest illegitimates
are described as being honest, industrious, and

'THEY ALL LIVED HAPPY EVER AFTER' 145

self-supporting. The fourth child was not a
criminal, but he married outside the Juke blood,
and among his children are found criminals. If
any inference at all is justified, it is that the " X "
blood and not the Juke blood was responsible for
these particular criminals.'

Dr. Brend's correction of the popular idea about
the Juke family is interesting and valuable.
Every one beheves, because we have been so often
told it, that the Juke strain was the one at fault,
and a wrong impression once generally accepted
is difficult to correct. In the hght of Dr. Brend's
remarks on the Juke pedigree we see how unhkely
it is that any drastic regulations for medical in-
spection before marriage would have prevented
miseries and wickednesses which were, to a large
extent, the outcome of the pressure of environment
upon conduct.

It is submitted that, in the present state of
medical knowledge, no case can be made out
for compulsory health certification previous to
marriage. In a complicated society like our own
the legal restrictions would be insuperably difficult
to enforce, though younger countries may find the
task simpler.

A married couple may look upon their marriage
as an affair for two people only (which is myopic of
them), as an affair for society, or as an affair for
the race to come, and in no one of these aspects
would compulsory medical certification, in the
present state of our knowledge, ward off disap-

K

146 PHYSIC AND FICTION

pointments in a sufficiently large number of cases
to warrant the proceeding with its attendant in-
conveniences. The most physically suited for
union can be made acutely unhappy by a thousand
things having nothing to do with their healths —
in real life it is not Cinderella's lungs but her accent
and her ignorance which spoil domestic life, and
lead to differences of opinion about the manage-
ment and future of the children which must have
an unfortunate effect upon the next generation.
In the absence of more precise knowledge, medical
inspection yielding an unfavourable report might
prevent marriages that would have brought content
and healthy children in their train — how many
perfectly healthy people of quite advanced age do
we not know who can tell a story of a consumptive
grandmother ? Conversely, a favourable medical
verdict might lead to a union the resulting offspring
of which presented some wretched dyscrasia.

If doctors desired to institute any form of
medical priestcraft, no more direct move could be
made than to press for compulsory health certifica-
tion previous to marriage. But the medical pro-
fession, having no such desire, recognises that the
position of independent adviser is a stronger one
than that of State certifier, though whether it is
as strong to-day as it was formerly I doubt. In
considering the status, in previous chapters, of the
doctors of the early and mid- Victorian eras we
saw that their opinions were delivered from a
platform of authority which no longer stands.

« THEY ALL LIVED HAPPY EVER AFTER ' 147

To-day, therefore, the counsel of a doctor may
not be taken as the last word on the subject ; and
if this is so, to make him deliver that counsel, in
the form of his signature to a legal document,
cannot be prudent.

CHAPTER VI
PRIZES AND PERFORMANCES

The Significance of Prizes— The Real Professional Race—
The Race illustrated by Medicine — Some Figures from Three
Great Hospitals.

Novelists have certain conventions in their treat-
ment oi intellectual success among the young, and
brief biographies and obituaries, dealing with
persons who have lived, observe corresponding
rules. It would seem to be generally accepted that
young students can be divided into three classes,
the brilliant, the assiduous and the rest, and it is
to the last class that the good things usually come
in stories of adventure, and often in stories of
manners, especially if the actor is what may be
vaguely termed ' good-hearted.' Of course, in any
school or college or seminary the number of girls
and boys left, after the brilliant and the assiduous
have been subtracted, will be a large proportion
of the total, so that when the protagonist of ad-
venture, or the exponent of manners, is found
among the ' also ran,' the novelist has numerical
probability on his side. But none the less, the
imphcation in many stories is that the sweet-
natured dolt represents the most likely material

118

PRIZES AND PERFORMANCES 149

from which the resourceful, the resolute and the
courageous dealer with the facts of life will emerge.
If that is a considered decision of the way that
things happen, it amounts to a wholesale con-
demnation of the examination system, with its
concomitants of scholarships, bursaries and prizes.
A similar attitude of mind seems to influence the
writers of short lives of dead distinguished persons.
The subject of the biography is very generally
described as having shown either extraordinary
promise when young, or steady ambition, and the
rest of his career is made appropriately to fit into
one or other preface. If he, or she, be a failure in
the race for intellectual eminence or material
success, the failure is attributed either to a want
of staying power in the brilliancy or to some undue
reticence associated with the plodding career. If,
with due respect to those who write appreciations
of their dead friends, we may suggest that these
appreciations are to some extent works of art, it
becomes an interesting subject of doubt whether
the stereotyped form of piety is inspired by fiction,
or whether the noveUsts have felt bound to divide
their heroes and heroines into the classes which
are indicated by the descriptions of authenticated
lives. My suspicion is that many writers of
biographies have been swayed unconsciously by
fiction, and that the piquant dichotomy illustrated
by, for example, Tom Jones and young Blifil,
Charles and Joseph Surface, and Randal Leslie
and Lenny Fairfax, has influenced their views.

150 PHYSIC AND FICTION

Consideration of what happens in the medical
profession reveals that success in after-life is
found in large proportion among those whose per-
formances as students have commended them
highly to examiners and have earned them prizes.

All the year round, and in ever}^ class of academic,
institutional and professional training, men are
winning prizes, losing prizes, competing for prizes
or scratching for those competitions ; and a system
that is so universally in employment among us
may easily become accepted in a mechanical way,
and thus may cease to have a reason which appeals
to judgment, and come to be regarded as one of
those things that happen in the course of education.
It is such frequent and general features in the
scheme of life that pass unnoticed because of their
very familiarity. If familiarity were all that were
needed to grasp the significance of prize days, we
should all know all about prizes — their uses, their
abuses, and their relation to the spread of wisdom
generally, and to the efficiency of students and
scholars in particular. Our opinions founded upon
such full knowledge should be unanimous, when
there would be no need for any discussion. As a
matter of fact, the value of prizes and their relation
to further performances are subjects of constant
debate.

For although we cannot conceive any system of
professional training without prizes and their
attendant troubles — namely, examinations — ac-
quiescence in the principle of rewarding early

PRIZES AND PERFORMANCES 151

merit in examinations by gifts is not universal.
Many persons may be heard to express opinions
of opposite natures on the value of prizes, upon the
systems under which they are awarded and upon
the utiUty of examinations generally. Many of us
have said that prizemen are too often found not to
fulfil their early promise — it is one of those things
that is repeated until its truth remains unchal-
lenged. Yet it may not be true. Occasionally
we hear of the insignificant future which some
brilhant student has made for himself. We are
told that the first mathematical scholar in our
batch at school is an under master in a second-rate
seminary ; or that the best classic of our year may
be seen dozing away a valueless existence in front
of a club fire, or using his recollections of the
classical dictionary in an acrostic competition.
My natural impulse, when these things are pre-
sented to me, is to recall old novels, and to wonder
whether the reporter is under their spell ; for in-
stance, I attribute a large proportion of the sad
stories about broken-down classical scholars to one
wonderful sketch by Thackeray.

Many of us, again, in congratulating a prize-
winner, have said that in a world of stress and com-
petition there is nothing like making a good start.
And some of us have certainly said both things,
suiting our words to the circumstances, and
applauding the prize system when a success is in
question, though belittling it out of condolence
with the empty-handed. And the same diversity

152 PHYSIC AND FICTION

of view is expressed with regard to the value of
examinations as a test of present merit or as a
guide to prognostications of future success. This
we should expect, for those who profess to hold
cheaply the winning of prizes must believe that
the easy and rapid passing of examinations furnish
no sure ground for future honour. Those who
think highly of the prizes must think highly of the
tests, for if the tests are wrong the merits of victory
are gone.

There is, then, complete difference of estimate
with regard to the value of prizes and the signi-
ficance of passing examinations, and this is trouble-
some while our educational schemes are largely
founded on the promotion of the prizeman and the
nurture of the successful examinee. How can
thoughtful persons be found uttering such opposite
opinions ? And observe that, whichever view we
take, we all of us accept regular examinations and
regular prize-givings as the most practical way in
which education can be conducted, though when
we are called upon to express an opinion concerning
the matter we are not necessarily consistent. We
take one side or the other — whichever one suits the
particular case — congratulations or condolences
coming with equal readiness from us, but we never
suggest that education can be carried on to a
practical end in any other way. Verbally we may
be willing to sacrifice a lightly held conviction as
to the value of prize-winning to a desire to be
agreeable to some one who has not been a winner ;

PRIZES AND PERFORMANCES 153

but even then we are almost sure to endorse the
principle of examinations and rewards by alluding
to it as a time-honoured abuse — one of the per-
petual sources of grumbUng that we should all be
sorry to lose.

This is really an admission that there is no
way yet known to us of ascertaining whether
students are up to a certain standard save by
examinations, and that there is at least no surer
way of stimulating the work of a group of students
than by appealing to an honourable as well as to
an inevitable spirit of rivalry. Further, we have
the position that, while an important part of our
educational system is regarded in two opposite
ways by reasonable people, those who have the
most to say against it do not come into the
open with any alternative proposal. Their self-
restraint is unhelpful.

Take the position of medical education as an
example. Those who cry out most persistently
against examinations and prizes as gauges of
future success are regarding medical education as
a thing which begins at a certain time and ends at
a certain time — begins, say, with going to a board-
ing school and ends with the day when £5 is paid
to the Registrar of Medical Education and Regis-
tration for the right to have a name placed upon
the statutory roll of the medical profession. If
this view of education be taken, it is easy not only
to show that success in examinations is no certain
gauge of success in life, but also that the whole

154 PHYSIC AND FICTION

system of examinations and prizes is wrong. But
medical education does not end with registration
or qualification, with the obtaining of a commis-
sion or a diploma or a degree. There is no pro-
fessional life in which this truth can be seen more
clearly than in the medical hfe, in relation to which
it is stark staleness to say that education never
ceases, and that the longer the practice of the
medical calhng the more opportunity is there of
learning, of testing that learning, and of obtaining
its rewards. This, at any rate, is the fortunate
plight with most men ; a few may get out of
sympathy with progressive medicine as time goes
on. They often began in a particularly brilhant
way, and their later plight is analogous to the
condition which the athletic trainer calls ' muscle
bound,' where the muscles under excessive train-
ing in some given direction become hypertrophic,
and lose their elasticity, reducing the quondam
champion to a melancholy inertia. These un-
fortunate exhibitions of reaction are not often
seen, but they account for much of the distrust
which the examination system inspires.

In respect of medical training the divergency of
opinion as to the value of prizes and of the associ-
ated examinations has become acute of late. It
may be that in all professions there is a similar
feeling that theoretical acquisition plays too great
a part in technical training, but in the pursuit of
medicine there are certain factors present which
are not present, or present only in a modified

PRIZES AND PERFORMANCES 155

degree, where other calhngs are in question. (I
tliink this is so, though, just as every one of us
may believe that he possesses individual qualities,
so it is possible for a member of any profession to
believe that his calling is attended with individual
circumstances.)

In a previous chapter the rapid evolution of
modern medicine has been described, and it is
clear that medical life under such changing con-
ditions must constitute a progressive education
throughout, and that as the practitioner's scientific
information steadily increases in bulk, or regularly
calls for sifting or rearrangement, so his personal
relations with his clients will be modified. His
career as a citizen, tax-payer and doctor will be
altered in accordance. I cannot conceive that
any other profession calls for such rapid changes
first of theory and then of practice, compelling
its followers perpetually to adjust what they think
and do in the light of fresh events. New legis-
lation is enacted to meet new international,
national or social needs, but lawyers do not have
to reconsider the principles of law, they have
to adapt practice to circumstances. Relativity
arrives, and interferes with our conceptions of
gravity ; this is fundamental enough, but the
practical work of the engineer or of the architect
is not affected thereby. But when the anti-
septic doctrines are introduced, medicine is
changed from top to bottom, and the life of the
doctor reacts to the change ; and so does the

156 PHYSIC AND FICTION

record of public health. When the interplay of
parasites and disease is unravelled, tropical
pathology is discovered, and a whole system of
additional education is postulated for medical
men who have long been absent from educational
centres. Comparable events do not occur in
other professional lives. The position is illus-
trated by the fact that in every scheme for the
improvement of medical education, in every plan
for the reform of medical practice among the people,
and in every development of the university
faculties of medicine, provision is being made for
post-graduate teaching, in order to help the medi-
cal practitioner in that after-education which will
lead him on throughout his life.

Modern conceptions of medicine are such that
all men, in whatever walk of life they are practising,
feel that their life is one long education, and that
what they have learnt in the past may be regarded
as an introduction to what they are likely to learn
in the future. No profession opens so many paths
as medicine of a totally different sort, though they
all converge to one objective — the discovery,
maintenance and practice of truth ; and, as a
consequence, this feeling that the whole of pro-
fessional life is one long course of education appeals
to medical men with particular force. The colonel
feels it as well as the medical officer of health ; the
operating surgeon shares it with the consulting
physician, the bacteriologist and the bio-chemist ;
while to none can it come more home than to the

PRIZES AND PERFORMANCES 157

general practitioner, whose five-hundredth case
of whooping-cough may give him some practical
hint for the relief of a certain symptom met with
in a certain type of case. Alas ! that we do not
get these valuable experiences recorded in any
regular and systematic manner. The note-books
of a general practitioner, now that the educational
level for entering the medical profession is so good,
would make most valuable reading for his col-
leagues ; but the translation of their message from
the private to the public — the collation in any
public manner of things in themselves so often
shrouded in professional secrecy — is a matter of
such difficulty that at present the clinical experi-
ence of large numbers of the medical profession is
but little exhibited for the instruction of their
colleagues.

The winning of prizes and the passing of examina-
tions mark the results of education at one stage of
a long race — the earliest stage of that race. Those
who look upon education as a short race, starting
in the case of the medical man with his school
curriculum and ending with registration, and con-
sider the professional life that follows as a long but
completely separate race — another item on the
race-card — will hold on the soundest of sporting
grounds that the man who wins the sprint need not
win the staying contest. And it is in support of
this self-evident proposition that we have quoted
to us the instances of the various failures in after-
life of men who vastly flattered their friends and

158 PHYSIC AND FICTION

tutors at the outset of their careers. Those who
regard education in a more comprehensive sense,
as one long event beginning with the dawn of our
consciousness and ending only as our senses and
powers fail us, will regard prizes and success in
examinations differently. They will see in them
proofs of good training, and evidence that the com-
petitors are trying their strength and endeavour-
ing to run the course with judgment ; and they
will appreciate after-successes in life at different
stages in a long race with due respect to the way in
which the whole track is being covered. Regard-
ing education in this comprehensive way, as
medical men must, we find that the two contrary
acceptations of the value of examinations and
prizes become at once reconcilable. Examina-
tions and prizes have their place in the medical
educational scheme, because they are necessary to
determine that no one shall enter the profession
who is not so far educated that he can take full
advantage for his own benefit, and notably for the
public benefit, of the greater tuition which is to
proceed for him during the rest of his lifetime.
Examinations are a means to this end and no
more ; prizes are an incentive to this end and no
more. Their purport being so good — namely, the
standardising up to a proper level of the knowledge
of those who enter our ranks — we ought to be
very sure of our ground before we abuse the means
or the incentive. But while we must recognise
that examinations in their place are not only

PRIZES AND PERFORMANCES 159

necessary things, but good things, we are not
obhged to acquiesce in tiieir endless and vexatious
multiphcity. And those of us who admit that
examinations are a valuable and, in fact, the
only way of testing our young men, may also, and
without inconsistency, deplore the present tendency
of the medical curriculum, the strictly student's
curriculum, which leans towards over-examination.
The system is too hardly worked, because of the
unfortunate feeling that all the modern develop-
ments of medical science, general and special,
laboratorial and clinical, ought to be represented
in the examination papers. The mesh of the net
spread by the examiners has become too delicate ;
they catch in their elaborate toils too many. We
need not commend the multiphcity of examina-
tions any more than we need lay too much stress
upon them. The indication for future action
cannot be misread ; post-graduate education in
medical studies should be developed generously.

There is an old story of a senior wrangler who
happened to enter a playhouse at the same time
as King George iii. on the evening when the few
newspapers of the time had chronicled the scholar's
success at Cambridge. The senior wrangler
solemnly bowed to the audience before he sat
down, believing that the national anthem was
being played out of compliment to himself. In-
asmuch as we must all find that senior wrangler
ridiculous, the story contains in itself an exact
illustration of the points which I have been labour-

i6o PHYSIC AND FICTION

ing. In Georgian days a senior wrangler was a
made man. There was no need for him to do more.
His college made him a Fellow for life, and he be-
came its master, or a bishop, or a judge, or did
nothing, just as he liked. We see how foolish it
was, but in times much nearer than those of
Good King George it was perfectly in order for
the successful scholar not to try to do anything
more ; and Thackeray's university snobs, viewed
in this light, were not failures so much as victims
of a narrow view.^

I am aware that here I am on somewhat delicate
ground, as I may seem to be regarding knowledge
pursued for its own sake, and with no m.ateriahstic
proposal, as of little account. I may seem to slight
the erudition of a Porson prizeman who is no longer
a made man because of his dexterity in iambics.
This is not my desire at all. The subtle classic
and the transcendental mathematician have a
place in the scheme of our education in the broad
humanities, and that place is, I think, comparable
to the one occupied by the elaborate bio-chemist
or statistical eugenist in medicine. Their know-
ledge is required by us as a reinforcement of ordin-
ary learning, as a proof of its basis, as an index to
the direction of its expansion and — greatest duty
of all — as inspiration for our progress. If such
learning could be regarded as a thing apart we
should have the right to ask what it is for, but no

1 Part of this chapter formed an address to the students at
St. Georgc'b Hospital ou a prize-giving occasion.

PRIZES AND PERFORMANCES i6i

thinking man should take this huckstering view.
It is unfortunate that the highest ranges of philo-
sophical research seldom bring their due return in
money, and that their devotees must largely depend
for reward upon the sweetness of their labours,
the keen and splendid delight in the exposition of
rare wisdom.

' The mountain sheep are sweeter, but the valley sheep

are fatter,
We therefore deemed it meeter to carry off the latter,'

sang the marauder. He was a wise man within
his limits, for he knew what he wanted ; but he was
a marauder, and the triumphs won on the bleak
mountain-top, though lean when viewed from a
financial aspect, have a flavour of their own com-
pared to which the more material victories of the
valley are insipid. In the commercial world, where
men are engaged in what Henry James has termed
' the horrid vulgarity of getting in or getting out
first,' the creation of interests is too often intended
merely to extinguish other interests. In the world
of medicine the gains of one man are used for the
good of all, and the supreme type of this altruism
is the worker in the higher planes of research.
Here, especially in this country, those engaged are
far away from the pleasures and lures of tangible
prizes. Unless the philosopher can by his learning
show the capitahst or the shareholder how to trans-
mute baser material into gold, it is Uttle enough
gold that he will get in return for his toil. And
this is not because the exponent of academic

i62 PHYSIC AND FICTION

wisdom is necessarily a visionary, but because the
application of his researches is never quickly ob-
vious to a nation that is still in the ancient attitude
regarding education — a nation which still believes
that education is something like measles, which
you get young and get done with. To such the
man who continues in the laboratory or the library
appears to be a sort of permanent invalid, removed
by a malady of interesting duration from connec-
tion with the real problems of life.

It is to my mind one of the greatest glories of
modern medicine that we have taught our gen-
eration, as far as medicine is concerned, a truer
view ; for the whole story of pathological progress,
which has been so striking during the last thirty
years, may be summed up in the statement that
scientific research of the highest and broadest kind
in physics and chemistry — in which is included
physiology — has been made to play a part in prac-
tical medicine, therapeutic and preventive. But
although the profession of medicine is showing the
way by which in its workaday proceedings the
finest flowers of its philosophy can be gathered and
used, the fact remains that prizes — material prizes
— come no more in medicine than in other walks of
life to the actual exponents of that philosophy.
The simple way in which this great wrong could
be in part set right would be by some wider endow-
ment of teaching. Into the hands of the leaders
of our thought falls the duty of teaching our
students, but the duty is largely discharged as a

PRIZES AND PERFORMANCES 163

gratuitous one. The shortsightedness and false
economy of encouraging students freely with ex-
hibitions and scholarships, while making scanty
provision for those who teach them, is simply an
exhibition of the old and narrow view of education.
The successful student is rewarded with prizes at
the end of his first lap — if I may be allowed to harp
on an obvious simile ; let him rejoice and be glad
in them, for assuredly his strictly academic career
will bring him few more emoluments. But it is
an absurdly wrong policy which leads wealthy and
generous persons so much more frequently to
found scholarships for the students than lecture-
ships, readerships, fellowships and professorial
chairs for the teachers. Both are wanted, but the
needs of the instructed always appear in this
country to appeal much more powerfully to donors
than the needs of the instructors — a position which
seems not to obtain in the progressive educational
centres of the United States. Why expect that
the highly endowed student will receive adequate
instruction if we fail to endow his masters ? The
course of education is a long one. Those who once
were the taught become the teachers ; they have
the right to expect some continuance of the en-
couragement which they received at the early
stages of the race.

Prizes standardise candidates, reward industry
and intelHgence, and stimulate study. They do
great good to those who do not get them ; they
persuade those people, often unconsciously, to do

\

164 PHYSIC AND FICTION

better work. They raise the general level of learn-
ing by forming a direct object for assiduity. The
fact that those who win prizes at the beginning
are not always those who do well afterwards has
had too much stress laid upon it. The men who
make a good start do to a great extent throughout
life enjoy the advantage of that start ; when this
does not occur it should be remembered how long
the race is.

A humorist has said, with regard to the success
of a lady of fashion, that she progressed in com-
parative degrees : first she got on, then she got
honour, and then she got honest. The process by
which success is achieved in the medical profession
is reversed, and all three degrees of comparison
may never be reached. First, the student must
be honest, then he may get honour ; and lastly,
though it does not follow, he will get on. And it
is not so perfectly easy to be honest at first, for the
medical curriculum is an exceedingly strenuous
test. There is a multipHcity of subjects to be
dealt with. There is confessedly inadequate time
within which to acquire more than the rudiments
of any of them. There is therefore an enormous
temptation before every student to slur over the
difdcult parts, to quote in parrot-wise the phrase-
ology of others, and thus to clothe personal naked-
ness. The very scope of the schedule within which
examination questions may be set makes the
neglect of numerous subjects a matter of no great
risk, and many a man has left out whole slabs of

PRIZES AND PERFORMANCES 165

a text-book with a fervent hope that ' we shan't
get that in the paper.'

For the student to resolve that, come what may,
he will understand what he sees, what he hears,
and what he reads before he proceeds to the next
stage in his education entails upon him a rigorous
process of self-examination which constitutes the
finest kind of honesty. Success in examination
may follow, proving that the student is learning
to know himself ; that he has subdued a natural
tendency to go in the direction of least resistance,
and can attack and master allotted tasks. If
prizes also occur they indicate proper preparation
for evolution — nothing more, but it is much. The
rest is on the usual knees. If the evolution takes
place in true, scientific shape success will be de-
served, but it cannot be commanded.

As far as the medical profession is concerned —
that is the profession to which in particular every-
thing which has gone before has reference — we
have the results of three inquiries, small and
limited, but useful because of their limitations,
into the future careers of three sets of medical
students. The three sets cover the ground of the
last fifty years, and the students in question were
connected with St. Bartholomew's, St. George's
and St. Thomas's hospitals respectively. To a
certain extent these inquiries indicate how far
early success has contained a faithful promise.

In 1869 Sir James Paget undertook, with the

i66 PHYSIC AND FICTION

assistance of a colleague at St. Bartholomew's
Hospital, an investigation into the chances of the
medical student as shown by his subsequent
career. The investigation resulted in the publi-
cation of figures showing that a medical student
had at least as good a chance of worldly success as
a lad embarking in any other career. Sir James
followed up the lives of a thousand medical
students who had joined the medical school of
St. Bartholomew's Hospital, with the following
result. He found that 23 had met with distin-
guished success, 66 with considerable success, 507
with fair success, and 124 with very limited
success ; 56 had failed, 96 had discontinued
medical studies while in pupilage, 41 had died
during pupilage, and 87 had died too young for
any one to say whether they would succeed or no.
The value of these figures depends, of course, upon
the meaning of the classification.

