“When the melancholic hallucination has fully taken possession of the mind, it becomes the sole object of attention, without the power of varying the impression, or of directing the thoughts to any facts or considerations calculated to remove or palliate it. The evil seems overwhelming and irremediable,admitting neither of palliation, consolation, nor hope. For the process of mind calculated to diminish such an impression, or even to produce a hope of the palliation of the evil, is precisely that exercise of mind which in this singular condition, is lost or suspended; namely, a power of changing the subject of thought, of transferring the attention to other facts and considerations, and of comparing the mental impression with these, and with the actual state of external things. Under such a conviction of overwhelming and hopeless misery, the feeling naturally arises of life being a burden, and this is succeeded by a determination to quit it. When such an association has once been formed, it also fixes itself upon the mind, and fails to be corrected by those considerations which ought to remove it. That it is in this manner the impression arises, and not from any process analogous to the determination of a sound mind, appears, among other circumstances, from the singular manner in which it is often dissipated, namely by the accidental productions of some new impression not calculated in any degree to influence the subject of thought, but simply to give a momentary direction of the mind to some other feeling. Thus a man mentioned by Pinel had left his house in the night, with the determined resolution of drowning himself, when he was attacked by robbers. He did his best to escape from them, and having done so, returned home, the resolution of suicide being entirely dissipated. A woman mentioned, I believe by Dr. Burrows, had her resolution changed in the same manner, by something falling on her head, after she had gone out for a similar purpose.
“A very irregular modification occurs in some of these cases. With the earnest desire of death, there is combined an impression of the criminality of suicide; but this instead of correcting the hallucination, only leads to another and most extraordinary mode of effecting the purpose; namely by committing murder, and so dying by the hand of justice. Several instances are on record in which this remarkable mental process was distinctly traced and acknowledged; and in which there was no mixture of malice against the individuals who were murdered. On the contrary, these were generally children; and in one of the cases, the maniac distinctly avowed his resolution to commit murder, with the view of dying by a sentence of law; and at the same time his determination that his victim should be a child, as he should thus avoid the additional guilt of sending a person out of the world in a state of unrepented sin. The mental process in such a case presents a most interesting subject of reflection. Itappears to be purely a process of association, without the power of reasoning. I should suppose that there had been at a former period, during a comparatively healthy state of the mental faculties, a repeated contemplation of suicide which had been always checked by an immediate contemplation of its dreadful criminality.
In this manner a strong connexion had been formed, which when the idea of suicide afterwards came into the mind, during the state of insanity, led to the impression of its heinousness, not by a process of reasoning, but by simple association. The subsequent steps are the distorted reasonings of insanity, mixed with some previous impression of the safe condition of children dying in infancy. This explanation I think is strongly countenanced by the consideration that, had the idea of the criminality of suicide been in any degree a process of reasoning, a corresponding conviction of the guilt of murder must have followed it. I find, however, one case which is at variance with this hypothesis. The reasoning of that unfortunate individual was, that if he committed murder, and died by the hand of justice, there would be time for his making his peace with the almighty between the crime and his execution, which would not be the case if he should die by suicide. This was a species of reasoning but it was purely the reasoning of insanity.”
Still these remarks do not go to prove that suicide is always the result of insanity, since it can in most instances be attributed to a moment of despair and impatience under a heavy visitation of calamity, or the dread of contempt of society. The frequency of this rash act, cannot therefore be adduced as a proof of the greater prevalence of madness in any country. With greater reason, self-destruction is to be referred to the want of a proper religious education and feeling, which will enable man to bear up against the world’s vicissitudes, and deem life a more or less painful journey to a peaceful abode.
Montesquieu was one of the many writers who attributed this propensity as being nearly exclusive to the English. “Les Anglais,” he says, “se tuent sans qu’on puisse imaginer aucune raison qui les y détermine; ils se tuent dans le sens même du bonheur. Cette action, chez les Romains était l’effet de l’éducation, elle tenait à leur manière de penser et à leurs coutumes; dans les Anglais c’est l’effet d’une maladie, elle tient à l’état physique de la machine.”
Two very curious works on suicide have been lately published in Germany by Dr. Arntzenius and Dr. Schlegel. The former writer divides this fatal propensity into acute and chronic; thefirst marked by great physical excitement, the latter accompanied or preceded by sadness, moroseness, and love of solitude. Curious cases are related in illustration of this doctrine, amongst others we remark that of an English nobleman who cast himself into the crater of Vesuvius. A German in the same year, not being able perhaps to travel so far, threw himself into a smelting furnace. Several cases are recorded of individuals who formed the desperate resolution of starving themselves. It appears that in many instances the most trifling circumstance has driven these reckless beings to the commission of this desperate action. The case of a young Parisian author of the name of Escoupe, who suffocated himself because one of his dramatic productions had been severely criticised, is well known. A German student destroyed himself because he had a club-foot, and another youth put an end to his existence in consequence of his not having been allowed to put on his Sunday clothes. Dr. Schlegel has given a curious table of the means of destruction resorted to according to the several ages of individuals, and we give the following abstract:
In classing 9000 cases of suicide which happened in Paris between the years 1796 and 1830, Dr. Schlegel concludes that what he terms the “philosophic suicide,” is that which is perpetrated after deliberation, during the night or shortly before sunrise; whilst when it is not the result of premeditation, it occurs during the day.
The choice between shooting and hanging may be accounted for on the same grounds. A young man, in a fit of frantic passion, from disappointed love, or losses at play, will probably, on his return home, seize a pistol and blow out his brains; whereas hanging needs reflection and some preparation and precaution, which would alone suffice to bring a reflective creature to a proper sense of his folly, unless predetermined to destroy himself by “philosophic suicide.”
It appears in these accounts that suicide in France has greatly increased since the revolution. The average number during the last forty-two years being 409⅚, the number in Paris being 1639 annually. Dr. Schlegel informs us that there exists a society in Paris called, “Society of the Friends of Suicide.” It consists of twelve members, and a lot is cast annually to decide which of them is to destroy himself in the presence of the others. Certain qualifications and testimonials were required before a candidate could be admitted into this amiable club:
1. He must prove himself a man of honour.
2. He must have experienced the injustice of mankind, been injured by a dear friend, or betrayed by a mistress or a wife.
