Samuel Johnson in the Medical World: The Doctor and the Patient 
by John Wiltshire.
Cambridge, 293 pp., £30, March 1991, 0 521 38326 9
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‘I want to draw some connections between Samuel Johnson, the amateur doctor and enthusiast for medicine, and the Doctor Johnson who figures so largely in the cultural imagination ... If we focus on the figure of Samuel Johnson, the unco-ordinated, discontinuous events of 18th-century medicine will seem momentarily at least to converge. He lived a life within medicine, intimate with some of the age’s chief practitioners, learned in both the classical and contemporary branches of the art, receiving upon and within his body its various ingenuities and interventions.’ Using a mass of material drawn from Johnson’s writings and those of contemporary medical men, besides the testimonies of friends and strangers, John Wiltshire examines Johnson as both sufferer and physician (or healer). Hence his punning subtitle. Some of Johnson’s best friends, starting with his godfather, were doctors, and in addition to being himself a monumental patient, he was ready to give others the benefit of his advice. He emerges as both the most morbidly disordered of men and the sanest, and a typical virtue of his medical pronouncements, whether somatic or psychological, is that they are cool, measured and carefully framed. Boswell was at his most Johnsonian when he observed that since the exercise of his reason was Johnson’s ‘supreme enjoyment’, any threat to that faculty was ‘the evil most to be dreaded’: ‘He fancied himself seized by it [insanity], or approaching to it, at the very time when he was giving proofs of a more than ordinary soundness and vigour of judgment.’

Johnson’s Bolt Court household was itself a hospital in miniature with ‘whole nests of people ... the lame, the blind, the sick, and the sorrowful’, as Mrs Thrale sniffily put it, where ‘his old Inmate Mr Levet’ (she must have balked at the word ‘friend’: she was a friend) ‘used to bleed one, & blister another, & be very useful, tho’ I believe disagreeable to all’.

‘Obscurely wise, and coarsely kind’ describes the best clinical care that most people could hope for, particularly at a time when traditional lore, empirical practice and scientific theory co-existed and intermingled. Wiltshire rightly devotes close attention to the poem ‘On the Death of Dr Robert Levet’ (in Johnson’s posthumously published Works ‘Dr’ was downgraded to ‘Mr’), first printed in the Gentleman’s Magazine in 1783. In the lines ‘Nor, lettere’d arrogance, deny/Thy praise to merit unrefin’d’ it is hard not to see an allusion to those who could put the letters MD after their names. As Johnson noted on one occasion, Levet walked across London on his rounds, which is reflected in ‘His virtues walk’d their narrow round’, where ‘narrow’ refers to the clientele in question (plainly outside the circles of the great) rather than the distance covered. Wiltshire is probably over-ingenious in claiming that the word ‘sure’ in the following lines, ‘And sure th’Eternal Master found/The single talent well employ’d,’ might well ‘convey doubt whilst appearing to express certainty’, and thus hint at a faint embarrassment or distancing: Levet wasn’t a gentleman, as the poem’s polite readers would know. He was said to have begun his career as a waiter in a Paris coffee-house frequented by surgeons who took an interest in him, securing free admission for him to lectures on pharmacy and anatomy. No other word (e.g. ‘certainly’) would scan, and the element of unsureness in ‘sure’ is most likely a more recent mannerism. Nor, in the concluding word of ‘His vig’rous remedy display’d/The power of art without the show,’ are we much inclined to glimpse ‘the armorial bearings, the gold-topped cane’ sported by the prosperous licensed practitioners; opposed to ‘display’d’, ‘show’ rhymes with the ‘blow’ prepared by ‘hov’ring death’ (represented as a footpad or mugger), and is in other respects exactly the right word: neither showiness nor showing-off has any part in true art, whatever the art might be.

It is a magnificently compressed poem, a memorial to more than its titular subject, powerful without any show of power. To complain about the niggling interpretations of others can lead one to niggle oneself. And what Wiltshire offers is the sort of practical criticism which, albeit the basis of literary study, appears nowadays to have fallen into a disrepute worse than Levet ever knew.

Of two mysteries arising in Johnson’s medical biography, the lesser or less sensational concerns the ‘trick’ whereby he drove away his gout, a recourse deplored by Mrs Thrale, who believed quite orthodoxly that the disease was driven to some more dangerous site, and that it eventually caused his death. The trick may have consisted in ‘putting his feet in cold water’, as reported by Mrs Thrale: a not unreasonable expedient, though unlikely to achieve much in the way of cure.