Sir James Paget defined ' distinguished success '
as the attainment within fifteen years of qualifica-
tion to a leading position in practice in great cities,
to a scientific professorship at a university, to a
place on the staff of a large hospital, or to the
tenure of some important public office. He
ascribed ' considerable success ' to those who
gained high positions in the Services — by which
he meant the Naval, Army, and Indian Medical
Services — who obtained good provincial and
country practices, or who enjoyed more than
ordinary esteem and influence in society — the

PRIZES AND PERFORMANCES 167

last being a very vague category. ' Fair success '
he defined as being in the possession of a practice
sufficiently large to maintain a professional man
in adequate style, or the tenure of an advancing
position in the Services, and in the Colonial
Service, which fifty years ago did not offer a
promising career. ' Very limited success ' he
assigned to those who never attained to moderate
good practice, but who were able just to maintain
themselves by their work either as principals or
assistants. Of the 56 who failed 15 could not pass
their examinations, 5 were convicted of misconduct,
10 were dissipated both as students and afterwards,
and 10 had bad health. The remainder were
known to have come to grief without any par-
ticular reason being assigned for their misfortune.
It will be seen that out of the thousand students
41 died during pupilage, and must be left out of
count. Again, the 96 who discontinued their
medical studies while in pupilage can hardly be
brought into calculation when we are considering
the chances of making a livelihood out of the
practice of medicine. They cannot be said to
have failed in a medical career, as they never
attained to professional rank. The fact that
nearly 10 per cent, of the thousand students left
the profession during their studies is not without
significance, as it would seem to imply that the
medical profession was not one to be undertaken
lightly even in the days when examinations were
comparatively simple and infrequent. The 41

i68 PHYSIC AND FICTION

who died during pupilage, and the 87 who died
before they had been in practice twelve years, were
also debarred by sad fate from obtaining any
position in their profession, and they can be left
out of calculation for practical purposes. We
have, then, 776 students to consider who actually
reached practice, and of these 507, or about 66 per
cent., attained to fair success. These are the
figures that we must look at when we try to frame
our opinions as to chances of the medical career.
How far those who met with conspicuous reward
began by prize-winning Sir James Paget did not
record.

Some fifteen years ago it occurred to me that
with the lapse of time and the alteration of con-
ditions Sir James Paget's figures might no longer
give a true picture, though they were still quoted.
Accordingly permission was obtained from the
dean of St. George's Hospital to make a brief
investigation into the careers of a group of students
who had been entered for education at the medical
school of that hospital. The year 1879 was chosen,
and what happened to the first 250 students who
entered after October ist of that year was ascer-
tained as far as possible. Of the 250 students,
187 qualified, and 63 did not qualify. Of the 63
who did not quahfy as medical men, 2 obtained
places on the Dental Register without diplomas,
and succeeded, and 2 died as students ; i be-
came decently successful at the bar, i became a
veterinary surgeon and obtained credit in that

PRIZES AND PERFORMANCES 169

profession, i accepted a purely scientific post under
Government and rose in his department, i became
an artist, 3 went on to the stage with no success,
2 enlisted in the army and both obtained com-
missions, and I became proprietor of a boarding-
house. Four of those who gave up the struggle
were men of private means, to whom the practice
of a profession was not necessary as a livehhood.
Of the remaining 45, 15 of them never showed the
least aptitude for medicine. Of the 187 students
who qualified, 9 may be said to have met with
distinguished success as defined by Sir James
Paget, 5 of them secured, after more or less wait-
ing, positions on the medical or surgical staff of
their own hospital, and 2 became teachers at the
hospital ; 2 others are on the staff of large general
hospitals in the provinces ; 45 have met with con-
siderable success in practice, they hold good
appointments, have earned a strong local position,
and are respected prosperous citizens ; 25 obtained
commissions in the Services, 19 in the army, and
6 in the navy ; and of these 2 distinguished them-
selves particularly. Of 56 men who went into
general practice in England, including 5 who
practised dentistry, it was learnt that they were
practising in a manner compatible with a pro-
fessional position ; out of 9 who went abroad 2
were distinctly successful. Five men who ob-
tained medical qualifications left the medical pro-
fession, of whom I became a journalist, i became
an actor, i went on the stage, and 2 had private

170 PHYSIC AND FICTION

means. Six qualified men came distinctly to
grief, of whom 2 went to prison. Twenty- three
men died before they had been qualified twelve
years, and must be disregarded in making any
estimate as to the chance of success by the
practice of medicine. Of the rest, about 12 per
cent, of the total, it was not possible to learn
anything.

The following are the figures dealing with a total
of 250, which can be compared with Sir James
Paget's figures dealing with a total of 1000 : —
9 met with distinguished success ; 45 met with
considerable success ; 25 met with fair success in
the Services (two of these might be included in a
higher class) ; 46 met with fair success in practice ;
5 left the profession after quahfication ; 6 dis-
continued medical study as pupils ; 2 died during
pupilage ; 23 died within twelve years of com-
mencing practice ; and 6 failed entirely. Liber-
ality has been shown in awarding places in the
higher classes, but if we add the ' considerable '
and ' fair ' successes together we get by the com-
bination a section of 116 men out of 187. That is
to say that the figures, like Sir James Paget's
figures, though with much less certainty because
of the smaller range of the investigation, go to
show that 66 per cent, of qualified medical men
from one metropolitan medical school had reason
to be satisfied with their professional careers.
Of these men a large proportion of the successful
practitioners had been successful students.

PRIZES AND PERFORMANCES 171

The tale has been contmued with the pubhcation
by Mr. Edred Corner of similar information derived
from going through the lists of students at St.
Thomas's Hospital for the decade 1890-99 in-
clusive. He found Sir James Paget's researches
into the after careers of St. Bartholomew's men
half a century previously to be corroborated by
what he found at St. Thomas's. The following are
the several points which he considered worthy of
notice. His full article, from which I quote sub-
stantially, appeared in St. Thomas's Hospital Gaz-
ette for March 192 1.

' Sixteen per cent, to seventeen per cent, of hos-
pital entries are students joining for some special
reason, e.g. a qualified man coming for attendance
on the hospital practice. This group has none
dropping out from it, and constitutes what may
be called " the birds of passage." Men again enter
the profession and drop out of it from a variety of
motives such as circumstances of home, man or
future. It is easy to see that such defection must
be present in any profession with a curriculum of
five years. This is a very definite percentage
which parents entering their sons for the medical
profession may well bear in mind. It is one in
eight or i2'5 per cent., if the " birds of passage "
are considered, and one in six or i6'7 per cent, if
not.'

' Parents and advisers should remember also
that there is a considerable mortality in those
entering the medical profession. It begins, but

•^

172 PHYSIC AND FICTION

hardly shows itself, in the first year. It increases
in the second and third years, to reach its maximum
in the fourth and fifth years. It continues after
the student has become a duly quahfied doctor.
It is about 2 per cent, and the greatly predominant
cause of death is pneumonia, suggesting an infec-
tion picked up in the post-mortem room or wards,
increased by overwork, draughty corridors, in-
herited weaknesses or improper nourishment. It
forms a plea for a residential college where such
factors can be minimised. There is no such
mortahty amongst the " birds of passage," sug-
gesting that it is the student who picks up infec-
tions.'

* Yet another thing stood out : how often the
scholar and prizeman did Httle in after hfe and
how often the very ordinary man went ahead and
grew great. This fact is a distinct encouragement
to the ordinary man.'

' Two points of interest to parents, deans, and
schoolmasters are, that every year about eleven
men entering hospital will drop out from work in
the profession and about two will die. In every
year Sy per cent, of students persevere and get
qualified. These figures are derived from a study
of nearly nine hundred entries spread over a period
of ten years.'

' In the St. Bartholomew's 1000 students, rather
more dropped out from preparing for the profes-
sion than do nowadays — 15*2 per cent, against
I2'5 per cent.'

PRIZES AND PERFORMANCES 173

Too much stress need not be laid upon any of
the foregoing figures. That figures, particularly
if large deductions are attempted from small data,
can be made to prove most things is illustrated in
many controversies, and it is safer to claim proof
for as little as possible through their agency. But
the figures can fairly be used as replies to two vague
but common assertions : first, that the medical
profession is overcrowded ; and secondly, that in
following the medical life the game is not worth
the candle. These two statements have been
made so often that they are beginning to receive
unquestioned acceptance. As a matter of fact,
the medical profession in England, Scotland and
Ireland is not overcrowded so much as badly dis-
tributed. There are places where medical men
are sorely needed and where they would be found
if the conditions were fair ; there are large districts
where medical work is waiting to be done until
proper arrangements have been made for doing it.
When the administrations of the Poor Law and the
Sanitary Medical Services are considered, as well
as the warrants of the Naval, Military and Air
Force Services, and the conditions in the Colonial
Medical Service, it will be seen that the openings
for successful professional life before the medical
student are numerous and varied.

Secondly, the percentage of medical men who
reach a good and stable position through profes-
sional practice disproves the view that the medical
profession as a whole is wrongly paid. But the

174 PHYSIC AND FICTION

figures must not be taken to show that there are
no grave professional hardships. In all three cases
they refer to students at first-class London hos-
pitals, students of the class who enter the profes-
sion with good introductions and whose natural
sphere of practice presents the maximum of oppor-
tunities. It would be possible by selecting students
of other schools to obtain somewhat different
results, though not results that would contradict
the general inference that by comparison with
other callings the medical profession promises
much.

Mr. Corner, out of his knowledge of the meaning
of the figures from St. Thomas's Hospital, remarks
that the scholar and prizeman often did little in
after fife, while the ordinary man went ahead and
grew great. His experience runs along the lines
of fiction, but I doubt whether the deans of many
medical schools would confirm it. The failure of
a prizeman, and the unexpected success of one who
for a time remained in the ranks, form little events
that are chronicled and made much of, until their
numerical proportion becomes inflated. In the
case of the figures from St. George's Hospital the
majority of the men who got into the top class
within twenty years of the start began by being
successful examinees, and often were prize-
winners.

Conventions have been laid down by novelists
and supported by biographers (unless the novelists
have copied the biographers) under which, all

PRIZES AND PERFORMANCES 175

young people being divided into the brilliant, the
assiduous and the rest, success in life goes to the
third class : the thesis is that the conventions do
not hold good as far as the medical profession is
concerned.

CHAPTER VII
SOME PUBLIC DEVELOPMENTS OF MEDICINE

Medical Standards after the War — The Ministry of Health —
The Great Ideals of Ninety Years Ago — Disraeli, Gaskell,
Kingsley and Dickens as Sanitarians — The Modern Outlook
of Medicine.

We have considered a few facts and fewer figures
from which to arrive at tlie general chances offered
to a young medical practitioner of success in his
career ; recent modifications of medicine as a pro-
fession indicate that the public is more intimately
concerned than it can ever have been before in
seeing that good work shall command good results.
Legislation is admitting now in every way the
claims of the pubhc to be associated with any ex-
hibition of medical authority. What follows here
is an attempt to show why such an association will
be fruitful in good.

At the outbreak of the War the world was full of
the cries of men who had, and of men who believed
that they had, powers of organisation. The number
of these who subordinated their concrete claims
for work done to their abstract claims as possessors
of the gift of managing men was large ; and while
there is no suggestion here that those to whom the
various tasks of organisation were allotted failed

176

PUBLIC DEVELOPMENTS OF MEDICINE 177

in any general way to acquit themselves satis-
factorily, the fact remains that in some directions
there was vast muddhng.

The record of our armies as a whole in the
matter of health proves to demonstration that
the majority of those directing, and practically
all those who were carrying out directions, were
fitted by their administrative powers and their
devotion to duty for their various positions,
though there were well-known break-downs ; but
other departments of our multifarious activity
did not come out of the ordeal with so much
credit, and revelations of mismanagement in the
highest places give us good reason to believe that
a burden of debt will for long keep green the
memory of shortcomings. It is certain that some
of the things, which we now know happened,
would not have happened if organisation had been
left more in the hands of men whose claims were
tried, and less in those of persons who were able
to make us share, on insufficient grounds, their
belief in their own powers.

There is an immediate warning here as far as
the profession of medicine is concerned, and the
warning is not only to that profession but to the
whole public.

For as at the outbreak of war the welkin rang
with the claims of the organisers, now it rings
with the claims of the reconstructors. Just as
persons whose experiences were limited to the
management or neglect of their private corre-

M

178 PHYSIC AND FICTION

spondence, and the filling up of their income-tax
forms correctly or otherwise, were allowed to
represent themselves as defenders of our persons
and our purses in phases of the World War, so
there is danger lest the speculative Utopian should
obscure our designs for the restoring and re-
building of society, producing a mass of ill-
digested schemes, whose details obscure their
scope and whose plans would not accomplish their
purpose. New Government departments are
undertaking new tasks with every intention to
restore our damaged fabrics, to extend them in
wise directions, and to make the government of
the country represent more nearly than it ever has
yet a consensus of the opinions of an educated
nation. These departments are infused — no one
doubts it — with the will to do good, with the
intention to make the world a sweeter and more
orderly place, but their work is not assisted by
the vociferous thrusting upon them of patent
plans for making people happy or patent receipts
for control without coercion. There is, roughly
speaking, only a certain amount of happiness to
go round, as there is only a certain amount of
freedom available for society. To grant to one
class the freedom and happiness that it demands
may depress and degrade another class, so that
a Government yielding to strenuous representa-
tions in one and another direction may find itself,
while loudly acclaimed as a liberator, equally
loudly condemned as a slave-driver. The course

PUBLIC DEVELOPMENTS OF MEDICINE 179

of practical progress in every branch of social
politics has to be mapped out with an eye on the
public good, and the opportunism that gives a
ready approval to ill-considered demands will
only avoid the difficulties of temporary criticism
to find itself landed in a slough of desperate
commitments. The reflections are obvious but
pardonable, because at the present moment the
reconstruction of the profession of medicine is
being undertaken, for the good of the public, as it
is being demanded, for the good of the profession,
by many doctors and medical alliances. It is
for the common weal that the new order of things
should be orderly, and that no new policy should
be embarked upon without a reason that has a
wide application.

Union both of idea and of policy between
medicine and the public is being sought for and
is earnestly needed. There is a vast field for all
joint effort, and a dreary prospect where co-opera-
tion does not run. All over the world the pangs
of the Great War are still being felt ; wounds are
open and recent scars are contracting. In tortured
Europe serious epidemics are of constant occur-
rence. Whole populations are going short of food
and fuel, and there are prognostications that we
may have ourselves similar trials to face, despite
the comfortable feeling that for us the worst is
over. Meantime our social changes bid fair to
be rapid, and the man who would hasten slowly,
desiring to see where he is before insisting where

i8o PHYSIC AND FICTION

he will be, has to defend himself from charges
of apathy. In these anxious days medical men
have had their reconstruction processes to some
extent focussed. A new bureau of first-class
importance especially charged with the care of the
health of the nation has been created, and it is
committed to make such changes in the professional
life of the medical man as shall fit best into a
profoundly altered scheme of things. The position
of the medical profession, therefore, is that there
lies before it a vast amount of work, much of it
new and hard, and it will have to be done in new
and doubtful circumstances. But of these cir-
cumstances it can be added that there is now
provision for mutual understanding between the
employing public and the employed profession,
and this should imply a removal of many obstacles
to harmonious progress.

Before the War laziness or want of imagination
on the part of employer and employed — the lazi-
ness was mostly on the side of the public — caused
many necessary wants of the medical hfe to
remain unprovided for. The medical profession
was little, if at all, to blame for the fact that
admirable work in public health, prevention of
tuberculosis, control of venereal diseases, inspection
of school children, care of nursing mothers, and
domestic visitation of hospital patients, were all
better arranged in theory than carried out in
practice. Many members of the medical profession
laboured enthusiastically along these different

PUBLIC DEVELOPMENTS OF MEDICINE i8i

lines with small recognition from the public, which
did not understand the reason for the activities
or their object. While many members of the
public gave devoted gratuitous service to supple-
ment medical efforts, the mass of the people
remained indifferent, because not understanding.
This was when we had time and money. When
the War broke out, its long duration and its drain
upon medical resources were not anticipated, and
now we are left in considerable arrear with what
was already a low average of public performance.

Now all the work has to be taken up in a scheme
of society that differs in many respects from any-
thing previously experienced, and under the aegis
of a Government department which is still in its
swaddling clothes. It is natural, therefore, that
schemes should burst forth of various value and
with various main objectives, according as those
who father the schemes are more interested in
one than another of the many causes which require
championing, and of the many reforms which
require carrying out.

In this conflict of reconstruction the errors that
were made during the War, in response to the
stress of hurry, ought not to be repeated in respect
of the public health of the nation. Certainly let
there be no undue delay, but better a httle delay
occupied in genuine investigation of all the factors
at issue than a hurried policy of panic. The general
plan for a real union of public and professional
interests will evolve from the activities of the

i82 PHYSIC AND FICTION

Ministry of Health if patience and tolerance are
used, while their use need obscure no fine ideals.
The Ministry of Health has come into being be-
cause all the questions embraced under the word
' health ' have grown insistent for answer — in-
sistent on public grounds — and delay is only
recommended in regard to detailed procedure.
There certainly should be no hesitation about the
immediate desire to act, though in a sense the
suddenness which characterises military decisions
is not called for. But disease is every whit as
much an enemy as any armed power can be, whose
onslaughts do not wait while counter measures are
being devised. ±\ massed attack of influenza is a
more rapid as well as a more widespread danger
than any military onslaught ever devised by a
potentate. If fuller use is to be made of medical
science, not only for the treatment or the pre-
vention of disease, but also for the education of the
public in right ways of living, of working and of
playing, the medical profession as a whole requires
some of the reorganisation which is foreshadowed
in the Ministry of Health ; and, as will be seen, it
is the medical profession itself which showed the
need for a Ministry of Health by demonstrating
that to sound medicine the public must look for
national salvation.

The Ministry of Health is the outcome of a wider
recognition of things as they are, and not, as some
very eloquent persons would have us believe, a
panic-stricken crusade against overwhelming evils.

I

PUBLIC DEVELOPMENTS OF MEDICINE 183

We must all allow that there is plenty of room
for reform in the public and domestic health of the
country. The present industrial conditions have an
obviously evil influence on the normal expectation
of life, as can be guessed by figures taken from the
Registrar-General's publications. Of those who
survive fifteen years of age, the average period of
life among agricultural workers is sixty-seven,
while among purely industrial workers it is just
under fifty. Again, recruiting statistics have
shown that in several trades half of the workers,
by the time they have reached forty years of age,
are unfit for military service. In many occupa-
tions over a third of those employed receive sick
pay for some period in every year. The deaths
from tuberculosis in this country are about
70,000 each year. As a proportion of those
deaths have certainly been brought about by war
conditions, whether among the combatants or
the non-combatants, it is a risky statement to
say that more people died from tuberculosis than
from the War during the period of hostilities ; but
the statement is regularly made with the appalling
experiences of the World War before us, and made
so seriously that it must have a foundation in fact,
though the deduction may be challenged. There
is a wide prevalence of venereal diseases, and the
infantile mortality in some of our large cities is
appalhng. No figures here are quoted, because
they vary so widely and on such different grounds
that the average percentages convey nothing that

i84 PHYSIC AND FICTION

has a local application, while it may be a local
remedy that is wanted in the medical view.

Now, no one wants to make light of circum-
stances hke these, and if it were because of them,
and because of them only, that a Ministry of Health
was required, it would be clear that the Ministry
was a piece of panic legislation. And as a rule
sudden and belated determinations to deal with
widespread evils do not present a promising out-
look. It is thus a good omen that the Ministry of
Health should be the natural evolution of a great
deal of sound public health policy, statesmanship,
accomplishment and endeavour which have
marked the social history of this country for two
generations. It is a co-ordination of efforts which
have borne admirable fruit in many directions,
and to some extent it is because of the success of
those efforts that the knitting together of their
activities and a removal of overlapping in per-
formance were necessitated. The medical pro-
fession has much to answer for in the muddle that
exists, but it is its virtues and not its faults which
have brought the position about.

The era of sanitation, as we now understand it,
and for all practical purposes the whole of our
modern system of preventive medicine, dates from
sixty years ago, founded though our wisdom is on
the wisdom of our ancestors and even of preceding
civiHsations. During these sixty years scientific
knowledge has developed to such an extent that
it has driven State organisations hither and

PUBLIC DEVELOPMENTS OF MEDICINE 185

thither in the attempt to carry out the medical
ideal — or to avoid carrying it out, as the case
may be.

The sanitary conscience, however, awoke many
years before preventive medicine was in a position
to intervene usefully. Some ninety years ago the
social and economic conditions in England, griev-
ously affected by the Napoleonic wars, produced a
feeling that the health of the people ought to be
a national care. That feeling, as we know, took
outward form at first in what we should to-day
consider a highly unphilanthropic form, for such
laws as were made were mainly intended to con-
fine the ills of the poor, as far as they were the
outcome of disease, to their places of origin ; pre-
vention was not mentioned, although there may
have existed behind the rough machinery of segre-
gation a consciousness that eradication of the ills,
rather than a lopping of their branches and a
topping of their shoots, ought to be effected. The
need for making the health of the people the care
of the State had become obvious, but only those
who could read with sympathetic heart the signs
of the times grasped the significance of the condi-
tions in which a large proportion of the population
were strugghng ; and the legislature found the
removal of those conditions to be beset by the
difficulties everlastingly associated with the altera-
tion of established customs or the restriction of
vested interests. The science of medicine had not
acquired a famiharity mth the etiology of disease

i86 PHYSIC AND FICTION

that could enable its professors to preach the
doctrines of prevention with sufficient authority
either to arouse the public conscience or to rein-
force the voice of reform. And so in 1834 the Poor
Law Commissioners, perceiving that ill-health was
a principal source of pauperism, and knowing that
the removal of the causes of ill-health would be a
more righteous proceeding than the treatment of
its consequences, could none the less conceive no
course open to them save remedial treatment, in
an economical way, of those whose ills were already
past remedy.

What the medical profession thought of the
Poor Law and its amending Act of 1835 was
chronicled in the Lancet at the time, and in lan-
guage that would make this politer age squirm.
The medical criticisms were, to the credit of all,
directed mainly against the neglect of pubhc
health, though resistance was urged on the personal
ground of injustice. For example — one among
many — the Memorial from the Practitioners of
Buckinghamshire, dated August 5, 1835, showed
well the feelings aroused. Herein the memoriahsts
expressed their concern that no efficient medical
aid was secured to the poor in sickness under the
Act, and they submitted that the medical proceed-
ings of many Boards of Guardians must terminate
in inconvenient appropriation and inadequate
division of medical duties, ending in fatal conse-
quences to the sick. They begged that the new
Commissioners would reconsider the subject and

PUBLIC DEVELOPMENTS OF MEDICINE 187

direct such regulations as would be beneficial to
the sick poor, satisfactory to the public, and just
to the medical profession. The general feeling of
the medical profession was justified later. The
times bore a great resemblance to those we live
in — this will not be pointed out here, from a
partial acquaintance with social history, because
the parallel is now being drawn by many expert
pens ; but, historians apart, the pages of some of
our greatest novelists show that in all the domestic
disorder, often of the bitterest sort, that raged
round Chartism, the Com Laws and the founda-
tion of Trade Unions, the inadequate care of the
health of the people was the most telling argu-
ment employed in favour of reforms. Disraeli
and Dickens, Gaskell and Kingsley can all be
quoted as showing the appalling conditions among
the poor between 1835 and 1855 ; the ill effects
of all measures, whether of remedy or repression ;
and, lastly, the manner in which the interplay of
poverty, industrial conditions, over-quick reform
and apathetic conservatism produced physical ills
of the worst description.