3. He must have experienced, for some considerable time, a miserable vacuity of soul, and a discontent with every thing in the world.
This association reminds me of a ball that was established in Paris after the reign of terror, calledLe Bal des Victimes, to which no person could be admitted unless they had had a near relation guillotined.
Dr. Schlegel has also given the following statistical table of the proportion of suicides to various populations—both as regarding counties and principal cities:
According to our ingenious author, drunkenness is the chief cause of suicide in England, Prussia, and Germany; love and gambling in France; whilst bigotry, or the fear of dying without having received the sacrament, he supposes, prevents it in Spain, where, comparatively speaking, suicide is seldom heard of.
The same remark may apply to Italy, where a Roman lady, having heard of such an action, exclaimed, “Dev’ essere un forestiere; gli Italiani non sono tanto matti.” She was right, the suicide was a melancholy German tailor.
In India, where the doctrine of predestination is generally prevalent, it is calculated that in one year there were forty suicides in a population of 250,000, twenty-three of which were females.
Arntzenius quotes Gall’s opinion, that suicide arises from too great a predominance of the organ of cautiousness. Combe and other phrenologists are of opinion, that with this predominance a deficient development of hope and a large destructiveness must be conjoined.
It has been remarked that in Spain and Portugal, where insanity is comparatively rare, malconformation of the brain and consequent idiotism are very frequent.
Since the peace it may be more difficult to arrive at any conclusion on the subject of increase of lunacy, founded on the admission of lunatics into public and private establishments, since emigration has carried so many families and operatives of every description abroad, many of whom, from various disappointments and vexations, might have been predisposed to insanity.
It appears that in 1836 there existed in England and Wales 6402 lunatics, 7265 idiots—13,667 lunatics and idiots. Of paupers alone, or lunatics and idiots, there were 1.00098 of the total population, or 1 in 1024.
However, according to the most probable calculation, the number of lunatics in England amounts to about 14,000, out of which about 11,000 are paupers. Idiots are nearly as numerous as lunatics. Sir A. Halliday states the former to amount to 5741, and the latter to 6806. To this it must be observed that many harmless idiots are allowed to remain in their usual residence. In Wales it appears that idiots are to lunatics in the proportion of seven to one. The difficulty of obtaining any certain information on this subject, however, is such, that it is scarcely possible to decide the question with any chance of a probable certainty.
In regard to the prevalence of lunacy in other countries, the following are curious statistical statements:
In Spain, in 1817, according to the report of Dr. Luzuriaga, there only existed in the asylums of Toledo, Granada, Cordova, Valencia, Cadiz, Saragossa, and Barcelona, 509 lunatics—only fifty were in the hospitals of Cadiz, sixty in that of Madrid, and thirty-six in the kingdom of Granada.
In Italy, in twenty-five asylums in Turin, Genoa, Milan, Brescia, Verona, Venice, Parma, Modena, Bologna, Ferrara, Florence, Sienna, Lucca, and Rome, Mr. Brierre only found 3441 patients. The population of these parts of Italy amounting to about 16,789,000 inhabitants, which gives one lunatic to 4879 persons.
Scott, who accompanied Lord Macartney’s embassy to China, observed that very few insane persons were to be found there. Humboldt states that madness is rare amongst the natives of South America. Carr made the same remark in Russia. In Spain and Italy, religious melancholy, and that most vexatious species of insanity callederotomania, are the more common.
In the savage tribes of Africa and America insanity is very rare. Dr. Winterbotham affirms, that among the Africans near Sierra Leone, mania is a disease which seldom if ever occurs. Idiotism was likewise a rare phenomenon among them. Among the negro slaves in the West Indies it is scarcely known, and during three years’ residence in the Bahamas, only one case of monomania fell under my observation. Amongst the native races of America it scarcely exists. From these observations we may conclude, with Esquirol, that insanity belongs almost exclusively to civilized races of men, that it scarcely exists among savages, and is rare in barbarous countries. To what circumstance are we to attribute this exemption? Possibly it may be attributed to simplicity in living, which predisposes to less disease and morbid varieties of organization, and to the absence of that refined education which exposes man to the artificial wants and miseries of high civilization. It is moreover probable that the constant occupation which the existence of the savage requires to satisfy his absolute necessities, does not leave him leisure time to ponder over gloomy ideas and fictitious sufferings. In addition to these circumstances, Dr. Pritchard has justly remarked, that we might also conjecture that congenital predisposition is wanting in the offspring of uncivilized races. The sameauthor admits the probability of the brain receiving a different development in the progeny of cultivated races, or of those whose mental faculties have been awakened.
Various professions have been supposed to exercise much influence on the intellectual faculties. The following observations at the Salpétrière during one year may tend to illustrate this subject:
In Mr. Esquirol’s establishment:
According to the prevalence of the ideas connected with their former pursuits do we observe the hallucination of these unfortunate persons to be of a different character. Dr. Abercrombie relates the case of a Scotch clergyman, who was brought before a jury to be what is called in Scotlandcognosced, or declared incapable of managing his affairs. Amongst the acts of extravagance alleged against him was, that he had burnt his library. When he was asked by the jury what account he would give of this part of his conduct, he replied in the following terms: “In the early part of my life I had imbibed a liking for a most unprofitable study, namely, controversial divinity. On reviewing my library, I found a great part of it to consist of books of this description, and I was so anxious that my family should not be led to follow the same pursuits, that I determined to burn the whole.” Hegave answers equally plausible to questions which were put to him respecting other parts of his conduct; and the result was, that the jury found no sufficient ground for cognoscing him; but in the course of a fortnight from that time, he was in a state of decided mania.
What a school of humility is a lunatic asylum! What a field of observation does it not present to the philosopher who ranges among its inmates! We find the same aberrations that obtain in society; similar errors, similar passions, similar miserable self-tormenting chimeras, empty pride, worthless vanity, and overweening ambition. There we
See that noble and most sovereign reason,Like sweet bells jangled, out of tune and harsh.