The other mystery derives primarily from Johnson’s letter to Mrs Thrale of 1773, written in French on the principle of pas devant les domestiques, which has been construed as revealing masochistic proclivities in which he had either involved the lady or sought to do so. The supplementary evidence of the padlock and fetters finds a simple explanation in Johnson’s fear of madness, and the thought that he might need to be restrained: not so much a skeleton in the cupboard as a straitjacket in the wardrobe. The letter, however, has been seen as evincing a pathological desire for ‘discipline’, for abasement, in the mode of some seedy Soho speciality. At the time Mrs Thrale was much preoccupied with her dying mother, besides the financial troubles besetting the family brewery; and the letter is that of a guest who doesn’t want to be too much of a burden to his much admired hostess, but wishes to establish the domestic arrangements governing his sojourn (que votre autorité me soit toujours sensible: i.e. readily perceived), while trusting (for his need was acute) that these would be to his continued advantage.

The letter is imperfect in grammar, high-flown in its politesse, and roundabout in expression, but straightforward in intent, with nothing to be read between the lines. What shines through is the writer’s affectionate considerateness. Wiltshire comments: ‘A writer who only uses a foreign language occasionally is not in so much command of its idioms and tone as to prevent the possibility of misinterpretation.’ More to the point in this case is that Johnson’s French was better than that of some who have studied the letter avidly. The tenuous speculations it has inspired – it would have attracted little attention had it not been couched in a suspect tongue – are the more absurd in view of Mrs Thrale’s known character, not to mention Johnson’s.

Wiltshire’s discussion of medicine as a source of metaphors for intellectual or moral maladies – if ‘metaphor’ is the right word, for which came first? – is somewhat laboured; such usages are as ancient as language (‘sick at heart’, ‘love’s fever’), and as modern (‘allergic to hard work’, ‘writer’s block’: cf. ‘costive brains’ in Johnson’s Dictionary). Whether discerned as metaphorical or not ‘sudden blasts’ (contagion) and ‘slow decline’ (wasting disease) are finely felicitous at the opening of the Levet poem. In Illness as Metaphor Susan Sontag considers a degenerate usage: expressions like ‘the cancer of racism’ suggest that cancer sufferers are somehow affiliated with racists – ‘moral lepers’, you might (also hurtfully) say. Though peevishness is hardly a mortal sin, Johnson’s choice of words, quoted below, might be deemed off-colour in a solicitous society.

Wiltshire gives chapter and verse for a text most of us were only indistinctly aware of – the Doctor as doctor, knowledgeable, keen and sceptical – and shows how central the motif was and, in Johnson’s writings, is. Like many scholars, he doesn’t always quite know when to call a halt. But the minuteness of his analysis, the range of his clinical reference, are alleviated by the recurrence of Johnson, and Johnson is rarely flat; even his dealings with the commonplace (peevishness ‘wears out happiness by slow corrosion ... It may be considered as the canker of life, that ... taints and vitiates what it cannot consume’) carry a force and precision that make them appear virtually novel.

‘Perhaps, if we speak with rigorous exactness, no human mind is in its right state.’ In Rasselas Imlac is more persuasive on the growth of madness – the ‘power of fancy over reason’ reaches the point where ‘fictions begin to operate as realities’ – than the well-intentioned doctors of the time with their theories involving such physical causes as compression of nerves due to distention of contiguous vessels. Later writers have seized on the passages from Rasselas as accurate, even ‘beautiful’ (John Haslam, 1808) and ‘poignant’ (Roy Porter, 1987) illustrations of the workings of madness. The old astronomer has come to believe that, far from merely observing the weather, he is regulating it: a reason for deep anxiety since his responsibility is greater than that of any monarch, and who can take over the awesome task? Who but Imlac – in modern parlance, I suppose, his analyst.

I cannot follow Wiltshire when he states that the anxiety accompanying the delusion and likewise the process of ‘going mad’ are ‘not explicable in the terms that Johnson had available to him’, and subsequently suggests that Johnson is far from ‘the Freud to whom he has been so often compared’. Indeed. The ‘modern reading’ Wiltshire adduces – that the astronomer’s guilt really attaches to some original and hidden fantasy, or indulgence in it, which in the course of repression has been transformed into another idea or fantasy: i.e. something nasty in the woodshed mutates into something worrying in the observatory – merely employs a different set of terms, entailing the assumption that the patient (in this case a fictional creation) doesn’t know what he is talking about. The novelist Shirley Jackson won’t be the only person to have said, or said something like: ‘When I have nightmares about a horrid building it is the horrid building I am having nightmares about, and no one is going to talk me out of it.’ As for ‘guilt’, when the astronomer begins to get the better of his delusion, he is sad to think he has sacrificed so much for the sake of doubtfully useful knowledge, but Imlac credits him with virtue as well as learning. Who are we to give Imlac the lie?