We get in novels, published when the evils de-
scribed were actually upon the nation, or barely
subsiding, more moving pictures and more arrest-
ing warnings than we can construct for ourselves
by the consultation of blue-books or biographies.
Sybil was written in 1845, and contains chapters
whose force and spontaneity prove the claim of
the author that the descriptions of the condition

i88 PHYSIC AND FICTION

of the people had been written from personal
observation. The vigorous sketch of the little
town of Marney is a whole indictment of the
sociology of the period, and the humorously ex-
travagant pedigrees of the Egremonts and the
Mowbrays must not alter our estimate of the more
serious things in the book.

When Disraeh was pointing out that in fiction
first the Turkey-merchant, then the West India
planter, and then the Nabob had figured as the
examples of the new rich, to be succeeded by the
loan-monger, and, lastly, by the wealthy manu-
facturer produced by long wars, he was thoroughly
enjoying himself, and never more than when he
was showing how these characters had gradually
merged into English aristocracy. But while no-
body to-day would quote him as an accurate
authority on the rise of great families, he can be
adduced as a sound chronicler of the popular
misery of the times. Sybil contains pictures of
the conditions of the poor under the Poor Law
which can be verified over and over again by
medical history.

Kingsley, as ' Parson Lot ' and the author of
Yeast and Alton Locke, told in burning language of
things which he knew ; they were occurring in
the forties and fifties during a period when he
was in intimate touch with all the movement of
the Chartists as they developed into trade union-
ism and co-operative societies. His description in
Alton Locke of a tailor's work-room, given in the

PUBLIC DEVELOPMENTS OF MEDICINE 189

words of a worker, shows in a few horrifying
phrases the sort of thing against which preventive
medicine had to work in its early days : —

' Concentrated essence of Man's flesh, is this here as
you're a-breathing. Cellar work room we calls Rheu-
matic Ward, because of the damp. Ground-floor 's Fever
Ward — them as don't get typhus gets dysentery, and
them as don't get dysentery get typhus — your nose 'd tell
yer why if you opened the back windy. First Floor 's
Ashmy (Asthma) Ward — don't you hear 'um now through
the cracks in the boards, a-puffing away like a nest of
yoimg locomotives? And this here most august and
upper-crust cockloft is the Conscrumptive Hospital.'

This is an unexaggerated delineation of the
horrors which a growing sense of the value of
preventive medicine has aboHshed by gradual
relays of legislation.

Mrs. Gaskell, in Mary Barton : a Tale 0] Man-
chester Lije, published in 1848, disclaims all know-
ledge of political economy or the theories of trade,
but her description of the state of living among the
factories in Manchester conveys a medical message
worth fifty disquisitions or political creeds. To the
work of Dickens as sanitarian no detailed refer-
ence is necessary, but from almost his first novel,
Oliver Twist, to almost his last, Our Mutual Friend,
he was the champion of the cause of the sick poor
against mistaken State action. Other well-known
novels worth reading for the light which they shed
on a sad and puzzhng epoch of national history are
Charles Reade's Put YourselJ in His Place, full of

190 PHYSIC AND FICTION

fine writing and moving adventure, but often
terribly foolish ; and John Saunders's well-known
novel, Abel Drake's Wije. Both these stories
appeared in the same decade, the former in the
pages of the Cornhill, the latter under the imprint
of the Cornhill firm, and are rather reviews of
past abuses and denunciation of strike methods
than appeals for better sanitation under a properly
organised State system of public health. Still
the appeals underlie the message delivered ; and
when Mr. Stanley Weyman, in a novel which
recently appeared in the Cornhill, desired to draw
a poignant episode in the miseries of the poor at
the beginning of the Victorian era, he selected the
haling to the workhouse of a helpless woman
whose son had died of fever. The poor in those
days knew well what a poor-law infirmary meant,
and so did the medical profession, to whose efforts
later the vast improvements in these institutions
are largely due.

It is not claimed, however, that the public was
the villain and medicine the hero of the tragedy.
Medicine was not provided with the necessary
knowledge to assist Governments in any large
policy of a preventive character at the time when
the Poor Law came into being. That reproach is
now removed. During the last century medicine,
striding forward to accurate knowledge, became
first an official and later an inspiriting counsel for
further effort, when sections of the community
awoke to the fact that by sanitation there could

PUBLIC DEVELOPMENTS OF MEDICINE 191

be removed barriers to their health and happiness
which were remaining erect with no better apology
than might be found in their antiquity. As each
section was roused it made its claim for relief
heard, with the result that the remedy best fitting
the circumstances was applied. Schemes of re-
form, initiated in this haphazard manner, were
entrusted for their carrying out to various depart-
ments of Government and various local authorities,
with a consequent overlapping of jurisdictions and
waste of energy and money, while the resulting
confusion was worse confounded by the creation
of new Government bureaux and the rearrange-
ment of local administrative machinery. It is
the rapid increase of medical knowledge which has
been the reason for such facts as that, before the
invention of the Ministry of Health, no fewer than
eight first-class Government bureaux had charge
of medical affairs. Medicine demanded the inno-
vations ; various Governments, having no uni-
form plan, met the demands by putting the burden
on the nearest available back. The outcome was
to make the care of the health of the people, as
conducted in this country, a magnificent and
illogical muddle, in which fine ideas and accom-
phshments, many of which elicited the envy of
modern civilisation, were blended with the oppor-
tunities for extravagance and dissipation of
strength inevitably associated with the want of a
central plan.

And sometimes, when the course taken by the

192 PHYSIC AND FICTION

State has been perfectly logical, the result has
appeared to the public particularly comic. For
instance, one of the eight governing departments
which, previous to the creation of the Ministry of
Health, had charge of medical interests, was the
Privy Council, to which the Midwives Board owed
allegiance, and much merriment has been expended
over the droll bedfellowship of the Lord President
and the Gamp. Yet it came about in the most
reasonable manner. The Midwives Board was
created to be the authority for the registration,
education and discipline of midwives, as the
General Medical Council is such an authority for
registered medical men, and as the new Dental
Council will be for registered dentists. The
General Medical Council sits under the authority
of the Privy Council, and it was according to pre-
cedent that the Midwives Board with analogous
functions should do the same. The functions may
be epitomised as the elimination of Gamp. No
doubt the Privy Council was selected by those who
framed the Medical Act of 1858, under which the
original General Medical Council came into being,
because in this way the Crown members of the
Council would be appointed by a permanent body,
whose President alone would be subject to party
fluctuations.

There has now arrived that central plan which,
though overdue, could have had no promise in
the past Hke that which it offers in the light of a
real knowledge of the foundations of preventive

PUBLIC DEVELOPMENTS OF MEDICINE 193

medicine. The Ministry of Health has taken over
the interests of national health as far as they were
represented by the powers and duties of the Privy
Council in respect of midwives ; of the Local
Government Board in respect of sanitation and
preventive medicine ; of the Board of Education
in respect of school children, children under school
age, and expectant and nursing mothers ; of the
M Insurance Commissioners in respect of panel
practice ; of the Home Office, Colonial Office, and
Foreign Office ; and of other authorities dealing
with, for example, registration of births, deaths,
and marriages, and vaccination. Further duties
will be transferred to the Ministry as they appear
to be germane to the health of the people, but it
will be conceded that the new Minister of Health
has got enough to go on with.

What is the outlook for medicine, and what is the
outlook for the pubhc under the Ministry of
Health, which has been called into existence by
the brave aims and high developments of science,
and by the deep and deepening sense of the world
that the good health of the people is a nation's
greatest asset ? Surely that outlook is very
promising if the happy mean of pace is hit off ;
for then we shall stay the course — a splendid
course, which as it unrolls itself before us should
find us always progressing. But it is particularly
necessary that we should not be too precipitate
in the adoption of concrete schemes which, while
implying the destruction of things hitherto count-

N

194 PHYSIC AND FICTION

ing for progress, would also commit us in detail co
policies or side-shows, later to be found incor:-
venient and to be abandoned in the ill odour of
recrimination. In the more intimate relations
between the employing public and the employed
doctors which will follow the establishment of the
Ministry of Health, the pubhc should understand
that the whole of the professional fabric has beer
gravely affected, so that those who practise th '
calling of medicine may be forgiven if they d<
not quite know where they stand.

But the conditions of medical service are noi
unpromising because they happen to be sharing
in an all-pervading social muddle. On the con-
trary, while much that is dignified and some that
is useful may certainly be jostled out of existence
in the class and sectional fights ahead, it is certain
that medical science will receive new opportunities
for expansion. The whole of our civilisation is in
flux. In every country leaders of men, made to
admit by the revelations of the War the many
weak joints in their social armour, have resolved
that those joints shall be mended or that armour
of a new pattern shall be employed. At the start
there is necessarily more confusion than recon-
struction and, alas ! more words than deeds.
This cannot be helped. The necessary qualities
in these days of transition are hope and behef —
hope that the endurance which has carried us
through days of trial will be with us in those of
reaction, and belief that knowledge will triumph

PUBLIC DEVELOPMENTS OF MEDICINE 195

over ignorance when inequalities will be righted
by a general sense of justice. The medical pro-
fession stands to gain enormously when this bright
era arrives, but for the present its position is a
difficult one, and requires sympathetic attention.

The Ministry of Health, a new Government
iepartment, is designed at one and the same time
o provide for the people an efficient and orderly
ledical service, and to secure for the members
i that service better means of discharging their
nportant functions. It is impossible that the
;Ctivities of such a Government department,
rendered necessary by the progress of medicine,
should fail to operate in the near future to the
joint advantage of the community and of medicine,
practical and scientific. There is in the country
a number of young medical men at a loose end,
and, quahfied men though they be, they must be
nearly as much at a loss to adumbrate their
futures as any new student, but with the added
perplexity that they may have wives and families
to provide for. Many of them are full of new
experiences, and they are not finding opportunities
for bringing those experiences to market in such
a way that they can obtain good terms. The
hardship felt by many of the medical men return-
ing from war to practice is undoubted, and the
public who are suffering from any backwardness
of medicine should be ready to assist an organised
forward policy. The Ministry of Health, designed
for the public weal, must be administered by

196 PHYSIC AND FICTION

medical practitioners, and if they do it well they
are worth their reward.

They should obtain it. Reorganisation of panel
practice, which in many directions is imminent,
will certainly place at the disposal of yomig medical
men chances of obtaining an assured livelihood
and good scope for general or special clinical
knowledge. When the panel practice brings
with it a part-time appointment at a hospital, ||
and association with professional leaders and
specialists, the aggregate emolument will make
the young medical man better paid at the opening
of his career than his father or his grandfather
could ever have expected to be, had he joined the
profession, and will also give him greater oppor-
tunities. Hitherto one great and condemnatory
criticism of the position has been that while the
start is so good the future iiolds no greater promise.
In panel practice a man may make almost at the
outset what turns out to be his maximum income.
It is clear to every one that in the pubhc employ-
ment of the future some flexible system of pro-
motion will have to be laid down, so that the
inexperienced man does not receive as much
money as his senior. The income from panel
subscribers can only go up if the practitioner
increases the size of his panel, and while for
physical reasons this may be an impossibihty,
for public as well as scientific reasons it is an un-
desirable form of success. Justifiable comment
on the position of panel practice has always been

PUBLIC DEVELOPMENTS OF MEDICINE 197

that the good start does not necessarily ensure the
good future, and this is the main direction in which
panel practice requires reform, once the question
of proper emolument has been settled.

But the meaning of all this is that general
practice in Great Britain, as hitherto understood,
is largely in the melting-pot. In a few years'
time there may no longer be a group of family
practitioners having sole charge of the health of
certain districts, each of them supposed to repre-
sent all the medical and surgical wisdom required
in that district, save where the Ministry of Health
as medical heir to the Local Government Board,
the Board of Education, and the other bureaux,
annexes a portion of the burden, and therefore
of the remuneration. But the cessation of the
old-time methods of general practice will go hand-
in-hand with added opportunity, both for special-
isation and for the passage from the ranks of
general practice to those of hospital surgeon and
physician and scientific expert.

A little prophecy may be hazarded, based both
on what is happening and what is provided for.
Soon there may be no class of general practitioner
separated off from hospital surgeons and physicians
from specialists, and from officials. The principal
hospitals, becoming centres of scientific medicine
in their localities, will be officered by men who, by
fusion of duty with the general practitioners of
the neighbourhood, will make of the whole of the
medical energy one general scheme for the good of

198 PHYSIC AND FICTION

the populace. The medical men of the district
will have beds in their own hospitals, and will
receive for their patients the consultative advice
of their fellows and the assistance supplied by a
laboratory of clinical research.

And the time approaches when the general
practitioner, reinforced in this manner by close
communication with all branches of the medical
profession, will take his part in the education
of the student. Despite all the advances made
in medical science during the last half-century,
knowledge of disease relates far too much to con-
ditions where the patients are already seriously
damaged, and the reason for this is obvious.
Such are the patients which reach the hospitals,
where they come under the ken of those who have
charge of the medical education of the student,
and their teaching is accordingly based upon the
material under their hands. But that material
consists too much of serious emergencies and
incurable pathological developments. The present
system of medical education is divorced too much
from the work of the general practitioner, only
out-patient practice being really comparable with
general practice. Following this line of argument
in his recent book, The Future of Medicine, Sir
James Mackenzie has suggested that in every
school of medicine there should be at least one
teacher who has done ten years of general practice.
We must not confuse this proposal with a recom-
mendation to return to the old system of appren-

PUBLIC DEVELOPMENTS OF MEDICINE 199

ticeship. under which the medical student before
ioining a school acted as pupil, pupil-assistant,
and (alas, too often !) as obstetric substitute to a
general practitioner. That plan had advantages
a hundred years ago, and, perhaps, even fifty
years ago, it may be admitted, for the medical
training of the time was of a much more simple
character. To-day any return to such procedures
is manifestly absurd ; but that does not mean that
there is no real virtue in having part of the student s
training in the hands of those with immediate
experience of the difficulties with which the genera
practitioner will meet in his Ufe's work. A part
of the medical education of the apprentice, a
student, might well come from selected general
practitioners. In olden times the value of the
education which the medical apprentice received
depended entirely upon the unstandardised abihty
of a master-any qualified medical man-to
impart knowledge to the apprentice-any young
man who thought he had, or whose parents
thought he had, a bias towards medicme. Under
the old apprentice system some students obtained
extraordinarily valuable training. It is equally
obvious that some had no such good fortune.
No practitioner would to-day take part m the
conduct of an educational curriculum without
close scrutiny of his claims.

If the public takes advantage of the oppor-
tunities of the near future to co-operate wi h
medical endeavour ; if medicine speaks frankly

200 PHYSIC AND FICTION

and intelligibly on preventive problems to this
public, which both in theory and practice is be-
coming scientifically instructed ; and if ministers,
before taking action, Hsten to the considered views
of both sides — then the new Ministry of Health,
which cannot fail to be of benefit, will be trans-
formed into an immediate power for incalculable
good. And when some of the changes designed
appear sweeping, sedater persons can take comfort
from the fact that of these changes many were
desired by the leaders of thought in the early
Victorian era, whose views on preventive medicine
and the relations of medicine to the public must
not be judged by the legislation effected without
taking into account the ideals aimed at.

CHAPTER VIII
THE PATHOLOGIST IN THE STREET

The Artist, Novelist, and Doctor Abroad — Snapshot Pathology
and Pavement Diagnosis — Modern Cosmetic Surgery — Victor
Hugo and Sheridan Lefanu.

All of us look at the world with a prejudiced eye ;
we are ready with our judgments before we take
in the view. We see that which we expect upon pre-
vious report to see or that which we are equipped
by special instruction to see, and we make con-
sequently our visual estimates in a biassed way,
and in accordance with personal limitations.
Now we persuade ourselves that we have observed
what we think we should observe ; now, having
been trained to note certain matters, we note them
so clearly that the picture as a whole gets out of
drawing, unimportant things assuming for them-
selves a paramount place. Nobody can be with-
out personal limitations, that is to say that nobody
is both all-seeing and all-understanding. To look
about him with an absolutely unprejudiced eye a
man must be a good deal blind or very ignorant,
in which cases he will not only see so little, but be
content to see so little that there will be little call
upon a fallible imagination to fill up the blanks.
He will not be aware of any blanks, and while

201

202 PHYSIC AND FICTION

taking no risks of speculative sort will take no
profits in the shape of interesting deductions.
The more we do see and the more we do under-
stand, the greater become our opportunities for
appreciation and misappreciation. In proportion
to the breadth of our sympathies it grows exciting
for the imagination to try to fill the blanks which
should not be hopelessly large, but rather obvious
and stimulating. The jig-saw puzzle grows amusing
as the solution begins to develop ; and the more
a man knows of his fellow-man the more is he
tempted to guess at what is hidden. This is
what may make a walk in the street quite an
exciting experience for the pathologist.

I can imagine the artist being in a somewhat
similar position, with a comparable endowment
and also a comparable liability to error through
prejudice. And the position of the novelist is
that of the artist.

The novelist, the artist, and the pathologist
possess special information of a far-reaching sort
which leads them to see some things and infer
others, while it may betray them into dispro-
portionate estimates of the importance of these
things. But they, all three of them, are less hable
than the majority to errors arising in this way,
because the range of their sympathies is so inclu-
sive. The sky, the air, the outline, the colour, the
movement — each and all of these demand atten-
tion from the artist always and from the novelist
sometimes : the pathologist looking at his fellow-

THE PATHOLOGIST IN THE STREET 203

men can find in their frame, gait, deportment,
general appearance, and even their clothes, reve-
lations as to their physical condition : and the
artist and the novelist see in them models. They,
all three, have before them things which, though
exposed to the gaze of those who pass, yet go un-
noticed because they have to be looked at with
special knowledge before they can be truly seen.
The special knowledge is essential, and there
should be no suggestion that the artist, the
novelist, or the pathologist is in any way cleverer
than his fellow-men. This claim is not made for
either of them ; their harvest of observation,
when walking the pavement, is due to their habits
of mooning and gaping, instead of striding sternly
to business, looking neither to the right hand nor
the left. It is not clever or admirable to moon
and gape, and prudent persons avoid such habits ;
but these are forced upon the artist, the writer,
and the pathologist by the ever-present claims
of their particular equipments.

The artist must generally look about him in his
professional manner — the artist's manner. He is
to be judged by what he records ; he sees what his
prejudices make him see, the range and accuracy
of his record of course depending upon his sym-
pathies, his knowledge, and his technical equip-
ment. It must be remembered that the artist as
a chronicler is a man of dehberate artifice ; the
suppression of things unnecessary to a central
conception of composition must always be occur-

204 PHYSIC AND FICTION

ring in his work, and for the highest reason,
namely, because he is aiming at an effect which
can only be obtained by omitting certain things
which obscure that effect. Artists aiming at
different main effects will, consequently, reproduce
the same scene in very different ways ; but in the
case of the man who is trying to set down all that
he sees, adding nothing and subtracting nothing,
we shall find that, however conscientious he is,
his personaUty as well as his deftness will influence
his picture. Not only do no two composers desire
to see a scene in the same way, but to no two
artists does the same scene appear alike, though
the conditions under which their experience is
obtained may be exactly similar. Two equally
honest and capable draughtsmen do not convey in
their drawings the same idea of so concrete a thing
as a tower — one will show us especially its height,
another especially its massiveness, though both are
drawing the tower as it strikes them. When we
come to colouring we know that equally con-
scientious painters see things actually of different
hues. I do not refer to the moral any more than
to the physical defaults of the executants. There
are, of course, painters who are purposely perverse,
as there are painters who are physically deficient
in colour sense — at least it is kind to believe that
the colouring of some, who none the less exhibit
in quite good company, is their misfortune and
not their fault. But let us suppose that two men,
alike sane in judgment and ahke able to pass

THE PATHOLOGIST IN THE STREET 205

lantern or wool tests, sit down on the same day and
at the same hour to paint the same object from the
same point of view. Is it not certain that the two
paintings would have many points of difference ?
The painters actually do not see the object ahke.
The reason for this is usually that, while each
paints to some extent what he is compelled to
paint by the model, each seizes on the thing in
that model which he loves best to express, and
elaborates that thing. Sometimes the pride of
the workman gets ahead of the sense of artistic
truth ; sometimes the deftness or ease with which
certain things by long practice can be done leads
the artist to select them for record to the uncon-
scious subordination of other things. Here, of
course, the ordinary dictation of trade may be
influential. If the crocket on the spire, or the
veins on the marble, or the multi-coloured creeper
can stream from a painter's brush at the maximum
of speed with the minimum of effort, and if these
are the items of his achievement which the public
have decided to admire in his pictures, he will be
a rarely conscientious person if he does not let
them stream. A picture in which these details
are conspicuously brought out represents for him
the least trouble and the greatest chance of reward.
But all the time he may be a perfectly honest
painter, unaware wherein his pictures differ from
the truth. He beheves that he sees things like
that.

It would be tedious to use almost the same words

2o6 PHYSIC AND FICTION

to set out the situation of the noveUst. He, too,
sees much, selects some, and treats the selection
with individuality. The pathologist in the streets
is in something the same position. The artist is
trained to take in the story of line and colour in
detail and in mass, to note where lights and
shadows fall and their effect, often their unexpected
effect, on line and colour. The novelist notes the
episode and the characters in relation to life at
large. The rest of the world sees some of this, but
is not looking for any of the effects and contrasts,
and misses, because of indifference of gaze, a
thousand things which are revealed by pen or
brush. Neither writer nor artist may keep his
eyes open in the colloquial sense ; he may have his
pocket picked, he may walk beyond the post-
office which he imagines himself to be looking out
for, he may be run into on the pavement, or run
over in the road ; but all the time he is seeing.
But the more observant rest of the world is for the
most part not seeing, save within narrow limita-
tions. To the pathologist as he takes his walks
abroad there are revealed by countless signs and
symptoms details concerning his fellow-men which
he cannot fail to observe, and which he will inter-
pret, first, in accordance with his general know-
ledge, and, secondly, in accordance with his
personal prejudices. Many of these things are as
visible to the rest of the world as to himself, but,
having no significance for the non-medical spec-
tator, call for no attention.

THE PATHOLOGIST IN THE STREET 207

The position, it seems to me, is not quite the
same when any other calhng is concerned. For
though all must notice that in which they are inter-
ested by their training, the observations to which
expert knowledge in the case of most professions
or trades leads are of a much more limited char-
acter. They are not provoked by everything ;
they are not elicited by every conceivable situa-
tion. When made they may be very exact as far
as they go, but they cannot go far. To the lawyer
as he walks the streets many of the circumstances
of his professional work may be present mentally,
but they cannot be brought to mind often by what
he sees. His concern is so invariably with the
unrevealed qualities of what lies before him, rather
than with what is bare to his inspection, that his
legal reflections are not called up by his particular
environment. He feels that no concentration of
gaze, no accentuation of interest, will enable him
to arrive at the unrevealed qualities. A house to
a lawyer is good property or bad property, or
decently profitable property, but he knows that
he cannot tell by the look of it to which category
it belongs. Grandeur or dilapidation is no just
criterion — nothing that can be seen is any criterion.
A lawyer cannot tell by inspection whether a house
is leasehold or freehold, mortgaged or not, under-
rented or over-rented. The lawyer's mind may
be full of general ideas on the creation of urban
estates or particular ideas on the rating of a certain
area, but the environment in which he finds him-

2o8 PHYSIC AND FICTION

self, the appearance of the houses or men around
him, cannot with any frequency compel him to
think professionally. To do so would be waste of
time, for what the eye alone can tell is worth
nothing to him as a motive for either thought or
action. He may feel sure that the streets represent
a certain average of acquiescence in the law, and a
certain average of revolt against it, and so be led to
think generally of the administration of justice.
Oppressors and oppressed, also in their certain
average, rub elbows with him on the pavement,
but he cannot pick out unhesitatingly by inspec-
tion one man who has committed an illegal act.
He differs absolutely from the artist and from the
medical man in that the outside tells him so little,
and enables him to guess so little.