Each madhouse has its gods and priests, its sovereigns and its subjects, terrific mimicry of worldly superstitions, pomp, pride, and degradation! There, tyranny rules with iron sway, until the keeper’s appearance makes tyrants know there does exist a power still greater than their own. In madhouses egotism prevails as generally as in the world, and nothing around the lunatic sheds any influence unless relating to his wretched self. In this struggle between the mind and body, this constant action and reaction of the moral and the corporeal energies, when reason has yielded to the brute force of animal passions, and the body with all its baseness has triumphed over the soul, one cannot but think of Plutarch’s fanciful idea, that, should the body sue the mind for damages before a court of justice, it would be found that the defendant had been a ruinous tenant to the plaintiff.
In many cases of insanity we observe a singular fertility of glowing imagination and a vivacity of memory which is often surprising. Dr. Willis mentions a patient who was subject to occasional attacks of insanity, and who assured him that he expected the paroxysms with impatience, as they proved to him a source of considerable delight. “Every thing,” he said, “appeared easy to me. No obstacles presented themselves either in theory or in practice. My memory acquired of a sudden a singular degree of perfection. Long passages of Latin authors occurred to my mind. In general I have great difficulty in finding rhythmical terminations, but then I could write verse with as much facility as prose.”
Old associations thus recalled into the mind are often mixed up with recent occurrences, in the same manner as indreaming. Dr. Gooch mentions a lady who became insane in consequence of an alarm of fire in her neighbourhood. She imagined that she was transformed into the Virgin Mary, and that a luminous halo beamed round her head.
It is said that the Egyptians placed a mummy at their festive board, to remind man of mortality. Would not a frequent visit to a lunatic asylum afford a wholesome lesson to the reckless despot, the proud statesman, and the arbitrary chieftain? There they might converse with tyrants, politicians, and self-created heroes, in all the naked turpitude of the evil passions, who in their frantic gestures would show them that which they wish to be—that which the world considers they are! Often would they hear the maniac express the very thoughts that ruffle their own pillows, until the dreaded bell that announces the doctor’s visit, and which with one loud peal destroys his fond illusions, herald of that knell which sooner or later must call them from the busy world they think their own. How beautifully has Filmer expressed the madman’s fears!
See yon old miser laden with swelling bagsOf ill-got gold, with how much awkward hasteHe limps away to shelter! See how he ducks,And dives, and dodges with the gods; and allOnly in hope to avoid, for some few daysPerhaps, the just reward of his own sad extortions.The hot adulterer, now all chill and impotentWith fear, leaps from the polluted bed,And crams himself into a cranny!There mighty men of blood, who make a tradeOf murder, forget their wonted fierceness;Out-nois’d, they shrink aside, and shake for fearO’ th’ louder threat’nings of the angry gods.
Whatever may be the nature of insanity or our fallacious views regarding it, it is a matter of great consolation to find that our mode of treating it is at last founded on rational and humane principles. The unfortunate lunatic is no longer an object of horror and disgust, chained down like a wild beast, and sunk by ignorance or avarice, even below the level of that degradation in the scale of human beings, to which it had pleased Providence to reduce him,—we no longer behold him rising from his foul and loathsome bed of straw, scantily covered with filthy tatters, his hair and beard wild and grisly—his eyes under the influence of constant excitement, darting menacing looks—the foam bubbling through his gnashing teeth—clanking his fetters with angry words and gestures,threatening heaven and earth—gazed at with dismay, through massive bars—the very female seeming of doubtful sex:
Her unregarded locksMatted like fury-tresses, her poor limbsChain’d to the ground; and stead of those delightsWhich happy lovers taste, her keeper’s stripes,A bed of straw, and a coarse wooden dishOf wretched sustenance.[18]
Now, the unfortunate persons are restored to social life as much as their sad condition allows; they enjoy every comfort that can solace them in their lucid intervals, when their hallucinations cease; in illness they are treated with kindness and liberality, and in health, their former associations with the busy world, are recalled by labour, voluntarily performed or stimulated by the incentive of some additional comfort. No coercion is resorted to, except to prevent the furious maniac from injuring himself and others, and then, such means are adopted that restrain his violence without a painful process. Even the straight waistcoat, which impedes respiration, is generally banished in all well-regulated establishments, and belts, sleeves, and muffs, which merely secure the hands, without preventing a free motion of the articulations, are usually resorted to. To such an extent is healthy occupation carried on in lunatic asylums, that at this moment at Hanwell, out of upwards of 600 inmates under my care, 421 are at work and distributed as follows:
Hanwell may be said to be an asylum for incurables, since it is doomed to receive old cases that scarcely ever afford a chance of recovery; to which are added a large proportion of the idiots and epileptics of Middlesex, whose families cannot support them.
Let us hope from this gradual amelioration in the condition of this illfated class of our fellow-creatures, that every institution, both public and private, will shortly be conducted upon a similar plan, having sufficient grounds attached to it, to give occupation to such of their inmates as may still be able to enjoy some share, however trifling it may be, of the blessings of this life.
Bontius informs us that this disease was observed on the banks of the Ganges, where it was known by the name ofCowrap. Kaempfer noticed it in Ceylon and Japan. In Sumatra, whole generations are infected with both leprosy and elephantiasis; and those who are labouring under the latter disease, although it is not contagious, are driven into the woods. Christopher Columbus found lepers in the island of Buona Vista in 1498, and frictions of turtle blood were used to relieve them.
In our days it is a disease of rare occurrence, at least in Europe; yet it was observed at Vetrolles and Martignes, in France, in 1808, and at Pigua and Castel Franco, in Italy, in 1807. The elephantiasis still prevails in our West India colonies, more especially that species which is called “elephant leg,” and which is not uncommon at Barbadoes, St. Christopher, and Nevis. Parsons, in his Travels in Asia and Africa, informs us that a similar complaint exists on the coast of Malabar, where it is called the “Cochin leg.” The Hindoo physicians treat it with pills of arsenic and black pepper.