Wiltshire cites Johnson’s story of how his father locked the front door of his decrepit workshop every night although anyone could walk in by the back. In Mrs Thrale’s report, he went on to say that this behaviour was a form of madness – in which case it must be true that few human minds are in their right state! – though barely visible since Michael Johnson’s poverty prevented the imagination ‘from playing such tricks as riches and leisure encourage’. It was ‘the perpetual pressure of his pecuniary affairs’ and the ensuing need to concentrate on business that kept his father’s melancholy – which he believed he had inherited – in check. The preventive Johnson recommended to Boswell was a course of chemistry, or of rope-dancing, or of any activity (though not the one Boswell was contemplating) to which the mind could ‘fly from itself’. For the astronomer the cure lay in ‘the endearing elegance of female friendship’ and exposure to ‘the gay tumults of life’ (remote from Boswellian notions); in the event of a relapse, Imlac advised, ‘fly to business or to Pekuah.’

On the paramount theme of suffering, the locus classicus is of course Johnson’s 1757 review of Soame Jenyns’s Free Inquiry into the Nature and Origin of Evil. It was one thing for Gloucester, in his despair, to feel that ‘As flies to wanton boys, are we to the gods;/They kill us for their sport’ – later he would say, ‘henceforth I’ll bear/Affliction till it do cry out itself/“Enough, enough,” and die,’ a Johnsonian sentiment – but for a comfortable belletrist to elaborate the thought into an amusing world-view was altogether different. At best, the idea that evil is necessary and suffering a part of some greater good plan doesn’t sit too well on human lips, if only because those who have suffered most are commonly voiceless. The excess of outrage that punctilious commentators have detected in the review, the intemperate breaking of a butterfly, is not difficult to render in other terms. ‘Poor Jenyns!’ one may murmur, but the expostulations of scholars will seem oddly gratuitous and genteel, not unlike the bemused reactions of Thomas Mann’s music lovers to Leverkühn’s discourse on the fires of hell: ‘One thinks one is hearing poetry’ – when one had expected a judicious and decorous piece of literary criticism.

That discourse on such a subject should be taken as ‘poetry’, that Jenyns’s essay should offer itself as higher entertainment, would appal Johnson. Wiltshire links the review with the Idler piece on vivisection printed a year later, which speaks of the ‘race of wretches ... whose favourite amusement is to nail dogs to tables and open them alive’. Johnson doubts that any discovery of practical value to the art of healing has been thus made; he is sure that the same experiments are repeated over and over, and ‘he that burned an animal with irons yesterday, will be willing to amuse himself with burning another tomorrow.’ Whatever the gain in knowledge, the cost to the practitioner’s humanity will be greater. His heart thus hardened, his imagination deadened, the physician prepares himself to ‘continue those experiments upon infancy and age, which he has hitherto tried upon cats and dogs’. Wiltshire observes that the pernicious effects of habituation form a prominent feature of Johnson’s moral writings. And in the same connection David Rawlinson has invoked those ‘compunctious visitings of nature’ which, Lady Macbeth recognised, need to be forestalled when stern business is afoot. Though they lived in violent times, the Macbeths were not habituated to the killing of kings.

Scrofula, gout (or arthritis), insomnia, tics (Tourette syndrome?), sarcocele, chronic bronchitis, asthma (or emphysema), congestive heart failure, oedema ... These were some of the ailments ‘laying siege to life’, and Johnson waged war against them, keeping detailed notes on the ebb and flow of battle. If he can be called a hypochondriac, he was hypochondriacal with reason. What he more correctly was, was a close observer of himself, patient and to some degree physician in one. To have suffered so, and yet lived and worked as he did, he must have had a ‘strong constitution’. It could be said, with Baudelaire’s ‘Voyage à Cythère’ in mind, that he had the strength and the courage to contemplate his body without disgust. After his paralytic stroke in 1783 he composed a prayer in Latin verse so that he ‘might try the integrity of my faculties’: ‘the lines were not very good, but I knew them not to be very good’. On his penultimate day he literally took up arms, lancing the calves of both dropsical legs (and perhaps his swollen testicle as well), not too unskilfully, according to a second-hand report; being neither suicidal nor insane, he would have known what he was doing or hoping to do. The words with which he greeted a visitor near the end confirmed the image of the fighter: I am moriturus.

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