The observant clergyman can deduce whether
he is in a good neighbourhood or a bad neighbour-
hood as he passes through it, and if he has a little
familiarity with the world he will know that the
inhabitants of the neighbourhood and the trafficker
in its marts are of a certain level of virtue and
therefore of wickedness. But he cannot diagnose
individual instances ; virtue wears no languid
lilies and vice no rapturous roses. He cannot
accost the complacent merchant and tell that
valuable citizen that he is a callous, selfish fellow.
Manners might not prevent him from doing this,
if he were in earnest, but the limits of his under-
standing forbid him. He does not know, and he
cannot guess, whether the merchant is an altruist

THE PATHOLOGIST IN THE STREET 209

or a pig, or at what point between these extremes
he may be found. Generahties he may assume ;
the particular is as beyond him as it is beyond the
lawyer.

Whether the medical man likes it or not, he
must always be regarding his fellow-man, when
he meets him in the street, in the light of a
potential patient, as inevitably as the artist must
always find in the scene or the episode the motive
of a picture or a story. It is a misfortune for the
pathologist in some ways, though it is his pleasure
in others, that the toils of his profession hold him
very tightly. The outsides of men thrust them-
selves upon the pathologist and demand his
attention from every point of view, and from
inspection of the outsides he is forced to reflection
upon all that he cannot see. He never escapes
the penalty of his familiarity with the meaning of
symptoms. All who occupy the pavements as he
passes will group themselves for him into clinical
pictures, and the interesting nature of these
pictures will be revealed to him, just as the usual
or unusual effect of some light or shade may be
revealed to the painter. This position carries
privileges as well as penalties, and is by no means
so gruesome as many seem to suppose. I do not
refer, as among its privileges, to the consciousness
of being well informed, to the feeling that what is
revealed to the medical eye is another's most
cherished secret or a matter which, if he knew it,
would alter the whole tenor of his ways : my

o

210 PHYSIC AND FICTION

own belief is that such feelings are foreign to the
medical mind. The great privilege conferred on
the pathologist by his equipment is his sure know-
ledge that the tragedies which unfold themselves
are balanced by compensating comedies. The
nature of what is made patent to the medical man
by his expert knowledge is sometimes grim, for
to him superficial appearances are often no disguise
at all, and the sinister truth becomes apparent
when the evidence is slight.

Who would suspect, not being able to estimate
the evidence before him, the sword of Damocles
that is hanging over this red-faced, cheerful fellow,
or see in his cheeks the signal of a fruit over-ripe ?
To the lay mind this portly person stands for all
that is prosperous and confident, and his appetite
is the envy of many of his dyspeptic friends —
who will send wreaths to his funeral. See the
bluff and kindly manner with which he hands his
shilling to a thin-faced woman selling boot-laces
in the gutter. It is only the medical man who
would dare to prophesy white hairs for her long
after her benefactor has been gathered to his
fathers. Here is a sunburnt cheek that makes
all these other circling faces look pallid and worn
by contrast. It is natural for the passer-by to
covet this brown-red hue, but the medical man
may recognise the imprint of the health-resort,
and be confirmed in the idea by other things
pointing to an ominous diagnosis.

These are two instances where the medical view

THE PATHOLOGIST IN THE STREET 211

is black. The lightning diagnosis may be wrong
in the case of the merchant, and unduly pessimistic
concerning the case of tuberculosis, but there are
many less ominous cases of hepatic and renal
disease (for example) where the medical man can,
with considerable likelihood of being right, pro-
phesy, and prophesy in gloomy vein. Many of
these persons do not know their own position,
which is perhaps a merciful fact ; and some have
been told the worst, sometimes to find that an
unnecessarily depressing forecast of their chances
has been made. Especially may that be the case
with certain forms of nervous disease. We have
all of us seen a man in the prime of life titupping
along the pavement with legs kept close together
and with hesitating steps and scarcely lifted toes.
As long as his lesion remains in the state which
merely affects his legs, life is far more endurable
to him than the sympathetic onlookers imagine ;
and, while it is more than probable that he has
learned that his paralysis may spread, and that
with its spread muscular atrophy and a dread
train of symptoms may supervene, he knows also
that he may remain in his present state for many
years. Each day's respite brings him an accession
of hope ; and in many cases familiarity with the
limitations imposed on him by his disease serves
him well by enabling him to contrive for himself
many things which make his plight more tolerable.
I do not belittle the trials and sufferings of the
spastic subject, but his physical circumstances

212 PHYSIC AND FICTION

are very usually much easier than his appearance
warrants, and his chance of outliving many of his
florid athletic contemporaries is quite a good one.
Sympathy he commands, but he is far from ready
for the grave which seems to yawn for him, and
when he goes there it is quite frequently at the
bidding of some intercurrent disease which arrives
before his nervous lesion makes any vicious
development. In such instances the pathologist
has his compensations, for his knowledge, instead
of serving to rack him with pity, allows him to
judge more fairly the calamity before him.

Not infrequently where the layman sees no
particular reason for sympathy the pathologist is
aware of the presence of a tragedy ; but, on the
other hand, where the uninstructed are readiest to
offer consolation the pathologist may see no
veritable cause for sympathy. He does not share
the pity that runs through the crowd as a chalk-
faced man, with his arm in a sling, makes his
cautious way along, keeping his damaged side
against the wall, and being ready with his sound
limb to fend off those who press against him.
Clinical experience shows him this same man, two
or three months hence, wielding a spade or hunting
four days a week, according to his rank in life.
In the same way the medical man escapes much
harrowing of his feelings by the professional mendi-
cant whose claim upon our purses is founded upon
his appalling physical ills. The knotted cripple,
as he drags his misshapements before the eyes of a

THE PATHOLOGIST IN THE STREET 213

pitying world, is recognised by the pathologist,
despite his countenance full of long-drawn anguish,
to be often no great sufferer ; his ankylosed joints
are causing him no pain, his tuberculous trouble is
arrested, and there is no longer any acute mischief
present to warrant the appeal of his features. Sad
it is, certainly, to look upon the ruined form, and
sad to speculate what a closing up of the channels
of usefulness and happiness the deformities must
mean ; but it is idle to regard the matter from this
point of view only, while it is an unnecessary
excitement of gloomy thoughts to imagine these
people the perpetual victims of ill-fortune. In most
cases of the begging cripple we are dealing with no
slave to grinding pain, nor even with one bereft
of home affections and denied employment be-
cause of his physical and aesthetic defaults. His
calling is regularly followed, his contorted body is
his well-displayed advertisement, and the com-
fortable lady in a potato-coloured ulster, who
accompanies him, is the wife of his bosom, who has
married him despite his scoliosis, and on the
strength of his abiUty as an ' asker.' There are
pot-bellied financiers who have been married on
similar grounds. To call Dickens ' a pathologist
in the street ' is justified by his observation of the
physical abihty which many of his grotesques, like
Quilp, display.

We have now in our streets many whose de-
formities and deprivations are their glories, and
the transmitted glories of us all. For us they have

214 PHYSIC AND FICTION

suffered, and they are of our race. At them none
looks, nor doctor nor decent passer-by, feeUng
that they would not wish from any one either com-
passion or wondering regard. Medicine may claim
here a congratulatory word for itself. There are
many who now pass unnoticed whose injuries not
so long ago would have drawn inevitable attention
to them, or, worse, would have been met with that
resolute imitation of blindness which deceives no
one less than those for whose sake it is assumed.
Modern prosthesis, or artificial limbs, and the
latest cosmetic or plastic surgery, which includes
the refashioning of features, have worked many
marvels, and it is due to the science of to-day to
acknowledge this.

There are two particular conditions under which
the mutilated man can work among his fellows,
discharging his duties of citizenship with more
or less measure of disability. To make that
measure small has been the painstaking endeavour
of medicine. Those who have lost a limb will take
their place in proportion to the completeness of
surgical assistance which it has been possible to
render them. Those who have suffered from
wounds of the face are, making allowance for
residual pains and minor complications, as fitted
as any one to do their full day's task, save where
cosmetic reasons may interfere with them. To the
education of the blind in manual performances,
which once were considered to be impossible save
to those with sight, and to the education of the

THE PATHOLOGIST IN THE STREET 215

deaf by the art of lip-reading, which makes many
of them largely independent of the sense of hear-
ing, I am making no reference — the circumstances
are not quite comparable.

The functions of the lost leg have been replaced
by mechanical contrivances from historic times,
and we should not expect here any fundamental
development of prosthesis. The manufacture of
the limbs, however, has improved beyond all
description, so that lightness and adaptability of
the contrivances are enabling many without a leg
not only to enjoy tolerable lives, but to enter upon
the ordinary routines of activity, and, to some
extent, to approach athleticism. Many who have
lost a leg defy detection, when walking in the
street, from any but the pathologist, while their
appUances enable them to get to such business as
they are fitted for — and the range is surprisingly
large — there to discharge their duties perfectly.
It is different, however, with the man who has lost
an upper limb. The man who has a lower Umb
replaced can get to his work with some disability —
to discharge that work perfectly. The man who
has lost an upper limb can get to his work with no
disability at all, but when he gets there he under-
goes a serious handicap. Here it is that modern
prosthesis has worked a complete revolution. The
latest artificial arm, with its arrangements for
attachment and for securing motive power, is a
wonderful thing, and, although the complex
functions of the normal arm are impossible of

2i6 PHYSIC AND FICTION

exact reproduction, it has been proved that they
can be imitated to a considerable extent. Some
movement can be produced at the shoulder-joint
and much at the elbow-joint, while springs and
locks will give grip, and the limb may terminate
with an arrangement for the adjustment of tools,
or in a gloved hand. The labours of those in
charge of the arm-training centre at Roehampton
have had these wonderful results, and many a one-
armed man can do a good day's work, and move
unnoticed among us.

Coming to what can be done for the mutilated
face, the War has afforded tragic opportunities
here for the display of surgical skill. The classic
labours of Tagliacozzi, already referred to, whose
treatise on plastic surgery was published in 1597,
were in the main directed to the replacing of noses
and lips which had been removed either by in-
jury or by disease, and since his day until our day
little improvement was effected in the technique,
save in India, where rhinoplasty made some pro-
gress under good opportunity. The operations in
India were designed to repair the brutalities of
husbands, for slicing off the nose has been a time-
honoured gesture in some districts of India,
signifying disapprobation of a wife's conduct.
This form of cruelty or revenge, though rare in
modern Europe, is of great antiquity. It may be
remembered that when iEneas revisited in the
under-world his friends who had been killed at the
capture of Troy, he saw Deiphobus—

THE PATHOLOGIST IN THE STREET 217

' lacerum crudeliter ora,
Ora manusque ambas, populataque tempora raptis
Auribus, et truncas inhonesto volnere nares.'

(Virg., ^neid, lib. vi., 495.)

Deiphobus was the paramour of Helen after the
death of Paris, and received this treatment at the
hands of the aggrieved Menelaus and on betrayal by
' the Laconian woman.' The late Colonel D. F.
Keegan, I. M.S., had some very satisfactory results
in India in dealing with amputated noses, and the
treatment of some of our recent military patients
has been along the same lines. It is probable
that some religious animus against this repair pre-
vented Tagliacozzi's example being followed at
the time, for it is said that his almost contempor-
ary, the great Ambrose Pare, denounced as im-
pious such interference with features which had
been fashioned originally in God's image, to be
brutalised by man's action.

But at best plastic surgery must have remained
very rough when the surgeon had the help neither
of anaesthetics nor of aseptics. The mediaeval
world was not without a certain sinister experience
of facial surgery, and knew the possibility of repair
that such highly vascularised and mobile tissues
as those of the face possess, but their knowledge
was displayed in destruction, not in restoration or
beautification ; for destruction was a trade of
value to the operators. We may recall the hero
of L' Homme qui Rit, surely the most ridiculous
book that ever was written by a supremely great

2i8 PHYSIC AND FICTION

man of letters. Gwynplaine had a permanent
and terrible grin fixed by an operation, and fixed
for ever, on his face, and the novel opens with a
disquisition on the misdeeds of the ' comprachicos '
whose grisly trade of mutilating children in the
manufacture of monsters, buffoons and grotesque
pets certainly existed three hundred years ago.
We are not bound to beheve the voluminous
and staccato information given by Victor Hugo
in a typical mixture of eloquence, erudition,
credulity and pomposity, but the evidence,
literary and artistic, of the fact that the fabrica-
tion of monsters was a recognised business is
beyond dispute.

An expert in this revolting traffic was intro-
duced by Sheridan Lefanu into his sensational
novel Checkmate, and the transfiguration of
Lefanu's unspeakable villain is far more convincing
than that of Hugo's romantic hero. The passage
is worth quoting, so nearly has Lefanu recorded
the possible procedure, its risks and its results : —

' Now, look at Herr Yelland Mace,' said the Belgian
operator. ' It was a severe operation, but a beautiful
one ! I opened the skin with a single straight cut from
under the lachrymal gland to the nostril, and one under-
neath meeting it, you see ' (he was tracing the line of the
scalpel with the stem of his pipe), ' along the base of the
nose from the point. Then I drew back the skin over the
bridge, and then I operated on the bone and cartilage,
cutting them and the muscle at the extremity down to a
level with the line of the face, and drew the flap of skin
l:>ack, cutting it to meet the line of the skin of the cheek ;

THE PATHOLOGIST IN THE STREET 219

there, you see, so much for the nose. Now see the curved
eyebrow. Instead of that very well-marked arch, I
resolved it should slant from the radix of the nose in a
straight line obliquely upward ; to effect which I removed
at the upper edge of each eyebrow, at the comer next the
temple, a portion of the skin and muscle, which being
reunited and healed, produced the requisite contraction,
and thus drew the end of each brow upward. And now,
having disposed of the nose and brows, I come to the
mouth. Look at the profile of this mask. . . . Now, if you
observe, the chin in this face, by reason of the marked
prominence of the nose, has the effect of receding, but
it does not. If you continue the perpendicular line of ze
forehead, ze chin, you see, meets it. The upper lip,
though short and well-formed, projects a good deal. Ze
under lip rather retires, and this adds to the receding
effect of the chin, you see. My coup d'ceil assured me
that it was practicable to give to this feature the character
of a projecting under-jaw. The complete depression of
the nose more than half accomplished it. The rest is
done by cutting away two upper and four under-teeth,
and substituting false ones at the desired angle. By that
apphcation of dentistry I obtained zis new line.' (He
indicated the altered outline of the features, as before,
with his pipe.) ' It was a very pretty operation. The
effect you could hardly believe. He was two months
recovering, confined to his bed, ha ! ha ! We can't have
an immovable mask of living flesh, blood, and bone for
nothing. He was threatened with erysipelas, and there
was a rather critical inflammation of the left eye. When
he could sit up, and bear the light, and looked in the glass,
instead of thanking me, he screamed like a girl, and cried
and cursed for an hour, ha, ha, ha ! He was glad of it
afterwards : it was so complete.'

But to return to the sufferers of to-day and the
things which have been done for them to render

220 PHYSIC AND FICTION

existence among their fellows not only tolerable
but in many instances normal. Where only the
soft parts of the face have been injured, the inter-
position of skin from elsewhere to fill the gaps may
be sufficient to remedy disfigurement. The various
methods for obtaining skin flaps and for placing
them in the proper position to simulate lost
surfaces or lost mucous membranes are the results
of careful ingenuity ; while every sound surgeon,
in using certain flaps of skin to replace lost mucous
membrane, will remember that it is not sufficient
to have good cosmetic results, but that it is
essential to restore function.

As war victims multiplied, it was found by the
operators that cosmetic results could be made
satisfactory to a point that hitherto would have
seemed incredible, but the intimate co-operation
of surgical and dental experts was usually required,
and sometimes great patience and confidence were
asked from the subjects. Where in addition to
damage of the soft parts the upper or lower jaw
has been injured, in all but the slightest cases the
operating surgeon must have recourse to the
assistance of the dentist. Mechanical support is
required during the treatment which can only
be provided by a dental expert, while the repair
of the nose and jaws presents more elaborate
problems to the surgeon and to the anaesthetist.
They have been solved by various operators with
remarkable ingenuity, and the results have been
wonderful, improvements in appearance going

THE PATHOLOGIST IN THE STREET 221

hand-in-hand with benefit of function. Pieces
of bone and cartilage have been implanted as
substitutes for missing structures, ribs replacing
mandibles, costal cartilages becoming noses,
phalanges supporting artificial eyes, and bridge
flaps taking the place of missing lips and chin ;
and the long-suffering patient has found himself
able to breathe and eat, as well as able to face the
street without shrinking. It must be remembered
that the cosmetic work at Queen's Hospital,
Sidcup, where these miracles have been per-
formed,^ had the advantage of the aid of Professor
Henry Tonks, himself a surgeon as well as an artist.
The consequence was that the team of surgeons,
dentists and anaesthetists had before them, at
all stages of any procedure, expert help both in
the advising of the practice and the visualising of
the ideal. This splendid surgical work has enabled
a large number of our war victims to take an active
position among their fellows without any wounding
or even inconvenient notice being aroused by their
deprivations. In many cases only the pathologist
can guess the debt that they owe to modem
medicine, or estimate the fortitude and persever-
ance which they have displayed on their side, to
help towards such good results.

Others besides the artist, the noveUst and the

1 Those interested in the details will find fully illustrated
articles in the Lancet, vols. i. and ii., 1917, by Mr. H. D. Gillies,
Mr. L. A. B. King. Mr. Percy P. Cole, Mr. Kelsey Fr>', Mr. J. L.
Aymard and Mr. G. Seccombe Hett, who worked together at the
Queen's Hospital, Sidcup.

222 PHYSIC AND FICTION

pathologist have their professional ardour aroused
now and again when walking the streets. The
tailor, no doubt, is a keen critic of the garments
which he passes by : he grieves over the sagging
shoulders of the badly fitting coat, diagnoses the
age of our blue serge suit, and changes his mood
from cynicism to gladness when that rare animal
the dandy saunters by with his gleaming boots,
thoughtful necktie and well -creased trousers.
But it does not require a man to be a tailor to
see that another man is ill-dressed or well-dressed.
In the same way all craftsmen may have their
professional instincts stirred by what they see,
but it is not often possible for them to look behind
or beyond what they see, to read hidden meanings
into their observations, or to group and interpret
these observations until they amount to revelation.
These are the things which the pathologist is
regularly invited to do. Dupin, Lecoq, and
Holmes, of course, behave like this in real life as
well as in novels, but observe that it is their
business to do so, which puts the whole matter on
a different basis. The pathologist's business is
not to pry into the health of strangers, but to heal
those who apply to him. His detective work is
outside his calling, but is forced on him by that
calling in the same way that the artist's
instincts are aroused by a cloud effect or a colour
scheme. Tinkers or tailors, lawyers or clergymen,
soldiers or dog-fanciers, being in the street, may
happen to make, or not to make, certain observa-

THE PATHOLOGIST IN THE STREET 223

tions because of something connected with their
occupation which attracts their attention ; but
what they can see, as far as their work is concerned,
gives scant play for deduction or analysis, though
the range of thought that may be entered upon is
unlimited, as Dupin proved.

And the errors of the artist or writer, committed
in accordance with various influences which pre-
judice his judgment, have their counterpart in the
errors of the pathologist, whose claim to infalli-
bility is not made by himself. The public, over-
generous when not over-depreciating, gives credit
to the doctor in the street for accurate surmises as
to the health of the passer-by. There is often not
much accuracy about the deductions which the
medical man draws when guessing at the physical
condition of those with whom he finds himself in
accidental and brief association ; the number of
mistakes that he who risks a diagnosis on the pave-
ment is liable to make is well illustrated by the
varying aspect given to any definite object by
different artists. It is unlikely that many medical
men would agree about a given obscure case, when
the information was derived from casual inspec-
tion. Upon certain points there could be no
difference of opinion, upon others there could be
wide difference ; while equally good pathologists,
yielding to the bias acquired by the particular
direction of their studies, would see things in
different lights, or would receive varying impres-
sions from the same objects. It is this which.

224 PHYSIC AND FICTION

while it keeps the attention of the medical man on
the stretch, prevents any too great feeling of
depression at what he sees. There is so generally
a brighter side.

Diagnoses at sight can often be made, but the
wider the medical range of the observer the more
surely he feels that such diagnoses are not always
right, and the more ready he will be to confess
that in his surmises he may be swayed by personal
feelings. That this should be so is contrary to
the general opinion, which holds the pathologist's
estimate of the health of those whom he passes
in the street to be nearly infalUble and usually
gloomy.

CHAPTER IX

MEDICINE IN ART

L'Ariet la Medcane — Plague as a Favourite Subject — Emerods
and Mice — The Value of Pictures to Pathology — ' Bernini's
Enigma' — Jane, John, and the Fanciulla d'Anzio— Incredible
Pictures and Credible Stories.

In speaking of the way in which the street scene
appeals to the pathologist and the artist, no allu-
sion was made to the possible concentration of the
artist upon medical events, appearances or stories.
This is another, and an interesting subject.

The artist of all sorts — painter, sculptor, en-
graver, and jeweller — has portrayed medical events
in the manner dictated by his respective branch of
art, and has done so from very early times, for some
of our most ancient discoveries in sculpture and
pottery bear representations of disease and de-
formity. Several observers, as Mr. Hastings Gil-
ford did in a Hunterian lecture delivered before
the Royal College of Surgeons of England, have
called attention to prehistoric drawings of the
human figure displaying various physiological and
pathological conditions ; one of these, an outline
sketch from the rock sculptures in the Dordogne,
is at least 15,000 to 20,000 years old in the opinion
of experts.

Many readers, I have no doubt, are familiar

226 PHYSIC AND FICTION

with L'Art et la Mcdecine, by Dr. Paul Richer ;
this book is a storehouse of information on the
relation of art to medicine, and beautifully illus-
trated, as well as admirably written. The work
had its origin in the impression made upon Pro-
fessor Charcot, the great neurologist, by seeing in
the church of St. Ambrose, in Genoa, the famous
picture by Rubens, representing St. Ignatius cast-
ing a devil out of a young girl, and simultaneously
bringing a child to life. Charcot recognised the
acute observation that had enabled the artist,
working from memory, to reproduce accurately
the correct features of acute hysteria ; the very
symptoms which presented themselves daily at
the Salpetriere were set down, he perceived, on
Rubens's canvas. The famous professor and his
assistant, for at that time Dr. Richer was an
interne at the Salpetriere, were accordingly moved
to study la grande nevrose from the medico-artistic
standpoint, and the result was a brochure entitled
The Demoniac in Art. Later their studies in this
direction took them into other pathological fields,
while at the same time a record of conspicuous
cases at the Salpetriere began to appear, illustrated
by photographs and drawings contributed by the
staff of the hospital and their pupils. All this
work has been largely drawn upon by Richer, with
the result that on the neurological side very little
is left to be said in a fascinating volume which is
easy of access. In other fields of medicine the
work is far less complete, though there is a general

MEDICINE IN ART 227

indication, through the pictures, how universal
since the dawn of our existing civiUsation the
practice among artists has been to depict the
results of disease or deformity.

From the vast selection of illustrated disease
which any of the great picture galleries of the
world will be found to possess, one thing will be
learned immediately : the result for us in this age
from the labours of the artist in the past contrasts
remarkably with the result derived from the
writings of numerous authors who have described
medical events in general literature. The differ-
ence is this. The artists have very usually shed
definite light on medicine, while the chroniclers,
poets, and dramatists, though deaUng freely with
medical topics, have not been as distinctly in-
formatory. Written descriptions of diseases
occurring in early literature leave largely doubtful
diagnoses for the reader to choose between ;
pictorial representations have often been equiva-
lent to accurate naming of the conditions. His-
torians certainly have touched upon epidemics in
accounting for the social and political conditions
of the nations of which they are writing, but as
often as not it remains a matter of doubtful
inference from their words under what particular
pest the people were abiding. Malaria appears to
have been described in classic Greek hterature,
and in the Bible there are accounts of some epi-
demics the nature of which we can identify. But
there are other pestilences which conform equally

228 PHYSIC AND FICTION

to any of two or three diseases, and leave the
searcher for the truth considerably puzzled. The
epidemic to appear in most obvious guise upon
the stage of history is plague, but it is quite likely
that many chroniclers have here confused leprosy
with it and with syphilis, and perhaps with typhus
fever.