A curious species of leprosy appeared in Rome under the reign of Tiberius, which was brought thither from Asia. The eruption first broke out upon the chin, whence it was calledMentagra, and is thus alluded to by Martial:
Non ulcus acre, pustulæve lucentes;Nec triste mentum, sordidive lichenes.
From the chin it extended over the entire body, and on its disappearance left scars more unsightly, if possible, than the former disease. Its virulence and difficulty of cure induced the Romans to send to Egypt for attendance. The same disease prevailed in the second century, and Soranus, a physician of Aquitania, was sent for to heal it. Crispus, a friend of Galen, is said to have discovered the best method of cure. Pliny has given an accurate account of the mentagra in his Natural History, lib. xxvii. cap. 1. According to the same writer, elephantiasis was brought to Rome by Pompey’s troops. Plutarch fixes its apparition to the time when Asclepiades of Bithynia flourished as one of his disciples. Themison wrote a treatise on the disease, which is mentioned by Cælius Aurelianus, but has not been preserved from the ravages of time. Lucilius called the affectionodiosa Vitiligo. TheGemursaof Pliny appears to have been a similar complaint; and Triller thinks that it was theGumrethaof the Talmud.
Formerly, in England, the causes of lepers were committed to the ecclesiastical courts, as it was prohibited to prosecute a leper before a lay judge, as they were under the protection of the church, which separated them from the rest of the people by a ritual. At this period a law existed, calledLeproso amovendo, for the removal of lepers who ventured to mix in society. Thus leprosy may be considered one of the most terrific maladies inflicted on mankind. Holy Writ affords us abundant proofs of its fatal character. It is probable that this disease was first observed under the scorching sun of Egypt, whence it spread its ravages to Greece and Asia; and when the East was obliged to submit to the Roman legions, the conquerors carried the scourge of the vanquished to their own country. From Italy the disorder extended to France; and in the reign of Philip I. we find some members of the church militant, calledhospitaliers, who spent their arduous life in attending upon lepers, and waging war against the infidels.
The Hebrew tribes, on quitting Egypt, were subject tothree kinds of leprosy; all of them were distinguished by the name ofBerat(בחרת), or “bright spot.” One calledBoak(חקב), of a dull white; and two namedTsorat(צרעח), or “venom or malignity:” the first variety of the latter being theBerat Lebena, or bright white berat; and the next theBerat Cecha, or the dark and dusky berat; both of which were highly contagious, and rendered those who laboured under their attack unclean, and dangerous to society.
Manetho, Justin, and several historians, pretend that the Hebrews were expelled from Egypt in consequence of their being infected with this formidable disease; a reproach from which Josephus attempted to exculpate his countrymen. It appears, however, that, during their captivity of one hundred and thirty-four years, the Israelites laboured under this awful visitation; and, three thousand years after their migration we find Prosper Alpinus describing the banks of the Nile as the principal seat of the disease. Lucretius gives the same account of it:
Est Elephas morbus, qui, propter flumina NiliGignitur, Ægypto in mediâ, neque præterea usquam.
Pliny and Marcellus Empiricus refer the calamity to the same source. They state, however, that it was more general in the lower classes, although it sometimes attacked their sovereigns; an event which added to the horrors of the infliction, since it appears that royalty had the privilege of bathing in human blood as one of the most effectual curative means. Gaul and Avicenna attribute its fatal prevalence in Alexandria to the influence of the climate, and the quality of their food. The Persian writer thus expresses himself: “Et quando aggregatur caliditas aëris cum malitiâ cibi, et ejus essentia ex genere piscium, et carne salitâ, et carne grossâ, et carnibus asinorum, et lentibus, procul dubio est ut eveniat lepra, sicut multiplicatur in Alexandriâ.”
TheBoak, or slighter berat, which is not considered to be contagious, still bears the same denomination amongst the Arabs, and is the λεπρα αλφὸς or dull white leprosy of the Greeks. The bright white and dusky berats of the Hebrews were distinguished on account of their malignity, and with theTsorat(צרעח) are still called among the Arabians by the Hebrew generic term with a very slight alteration, for theBerat Lebenais theirBeras Bejas, and theBerat Cecha, theBeras Asved.
While the Arabians borrowed the Hebrew terms, theGreeks took their denominations from the same source; and fromTsoratthey adopted the wordPsora. TheTsoratis restrained by the Hebrews to the contagious form of leprosy. Amongst the Greeks Lepra was a generic synonyme ofBeratorBeras.
This confusion in the adaptation of the names given to the varieties of leprosy has occasioned much perplexity in the study of the disease. Actuarius, in endeavouring to rectify these errors, has produced a greater confusion. According to him, they are different forms of a common genus. However, the most important distinction was that which defined the contagious and the non-contagious forms. The leprosy described by Moses under the name ofBoakorBohakwas the αλφὸς of Hippocrates;Seeththe φακος;SaphachathandMisphachaththe λειχην; andBahereththe λευκη; and according to Carthenser and other writers, this leprosy was theLeucéof the Greeks.
The elephantiasis was long confounded with leprosy; but the former is a tubercular affection of the skin, widely different from the scaly leprosy, and certainly not contagious. Its singular name was derived from the condition of the surface of the huge misshapen limbs of those who were affected with the malady, and which bore some resemblance to the leg of an elephant. This morbid state is not uncommon in the island of Barbadoes, and in England it has been called “the Barbadoes leg.” The original Arabic name for this affection wasDal Fil, or “the elephant’s disease,” which is now the common denomination; although it is frequently abridged intoFilalone, literallyElephas. The elephantiasis is not even alluded to by Moses in his descriptions of leprosy. However, the elephant leg of the Arabians is a disease totally different from the specific elephantiasis, which is a disorder of the skin, the roughness of which led to the name, and which the Arabians calledJuzamorJudam.
These errors of description amongst medical writers have of course occasioned much obscurity and perplexity in the productions of travellers and historians, who have generally confounded all these diseases with the Hebrew leprosy, or the leprosy which for so long a period desolated the fairest portions of Europe, where every country was crowded with hospitals established for the exclusive relief of the malady. The number of leper-houses, as they were denominated, has been singularly exaggerated. Paris has been made to assert that there were nineteen thousand of these hospitals, whereashe merely stated that the Knights Hospitalers, under various patron saints, but more particularly St. Lazarus, were endowed with nineteen thousand manors to support their extensive establishments; and he thus clearly expressed himself: “Habent Hospitalarii novemdecim millia maneriorum in Christianitate.” It appears that in the reign of Louis VIII., France had no less than two thousand of these hospitals. Leprosy was well known in the eighth century, and St. Ottomar and St. Nicholas, were considered the first founders of establishments for its treatment in France and in Germany. The Crusaders, however, by their connexions with the East, materially increased its inroads in Europe, and the disgusting malady appears to have been considered as a proof of holiness. Mœhser, in his work “De medicis equestri dignitate ornatis,” informs us that the Knights of the order of St. Lazarus were not only intrusted with the care of lepers, but admitted them into their noble order: their Grand Master was himself a leper. The Crusaders, returning from their useless wars, eaten up with the disease, received the honourable distinction of beingpauperes Christi, morbi beati Lazari languentes. The most distinguished individuals in the land attended upon them with the utmost humility; and Robert, King of France, used to wash and kiss their filthy feet to keep himself in odour of sanctity. All these attentions, however, did not always prevent the lepers from complaining of their complicated sufferings, but they were exhorted by holy men (who of course had never experienced the miseries of the malady) to be of good comfort, as their illness was a blessed favour conferred upon them as the elect of the land. St. Louis thought the Sire de Joinville an unbeliever; for having once asked him which he would prefer, being amezieuorlaide(a leper), or having to reproach his conscience with any mortal sin, his favourite replied to the singular question, that he would rather be guilty of thirty deadly sins; whereupon the sanctified monarch severely rebuked him by telling him in the quaint language of the times, “Nulle si laide mezeuerie n’est, comme de estre en péché mortel.”
Notwithstanding the sanctity of their disease, lepers were by various laws separated from the healthy portion of the community. The ceremonies used on these occasions were curious; and we find the following description of them in the History of Bretagne: A priest in his sacerdotal robes went to the leper’s dwelling, bearing a crucifix. He was thenexhorted to submit with resignation to the affliction: he afterwards threw holy water upon him, and conducted him to church. There he was stripped of his ordinary vestments, and clothed in a black garment; he then knelt down to hear mass, and was again sprinkled with holy water. During these ceremonies, the office for the dead was duly sung, and the leper was finally led to his destined future residence. Here he again knelt, received salutary exhortations to be patient, while a shovelful of earth was thrown on his feet. His dwelling was most diminutive: his furniture consisted of a bed, a water-jug, a chest, a table, a chair, a lamp, and a towel. He further received a cowl, a gown, a leathern girdle, a small cag with a funnel, a knife, a spoon, a wand, and a pair ofcliquettes, (a sort of castanets,) to announce his approach. Before leaving him, the priest added another blessing to these gifts, and departed, after commanding him under the severest penalties never to appear without his distinctive apparel, and barefooted; never to enter a church, a mill, or a baker’s shop; to perform all his ablutions in streams and running waters; never to touch any article he wanted to purchase, except with his wand; never to enter drinking-houses, but to buy his liquor at their doors, having it poured into his barrel by means of the funnel graciously given him for that purpose; never to answer any question unless he was to windward of his interlocutor; never to presume to take a walk in a narrow lane; never to touch or go near children, or look at a good-looking wench; and only to eat, drink, and junket with his brother lepers; and invariably to announce his unwelcome approach by rattling his castanets.
The offsprings of these sequestrated creatures were seldom baptized; and when this rite was performed, the water was thrown away. After this oration his ghostly adviser took his final leave, and the patient’s former dwelling was burnt to the ground. The sepulchre of St. Mein, in Britanny, was frequently visited by these poor creatures; and on such occasions they were obliged to have both their hands covered with woollen bags, as a distinguishing mark amongst the other pilgrims. Lepers were only allowed to intermarry with fellow-sufferers; yet we find in one of the Decretals of St. Gregory, that any woman who chose to run the chances of contagion could please her fancy. St. Gregory perhaps thought this the most effectual method of preventing the dreaded intercourse, as most probably, had it been prohibited, lepers would have been in great request, they having alwaysbeen notorious for their amorous propensities. Muratori informs us that these unfortunate persons did not always submit quietly to these severe regulations, but several times joined the Jews in a revolt against the authorities.
This affliction has been observed in various countries. In Iceland it is calledLikraa; in Norway,RadesygeorSpedalskhed. It is to be apprehended that many of these cases of leprosy belong more particularly to the elephantiasis: such is the red disease of Cayenne, and theBoasiof Surinam.
It is especially in the East, its probable original seat, that leprosy is observed. In Damascus there are two hospitals for its treatment. The waters of the Jordan are still considered efficacious in its cure, and the waters of Abraham’s well are looked upon as a specific. In Candia the disease was common, and lepers were noted for their obscene profligacy. From Crimea it has also been carried to Astracan, whence it infected the Cossacks of Jaïck. Pallas and Gmelin have given an accurate account of its invasion.
Various opinions are entertained respecting the reptile that inflicted the fatal sting on Cleopatra. According to Pliny, it had hollow fangs, which distilled the venom in the same manner as the tail of the scorpion. Ælian states it to have been a snake that moves slowly, covered with scales of a reddish colour, his head crowned by callous protuberances, his neck becoming swollen and inflated when he sheds his poisonous secretion. Other naturalists affirm that the scales are shining, and the eyes of a dazzling brightness; while some authorities maintain that the reptile’s hue is of a dark brown colour, and that, like the chameleon, it can assume the colour of the ground on which it drags its writhing form. However, later observers have now clearly ascertained that the aspic of the ancients is thecoluber haje, called by the Arabsnascher, and classed by Lacepède as the Egyptian viper. Lucan seems to have described this serpent in the following lines:
Hic, quæ prima caput movit de pulvere tabesAspida somniferum tumida cervice levârit.