The artist in his reproductions is limited by
what he can see, so that we cannot expect from
him pictures which will enable us in many instances
to decide which particular internal or general
disease his subjects may be suffering from. The
face of pain is the face of pain, whether the symp-
tom be produced by one poison or another. The
outward signs of disease and the visible results of
disease must be the artist's field ; he can depict
signs but can only suggest symptoms. We do not
look to find in general art anything like a general
representation of disease ; and even to-day, with
all our easy and cheap aids to illustration, the
medical treatise is never fully illustrated. The
illustrations in the case of most of the great infec-
tions must be of pathological details and not of the
patients themselves. But of five diseases which
are to-day, as they may have been for many
centuries, special scourges of man, namely, cholera,
typhus fever, plague, syphilis and leprosy, three at
any rate require illustration to explain them
clearly, and the older writers of medicine lost by
not calling to the aid of their vivid pens the pencil
or brush of the artist. It is quite likely that if

MEDICINE IN ART 229

such collaboration had been thought of much
haziness in diagnosis would have disappeared.

Plague has been the subject of earnest attention
among artists, as well as writers, and it would have
been surprising had it been otherwise, for pictorial
and plastic art in all its forms had its principal
origins in districts where, or near to where, plague
has had an age-long home. But it is chiefly the
great panorama of a plague-stricken community
that has been painted for us, and generally the
pictures have been made from written descriptions
far anterior to the drawings qr paintings. The
word-pictures of plague are quite numerous, and
yet in several instances if the accounts had been
accompanied by illustrations our knowledge would
have been more precise. There is much in the
written history of plague that resembles typhus
fever, and it is quite likely that an eloquent writer,
having no special knowledge, in describing the
plight of Serbia in the spring of 1915, would have
conveyed a strong impression that a form of plague
had arrived there. Such an event, it may be
added, would not have been impossible. There
are, again, manifestations of syphilis, of leprosy, or
of tuberculosis that would be designated in identical
terms by the pen of a lay writer. A series of pictures
would have enabled us to make far surer than we
now are under exactly what scourge the various
nations fell in times of notorious pestilence. The
plague of Athens has been described by one of
the most famous writers in the world, but what

230 PHYSIC AND FICTION

exactly that plague was remains in doubt, perhaps
because no contemporary drawing of the victims
exists.

Pictures of the effect of epidemics upon a popula-
tion do not, however, necessarily give assistance
from the point of view of diagnosis. The artist
in these pictures is as a rule concerned in recording
a tremendous historic event : he is almost never
showing us anything he has seen, and it is the
great tableau, not the appearance of one sufferer,
that he is interested in handing down. The
famous picture by Nicolas Poussin, recording the
plague of the Phihstines ensuing upon the capture
of the ark, follows very closely the biblical narra-
tive. The ark has been brought from Ebenezer
to Ashdod, and placed in the house of Dagon. We
see the stump of Dagon prostrate on the base of
his altar, the head and hands are scattered beneath,
while the people of Ashdod, smitten with ' emerods,'
are lying in numbers on the ground. All sexes and
ages have been attacked, the noisome nature of the
infliction as well as its suddenness and devastation
are indicated, and the appearance in the picture
of numerous rats has for us of to-day a significance
that it certainly had not for Poussin, though the
biblical chronicler may have been better informed
than the seventeenth-century painter. It will be
remembered that the ark of the Lord, whose
possession by the Philistines was considered by
them to be the cause of the pestilence among them,
having been carried on a devastating career

MEDICINE IN ART 231

through Gath and Ekron, was at last, after re-
maining seven months in PhiHstia, returned to
Israel at Bethshemesh, where at once a sharp
outbreak of plague occurred. The surrender of
the ark to its owners was accompanied by placating
gifts consisting of ' five golden emerods and five
golden mice.' The story as handed down gives
no further explanation of these gifts, but now that
we know the spread of plague to be largely effected
through the medium of rodents, it is reasonable to
suppose that the golden mice were typical of the
disease that had smitten the donors. The golden
' emerods ' were presumably metal facsimiles of the
actual parts whereon the buboes of plague usually
appear. In this way the * jewels of gold ' pre-
sented to the Israelites would form a picturesque
invoice accompanying the despatch of the ark,
designed to explain that the shrine was being
restored to the real owners because its retention
had produced among the captors a disease well
known to be disseminated by rats or mice, and to
produce pathological lesions which assumed a
certain shape. It is, by the way, exactly significant
of the uncertainty to which we are reduced by
verbal descriptions of epidemics, that the 'emerods'
have been identified by some writers as typical of
venereal disease, although in this case their associa-
tion with the golden mice loses its meaning. Com-
mentators have had much to say, from the days
of good Bishop Simon Patrick onwards, as to the
palhating presents of the Philistines, but in many

232 PHYSIC AND FICTION

primitive civilisations representations of disease
and deformities were brought to the temples to be
left behind as clinical memoranda or votive offer-
ings. A varied collection of these pathological
simulacra is exhibited at the Museo delle Terme
in Rome. Unluckily no such tangible records of
the plague in Philistia were preserved. The verbal
description of rude tribesmen became the written
word of unsophisticated chroniclers, and the
story, reaching us without illustration, remains
vague, as so many stories of disease have always
done.

Nor is this difficult to understand when we see
how many adjectives must be common property
in descriptions of the four great ills of human flesh.
It is almost impossible for a layman to derive a
clear mental picture of the manifestations of
plague, leprosy, tuberculosis and syphilis from
the words of even the most carefully written
medical text-book ; by the accounts of a layman
he would certainly be misled. The prominence of
a bulla and the swelling of a bubo would receive
the same epithets, the identical disagreeable terms
would be used in describing the various forms of
sore or ulceration that present themselves in each
malady ; even the stories of the diseases, though
in their present form at any rate so different, have
features of resemblance. The artist could often
have solved these problems for us, as is well seen
by such pictures as do exist in illustration of disease.

There is, for example, in the cloisters of San

MEDICINE IN ART 233

Marco in Florence a picture of St. Anthony ex-
tending the consolation of religion to a plague-
stricken youth, in whom the typical bubo in the
armpit is so defined as to leave no doubt as to
the diagnosis, or as to the artist having seen a case
of the disease ; while many of the frequent repre-
sentations of St. Roch baring his thigh might serve
to illustrate a manual on epidemic afflictions. The
destructions of leprosy have been depicted by
Itahan and German painters in such a way that
no mistake can arise as to what it was intended to
show. A certain number of representations of
skin disease suggest that artists had observed the
nature of the typical lesions of tuberculosis and
syphilis, though without having any knowledge of
the pathology of what they were putting on the
canvas, while the results of the last disease in its
congenital form are the distinguishing features in
some paintings of dwarfs and grotesques.

What was the ' English Sweat ' ? Although
the great Caius wrote a ' Boke or Conseill against
the Disease commonly called the Sweate or
Sweatyng Sicknesse,' we do not obtain a description
from which a diagnosis can be made for certain,
and with some doubt we decide to think that this
mysterious illness was influenza. No one could
possibly illustrate a case of influenza so that the
disease could be identified from the drawing or
painting, but much might have been learned if
any pictures of the * English Sweat ' existed, for
lesions might have been depicted, either definitely

234 PHYSIC AND FICTION

proving that influenza was not in question, or
suggesting that there was more than one disease
concerned in the epidemic visitation.

Of course, medicine has a very definite literature
of its own, in which it has been for many genera-
tions the mission and pleasure of learned men to
describe the origin, course and therapeutics of
disease. Of this learning enshrined for the infor-
mation of scientific men generally, or of prac-
titioners of medicine in particular, much is splen-
didly written, nor do such books lack what for
purpose of definition has been described as the
essential principle of literature — namely, universal
appeal. For all are interested in their teachings,
though expert intervention is required to trans-
mute the theories into practice. The most
authoritative of these books belong to the class
which De Quincey called ' the literature of know-
ledge,' as distinguished from ' the literature of
power,' for each of them must remain upon trial
for ever : ' let its teaching be even partially
refuted,' said De Quincey, ' let it be expanded,
nay, even let the teaching be placed in a better
order, and instantly it is superseded.' This is a
particularly just observation with regard to the
literature of medicine ; and in many of these super-
seded books there are word-pictures of disease
every whit as informing as it is possible to make
them without the aid of brush, pencil, or chisel.
It is most unfortunate that the artist was never
called in to illuminate the text. For in the dis-

MEDICINE IN ART 235

eases and deformities which he is able to represent
he must give the sahent features in such a way that
no one can fail to diagnose the condition intended.
Nothing that ever can happen in the development
of medicine will alter the truth told in the picture of
St. Ignatius's miracle, while we know from the
portraits of dwarfs, in which Velazquez revelled,
the types of infantilism which were prevalent in
the seventeenth century, and can guess at the
probability of their artificial manufacture.

Pictures show how faithful artists have been in
their delineation of such diseases as leprosy,
syphilis, plague, and rickets. Historians have
described these conditions with pains, and medical
literature has referred to them with particularity,
but in the written accounts stress is so easily laid
upon other than essential things, that for the pur-
poses of diagnosis the artist often gives the larger
help.

There is a pictorial art associated with medicine,
but it came into existence too late to be of much
use for purposes of diagnosis of the history of
disease. I allude to the illustrations, often beauti-
ful as well as truthful, which accompany treatises
on anatomy, physiology, and medicine, and to the
charts, maps, and pictorial diagrams intended to be
hung in lecture halls for the instruction of students
and the assistance of teachers. To this category
of artistic productions belong many admirable
albums illustrating surface lesions, many adroit
wax models, and some large oil paintings of strictly

236 PHYSIC AND FICTION

pathological conditions. There were reproduced
recently in the columns of the Lancet some famous
panels of this sort by Jacques Gautier D'Agoty.
The anatomical exactness was here accompanied
with beautiful drawing and painting, and all inter-
ested can now see the original paintings in the
Wellcome Historical Medical Museum. But photo-
graphy and mechanical reproductions, colour print-
ing and the cinematograph have entirely removed
such paintings as those of D'Agoty from the sphere
of practical utihty ; while this art, which came
into being too late to have any historic importance,
was usually employed in depicting what could
have been learned without it.

The pathological subject is not Hkely to be the
pre-eminent favourite with great artists that it was
in the Middle Ages. To the old masters the Bible
and the lives of the saints were the source of
inspiration, and representations of pestilences,
martyrdoms and miraculous healings were the
ever-recurring themes of their canvases. To-day
the pathological subject is left severely alone by
artists whose ambitions lead them to make any
appeal to the world at large. Great pathological
pictures are not painted and diseased subjects are
seldom present now in even crowded canvases,
proving that the numbers of crippled and scarred
among the ordinary population have much dimin-
ished since the reign of scientific medicine began.
We have just seen that the developments of
medicine are enabling to-day men to mix with us

MEDICINE IN ART 237

unnoticed who, a hundred years ago, when ruth-
less caricature was in vogue, would have been
seized upon by the artist as typical points in a
street picture.

The illustrations of strictly medical treatises,
however good, do not belong to the general
province of art, even though they may be very
beautiful in themselves, and remarkably executed,
and I propose to make no further reference to
them. But we find that many surgical and medi-
cal conditions have been wonderfully well repre-
sented by painters in all ages, where the patho-
logical subjects are but episodes in the pictures,
and where the pictures have been masterpieces of
art. These more or less accidental representations
of disease are executed by artists who do not know
i| what they are depicting. There are a great num-
ber of famous works in which such conditions as
the deformities of rickets and the results of ampu-
tations occur, while grotesques, either in pictures
or sculpture, in ornamental detail within buildings,
or as gargoyles, are as often as not exaggerated
examples of well-known pathological conditions.
The pigeon-breast, the curved spine and the club-
foot have been in particular seized upon in this
manner as models, the familiar figure of Mr. Punch
being a kindly example of such artistic fancy.
Rowlandson's regular delineation of a man whom
he desired to humiliate with his pencil is a carefully
drawn picture of an acromegalic subject, and the
Italian master Piero di Cosimo had a similar idea

238 PHYSICS AND FICTION

three hundred years before, as he showed in a
splendid panel of Centaurs and Lapithae. Piero
di Cosimo's cave man was an acromegalic.

The horror of some of the more hideous masks,
which have been from very early days a feature of
sculptural decoration, has been obtained by accen-
tuating the lesions of Bell's paralysis, or the de-
formities produced by facial tumours and goitre.
It is often quite easy to see in an apparently in-
human congeries of features the normal ground
plan and the influence upon that plan of one of
these common disfigurements, but a singular
omission may be noted, though, perhaps, only to
be corrected. As far as I can remember, the dis-
figuration produced by hare-lip and cleft-palate
seems to have been ignored by the manufacturers
of grotesques, and yet in the days when the condi-
tion went untreated many countenances, made
particularly unpleasing from this cause, must have
impressed themselves upon the attention. I shall
not be surprised to learn that the condition has
been portrayed by some well-known artist, but I
cannot recall having seen any such picture.

Augustus Hare has drawn attention to a remark-
able example of the employment of medical know-
ledge in art, displayed by Bernini in the famous
Barberini baldacchino in St. Peter's. The struc-
ture, which was erected by the order of Pope
Urban viii., is so splendid and immense that all
who have been in the church must have seen it,
though few have perceived its interesting medical

MEDICINE IN ART 239

features. The pedestal of each huge spiral column
bears on the outside surfaces fantastic representa-
tions of the Barberini arms, surmounted by a
woman's head, whose features express the various
stages of labour pangs in a series of eight repre-
sentations. The first face is quiet, the next two
show pain, the fourth face is serene again ; in the
next masks the pains have returned, while in the
last of the series the face has become peaceful.
Hare records that during the construction of the
baldacchino, a Barberini princess, a niece of Pope
Urban, was enceinte, and presented the pedestals
upon her safe delivery. A more cynical version
of the story is that Bernini was revenging a slight
put upon himself by the Barberinis, who had
opposed his marriage to a daughter of their
patrician house. Professor Curatulo, in an in-
teresting note upon what he terms ' Bernini's
Enigma,' has pointed out that while the expres-
sion on the masks varies, the shields below, repre-
senting the abdomen, change in form and line at
the different stages, and that the papal mitre above
one of the masks bears a tiny baby's head.

Representations of diseased subjects, which were
so frequently and gaily introduced in mediaeval
pictures and in the illustrations to the comic
Hterature of the beginning of the last century, will
never, I think, become popular again ; but it is
inevitable that caricatures of the face should be
modelled on the lines of so-called normal faces,
because most faces carry in them indications where.

240 PHYSIC AND FICTION

by a vigorous insistence on a few lines, reasonable
comeliness may be transformed into something
approaching monstrosity. It was along these
lines, or against them, that the professional
mutilators used to work.

One of the most remarkable things about the
human face is the small amount of variant from the
normal which produces the most extreme and even
ridiculous difference in looks. The features of the
beauty are often little better shaped than those
of the beast, and a slight puffiness of a cheek or
eyelid, a small contraction or cicatrix will produce
a radical general difference in appearance. Obser-
vation sufficient to stimulate the possessor to draw
or paint or model would note this fact at once, and
hence it is that sinister grotesques are for the most
part only exaggerated pathological drawings. And
I think perhaps the reason why the comic or satiri-
cal artist so often gets his representation of the
pathological departure in the features correct is
that the outward mark which is made by the inter-
nal skeleton is strong in the face, where we usually
assume that all the distinctive qualities reside in
the soft parts and the colouring. This is not so ;
in the face it is the little bony ridges which deter-
mine the curves and planes of the soft parts, and
their rcsiune is the beauty of the subject. (This
is the point made by Sheridan Lefanu in a passage
quoted in a previous chapter.) We are ready to
think that the skeletal framework in man matters,
as far as appearances go, only to a secondary degree,

MEDICINE IN ART 241

of however paramount importance it may be in the
lobster. We can see that the skeleton of the hippo-
potamus suggests its squat, rude power, and that
the skeleton of the gazelle indicates mobility and
nimbleness. In both cases the character of the
skeleton is very marked, so that it is not so much
by the colour or the integument that we visualise
these animals, as by their framework influencing
their contours. But the influence of the internal
skeleton over the external view, which is so
violently obvious when species wholly divergent
in type are in question, is lost sight of when small
divagations in specimens of the same animal from
some type that is held to be normal are under
consideration ; the trained eye, whether assisted
or no by anatomical knowledge, does not appre-
ciate in a correct manner the fact that any
variation in bony surfaces and the smallest ex-
aggeration or suppression in bony ridges produces
a faintly different development in the plan of
action of all the muscles attached, giving a funda-
mentally different appearance. And the two great
proofs of this are the individuality of faces and the
difference between the male and female figure.

Women who masquerade in men's clothes and
men who masquerade in women's clothes are quite
usually detected by the crowd even though the
woman may shear off her tresses and the man
may hide his hirsute face under a veil. Swaddled
in cloaks and overcoats, either may defy in-
quiry, but short of such complete concealment,

Q

242 PHYSIC AND FICTION

or very carefully devised disguise, the secret is not
often kept for long. It is not the shape of the
bust that betrays the imposture, for, in England
at any rate, many of the men are nearly as pro-
minent in the nipple line as the women ; it is the
general look of the figure following on the slight
differences of the skeleton — the essential altera-
tions in external appearance following on small
differences of internal structure. But where these
differences are vague, as in the lad of the
effeminate type and the well-grown shm young
woman, the diagnosis of sex is not easy.

This has been shown by a dispute which arose
recently over a very famous statue, the Fanciulla
d'Anzio. The statue is in the Museo delle Terme,
and on recovery from the sea was purchased by
the Italian Government, when the world was in-
vited to admire it as a particularly lovely female
figure. At the first glance it certainly presents the
appearance of an exceedingly beautiful girl, but
soon after its exhibition, Mrs. Strong, Signer
A. Simonetti and Dr. P. Hartwig came to the con-
clusion that the statue was male, and in the Bur-
lington Magazine Mrs. Strong summarised the
evidence for what certainly appeared at first sight
a curious view. She made out such an extremely
good case for the male sex, that unless some actual
identification should turn up — some recognition of
the statue through contemporary records — the
gender of the Fanciulla d'Anzio will always remain
undecided. No casual observer would doubt that

MEDICINE IN ART 243

the figure is that of a girl — I saw it before I had
heard that the sex was in question — for it is hard
for any one not an experienced arcliaeologist to
dissociate the drapery, gathered in below the
breasts and again at the waist, hanging low on the
neck and flowing over pronounced hips, from the
idea of a female figure. To the eye familiar with
Greek sculpture, however, such drapery appears to
suggest the robed Apollos of the third and fourth
century, and the feminine beauty of the faces of
these statues is notorious.

Here is a case, it may be said, where the message
of the written word must be more vivid than that
of the work of art. A novelist calls a character
Jane and another character John, and no doubt can
arise as to their sex, though for the purposes of the
plot Jane may have a moustache and John wear
a petticoat. That does not seem to me to be a
correct comparison of the results of the two arts,
for many a novelist labels as John an unmistakable
Jane and as Jane a typical John. The label does
not matter ; the thing produced has to be judged.
Many authors have tried to describe the feminine
man and the manly woman without producing the
desired effect ; the old Greek sculptor, deliberately
or no, made a statue which is either that of a girl or
that of a boy, with the girhsh attributes frequently
found in the representations of Apollo, and such
has been his success that no one knows the sex of
his work. In medicine the question of sex is not
often open, but when sex cannot be stated the

244 PHYSIC AND FICTION

underlying framework of the body is usually in-
determinate.

The foundation of medicine is anatomy ; with-
out a knowledge of structure the phenomena of
normal life cannot be appreciated, and without a
familiarity with physiological processes the signi-
ficance of pathological departures will be missed.
But because anatomy is necessary to medicine, it
does not follow that the artist, either when he is
depicting the normal human subject or when he is
dealing with the victim of disease, ought to have
any profound anatomical knowledge. There can
be no doubt that a general acquaintance with main
anatomical facts will be a great gain to the draughts-
man, but there can be no general rule. The comic
artist, engaged upon the business of humorous ex-
aggeration, generally gets his drawing right, and
the grotesque sculptor his modelling correct, be-
cause the character laid down by the pathological
condition is so definite. This character is modified
by the quality of the external coverings, which may
be general in contour for many species, while vary-
ing in thickness for any individual ; but when the
artist concentrates his attention upon his object
unconsciously, or in the anatomical student con-
sciously, he sees to some extent beneath the surface,
so that the bony framework of the creature gives
on the one hand a pledi^e of coarse strength, or
on the other a promise of grace and alertness. It
would be a triumph of witty perversity to draw
a hippopotamus so that it should look buoyant ;

MEDICINE IN ART 245

and a gazelle, though its figure had run to seed
hopelessly, could never be made to suggest static
force. But detailed anatomical knowledge does
little for the artist. Where the skeleton is
coarsely of a certain type, its coverings, as seen
by the artist, will have such definite shapes that
it is needless that he should know what is beneath
them with any great exactitude before he repro-
duces what he sees. The masses of muscle and
the salients of bone present him with unmistak-
able objects. Where it is a question of minute
modifications of bone producing alterations of
surface, which, though not especially large, are
exceedingly significant, the close familiarity with
anatomy required to appreciate the modifications
would not help the artist to any unusual fidelity.
The differences in contour and surface markings
are often great, but the differences in the under-
lying skeletons are little, so little that no one
would suggest that the artist ought to be able to
say of a certain bone, not markedly large or slight,
whether it has belonged to a male or a female
subject, though he might be expected to give the
sex to a properly articulated skeleton. I doubt if
the comprehension of the mechanism of the joints
protects a weak artist from getting his figures out
of drawing, and the great draughtsman does not
want to know in any meticulous fashion the under-
lying reasons for what he sees, before he can com-
municate his reflections to us on the canvas.

The assistance given by art to medical research

246 PHYSIC AND FICTION

is certainly real but limited, and there is a point
here which has significance. Art has sometimes
been as valuable in contradicting a medical myth
as in confirming an historical episode ; the fact
that certain medical events, though vouched for
by writers, have gone unnoticed by artists, may
imply not want of resource on the part of the
artist but too lively an imagination on the part of
the author. A lie is told more easily with a pen
than with a brush or a chisel. This is shown by
the frequency with which illustrators have rejected
as subjects medical stories which are obviously
incorrect, save where in holy writ or sacred tradition
the association with a creed makes all things
credible.

And even here a picture, however beautiful and
however piously inspired, seems often to reveal
the legend as false. When we read of the terrible
sufferings of a blessed martyr, of remarkable re-
sistances to torture, of extraordinary combinations
of the elements not to destroy the sacred person,
and even of restoration to life after executions oft
repeated, we do not revolt at the improbability of
the details ; we can catch from the written words
a contagious faith in the glorious stories. But it
is not easy to regard the pictures of these happen-
ings in any spirit but one of scepticism ; and the
very things which were painted in the liveliest
desire to champion the truth are those which most
clearly reveal the impossibilities of the record.
As documents to the critic, or as delights to the

MEDICINE IN ART

247

eye, these pictures have a high value, but even in
the less sophisticated day of their origin they can
hardly have increased public confidence in the
gesta sanctonim. It is doubtful if, for example, the
glass in his church in Rouen could have stimulated
any close behef in the adventures of St. Vincent.

Our conception of history may have suffered
considerably by our ignorance of the diseases to
which different races have been subject at certain
epochs. For example, the sudden decadence of
Greece may have been as much determined by
virulent epidemic malaria as by any defects in
her political systems, and a few frescoes would
have helped to settle the debated point.

CHAPTER X

COMFORTABLE WORDS ABOUT POISONING:

OLD CASES

Where Truth beggars Fiction — The Cases of Mary Blandy,
John Donellan, and John Tawell.