According to Hasselquist, the aspic’s head is raised in a protuberance on both sides behind the eyes; the scales which cover the back are small, of a dirty white colour, and speckled with reddish spots. The lower surface of the reptile is striated with one hundred and eighteen small parallel zones, and forty-four smaller ones are under the tail. The teeth resemble in their structure those of other vipers; and, when the animal is irritated, its neck and throat are swelled up to the size of the body. Authors vary in regard to its length. Hasselquist, from whom we have derived the above description, says that it is a short reptile; while Savary assures us that it sometimes measures six feet.
The ancients stated that the poison of the aspic did not occasion any pain, but that the person it had stung gradually sunk into a calm and languid state, which was followed by a sound sleep, the forerunner of dissolution. Modern travellers assure us, on the contrary, that this venom is most active; and Hasselquist has observed an aspic in Cyprus, the bite of which brought on a rapid mortification, which generally proved fatal in a very few hours.
In Egypt the viper is still made use of in medicinal preparations; and a great number of them are sent to Venice for the confection of the celebratedTheriaca. Under Nero, we are told, that these reptiles were imported into Rome for pharmaceutical purposes.
In the above description, and endeavour to ascertain the nature of the aspic of the ancients, there must be some error. Thecoluber aspisof Linnæus is not venomous, and we may therefore conclude that the aspic was of the same species as our viper. The venom of this animal is of a yellow tinge, and small in quantity, seldom exceeding two grains in weight. In hot weather it becomes more active in its effects. Time does not seem to deprive it of its fatal properties; for instances have been known of persons having pricked their fingers with the pointed fangs of a viper preserved in spirits, when the most serious accidents have followed. The dried teeth lose this noxious power. The venom of the viper may be swallowed without any risk, provided there is not an ulcer in the mouth. Fontana has made upwards of six thousand experiments to prove the activity of this substance. A sparrow died under its influence in five minutes, a pigeon in eight or ten; a cat sometimes did not experience any inconvenience, a sheep seldom or never; and the horse appears to be proof against its action.
Some naturalists have affirmed that the female viper, in cases of sudden alarm, possesses the faculty of securing the safety of her young by swallowing them and keeping them concealed in her stomach, as the kangaroo secures her offspring in her pouch. This assertion, although fabulous, was credited by Sir Thomas Brown, and since by Dr. Shaw. Stories equally absurd have been circulated of this reptile. The Egyptians considered the viper as a typification of a bad wife, since they believed that during their union the female was in the habit of biting off her partner’s head. They also looked upon it as the emblem of undutiful children, from the idle belief that the viper came into the world by piercing an opening in its mother’s side.
If a physician sees you eat any thing that is not good for the body, to keep you from it he cries out “It ispoison!” If the divine sees you do any thing that is hurtful to your soul, to keep you from it he cries out “You aredamned!”
To preach long, loud, and damnation, is the way to be cried up. We love a man who damns us, and we run after him again to save us. If a man has a sore leg, and he should go to an honest and judicious surgeon, and he should only bid him keep it warm, or anoint it with some well-known oil that would do the cure, haply he would not much regard him, because he knows the medicine beforehand to be an ordinary medicine. But if he should go to a surgeon that should tell him, “Your leg will be gangrene within three days, and it must be cut off; and you will die, unless you do something that I could tell you,” what listening there would be to this man! “Oh! for the Lord’s sake, tell me what this is:—I will give you any contents for your pains.”
This ingenious antiquary has also made some quaint comparisons between doctors of the body and doctors of the public interests. “All might go on well,” he says, “in the commonwealth, if every one in the parliament would laydown his own interest and aim at the general good. If a man was rich, and the whole college of physicians were sent to him to administer to him severally; haply, so long as they observed the rules of art, he might recover. But if one of them had a great deal of scammony by him, he must put off that; therefore will he prescribe scammony; another had a great deal of rhubarb, and he must put off that; therefore he prescribes rhubarb: and they would certainly kill the man. We destroy the commonwealth, while we preserve our own private interests and neglect the public.”
Grotius called John Selden “the honour of the English nation;” and Bacon had such an implicit faith in his judgment, that he desired in his will that his advice should be taken respecting the publication or suppression of his posthumous works.
Various species of this plant were known to the ancients. Its type is supposed to be theLactuca quercina, or theLactuca scariola; both of Asiatic origin. Many powerful effects were formerly attributed to its use. It was considered as producing sleep, and recovery from intoxication; it was in consequence of this belief that this salad was served up after meals. Thus Martial tells us,
Claudere quæ cœnas Lactuca solebat avorum,Die mihi cur nostras inchoat illa dapes.
Columella thus describes its properties:
Jamque salutari properet Lactuca saporeTristia quæ relevet longi fastidia mori.
This belief in its narcotic qualities induced the ancients to esteem it as an aphrodisiac: the Pythagoreans had therefore named it ευνουχιον; and Eubulus calls it the food of the dead,mortuorum cibum. Venus covered the body of her beloved Adonis with lettuce-leaves to calm her amorous grief; and vases, in which they were planted, were introduced in the Adonian festivals. Galen, who had faith in its powers, called it the herb of sages, and in his sleepless nightssought its influence by eating it at supper. It was also frequently put under the pillow of the rich to lull them to repose. Its cooling qualities were so much dreaded by the Roman gallants, that its use was abandoned; but Augustus’s physician, Antonius Musa, having calmed by its prescription his master’s uneasiness in a hypochondriac attack, lettuce recovered its popularity: a statue was erected to the doctor, and salad once more became the fashion, although the prejudices against it could not be removed. Lobel informs us that an English nobleman, who had long wished for an heir, but in vain, was blessed with a numerous family by leaving off this Malthusian vegetable.