Amid the unbroken laudation of the value of
scientific discovery there has grown up, and not
only among the nervous and ignorant, a suspicion
that powers able to go so far in certain directions
for human welfare may, under the employ of the
unscrupulous, prove themselves to be very formid-
able assistants in evil designs. The suspicion has
some good grounds. The adulterator of food is
often an expert chemist, the coiner is nowadays an
electrician, the possibilities of the motor-car as an
adjunct to burglary have been demonstrated, and
those of the aeroplane, which laughs geographical
and fiscal boundaries to scorn, can scarcely be
imagined. And while there are many sorts of
rogues and villains to whom science would prove an
excellent handmaid, to no one can she appear more
useful at first sight than to the poisoner. But when
we come to look a little closely at the directions
in which the advancement of scientific knowledge
might facilitate the poisoner's plans, we see that
the apprehension — which is perhaps more marked

24S

COMFORTABLE WORDS ABOUT POISONING 249

in France than with us — that secret poisoning is
on the increase is groundless, while the celebrated
cases which are here briefly narrated have all this
comfortable feature about them : — the increasing
ingenuity of the criminal is met by commensurate
skill and knowledge on the side of the law. Which
means to say, that scientific development, where
criminal poisoning is concerned, makes for security,
for the law keeps ahead of the law-breaker. That,
at any rate, is the conclusion to which the reader is
invited to come.

What is a poison seems an easy enough question
to answer. Common intelligence defines as a
poison anything that, being absorbed by or re-
ceived into the subject, results in bodily harm.
Such a sweeping definition has much to recommend
it, but it is too vague. On the other hand, it is
impossible for any one — the lawyer, for example —
to be entirely exact, and to codify all substances
into poisons and non-poisons. If, for instance, a
host seduces a guest into over-indulgence, and there
should be a headache on the morrow, this would
not be a case of poisoning within the legal meaning
of the term, even though the host should know
from common experience of wine, or special know-
ledge of the quality of his own cellar, that his invi-
tation might lead to such a disaster. Yet, in
certain circumstances, alcohol is a poison and a
very effective one. Or, again, a man might, as
Brunei the great engineer did, under a too literal
auri sacra James, swallow a sovereign, and it might

250 PTTYSir AND riCTION

stick in his lar3mx and cause inconvenience ; tin
occurrence would not erect a certain combinatioiv
of gold and copper into a poison. These ridiculou
illustrations serve to show that, for practical pu'
poses, the definition of common intelligence is t'
loose, as the poisonous nature of any substances-
determined, not by its identity alone, but by otl q.
circumstances, notably by its dose, and by o
method of administration. >

By criminal poisoning we mean here, as is usuall
meant where no qualification of the phrase is intrc '
duced, the administration of a noxious substanc
with the intent to kill, and not merely with th
intent to inconvenience. This, of course, implie:
that the crime is done in accord with design, anc
that the substance is selected because of its kno\M
lethal qualities. Again, the particular crimes
that will be adduced as examples of the methods
of poisoning adopted belong in each case to a class
of crime that is known as ' secret poisoning,' the
qualification implying that the criminal hopes to
escape detection either by concealing the fact that
poison had been given or by avoiding the dis-
covery of the person who had given it. For it is
only in regard to these forms of poisoning that
any precautions, legal or scientific, can be taken.
Where the poisoner is absolutely reckless of his
own safety, and is, in fact, prepared to be hanged,
if only his deed can be accomplished, it is evident
that no safeguards can be erected. But this form
of crime is very rare. ' Secret poisoning,' as

DMFORTAI^LE WORDS AHOIT POISON IN(; 251

pposcd to sucli a prorodiiro, iiu luflcs all cases of
• riminal poisoning whose investigation j^rcscnts
ny legal or scientific interest ; but here again
xeve is room for confusion. The phrase ' secret
'isoning ' is used sometimes to mean one thing
Si.i sometimes another. No poisoners, whether
r : crime projected be a single-handed one or the
< -rk of a confederacy, take the outside world into
' .eir confidence, and in that way all criminal
Oisoning, save the form where detection is not
v^oided, is ' secret ' ; and the cases may be roughly
ivided into two classes — a class where the main
adeavour of the criminal is directed towards
:verting suspicion from himself, and a class where
.he main endeavour is directed towards hiding the
fact that the victim has been poisoned. In a
fhoroughly well-planned crime it is obvious that
the criminal would try to maintain both lines of
defence. In the first case one may conceive the
act of poisoning to be much cruder than it is in
the second, and indeed hardly a secret act at all,
the question to be met by the criminal being not
How was the death caused ? but Who caused the
death ? The second form of crime, where it is
attempted to conceal that poison has been ad-
ministered, is the form more strictly called ' secret
poisoning ' ; and it is this of which the public is
particularly apprehensive, and in the performance
of which it is presumed that the developments of
science may assist the malefactor. This is the
terrific crime which is justly regarded as the worst

252 PHYSIC AND FICTION

offence known to civilisation, for in this category
fall those hideous domestic tragedies where the
murderer seeks to destroy the near relative to
whom he has every facility of access, and on whose
deathbed he waits with simulated sympathy. The
bloody hypocrisy and bestial callousness that such
a criminal displays are made more loathsome by
the pertinacity in evil. Other murders, however
deliberately planned, are, in the end, sudden ; it
may be the essence of the secret poisoner's plot
that the victim's agony should be long drawn out,
so that the gradual sinking into the grave may
most resemble death from an ordinary pathological
failure. This, is the crime most feared by the
public, but good grounds are wanting for believing
that recent scientific developments make it easier
to accomplish . Novehsts here are not good guides,
for the secret poisoner is a frequent character in
sensational tales. It is natural that this should
be so, for in this particular phase of activity hfe
has produced some dramatic models, the truth
remaining more wonderful than any imitating
fiction. No one has imagined more poignant and
inexplicable situations than those furnished by the
cases of Mrs. Maybrick or Madeline Smith.

In England arsenic, strychnine, hydrocyanic,
carbolic, oxalic, and certain mineral acids have
been the more usual agents of poisoning, and in
none of the particular cases to which allusion will
be made have we to consider for a moment
whether the medium employed can fairly be called

( OMl-ORTABLE WORDS ABOUT POISONING 253

a poison. All the cases exemplify the procedure
which has been i)ursued over a long period of years.
The quantit}^ administered of these familiar poisons
is generally so entirely enormous, so vastly in
excess of the necessary fatal dose, that not only
has suspicion been aroused by the violence of the
symptoms, but plentiful traces of the poison have
been found in the victim's body. So that the
following is a fair summary of a typical case ending
in conviction of the murderer : —

a. The subject of the crime is taken suddenly
and extremely ill.

b. He dies with signs and symptoms that accord
with those produced by the administration of a
well-known drug.

c. This drug is found in his body after death, and

d. Possession of it is traced to the suspected
person.

If now the suspected person can be shown to
have any reason for desiring the removal of the
victim the story is complete. In such a case it
will be seen that the one safeguard of the public is
the ignorance of the poisoner. It is his ignorance
that leads him to employ the usual agents, for he
knows of no others ; and it is his ignorance of their
physical consequences that leads him to adminis-
ter them in the grossly unskilful manner that
ultimately leads to his detection.

Poisoning conducted on these Hues, however
secretly the criminal may have intended to carry
out his design, resembles the action of the wife-

254 PHYSIC AND FICTION

basher who attacks his victim with a poker ; and
it is obhging of such poisoners to employ as a rule
a medium which is as obvious as a poker, and with
it to inflict mischief which is as patent to inspection
as a smashed-in skull. For the injuries which
follow poisoning thus performed, are nearly as
gross as those accompanying a fractured skull,
while it is as easy for those who know to find an
overdose of undigested poison in the victim's
stomach as it is to pick up a bent and bloodstained
poker from the hearth-rug. The wife-basher,
however, is aware of the obviousness of his crime,
and generally makes no attempt to escape the
consequences of his action, beyond pleading that
he was drunk or that a nagging woman had tried
him too highly — he knows he cannot explain away
the poker ; but the poisoner always hopes that
the effects of his deed may simulate a natural ill-
ness, or that some one else may be suspected.

If we look at a few famous cases of poisoning
we shall see how closely the earlier ones fit, in their
coarseness of conception and execution, with the
summary which has been given of the usual events.
I make no attempt to give the full stories of notable
poisoning tragedies ; these can be found in the
State Trials or the Annual Register, and in some in-
stances in the Notable Trials Series. It is proposed
only to mention the salient features of a few cases
in support of the proposition that the more elabo-
rate murders by poison, such as scientific develop-
ments might prepare us to expect in these days.

COMFORTABLE WORDS ABOUT POISONING 255

carry with them enhanced risks to tlie criminal.
The carher criminals were hanged because they
were ignorant, not because the law was clever ;
indeed, so futile were the ancient legal proceedings
that it is more than probable that in the seven-
teenth and eighteenth centuries many able villains
escaped punishment for murder by poison. Nowa-
days, ability does not serve the criminal so well ;
the poisoner is more learned, but the safeguards
are vastly greater.

The case of Mary Blandy, who was tried at
Oxford in 1752, for the murder of her father with
arsenic, created enormous excitement, and in some
of its features bore a marked resemblance to the
famous Maybrick tragedy. A Dr. Addison, the
physician who attended the deceased, showed him-
self to be far in advance of his time, and his mode
of procedure might form a useful example to family
practitioners at the present day, when they are im-
pelled to the sinister theory that the patient, whom
they have been summoned to attend, is the victim
of a murderous attempt. He found the patient in
bed when he was first called to him, on a Saturday,
and was informed by him that, after drinking some
gruel on the night of the previous Monday — that is,
five or six days before — he perceived an extra-
ordinary grittiness in his mouth. Painful intes-
tinal symptoms developed and were relieved, but
returned on the following night, again after drink-
ing some gruel. He compared his pains to an in-
finite number of needles darting into him all at

256 PHYSIC AND FICTION

once, and stated that they came on ahiiost im-
mediately after taking the gruel. Dr. Addison
had been supplied with a story by the patient's
daughter, attributing the symptoms to natural
colic, with which they fitted in some respects, but
in others they were abnormal. He made up his
mind that he might be dealing with a case of
poisoning, and faced the appalling situation that
suspicions could only fall upon the unfortunate
man's daughter. He confined the daughter to her
room, confiscated certain porringers of gruel and
tea which had been prepared by her, discreetly
cross-examined the servants and even the dying
patient, and supported all his actions by associat-
ing another medical man with him in the conduct
of the case. Poor Blandy hved three or four days
in dreadful agony, but showed in his lucid intervals
that he shared the suspicions of his doctor, and
the daughter was arrested for murder on his death.
Arsenic was found in the deceased man's gruel and
tea, arsenic was traced to the girl's possession, and
evidence was forthcoming to show that the attempt
at poisoning had begun with her engagement to
the man who supplied her with the drug. This
man was not indicted, presumably because he was
believed not to be a willing accomplice ; but Mary
Blandy was hanged on circumstantial evidence.
She confessed to administering a powder to her
father, but declared that the nature of the powder,
which had been sent her by her lover ' to clean
Scotch pebbles,' was unknown to her, and pro-

COMFORTABLE WORDS ABOUT POISONING 257

tested her innocence to the end. Reading these
bald sentences it may be said that no diagnosis but
poison was possible, and that particular eulogy of
Dr. Addison is unmerited, as he only took an
obvious course in the clearest of circumstances.
But, as a matter of fact, his action was very com-
mendable, for he adhered to what could only be
suspicion after very plausible explanations had
been offered of the victim's condition. The
rough chemistry of the day gave him no sure
assistance, no elaborate text-books described the
associated symptoms of arsenical poisoning, and
probably he had never seen a case of the kind
before. But he acted on his judgment of the pro-
babilities, and at once the mystery began to clear
up. His knowledge of medicine would not allow
him to accept the story of colic as a satisfactory
explanation of the signs and symptoms of the case,
while his conscience forbade him to shrink from
the alternative. The story fits exactly with the
previous outline of a typical case of poisoning by
an unintelligent criminal. There was the poison
given in such large doses that its effects could be
definitely traced to a particular food, and there
was the palpable remnant of the poison in that
food. The same poison was traced to the criminal,
and a motive was forthcoming. But 150 years
ago the crime was not as infantile in its simplicit}^
as it now seems to us, and Mary Blandy might
easily have escaped punishment — would in fact
almost certainly have escaped it — had it not been

R

258 PHYSIC AND FICTION

for Dr. Addison's instinct and courageous adher-
ence to the view which that instinct prompted.
There was no Poison Act in 1752, and no system
of death-certification. This means that no record
of the obtaining of poison by Mary Blandy or by
any accomplice would necessarily have been forth-
coming, while, upon Blandy's decease, there would
have been no difficulty in accepting his daughter's
suggestion that he had died of colic. Severe colic,
and even cholera, much resemble arsenic poison-
ing ; indeed, no less a person than Sir Samuel Wilks
has said that arsenic poisoning and cholera are
often identical in appearance. In the middle of
the eighteenth century the crude poisoner had a
good chance of security. No one could have been
cruder than Mary Blandy, and she was unlucky
not to have gone scot-free.

We advance a step when we come to Captain
John Donellan, who was indicted about thirty
years later — that is, in March 178 1 — for the murder
by poison of his brother-in-law, Sir Theodosius
Boughton. Sir Theodosius Boughton, who at the
time of his death was within a few weeks of his
twenty-first year, resided with his mother, the
Dowager Lady Boughton, his sister, Mrs. Donellan,
and her husband, Captain John Donellan. On
the 30th August 1780, which was a Wednesday, a
manservant went into his young master's bedroom
at 6 A.M. to get some straps. Sir Theodosius
jumped from his bed to fetch them for him out of
the next room ; he was then in his usual good

COMFORTABLE WORDS ABOUT POISONING 259

health, save for a small local ailment. He p^ot
back to bed again, where his mother found him
when she went to his room at seven o'clock to
give him some medicine. This medicine was a
draught made up by the family apothecary con-
taining ostensibly the following : — rhubarb and
jalap, 15 grains of each ; spirits of lavender, 20
drops ; nutmeg water, 2 drachms ; syrup, 2
drachms, and an ounce and a half of water. These
ingredients had been put by the apothecary into
a two-ounce phial, which was given to a man-
servant, who gave it in his turn to Sir Theodosius
Boughton, who put it on a table in the hall of the
house. There would naturally be in this draught
a certain amount of sediment and of liquid. Lady
Boughton in her evidence at the trial described
how she first read the label on the bottle and then
administered the draught to her son, noticing that
it had a strong smell of bitter almonds. Immedi-
ately on swallowing the draught the unfortunate
lad complained of sickness and in two minutes he
was convulsed, dying in about half an hour with-
out speaking. By his death Mrs. Donellan in-
herited an income of about £2000 per annum, in
which her husband had a life-interest. Donellan
drew suspicion upon himself from the first. He
went into the boy's bedroom and rinsed out the
bottle containing the rest of the draught ; he
affected to find evidence that the death was due
to cold ; at the same time he confided to a neigh-
bouring magistrate his reasons for thinking that

26o PHYSIC AND FICTION

the death had a totally different cause. If he had
not behaved in this way he would probably have
been quite safe, for every one in the house believed
that Sir Theodosius's death was due to an error in
dispensing on the part of the apothecary.

Sir Theodosius, not of age, had a guardian, Sir
William Wheeler, and this gentleman now ap-
peared on the scene with a suggestion that the
body should be examined by two medical men
whom he named. Donellan, as master of the
house, acquiesced cheerfully, but was foolish
enough both to prevent the post-mortem exami-
nation from being made and to pretend to Sir
William Wheeler that it had been made with
negative results. The body was then buried, but
loose surmises had crystalHsed, owing to Donellan's
clumsiness, into a solid suspicion that there had
been foul play. An exhumation was ordered by
the coroner, and a verdict of wilful murder was
returned at the inquest by a jury who were offered
no scientific evidence, but who arrived at their
opinion as a deduction from Donellan's own be-
haviour. Donellan was immediately arrested. At
the trial some extraordinary circumstantial evid-
ence was forthcoming. It was elicited that Donellan
possessed a small still and could have distilled
laurel leaves ; that he had eas}^ access to the
draught before it was administered to his brother-
in-law, but niter it had left the apothecary's
hands ; that he washed out the phial containing
the draught ; and that he had in a sort of way

COMFORTABLE WORDS ABOUT POISONING 261

warned Lady Boughton of an impending tragedy.
He knew which morning the draught was to be
given, and planned that he and Lady Boughton
should be away from an early hour throughout the
day ; and, if this arrangement had not been upset
by Lady Boughton's personal administration of
the poison before starting, the unfortunate lad's
death would have probably taken place unseen,
and such evidence as there was of poisoning would
not necessarily have been connected with the
draught. These things, coupled with Donellan's
untrue versions of the cause of death, his resolve
to get the body buried witliout inspection, and his
large pecuniary interest in his brother-in-law's
estate, turned the scale against him. Of scientific
evidence there was hardly a trace, and Donellan's
resistance to Sir Wilham Wheeler's demand for a
post-mortem examination was idiotic, for the
chemistry of the day would have discovered no-
thing, while any abnormality of any organ that
might have been present would have furnished
some grounds for defence. The four medical
witnesses for the Crown laid stress on the absence
of all signs and symptoms of disease as a proof
that death was due to poisoning, but the post-
mortem investigation after the exhumation was a
very perfunctory one. The witnesses had made
some experiments upon animals, and partly as the
result of these, but mainly because of the statement
of Lady Boughton that death from convulsions
succeeded almost immediately upon the ingestion

262 PHYSIC AND FICTION

of a draught smelling of bitter almonds, they
concurred in attributing the death to a poisonous
distillate of laurel leaves. Donellan called to his
aid the father of modern surgery, John Hunter,
whose suggestion that death might have been due
to epilepsy or apoplexy was a surprising piece of
expert evidence. But it carried no weight, for
the great naturalist had to admit that all the
symptoms agreed with poisoning. So the wit-
nesses for the Crown prevailed, but Donellan
hanged himself every whit as much as Mary
Blandy hanged herself. The circumstances en-
sured that Donellan would be suspected, but he
would not have been convicted if he had known
the measure of his security, for he would have
made no contradictory and foolish suggestions as
to Sir Theodosius's state of health, and would
have offered no resistance to a post-mortem
examination of the body.

Prussic acid was not discovered by Scheele until
the year before the murder, and its actual com-
position was not defined until many years later.
But that a strong distillate of chopped laurel
leaves was poisonous was common knowledge —
indeed, there is a record of a death in 1731 having
occurred from the use of too strong an in-
fusion of laurel leaves as a flavouring agent in
cookery.

We now skip sixty years and more, and come to
the famous Salt Hill murder, which is a good type
of that form of poisoning where the poisoner does

COMFORTABLE WORDS ABOri POISONING 263

not try to conceal the cause of the victim's death,
but hopes that he will be in no way connected with
the crime, if and when it is discovered. The quan-
tity of prussic acid given here was so large that
death occurred with the same terrific violence that
might have followed upon a blow with a cudgel or
stab with a knife. The prisoner, John Tawell,
' the Quaker,' as he was generally called, was in-
dicted on the 1 2th March 1845, for the wilful
murder of Sarah Hart on the ist January of that
same year, by poisoning her with prussic or hydro-
cyanic acid. The deceased woman lived at Salt
Hill, near Slough, her residence being one of a row
of small four-roomed cottages. One evening her
next-door neighbour heard some curious noises
in the cottage occupied by the deceased, the par-
tition wall being very thin. The noises continued,
and took the form of moans or stifled screams.
She was much alarmed, and, taking a candle, she
left her house and went down the garden into the
high road. At this moment, and while the groans
were still audible, a man dressed like a Quaker,
whom she had seen entering Mrs. Hart's cottage
two hours before, came out of the cottage. As he
reached the garden gate she inquired what was the
matter in Mrs. Hart's house, but the Quaker, who
made no answer, hurried off. She entered the
cottage and found Mrs. Hart moaning on the floor.
She fetched a medical man, but Mrs. Hart died a
few moments after his arrival. This medical man,
a Mr. Champneys, had, however, the right detective

264 PHYSIC AND FICTION

instinct. 1 He suspected poison, and persuaded
the rector of the parish to go to the railway station,
and to ask whether a strange man, dressed hke a
Quaker, had taken a train to London. The clergy-
man arrived on the platform just in time to see a
man in Quaker's garb enter the London train ; it
was Tawell who, after hanging about the Eton road
for some time in indecision, had decided to return
to London. The telegraph communication be-
tween Slough and London had just been made.
The police at Paddington were put on the track of
Tawell, who was arrested on the following day and
subsequently convicted of murder on the clearest
evidence. He was shown to have purchased
prussic acid on the day of the crime, to have
entered Mrs. Hart's house two hours before her
death, to have left a few minutes before her death,
to have lied about all his movements during the
day, and to have forcible reasons for desiring to
get rid of his victim.

The post-mortem examination, not held as a
matter of chance, but a formal procedure provided
for by the Death Certification Act of 1836, proved
the presence of prussic acid in the stomach, and
the terrible story was complete. Here we have
a distinct improvement of the criminal's chances
more than counterbalanced by the resources of law
and order. I reckon as an accident that the victim
belonged to the class which enjoys the least security

* For the story in detail, and very gruesome detail too, the
Lancet, vol. i., 18^5, may be consulted.

COMFORIABLE WORDS ABOUT POISONING 265

(for the relations between Mrs. Hart and Tawell
were of the sort which neither would seek to adver-
tise) ; while it was also an accident, sensational
enough it must be granted, which placed in the
hands of the law the power of telegraphy almost
for the first time on the very day of the crime. The
essential differences between the proceedings which
convicted Tawell and those which brought home
the crime of poisoning to Donellan and Blandy go
to prove a solid advance in the machinery for the
protection of the public. The post-mortem exami-
nation of Mrs. Hart was conducted in accordance
with a proper chemical routine, methods for the
detection of prussic acid in the body and the esti-
mation of its quantity being now possessed by the
medical profession. The medical men no longer,
as in the case of Sir Theodosius Boughton, gave an
opinion of the cause of death based upon what
other persons — and those laymen — had seen of the
victim's last moments. They suspected poisoning
by prussic acid because of the various symptoms,
and then proved its presence in the unfortunate
woman's stomach. The railway, on the other
hand, offered facihties for crime which had not
been taken advantage of before, in that it allowed
poison to be purchased at a distance from the seat
of operations, and provided a speedy retreat for
the murderer, with the possibility of setting up an
alibi. The happy activity of the doctor and the
clergyman, and the alertness of the police at Pad-
dington, served to arrest Tawell ; the discovery

266 PHYSIC AND FICTION

that he was an ex-convict who had led an evil life
prejudiced his defence ; but the scientific evidence
hanged him.

Moreover, the General Registration Act (6 and 7
Will. IV., c. 86) had now been ten years in action.
It is droll to be praising our system of death certi-
fication, which is notoriously inadequate in many
respects, but we have to remember that the first
Act providing for the certification of births, deaths,
and marriages was a real stride forward. Murder,
and perhaps especially murder by poisoning, was
rendered much easier by the absence of such legis-
lation, and it is impossible not to believe that many
tragedies may have escaped notice before the pass-
ing of the General Registration Act, because no
account had to be given of the cause of death.
Death certification, which became the law of the
land in 1836, compelled the supplying to a Crown
official of information concerning a death before
burial could be effected, for which purpose in cases
of sudden or mysterious death a medical man had
very usually to be called in, or a coroner's aid in-
voked. Poor young Boughton, for instance, could
never have been buried without inquiry had even
the rough-and-ready system of certification pro-
vided by the first Act been in force. Three causes
were alleged by Donellan for his brother-in-law's
death, and a medical man must have been asked
to decide between them, and must have found that
he could not certify the exact cause, or permit
burial without adequate inquiry. The coroner's

COMFORTABLE WORDS ABOUT POISONING 267

inquest would have followed as a matter of course.
Death certification is a distinctly comfortable
thing to remember in connection with murder by
poisoning. The present machinery to that end
may, and does, require amendment, but such as it
is it brings the prisoner into relation, in most cases,
with the authorities, when it will be found that
the scientific knowledge at the disposal of the law
is probably superior to that displayed by the
criminal.