Such is the perversity of our nature, that the remuneration given with the greatest reluctance is the reward of those who restore us, or who conscientiously endeavour to restore us to health. The daily fees, it is true, are not handed with regret, for the patient is still suffering; but if they were to be allowed to accumulate to a considerable amount, they would be parted with, with a lingering look. The lawyer’s charges for a ruinous litigation, the architect’s demands for an uncomfortable house, are freely disbursed, though if exorbitant they may be taxed; but the doctor’s—a guinea a visit!—is sheer extortion. ‘Send for the apothecary: the physician merely gives me advice; the apothecary will send me plenty of physic: at any rate I shall have something for my money.’
To what can this unjust, this illiberal feeling be attributed? Simply to vanity and pride. Illness and death level all mankind. The haughty nobleman, who conceives himself contaminated by vulgar touch, can scarcely bring himself to believe that he is placed upon the same footing as a shoe-black. Allprestigesof grandeur and worldly pomp vanish round the bed of sickness; and the suffering peer would kneel before the humblest peasant for relief. Then it is that money would be cheerfully lavished to mitigate his sufferings. But how soon the scene is changed! The patient is well, thrown once more in the busy vortex of business or ofpleasure. He had been slightly indisposed; his natural constitution is excellent: the doctors mistook his case; thought him very ill, forsooth; but nature cured him.
Could the ambitious mother admit for one moment that her daughter had been seriously ill?—a sick wife is an expensive article! If her medical attendant unfortunately hinted that the young lady had been in danger, he is considered a busy old woman, exaggerating the most trifling ailment to obtain increase of business; in fact, a dangerous man in a family where there are young persons—to be provided for. Nor can we marvel at this. No one likes to be considered morally or physically weak, excepting hypochondriacs, who live upon groans, and feel offended if you tell them that they do not look miserable. The soldier will describe the slightest wound he received in battle as most severe and dangerous; a feeling of pride is associated with the relation. The bold hunter will boast of a fractured limb; the accident showed that he was a daring horseman. Nay, the agonizing gout is a fashionable disease, which seems to proclaim good living, good fellowship, and luxury: it is, in short, a gentlemanly disease. But the slow ravages of hereditary ailments, transmitted from generation to generation with armorial bearings, the development of which may be averted by proper care, or hurried on by fashionable imprudence! how difficult even to hint to a family the presence of the scourge, when, through the transparent bloom of youth and beauty, our experienced eye reads the fierce characters of death in the prime of years. The aerial coronet floats in fond visions before the doting mother’s ambitious eyes. A man would be a barbarian, nay, a very brute, to deprive the darling girl of the chances of Almacks, the delights of the pestiferous ball-room, or the galaxy of court or opera!
To attend the great is deemed the first stepping-stone to fortune, and patronage is considered as more than an equivalent of remuneration. Too frequently does the physician placed in that desirable situation forget what Hippocrates said of the profession. “The physician stands before his patient in the light of a demi-god, since life and death are in his hands.”
Curious anecdotes are related of this unbecoming subserviency. A courtly doctor, when attending one of the princesses, was asked by George III. if he did not think a little ice might benefit her. “Your majesty is right,” was the reply; “I shall order some forthwith.” “But perhaps itmight be too cold,” added the kind monarch. “Perhaps your majesty is right again; therefore her royal highness had better get it warmed.”
This absurd deference to rank and etiquette by a physician who at the moment is superior to all around him, reminds one of an account given by Champfort of a fashionable doctor. “D’Alembert was spending the evening at Madame Du Deffand’s, where were also President Hénault and M. Pont de Vesle. On this flexible physician’s entering the room, he bowed to the lady with the formal salutation, ‘Madame, je vous présente mes très humbles respects.’ Then, addressing M. Hénault, ‘J’ai bien l’honneur de vous saluer.’ Turning round to M. de Vesle he obsequiously said, ‘Monsieur, je suis votre très humble serviteur;’ and at last, condescending to speak to D’Alembert, he nodded to him with a ‘Bonjour, Monsieur!’” On such occasions a condescending smile from power is considered a fee.
Reluctance in remunerating medical attendants was also manifested by the ancients; and Seneca has treated the subject at some length. The difficulty in obtaining remuneration has unfortunately rendered many physicians somewhat sordid, and loth to give an opinion unless paid for. In this they are unquestionably right, as gratuitous advice is seldom heeded; and one of the most distinguished practitioners used to say, that he considered a fee so necessary to give weight to an opinion, that, when he looked at his own tongue in the glass, he slipped a guinea from one pocket into another.
To consider themselves in proper hands, patients must incur expenses, and as much physic as possible be poured down. Malouin, physician to the Queen of France, was so fond of drugging, that it is told of him, that once having a most patient patient, who diligently and punctually swallowed all the stuff he ordered, he was so delighted in seeing all the phials and pill-boxes cleaned out, that he shook him cordially by the hand, exclaiming, “My dear sir, it really affords me pleasure to attend you, and youdeserveto be ill.” Our apothecaries must surely meet with incessant delight!
The most extraordinary remuneration was that received by Levett, Dr. Johnson’s friend and frequent companion. It was observed of him that he was the only man who ever became intoxicated from motives of prudence. His patients, knowing his irregular habits, used frequently to substitute a glass of spirits for a fee; and Levett reflected that if he did not accept the gin or brandy offered to him, he could have been nogainer by their cure, as they most probably had nothing else to give him. Dr. Johnson says “that this habit of taking a fee in whatever shape it was exhibited, could not be put off by advice or admonition of any kind. He would swallow what he did not like, nay, what he knew would injure him, rather than go home with an idea that his skill had been exerted without recompence; and had his patients,” continues Johnson, “maliciously combined to reward him with meat and strong liquors, instead of money, he would either have burst, like the dragon in the Apocrypha, through repletion, or been scorched up, like Portia, by swallowing fire.” But though this worthy was thus rapacious, he never demanded any thing from the poor, and was remarked for his charitable conduct towards them.