CHAPTER XI

COMFORTABLE WORDS ABOUT POISONING:
MODERN DEVELOPMENTS

Four Medical Miscreants — Bacteriological Poisoning.

The cases so far selected for notice, which all
occurred between the middle of the eighteenth
and the middle of the nineteenth century, show
fairly well that the resources of science kept ahead
of the resources of crime in those cases. The
ingenuity of the criminals increased, but the work-
ing of the law was strengthened by the spread of
learning. An increased knowledge of social needs
had brought about death certification, and an
increased knowledge of pathology and toxicology
had made the post-mortem examination of those
who had died under suspicious circumstances a
genuine investigation, in the course of which the
true cause of death could be in many cases arrived
at and demonstrated upon oath to a jury.

The apprehensions, however, that the poisoner
may get ahead of the scientific expert, may, in
fact, himself use all the resources of science in a
successful manner, become stronger as we approach
more modern times, and in particular have been
aroused at different dates by the crimes of four
notable profound miscreants who belonged to the

208

COMFORTABLE WORDS ABOUT POISONING 269

medical profession, and who used their knowledge
acquired in medicine to perform their terrible deeds.

These four were William Palmer, Edward
Pritchard, George Lamson, and Thomas Neill or
Cream. Tawell has a connection with this group,
for in the character of a ticket-of-leave man he
had been a druggist in Australia, and the fact
enabled him to order poisons in a manner that
attracted no suspicion. For the same reason these
four persons had no trouble in obtaining the
poisons wherewith to carry out their monstrous
designs, though they varied much in the skill of
execution which they displayed.

William Palmer was hanged for murder in the
summer of 1856. After a short apprenticeship to
a firm of druggists, which was terminated in a
manner discreditable to himself, he became a
student at St. Bartholomew's Hospital, and
ultimately house-surgeon at that institution. He
then went into practice at Rugeley in Stafford-
shire, where he had family connections, but soon
deserted his profession for horse-breeding and
betting on the turf. Thus he became acquainted
with John Parsons Cook, a young man who was
engaged in getting rid of a small patrimony by
gambling, and who died in a suspicious manner at
a hotel in Rugeley, after taking medicines and
food which had been either prepared for him by
Palmer or which had been through Palmer's hands.
Palmer was arrested, and the Crown proposed to
prove that he had murdered Cook by administer-

270 PHYSIC AND FICTION

ing strychnine, while the defence was that Cook
had died of epilepsy or tetanus or angina pectoris,
all conditions attended with muscular contrac-
tions, but differing widely in history and symptoms
from each other, without in any case agreeing at
all well with Cook's dying condition. The cir-
cumstantial and the scientific evidence, and the
skill with which these were marshalled against
him by the Attorney-General, Sir Alexander
Cockburn, between them hanged Palmer, whose
tribute to the share in the result due to counsel —
' It was the riding that did it ' — is one of the
bravest pieces of cynicism on record. Palmer was
proved to have purchased strychnine on two occa-
sions just before the death of Cook, whose dying
manifestations exactly agreed with strychnine
poisoning. Palmer gave no reason why he re-
quired the strychnine, nor could he produce any
of it. After he purchased the strychnine he gave
pills to Cook which appeared to produce the fatal
convulsions. Palmer was in dire need of money
to avoid prosecution for forgery, and had robbed
Cook by methods which Cook must have dis-
covered in a few days, had he been ahve. The
medical evidence in favour of death being due to
strychnine was very strong, while the medical
evidence attributing the death to different natural
causes was weak and contradictory. But the
prosecution had one great difficulty to face. No
trace of strychnine was discovered at the post-
mortem examination. Antimony, however, was

COMFORTABLE WORDS ABOUT POISONING 271

found, and the theory of the Crown was that the
crime had been attempted with both poisons, and
that certain careless procedures in the performance
of the autopsy had prevented the detection of the
str^^chnine. This probably was the just explana-
tion, and it was fortunate for society that the
medical evidence and all the attendant circum-
stances left no room for doubt of Palmer's guilt,
otherwise the failure to detect strychnine in the
body at the autopsy might have made a jury
reluctant to convict. Palmer himself believed that
this fact would lead to a disagreement among the
jury, and exactly summed up the situation when
he attributed the verdict to the ' riding,' that is
to say, to the masterly manner in which the
Attorney-General closed the gap in the evidence.
On the pubhc the published accounts of the trial
produced the impression that Palmer's criminal
ingenuity knew no bounds. He was supposed to
have discovered some baffling way of administer-
ing strychnine so that it should leave no material
traces of its presence, and quite sober accounts of
the Rugeley crime attribute a mysterious know-
ledge of poisons to Palmer. But this is mere
imagination. In sensational fiction it is enough
for the villain to have been a medical student to
qualify him for the part of a secret poisoner of
transcendent ability, one who will prepare you in
a private laboratory, and with a steel mask over
his face, things which baffle the analytical powers
of the finest chemists ; but in real life the educa-

272 PHYSIC AND FICTION

tion of a medical man does not equip him as a
toxicologist. And Palmer was not a scientific
medical man. The failure to find strychnine in
Cook's remains was an accident due to the faulty
technique of the autopsy and not to any subtlety
of Palmer.

Some ten years later, that is to say in the summer
of 1865, came the Pritchard poisoning cases. Like
Palmer, Pritchard was a duly quahfied medical
man, and like Palmer, also, he at no time enjoyed
any large private practice, or showed any aptitude
for his profession. The difference between the
two men was that Palmer never made any pretence
to more than ordinary medical knowledge, aban-
doned practice almost at the outset of his pro-
fessional career, and depended upon betting and
his small horse-breeding establishment for his sup-
port ; whereas Pritchard, on resigning a commission
in the medical service of the Navy, attempted vio-
lently to pose as a man of high biological attain-
ments. His crimes were more elaborately con-
ceived than Palmer's, and he is generally placed
above the Rugeley murderer for sheer villainy
owing to the fact that he was convicted of the
double murder of his wife and mother-in-law ; but
Palmer, as a matter of fact, had murdered his own
brother before he murdered Cook, so that the
question of pre-eminence is a little doubtful.
Pritchard was in medical practice at the time that
he committed his murders, and particularly in the
case of his wife he employed a very complicated

COMFORTABLE WORDS ABOUT POISONING 273

method of procedure. For although large quan-
tities of antimony were found in the bodies of both
his victims, an uncommon stock of other poisons,
uncommon for any practitioner whatever the scale
of his legitimate operations, was traced to his pos-
session, and it is probable that aconite, chloroform
and atropine were at different times laid under
contribution, singly or in combination. Pritchard
was, in fact, an ingenious poisoner, and he con-
trived the dosage so as to give colour to certain
theories of death from natural causes. In the case
of his first murder, that of his mother-in-law, he
had no difficulty with regard to the death certi-
ficate ; but in the second case he had to give the
certificate himself, and this was the circumstance
which brought him within the grasp of the au-
thorities. Palmer was more fortunate, as in both
his crimes he found a brother practitioner willing,
in the most innocent and ignorant manner, to
certify death from natural causes.

Pritchard's crimes caused general public terror,
but, so far from there being a reason for increased
apprehension as to the possibilities of secret poison-
ing, there should have been a feeling of relief that
the developments of accurate scientific procedure
were more than keeping pace with the increased
facilities for crime. Pritchard belonged to a pro-
fession which gave him easy access to drugs, he
poisoned with ingenuity and determination, but
the safeguards erected by society proved sufficient.
One small point of comparison between the circum-

s

274 PHYSIC AND FICTION

stances which led to the execution of Mary Biandy
and those which led to the execution of Pritchard
does not whoUy redound to the credit of the
medical profession. In 1752 the medical man who
first saw Blandy's victim, having in spite of all
attempts to draw him off the trail become sus-
picious that he had to deal with a case of poisoning,
took immediate means to verify his suspicions and,
if possible, to protect his patient. He gave no
thought to the extreme inconvenience that might
accrue to himself if he had fallen into error. In
the case of Pritchard's crimes the medical man who
was called in both to the second poisoning case and
to the first poisoning case, had his suspicions
aroused with regard to the second case, but took
no further step than to refuse to be associated with
the treatment. He does not appear to have said
a word to Pritchard as to these suspicions, although
the possibility is that by doing so he would have
saved the life of the second victim, while by putting
the police in motion he would have brought the
first crime home to its perpetrator. Where the
eighteenth-century medical man faced the position
bravely, the nineteenth-century medical man
shirked his responsibility, and at the same time
damaged the prestige of the whole of his profession
by alleging, as an excuse for his conduct, the
dictates of ' medical etiquette.'

With the next murderer selected for notice we
make a distinct move forward towards scientific
crime. Dr. George Lamson was tried in 1882 for

COMFORTABLE WORDS ABOUT POISONING 275

the murder of his brother-in-law, Percy Malcolm
John, and the methods which he employed were
on a higher scientific plane. Lamson's crime did
indeed justify the question whether the develop-
ments of science might not, by removing the safe-
guards which protect us, elevate the poisoner into
the position of a real enemy to society. He
selected a rare alkaloid, aconitine, as his medium,
and all the circumstances of the crime were planned
to make the death appear a perfectly natural one.
He gave the dose enclosed in a capsule with some
white sugar. He chose his time wisely, for young
John, a boy in dehcate health, had just made a
plentiful meal of the sort that might well be ex-
pected to induce acute indigestion. Some hours
after swallowing the capsule the lad died.

Now Lamson was familiar with the ordinary
processes of an autopsy, and he thoroughly believed
that the fraction of a grain of an alkaloid, for
which there was no chemical test, would escape
post-mortem detection, especially when mixed
with the contents of a full stomach. He believed,
in the first place, that the symptoms of poisoning
would go unrecognised, and, in the second place,
that, should the death certificate be withheld, the
agent that he had selected would defy chemical
research. But the beliefs were ill-founded, and
this fortunate result is so likely to be the usual
issue of poisoning with rare alkaloids that, in see-
ing how it was brought about in this case, we shall
be able to appreciate what are our safeguards

276 PHYSIC AND FICTION ^\

against the criminal use of elaborate developments
in the art of chemistry. Lamson was a duly quali-
fied physician, by convention an expert in drugs,
and by law in a position to obtain possession of
deadly poisons with ease — a privilege, by the
way, that is known to be largely shared with the
medical profession by the public at large. He
chose a poison the dose of which was excessively
small, the chemical tests for which were unknown,
and the symptoms of which were obscure. Indeed,
aconitine had only once previously figured in
public as a cause of death, so that its effects were
necessarily a secret to most men, medical or lay.
The ordinary post-mortem examination revealed
no cause of death. So far all went well with
Lamson, and so far his expert knowledge stood
him in good stead as a secret poisoner ; but the
fact that an autopsy was made shows us that the
circumstances of the death, though they might
well be natural, were not explicable on the surface.
The symptoms were too violent to be attributed
to an ordinary gastric disturbance, and an investi-
gation was started with the view of proving that
the boy had been murdered by an irritant poison.
The clue was obtained by a few words of dying
complaint in which the unfortunate sufferer alluded
to some peculiar sensations in his mouth.

The awful suspicion thus aroused was confirmed
beyond a shadow of doubt by scientific evidence
from two sets of experiments, undertaken by ex-
pert chemists firstly upon themselves, and secondly

COMI'ORTABLE WORDS ABOUT POISONING 277

Upon living mice, by injecting them with the alka-
loidal extract of the victim's stomach. This alka-
loidal extract produced manifestations that are
always associated with the use of aconite, while
the symptoms of aconite poisoning more or less
corresponded with those which the moribund lad
had described. Again, the alkaloidal extract
killed mice in certain times and with certain signs,
which were demonstrated to be identical with the
times and signs when the same little animals were
killed with solutions containing aconitine of known
strength. These facts were submitted by the
Crown at Lamson's trial as proof that the boy had
died of aconitine poisoning. The brilliant Mon-
tagu Williams did his best to argue and laugh the
methods of proof out of court, but the scientific
men, the late Thomas Stevenson and August
Dupre, were too strong for him. The theory put
forward for the defence was very interesting, in
view of its indication of another and terrific form
of poisoning. It was suggested that the alkaloidal
extracts which proved so fatal to mice might have
contained ptomaines, the result of cadaveric
change. The view made no impression because,
as it happened, the body was not decomposed. It
was freely admitted by the Crown that there was
no known chemical test for the vegetable extractive
aconitine, but it was claimed, and the jury allowed
the claim, that the analysts had demonstrated the
extreme probability, almost the certainty, of their
views. Then it was proved that the prisoner had

278 PHYSIC AND FICTION

bought aconitine in more than one place, had tried
to buy it in others, and had in great probabiUty
attempted to administer the drug before. Per-
sonal advantage was shown also to accrue to him
by the death of the lad, for, as in the case of
Donellan, a valuable reversion fell to the murderer
on the death of his brother-in-law.

Here was a man of scientific attainments and
medical knowledge who chose his poison and chose
his time, but failed to secure immunity from punish-
ment, and the comfortable lesson from the story is
that similar failure would generally follow similar
attempts. Lamson was hanged, and the reason
was his ignorance. Ignorance still, though onl^^
comparative ignorance. He knew more than
those around his victim, but not so much as the
really learned. That is to say, when once sus-
picion fell upon him, his science became of no avail,
for more scientific people than himself were ar-
raigned against him. What was the measure of
chance that suspicion should fall upon him ? For
this constitutes the measure of danger to the com-
munity that such a person is likely to be, since,
once suspected, he is almost certain to be detected
owing to his comparative ignorance. These are
the circumstances which give the public a good
chance against the scientific poisoner ; they are
those which led to Lamson 's failure and execution,
and which possibly have given pause to some who
would emulate his exploits.

(i) The scientific poisoner using a rare drug is

COMFORTABLE WORDS ABOUT TOISONING 279

using an agent of which generally he can know
little, for the individual experiences of one man
concerning a drug amount to nothing. If he em-
ploys a drug which is rare enough to have a good
chance of baffling detection supposing a post-
mortem examination is made, it must be one of
which he himself, in common with everybody else,
is comparatively ignorant. Hence the chance is
great that he will give an overdose, and by pro-
ducing sudden symptoms arouse suspicion of foul
play. Then, scientific man though he be, his pro-
ceedings may be as crude as those of the wife-
basher. Lamson, taking him as the best example
of the scientific poisoner, was clumsy in his dosage,
and in consequence drew disastrous attention to
the fact that he had administered the fatal capsule.

(2) Lamson might have carried his scientific in-
genuity further and perfected himself by experi-
ment before venturing on his crime. Any other
scientific poisoner might do so, but, even so, he
would find great difiiculties in his way. Experi-
ments on animals can only be conducted with
certain formalities, in certain places, and under
due licence. Assistance is generally needed for
carrying them out in such a way that their results
shall be trustworthy. These things would dread-
fully embarrass a would-be secret poisoner.

(3) There may be difficulty in obtaining the drug,
when its purchase will attract pointed attention,
even though the purchaser be a medical man. The
professional use of rare alkaloids is not common.

2.So PHYSIC AND FICTION

(4) The plea of accidental death cannot be set
up with any show of plausibility where a rare
alkaloid has been used, as it can where the agent
has been some common commercial product, used
in the household offices for scouring or vermin-
killing, or one that is known to be the chief in-
gredient in popular hair-dyes or complexion-washes
or weed-killers. The person who dies of aconitine
does not die by any common or easily explicable
accident.

It would be a bold generalisation from the con-
sideration of the crimes of Palmer, Pritchard and
Lamson, to say that chemical developments in
poisoning are not likely to produce an increase in
the number of secret poisoners, but the murder
of Percy Malcolm John is a very good example of
the kind of crime concerning which the public is
naturally apprehensive, and the subsequent execu-
tion of his vile relative may well be believed to
have acted as a deterrent. Lamson chose the best
possible agent for his purpose, namely, a little-
known vegetable alkaloid. In favour of secret
poisoning by vegetable alkaloids we have the small-
ness of the fatal dose, the obscurity of the symp-
toms produced, and the impossibility of obtaining
chemical proof of the presence of the alkaloid in
the body. Against these we have the difficulty of
obtaining the drug, the notoriety that will attend
the purchase, and the impossibility of any question
of accident or suicide being seriously considered by
the jury. There is also the difficulty of determin-

COMFORTABLE WORDS ABOUT POISONING 281

ing the dose in the absence of laboratory facihties.
All this seems to imply that the successful secret
poisoner, the person who might sin and sin again
without much risk of detection, would have to be
a learned professor with a teaching appointment.
There are not many of these valuable citizens in
this country where educational endowment is still
scanty, and surely no large proportion of them is
indulging in homicidal mania. Yet to me it seems
likely that their number expresses the public risk
of secret poisoning on a scientific plane so lofty as
to be above discovery.

A fourth medical man is here introduced merely
to complete the category, Palmer, Pritchard, Lam-
son and Neill (or Cream) being the four last
medical men in this country to suffer the extreme
penalty of the law for poisoning. If any lesson is
to be drawn from a consideration of such murders,
it is clear that the lesson will have greater force if
no selection be made of the cases.

Cream had some low-grade American medical
qualification, and actually poisoned five or six
persons before he was hanged, so that the justice
which a science superior to his own was able to
secure for him may seem tardy. But the circum-
stances of Cream's crimes were special, and the
crimes could have been equall}^ well perpetrated by
a layman. The particular act for which he was
hanged was one of a series of murders which he
committed in a short space of time by methods
which did not offer any particular difficulty of

282 PHYSIC AND FICTION

detection, but which showed him to be a wild
beast preying on a section of the public whose
behaviour makes it almost impossible to protect
them by legal measures against any outrages. The
character of Cream's victims must be taken into
consideration, when we at once see that the public
as a whole runs no risks from similar miscreants,
while remarkable ease characterised the commis-
sion of his crimes. Cream's victims were low-class
prostitutes who had no personal acquaintance with
him until he accosted them, who lived under furtive
conditions in hired rooms, where little was known
of them or their acquaintances, and where they
received their clients with little desire for publicity
on either side. There is practically nothing to
stop a murderer from committing his crime in such
circumstances, and but little to trace him by when
the crime has been committed, as has been shown
over and over again when an unfortunate girl of
this sort has been done to death. Cream was a
wild beast, but he had no intention of lajdng down
his life to satisfy his blood lust. He selected, as
did the monstrous Whitechapel murderer, the most
defenceless class of all society as his victims, and
he might never have been arrested if an impudent
belief in his security had not led him to attempt
the blackmail of a distinguished physician whom
he threatened to accuse of the murders. In his
case the essence of the crime hardly resided in the
fact that he had employed poison as an instrument,
for he might with equal impunity have employed

COMFORTABLE WORDS ABOUT POISONING 283

a knife or a club. A knowledge of drugs served his
shocking purpose, but was only incidental to and
not essential to his crime, and no scientific subtlety
on his part would have made him a more dangerous
foe to society.

A terrific suggestion has been made by more
than one writer of sensational fiction that the
results of bacteriological research might furnish
the medical poisoner with the means to afflict his
fellow-creatures with mortal illnesses, but the fears
expressed have generally carried their own refuta-
tion, while they have been inspired, obviously, by
a more than usual capacity for swallowing mar-
vellous stories. Still the question has been seri-
ously asked — What is to prevent the scientific
poisoner from infecting his victim with ptomaines
or with the germs of fatal diseases ?

It is true that in certain infectious diseases of a
dangerous, even deadly, character, the existence
of minute living organisms which stand in causal
relation to the diseases has been demonstrated.
More, the discovery of a specific contagium vivum
in connection with several of the fevers has led
to the conclusion that an analogous cause is present
in all the other fevers. Here then seems a mighty
opportunity for the poisoner ! He has only to
infect his victim with the specific germ to inocu-
late him with a deadly disease. What risk does
he run ? At first sight it would seem that this is
a method of poisoning made possible by the pro-

284 PHYSIC AND FICTION

cesses of science which should bid defiance to
detection. The story of such a case would be in
direct opposition to the story of the typical case
of poisoning by drugs, such as has been already
narrated in several of its commonest forms. The
victim would not be taken suddenly extremely ill,
unless he chanced to be infected with one of those
fevers where invasion is very abrupt. He would
die with signs and symptoms according with those
produced by a well-known natural disease, from
which natural disease, indeed, he would have
suffered. The autopsy would either prove nega-
tive in result, or reveal the presence of the well-
known natural disease. Why should suspicion be
aroused ? Why should the necessary death certifi-
cate be withheld ?

The answers to these questions have been given.
The safeguards of the public are here really as
efficient as in poisoning by rare and elaborate
drugs, though they are of a somewhat different
character. First, the possible infliction of an
epidemic upon 3 community for the sake of secur-
ing the death of an individual is a course of con-
duct from which the hardiest villain might shrink.
This must minimise the attempts at the use of
the germs of zymotics. Next, to all but an
extremely limited class of persons germ-inocula-
tion must be quite impossible to perform. Much
technical knowledge and manual dexterity go to
the making of a bacteriologist, and this fact has
escaped the notice of those who think that be-

i, COMFORTABLE WORDS ABOUT POISONING 285

cause specific germs can be isolated they can be
readily obtained in an active state by any one
with access to a laboratory, and that the process
of inoculation can be secretly performed and with
no trouble. As a matter of fact, secret poisoning
I by inoculation of specific germs is well-nigh im-
possible. I have alluded to it because it is a
possibility which has exercised public imagination.
Like the highest developments of poisoning by
drugs, it could only be attempted by a person
with the resources of a laboratory behind him,
and an expert pathologist's training ; and I must
repeat that such persons are not very numerous,
and that the proportion of them who are murderers
is presumably small.

Everything goes to show that the poisoner of
the future will not be a very dreadful person — at
any rate, will not be a more dreadful person than
the poisoner of the present, unless we credit in the
future all the scientific acumen to the villain, and
none to those engaged upon the side of justice.
For this one dilemma will always remain to the
poisoner. If he is ignorant entirely, sheer ignor-
ance will hang him ; while, by as much as he
knows anything, by so much will he be a marked
man, upon whom suspicion will fall.

CHAPTER XII
PRIMORDIAL AND OTHER STUFF

The Survival of Personality — Ether as the Primordial Matter
— The Position of Professional Thought — Mysticism and the
Law — Phenomena of Materialisation — Thomas Vaughan
— Medicine as Counsellor.

Sir Oliver Lodge, at the Birmingham meeting of
the British Association, held in September 1913,
took the opportunity offered by his position as
president to make in an inaugural address an appeal
upon radical grounds for some conservatism in
scientific views, while at the same time indicating
that, for this reason or that, all old faiths in things
physical required new justification. Continuity
must be preserved and adaptation welcomed. His
words showed how well he knew that the results of
over thirty years of physical and psychical research
had brought him to conclusions which would not be
palatable to many of his audience, though, none the
less, he was resolved to put on record, in justice to
himself and to his co-workers in outlying provinces
of scientific investigation, a conviction ' that
memory and affection are not limited to that
association with matter by which alone they can
manifest themselves here and now ' — that, in other
words, what we call death, bodily death, does not
abolish personality.

286

PRIMORDIAL AND OTHER STUFF 287

Since those words were spoken much water has
flowed under the proverbial bridges to be absorbed
in the sea ; and countless lives have disappeared
like that water, the identities represented being
merged in an uncharted ocean. And the feeling
has increased in force that to be merged is not
necessarily to be lost — indeed, the rivers are not
lost in the scheme of physical geography.

The main proposition in Sir Oliver Lodge's
presidential address was that we have in the ether
our proof, hard as it may be to realise, of that
ultimate continuity which science is ever striving
to establish. The ether, as the one common per-
meating substance that binds all together, requires,
as is well known, to have its very existence as-
sumed, for, at any rate as yet, we have no physical
standards by which to estimate its qualities. It
may be that its omnipresence and uniformity with-
hold it from observation, but to say so is itself an
assumption. Sir Oliver Lodge has recently re-
affirmed his view with regard to ether, ' that its
ignoration is by no means equivalent to its extinc-
tion,' anticipating a not long deferred time when
it cannot be ignored. On the possibiHt}^ then,
that the ether of space exists, while we can expect
little material sign of it, a relaxation of the cordon
between the living and the dead is postulated.
This is continuity indeed — and some might say
continuity with a vengeance ; but Sir Oliver
Lodge's pronouncement was welcome because he
made it in certain terms and on a certain occasion.

288 PHYSIC AND FICTION

He is no smatterer in the mystic, and the sessions
of the British Association are the recognised oppor-
tunities for recording progress in science. By
stating that, as a sequel to the famous advances in
physics, made notably by himself and Sir J. J.
Thomson, he was able to assure himself that under
certain conditions discarnate intelligence may in-
teract with us on the material side of any imaginary
barrier, and thus produce manifestations that may
come, however indirectly, within scientific ken,
he placed the whole subject of psychical research
upon a different basis from any which it had
previously occupied. This was undoubtedly a
source of deep regret and even of some irritation
to many scientific men, while to others it came as a
hopeful inspiration. Sir Oliver Lodge threw down
a challenge to those who utter 'comprehensive
negative generalisations from a limited point of
view ' — his paraphrase of Hamlet's famous admo-
nition to Horatio ; and he conveyed a promise, im-
pHed in his words, that the results of investigations
already made would be published by pioneers in the
latest territory to be subjected to scientific swa)/.
Already thus, in 1913, in the last complete year
of the old order of things. Sir Oliver Lodge had
declared the existence of some proof that those
who are dead remain en rapport with those who are
alive ; and his later and pathetic personal testi-
mony must be considered as supplementary to
evidence previously acquired. Raymond brought
no conviction to many of us, and the fact that

PRIMORDIAL AND OTHER STUFF 289

it was a development of previous predilections
or acquisitions of fact did not advance its argu-
mentative position. But it need not detract from
it. Taking it as an example of the evidence on
which a great thinker rests his scientific belief that
the dead remain in physical communication with
the living, it may be asked whether medicine has
anything to gain by the systematic investigation
of borderland problems. The answer, of course, is
yes ; and more, it is the duty of medicine to aid
such investigation.

The persons to whom the public look for guid-
ance when a new doctrine is promulgated with
authority, and from founts of proven learning,
are of various sorts, according as their claim to
be guides has some practical substance behind
it. In the main the shoutings of ardent dis-
ciples will be discounted in the usual ninety days,
while the opinions will be valued of the leaders of
the learned professions ; these will take precedence
even of pure thinkers, whose daily province it is to
think, and to stop there. The views of philoso-
phers, logicians and artists in the widest sense
will hold good with the pubhc in so far as they re-
ceive endorsement in daily work from the typical
professional group, namely those who serve the
Church, the law, medicine, secondary education
and applied science, also in the widest sense.
Fortunately this group possesses men who display
in varying proportions philosophic spirit, logical
equipment and artistic sense. As mediums be-

290 PHYSIC AND FICTION

tween abstract and concrete knowledge they have
a position in which they can estimate the evidence
for or against immediate acceptance of a new
doctrine, being protected by their training from
creduHty, and, let us hope, from narrowness.

The years which have elapsed since Sir Oliver
Lodge's address was delivered have been years of
utter change in the standards of thinking, during
which the improbable has occurred so much as a
matter of course, and the impossible has been
achieved so often, that teachings which call for
faith are being accepted with readiness. There is
thus a risk lest we should exchange scepticism for
gullibility.

In this position those who make up the profes-
sional group are placed in different attitudes ac-
cording to their particular vocations ; while all of
them should approach the matter with the same
intent to let truth prevail, the points at which faith
in the unproven may dictate a work-a-day pohcy
cannot be the same. It has been said in previous
chapters, when considering the status of the doctor,
that divinity, law and medicine are no longer the
only callings for which education of a professional
standing is required, and that their followers have
no claim to represent in themselves a higher culture.
The contrasted position of the three professions
is pertinent. The Hmits of faith are undecided
in respect of medicine and physics, but they lie
between the extreme points which will be adopted
by the Church and by the law. The Church can

PRIMORDIAL AND OTHER STUFF 291

utter no comprehensive denial of the possibihty
that an immortal soul should manifest its immortal
existence to mortals. Belief in such a possibility
does not interfere with religious work, a fact which
does not make it other than right for religious
workers to probe as deeply as any one else into the
narratives of unlikely happenings, and to be as
guarded as their fellow-citizens against duplicities
or self-deceptions. The law is in the opposite case.
In the present state of our knowledge the law
cannot allow this possibihty to interfere with the
administration of justice ; the legally dead must
cease to play a part in the affairs of the world which
they have left, if only because they cannot be
called to account for any default. But there are
signs that the practice of law is becoming readier to
accept as actualities events that belong to the
mystical, inasmuch as they are inexplicable along
accepted lines. The signs are shght, and represent
an involuntary homage to popular phases of fancy,
but anything that seems to bridge the gulf between
mysticism and the law must be noted.

Whatever his private behefs, to the lawyer in the
practice of his profession the manifestations of
what is known as spiritualism have hitherto been
of no account. The revelations of the seance are
not laid before judges and juries ; the spirit of the
victim is not invoked to mend broken links in the
chain of evidence against a murderer; and, however
obscure the intentions of a testator may be, he is
not invited to explain them through the agency of

292 PHYSIC AND FICTION

a medium for the enlightenment of a judge of the
Chancery Division. The intervention of the dead
as witnesses has been ruled out by the famous
judge who refused to allow the court to be told
what the soldier said. It might be argued that
the medium would be in the same position as an
interpreter, if the fact that discarnate evidence
could be materialised were allowed. But the
medium as an interpreter is admitted by his most
fervent supporters, as well as proved by his actual
performances, to be a very faulty reporter, his
lapses into incoherency being attributed to the
disabilities of his informants. Moreover, the inter-
preter can always be checked b}^ others who know
the language interpreted, while the medium can
never be interfered with. Further, would the dis-
embodied spirit answer through the medium those
inconvenient questions which counsel describe as
* cross-examination to credit ' ? Would the errors
of a mundane career weaken post-mundane testi-
mony ? These are frivolous questions, and are
only asked to show how unthinkable it is that what
are called supernatural phenomena should be
allowed to carry weight in a court of law, even
though leaders of science may say that the bound-
ary between the natural and supernatural has been
so set back that there is nothing in physical ex-
perience to preclude an event from being in con-
sonance with undiscovered facts.

But are these questions quite frivolous ? Re-
cently the newspapers have reported two or three

PRBIORDIAL AND OTHER STUFF 293

occurrences unusual in courts of law, where official
notice has been taken in directions that seem al-
most mediaeval, though they represent a modern
desire to extend knowledge by faith. At an in-
quest in Wales upon a case of possible murder a
name, said to have been revealed at a seance, was
handed in and accepted by the coroner, in the sense
that he took physical possession of the paper.
Presumably he placed it in his archives without
comment, though he may have warned the witness,
who said that he was no believer in spirits, of the
dangers of libel or slander. The fact remains that
the name was offered for the information of the
court, and that a certain amount of evidence was
given before the coroner as to what took place at
the seance. Simultaneously, in another trial for
murder, evidence was tendered and accepted by
two judges, as to statements made to a doctor by
the accused when under hypnotic influence. And
in the same week a metropolitaxi magistrate Hs-
tened to the complaint of a woman who had been
served by her dead landlord with a notice to quit
her home. Her complaint to the court was that
the deceased had visited her every night since his
burial, and told her to leave the house at once.
The magistrate furnished her with a practical reply
for the wandering ghost and clearly saw no need
to consider that any fact was before him. ' Tell
the ghost,' he said, ' that he cannot e\dct you unless
he first makes application to the County Court.'
We are here reminded inevitably of the well-

294 PHYSIC AND FICTION

known story of a Lord Chief Justice, who was
visited at night by the friend of a prisoner awaiting
trial. In the character of an apparition the in-
truder, standing by the bed-side, proclaimed that
he was sent by God to command the judge to enter
nolle prosequi. The judge, of different metal to
Henry of Valois when similarly visited by Chicot,
sat up and thundered : ' Lying varlet, God knows
as well as I know, that it is not for the Chief Justice
to enter nolle prosequi, but only for the Attorney-
General.'

The position of medicine and of physics is, it
will be seen, much more flexible in respect of what
is called the supernatural than is the position of
the Church, where belief in the supernatural is
demanded, and that of the law, where its effective
existence is denied. Medicine has always to keep
a double object in view : to prevent and alleviate
disease, and to promote knowledge whereby such
prevention and alleviation may be rendered more
perfect. In the first half of its duties it must be
governed to a great extent by the dictates of ac-
cepted knowledge ; in the second half it must be
ready to receive all messages of hope. Thus it has
at one and the same time to go fast and to go slow,
to be wary and to be rash, to be sceptical and to
be imaginative. The critics of modern medicine
hardly appreciate the situation, whose complica-
tions are well illustrated when the possibiHty of
intercommunication between the living and the
dead is being considered.

PRIMORDIAL AND OTHER STUFF 295

The great extension of psychological medicine
must, for the good of all, be kept along an ordered
course, and although the leaders of medical thought
may be trusted to define the margins, there are
those within the medical profession, urged by an
inflamed public, who regard all reservations as due
to timidity, ignorance, or fat and fiat materialism.
This is unfair. There is no doubt that, as medicine
stands to gain by the systematic investigation of
all problems of a scientific nature, the subject of
physical communication with the dead is one that
medicine should study. But those who have made
up their minds to interpret their experiences, or
things which they have been told, in the manner
which suits their inclination must not be surprised
if medicine preserves a more discriminating manner.
I do not refer to matters where no question be-
tween people of sense can arise. Spirit photo-
graphs are not evidence while they can be faked,
and premonitions are not significant of anything
at all unless recorded beforehand in an unmistak-
able way ; the small fraction so recorded can often
be explained by no such violent method as postu-
lating the physical interposition of the dead, and
the balance is open to explanation by coincidence.
So much will be allowed by those who wish to ex-
tend the truth, and allowance may also be made,
if the position claimed for a medium is to some
extent admitted, for errors in the medium's
methods or technique. With the honesty and
courage of those who believe that they possess

296 PHYSIC AND FICTION

proofs of intercommunication between those who
are dead and those who are aHve there should be
much sympathy ; but there must be similar sym-
pathy with those who do not regard as proven
statements supported by evidence concerning
whose value there can be no easy agreement.
They are not making comprehensive denials but
are asking for something which they can com-
prehend.

Medical men should be, and, as a matter of fact,
almost invariably are, willing to hold that science
is incompetent to make comprehensive denials.
Medicine is constantly working on the border line
between the quick and the dead in one direction,
and in another between the material and the spirit-
ualistic. The barrier which is drawn for practical
purposes somewhere between that which we can
show by physical proof or deduce from accepted
physical knowledge, and that which we cannot
treat in this way, is well recognised by medical
men as being a shifting one. Moreover, it is one
that is constantly being set back, for example, in
neurological developments, and in the use that is
being made of the curative powers of radium, the
ionisation of drugs, and of hypnotic therapeutics.
But because successful incursions are becoming
frequent, a promise of the sudden removal of the
entire barrier has a particularly disturbing effect.
What is to restrain the wild faddist in a profession
where the greatest Hberality of thought and action
must be allowed ? Medicine, as we now under-

PRIMORDIAL AND OTHER STUFF 297

stand it, has evolved slowty ; true philosophers
have been aided in their work, as well as impeded,
by wizards and astrologers ; the lore of mysticism
and the researches of herbalists have alike been
drawn upon. Fundamental scientific discoveries
have enabled us to sift the materials, whatever their
sources, from time to time, fitting into a homo-
geneous scheme what duly belongs there, and re-
jecting what is seen to be absurd. But followers
of the discarded doctrines are not always satisfied
by this process ; they register their protests, and
disciples spring up who cling to the whole of the
ancient creed because parts of it have been sub-
stantiated by later work, and thus elevated from
intuition to deduction. The fact that once certain
doctrines stood for scientific medicine is remem-
bered, and permanent faith in them, as an entity,
is claimed to have a sound basis. In this situation
comprehensive negatives may be from one time to
another time necessary, for at the selected time
they prevent our knowledge from being choked by
its own undergrowth.

Recently the world has been asked to accept a
work by Baron von Schrenck Notzing entitled
Phenomena of Materialisation as a reason why
actual intercommunication between the Hving
and the dead must be held to happen. The Baron,
in his contribution to the investigation of ' medium-
istic teleplastics,' claims to give ' a full scientific
account of a set of strange occurrences observed
under the strictest conditions of control, and as

298 PHYSIC AND FICTION

yet quite unexplained,' but though the occurrences
are strange, and the photographs of primordial
stuff stranger, the conditions of control were the
reverse of strict, and the account is unscientific to
a degree. As long as such phenomena as those
narrated in this book are put forward as a proof
of materialisation, so long has the medical man the
right to warn his patients against any alteration of
conduct from a belief that their lives are being
practically affected by the energies of those who
are dead. It is true that Sir Arthur Conan Doyle,
in a set of lectures entitled Death and the Hereafter,
delivered recently at Queen's Hall, quoted certain
of the experiments recorded by Baron von Schrenck
Notzing as evidence in favour of the actual materi-
alisation, or re-incarnation, or transubstantiation,
or continuous existence of the dead, but until the
evidence of a chemical analysis, stated to be in
existence, has been published, the conditions of
the experiments have been explained and their
repetition, with full scientific precaution, has been
secured. Sir Arthur Conan Doyle, medical man as
well as historian and novelist, will not expect his
colleagues to be converted to his views.

Baron von Schrenck Notzing's work is an un-
fortunate one to be brought forward as a record of
scientific experience because of the close way in
which his description of materialisation phenomena
follows the description given by well - known
mystics. Cornelius Agrippa, originator of much
semi-scientific disquisition, in his De Principis

PRIMORDIAL AND OTHER STUFF 299

Rerum Naturalium, mentions the bitter fight which
has gone on from the beginnings of history among
philosophers concerning the matter which should
be held as the origin of all things, and in that
chapter, as well as throughout the treatise De Vani-
tate Omnium Scientiarum et Artium, betrays how
intimately scientific research has been mixed up
from the beginning of time with magic, this being
particularly the case in the fifteenth and sixteenth
century when the search for the philosopher's stone
and the elixir of life engaged so much attention.
Thomas Vaughan, the author of Aula Lucis and
eight or nine other treatises inculcating various
mystical doctrines, acknowledges his indebtedness
to Agrippa, and in one of his essays postulates a
kind of primordial stuff whose elements are com-
pounded by God into ' a sperm, viscous and sUmy,'
and throughout his writing speaks of something
' not water otherwise than to the sight, but a
coagulable fat humidity ' on the ' seminal viscosity
of which vegetables feed/ In another place he
speaks of ' a subtle moisture but glutinous ' ; a
certain ' thick, permanent, saltish water that is
dry and wets not the hands ' ; and of ' viscous
slimy water generated out of the fatness of the
earth.'

Vaughan claimed to have seen, handled and
tasted what he beheved to be the first matter, of
which he says immediately later : ' In vegetables
it oftentimes appears, for they feed not — as some
think — on water but on this seminal viscosity that

300 PHYSIC AND FICTION J

is hid in the water. This indeed they attract at
the roots, and from thence it ascends to the branches,
but sometimes it happens by the way to break out
at the bark, where, meeting with the cold air, it
subsists and congeals to a gum. This congelation
is not sudden but requires some small time, for if
you find it while it is fresh it is an exceedingly
subtle moisture but glutinous, for it will spin into
strings as small as any hair ; and had it passed up
to the branches it had been formed — in time — to a
plum or cherry.' Over and over again allusions
are made in Vaughan's eloquent and incompre-
hensible essays to some volatile coagulable origin
of all things, formed, under the direction of
some divine chemistry, from all the elements,
' fire, air and pure earth, overcast indeed with
water.'

Compare some of these imaginings with the
descriptions of the manifestations supposed to have
taken place in connection with a medium, as re-
corded by Baron von Schrenck Notzing, and the
similarity between the words of the modern
scientist and the seventeenth-century mystic will
be found striking.

The manifestations are supposed to emanate
from the medium, from her skin, her eyes, her
mouth or other orifices of her body. The emana-
tion, we are told, may take the form of threads,
white, grey or black, of clouds or mists, of ill-
defined solid masses, of materials resembling
muslin, wool, paper or other mundane substances ;

J

PRIMORDIAL AND OTHER STUFF 301

hands, arms or heads may be produced, and occa-
sionally fully-formed phantoms of distinct character
and definite features and forms. In mediumistic
phraseology such manifestations are described as
' teleplastic phenomena,' as distinguished frcjm the
' telekinetic ' class which comprises the spiritists'
table turnings, levitations, raps and ' direct '
writing. But the plastic emanations which can
turn from threads into ill-defined masses, and from
ill-defined masses into limbs and heads, must be
some form of primordial stuff summoned into
material existence from some immaterial origin,
and capable of infinite development.

Surely when we have arrived at this point we
are far away from the sound and philosophic posi-
tion of Sir Oliver Lodge, and when we remember
the sort of semi-scientific muddle produced by
Eugenius Philalethes and those whom he quotes as
authorities, we are right in saying that along such
paths no truth will be found. The works of Thomas
Vaughan, however, are interesting as showing the
way in which a philosophic search for primordial
stuff, a search based upon what was known and
directed towards probable issues, resulted in
searches for the Ehxir Vitae and the transmuting
ferment of metals. Such novels as Zanoni, A
Strange Story and Les Memoires d'un Medecin,
reproduce the pHght into which imaginative people
got when asked to believe that some ' first matter '
contained elements which could be recovered as
the ehxir of life and the philosopher's stone. And

302 PHYSIC AND FICTION

Bulwer Lytton and Dumas are very amusing
reading.

There is no more typical man of science than the
great physicist, and there is no more untypical man
of science than the great physician ; but each alike
desires to expand at the expense of metaphysics.
In one case the solid foundation of learning is laid,
the complete testing of every step as it is taken is
suppUed, by rulers, enumerators, balances and
clocks, and every elaborate mechanical appHance
that will measure, count, weigh or time. The
physicist proceeds from point to point in his work,
relying on the known or proven, eliminating
imagination in the details of his work, though the
theories may spring from boundless imaginings.
The physicist may be, and if he is a great physicist
he will be often, the superlative imaginer of any
amongst us, but his imagination does not come into
play while he is calculating his decimal points,
weighing his inexpressibly large quantities or
measuring his inexpressibly small ones. The
theory, which he is either being led to found or is
labouring to prove, can be the most daring flight
of fancy, at any rate in its early stages, but the
whole of his detailed work will be as matter of fact
as he can make it, for in exposing his procedures to
fellow-adepts there will be no room for private in-
tuitions. The point is, therefore, that he will not
be betrayed into daily multifarious error by his
ability to use his powers of imagination, by his
most reasonable willingness to believe that there

PRIMORDIAL AND OTHER STUFF 303

are all around us things to be seen which we cannot
see and things to be heard that we cannot hear.
But the physician is in a more perilous position
with regard to the exercise of his imagination. The
material in which he works can some of it be
measured, counted, weighed and timed, but only
some of it can be submitted to these processes, and
then only partially. There is room for the play
of imagination in the diagnosis of any pathological
condition, and in the treatment either of a whole
condition on broad lines or of any symptom associ-
ated with that condition. Exactly where to be
guided by a physiology whose laws are fully known,
and where by a psychology whose laws are but
partly known, is a difficulty which is only added to
if imagination is too freely employed ; while if it is
allowed uncontrolled play the errors of mysticism
may push up rankly and suffocate the truth.

Scientific medicine can boldly associate itself
with the vast mental projections of modern physics,
and yet demand in the details of therapeutics the
same close accuracy, and the same subordination
of theory to practice, that the most transcendental
physicist would have to display in doing an arith-
metical sum. There may be more than possibility
that we shall find in ether the medium of universal
continuity, but does this prove the non-existence
of any barrier between the quick and the dead ?
Not exactly ; but it does remove such a view from
the category of violent, visionary or poetic assump-
tion, elevating it into a deduction from what we

304 PHYSIC AND FICTION

postulate of the ether, and of the various modes of
motion propagated therein. We are asked, it
would seem, to regard the ether as the primordial
substance from which the universe has been
evolved, and to state what reasons we have for
believing that, while certain products of such evolu-
tion are what we call ' living * and certain other
products are what we call ' dead,' those products
cannot remain in inter-relation.

The discovery of a primitive principle from which
the contents of what man knows as the world have
been developed, and in which, moreover, other
worlds and world-systems have had their origin,
has, of course, been the ideal of philosophy through-
out the ages. Some philosophers replace to-day
the water of Thales by an omnipresent and all-
producing ether. The old Greek's was a grand
conception, the scientific attainments of his day
allowing him to attribute to water properties which
it did not possess. Our increasing wisdom has
compelled all theories concerning the primordial
stuff to undergo the process of natural selection,
and the claims of the ether will be tried in the same
way. As these claims are placed before us we have
to consider how far what we know supports them,
and how far the undoubted harmonisation of, say,
the principles of optics with the creation of force
or energy from the ether may be used as a legiti-
mate reason for larger beliefs. In doing this we
must preserve the right attitude. We must not
answer every question of ever}^ sort with the bald

PRIMORDIAL AND OTHER STUFF 305

expletive ' ether.' Similarly, we must not advance
against the claims of ether our inability to picture
its existence save by what we call imagination ;
and the non-appearance of anything alike perfectly
uniform and omnipresent is in accordance with
what might be expected. The right course is to
test the claims made for the ether side by side with
physical and chemical phenomena, so that we may
advance in our understanding.

In the ' Twelfth Kelvin Lecture ' delivered before
the Institution of Electrical Engineers, and pub-
lished in Nature on March 17, 1921, and con-
secutive numbers, a brief summary is given of the
results of experimental research on the properties
of the electrons. The lecturer. Sir Wilham Bragg,
pointed out that, as knowledge grows, the import-
ance of the part played by the electron in the
mechanics of the world grows clearer ; there are
all the signs of progress along a road leading some-
where, and continually the discovery is being made
that some electron action phenomena are hnked
together between which we had hitherto seen no
connection. ' Just as chemistry,' he says, ' has
grown and prospered on its recognition of the unit
of matter, so electrical science has already begun a
new life, and, to all seeming, a most vigorous one,
based on the understanding of Nature's unit of
electricity. ... If the chemist has found so much
profit in his recognition of the fact that Nature
has just so many ways, and no more, of doing up
parcels of matter, the electrician will surely gain

u

3o6 PHYSIC AND FICTION

in the same way when he grasps the fact that not
merely is electricity measurable in quantity, but
that there is already a unit of Nature's choice,
possibly no more than one unit. We may say
with justice that already the most wonderful ad-
vances in modern physics are the reward for our
appreciation of this truth, and we may hope with
equal justice that we are yet far from reaping the
full benefit/

Medical men will be found receptive of any new
doctrines which physicists offer and which will
stand such tests as medicine can apply, wherever
the doctrines may conduct them. To return to
the question asked at the beginning : What is the
position of the medical man with regard to the
beUef that material proofs are accumulating of
inter-relation between the living and the dead ?
The medical man's work must, on the one hand, be
guided by exact knowledge, and must on the other
be unfettered on its imaginative side. Remember-
ing the dilemma in which he is placed, it is sug-
gested that his duty to heal and prevent disease
does not ask him to account as proven any of the
so-called phenomena of materialisation. Where a
medical man finds his patients in any way mentally
oppressed by the tenets of spirituaUsm, he may
without fear of being a stumbling-block to know-
ledge point out to them that not a single thing has
yet been proved in respect of * mediumistic tele-
plastics,' nor are the phenomena in accordance

PRIMORDIAL AND OTHER STUFF 307

with any scientific laws. As he cannot utter any
comprehensive denials, his position in respect of
those to whom the doctrines of spiritualism are
comforting may well be one of congratulation . He
can be pleased that they are pleased, even if he
cannot go with them in the way.

Printed in Great Britain by T. and A. Constable Ltd,
at the Edinburgh University Press

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