Various professional persons have sometimes endeavoured to remunerate their medical attendants by reciprocal services: thus an opera-dancer offered to give lessons to a physician’s daughters for their father’s attendance upon him; and a dentist has been known to propose to take care of the jaws of a whole family to liquidate his wine bill. One of the wealthiest merchants of Bordeaux wanted to reduce the price of a drawing-master’s lessons, on the score of his taking his children’s daubs with him to sell themon account. This arrangement, however, did not suit the indignant artist, who left the Crœsus in disgust.
A singular charge for medical attendance was lately brought before the court of requests of Calcutta, by a native practitioner. He demanded 314 rupees for medicine alone, and in the items of drugs appeared pearls, gold leaf, and monkeys’ navels!
In one of the old French farces there is an absurd scene between Harlequin and his physician. The motley hero had been cured, but refused to remunerate his Esculapius, who brought an action for his fees, when Harlequin declares to the judge that he would rather be sick again; and he therefore offers to return his health to the doctor, provided he would give him back his ailments, that each party might thus recover their own property. This incident was perhaps founded on an ancient opinion of Hippocrates, who frequently mentioned salutary diseases. In 1729, a Dr. Villars supported a thesis on this subject, entitled “Dantur-ne morbi salutares?” and Theodore Van Ween has also written a learned dissertation on the same subject.
A celebrated Dublin surgeon was once known to give alesson of economy to a wealthy and fashionable young man remarkably fond of his handsome face and person. He was sent for, and found the patient seated by a table, resting his cheek upon his hand, whilst before him was displayed a five-pound note. After some little hesitation he removed his hand, and displayed a small mole on the cheek. “Do you observe this mark, doctor?”—“Yes, sir, I do.”—“I wish to have it removed.”—“Does it inconvenience you?”—“Not in the least.”—“Then why wish for its extirpation?”—“I do not like the look of it.”—“Sir,” replied the surgeon, “I am not in the habit of being disturbed for such trifles; moreover, I think that that little excrescence had better remain untouched, since it gives you no uneasiness; and I make it a rule only to take from my patients what is troublesome to them.” So saying, he took the five-pound note, slipped it into his pocket, and walked out of the room, leaving the patient in a state of perfect astonishment.
It is related of a physician who received his daily fee from a rich old miser, who had it clenched in his fist when he arrived, and turned his head away when he opened his hand for the doctor to take it, that, on being informed his patient had died in the morning, not in the least disconcerted he walked up to the dead man’s chamber, and found his clenched fist stretched out as usual; presuming that it still grasped the accustomed remuneration, with some difficulty he opened the fingers, took out the guinea, and departed.
The Egyptian physicians of old were paid by the state, but they were not prevented from accepting remuneration from individuals, and they were allowed to make demands for their attendance except on a foreign journey, and during military services.
When we compare the value of money it appears probable that the fees of olden practitioners were more considerable than the remuneration of the present day. Attendance upon royalty and the court seems also to have been more profitable. Dr. Radcliffe says, that he received from King William 200l.a year more than any other physician in ordinary—this monarch upon his appointment, gave him moreover, 500 guineas out of the privy purse for his attendance on the Earl of Portland, and the Earl of Rochford. When the same physician went to Hanau to attend Lord Albemarle, he received 1200l.from the king, with 400 guineas from his patient, besides a valuable diamond ring.
Dr. Radcliffe’s fortune must have been considerable, asappears from his legacies, bequeathing 5000l.for the improvements of University College—4000l.for the building of a library at Oxford—and 500l.yearly for the amelioration of the diet of St. Bartholomew’s hospital. Radcliffe had not been a year in London when he received 20 guineas daily, and he mentions that his fee for a visit from Bloomsbury Square to Bow, was five guineas.
We do not exactly know what was the exact honorarium of Doctors in former days, yet Baldwin Hammey informs us that in 1644, Dr. Robert Wright who had only been settled three years in London, was in the habit of receiving a thousand broad pieces (22 shillings) in the course of the year.
The following is a curious account of a puritan’s consultation with Dr. Hammey.
“It was in the time of the civil wars when it pleased God to visit him with a severe fit of sickness, or peripneumonia, which confined him a great while to his chamber, and to the more than ordinary care of his tender spouse. During this time he was disabled from practice; but the very first time he dined in his parlour afterwards, a certain great man in high station came to consult him on an indisposition—(ratione vagi sui amoris,) and he was one of the godly ones too of those times. After the doctor had received him in his study, and modestly attended to his long religious preface, with which he introduced his ignominious circumstances, and Dr. Hammey had assured him of his fidelity, and gave him hopes of success in his affair, the generous soldier (for such he was) drew out of his pocket a bag of gold and offered it all at a lump to his physician. Dr. Hammey, surprised at so extraordinary a fee, modestly declined the acceptance of it; upon which the great man, dipping his hand into the bag himself, grasped up as much of his coin as his fist could hold, and generously put it into the doctor’s coat-pocket, and so took his leave. Dr. Hammey, returned into his parlour to dinner, which had waited for him all that time, and smiling (whilst his lady was discomposed at his being absent so long), emptied his pocket into her lap. This soon altered the features of her countenance, who telling the money over, found it to be thirty-six broad pieces of gold: at which she being greatly surprised, confessed to the doctor that surely this was the most providential fee he ever received; and declared to him that during the height of his severe illness, she had paid away (unknown to him) on a state levy towards a public supply, the like sum in number and value of pieces of gold;lest under the lowness of his spirits, it should have proved a matter of vexation, unequal to his strength at that time to bear; which being thus so remarkably reimbursed to him by Providence, it was the properest juncture she could lay hold on to let him into the truth of it.” It has been supposed, that the sanctimonious sufferer was no other than Ireton, Cromwell’s son-in-law.
During the imprisonment of Dr. Friend in the tower, Dr. Head attended his patients, and on his liberation he presented him with 5000l.the amount of the fees received on his account. Dr. Meade’s practice averaged from 5000l.to 6000l.per annum. It is somewhat strange, that this celebrated physician whose evenings were generally spent in convivial meetings at Batson’s Coffee-house, used in the forenoon to receive consulting apothecaries at a tavern near Covent-garden, prescribing for the patients without seeing them at half-a-crown fee.