JOHN KEATS

THE APOTHECARY POET 1

We have the very highest authority for the statement that 'the lunatic, the lover, and the poet, are of imagination all compact'. In a more comprehensive division, with a keener discernment, Plato recognizes a madness which is not an evil, but a divine gift, and the source of the chiefest blessings granted to men. Of this divine madness poetry occupies one of the fourfold partitions. Here is his definition: 'The third kind is the madness of those who are possessed by the Muses; which, taking hold of a delicate and virgin soul, and there inspiring frenzy, awakens lyrical and all other numbers; with these adorning the myriad actions of ancient heroes for the instruction of posterity. But he who, having no touch of the Muses' madness in his soul, comes to the door and thinks that he will get into the temple by the help of art—he, I say, and his poetry are not admitted; the sane man disappears and is nowhere when he enters into rivalry with the madman.'

Here, in a few words, we have expressed the very pith and marrow of the nature of poetry, and a clearer distinction than is drawn by many modern writers of the relation of the art to the spirit, of the form to the thought. By the help of art, without the Muses' mad

1 Read at the Johns Hopkins Historical Club, October 29, 1895.Reprinted from the Johns Hopkins Hospital Bulletin, No. 58, January, 1896.

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ness, no man enters the temple. The poet is a 'light and winged and holy thing', whose inspiration, genius, faculty, whatever we may choose to call it, is allied to madness—he is possessed or inspired. Oliver Wendell Holmes has expressed this very charmingly in more modern terms, speaking of his own condition when composing the Chambered Nautilus. 'In writing the poem I was filled with a better feeling, the highest state of mental exaltation and the most crystalline clairvoyance that had ever been granted to me—I mean that lucid vision of one's thought and all forms ot expression which will be at once precise and musical, which is the poet's special gift, however large or small in amount or value.1 To the base mechanical of the working-day world, this lucid vision, this crystalline clairvoyance and mental exaltation is indeed a madness working in the brain, a state which he cannot understand, a Holy of Holies into which he cannot enter.

I

When all the circumstances are taken into account, the English Parnassus affords no parallel to the career of Keats—Adonais, as we love to call him—whose birthday, one hundred years ago, we celebrate to-day.

Born at the sign of the 'Swan and Hoop', Moorgate Pavement, the son of the head ostler, his parentage and the social atmosphere of his early years conspired to produce an ordinary beer-loving, pugnacious cockney; but instead there was fashioned one of the clearest, sweetest, and strongest singers of the century, whose advent sets at naught all laws of heredity, as his development transcends all laws of environment.

1 In a private letter which is published in a notice of Dr. Holmes, Johns Hopkins Hospital Bulletin, October, 1894.

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JOHN KEATS 39

Keats's father succeeded to 'Mine Host of the Swan and Hoop', but died when the poet was only eight years old. His grandmother was in comfortable circumstances, and Keats was sent to a school at Enfield, kept by the father of Charles Cowden Clarke. Here among other accomplishments he developed his knuckles, and received a second-hand introduction to the Greek Pantheon. He is described by one of his schoolfellows as 'the pet prize-fighter with terrier courage', but in the last two years at school he studied hard and took all the prizes. The influence of the Clarkes upon Keats was strong and formative, particularly that of the younger one, Charles Cowden, who was an usher in the school. In the poem addressed to him he frankly acknowledges this great debt, 'you first taught me all the sweets of song.'

In 1810 his mother died of consumption, and during a long illness Keats nursed her with incessant devotion.

On the completion of his fifteenth year he was removed from school and apprenticed to Mr. Hammond, a surgeon at Edmonton. The terms of the old indenture as surgeon's apprentice are quaint enough. I have one of my uncle, Edward Osler, dated 1811. The surgeon, for a consideration of £40, without board, undertook the care and education for five years of the apprentices, of whom there were often four or five. The number of specific negatives in the ordinary indenture indicates the rough and ready character of the Tom Sawyers of that date. The young apprentice promised not 'to haunt taverns or playhouses, not to play at dice or cards, nor absent himself from his said master's service day or night unlawfully, but in all things as a faithful apprentice he shall behave himself

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40 BIOGRAPHICAL ESSAYS

towards his said master and all his during the said term.

We know but little of the days of Keats's apprenticeship. A brother student said, 'he was an idle, loafing fellow, always writing poetry.' In 1814, in the fourth year of his indenture, the pupil and master had a serious quarrel, and the contract was broken by mutual consent. It would appear from the following sentence in a letter to his brother, that more than words passed between them: 'I daresay you have altered also—every man does—our bodies every seven years are completely fresh material'd. Seven years ago it was not this hand that clinch'd itself against Hammond.' 1

At the end of the apprenticeship the student 'walked' one of the hospitals for a time before presenting himself at the College of Surgeons or the Apothecary's Hall. Keats went to the, at that time, United Hospitals of Guy's and St. Thomas, where he studied during the sessions of 1814 — 15 and 1815 — 16. He became a dresser at Guy's in the latter year under Mr. Lucas, and on July 25, 1816, he passed the Apothecary's Hall. The details of Keats's life as a medical student are very scanty. In after years one or two of his fellow students placed on record their impressions of him. He does not seem to have been a very brilliant student. Poetry rather than surgery was followed as a vocation; one of his fellow students says, 'all other pursuits were to his mind mean and tame.' Yet he acquired some degree of technical skill, and performed with credit the minor operations which fell to the hand of a dresser. He must have been a fairly diligent student to have obtained even the minimum qualifications of the 'Hall' before

1 The extracts are taken from the edition of the Letters by Mr. Buxton Forman. Reeves and Turner, London, 1895.

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JOHN KEATS 41

the completion of his twenty-first year. In the Biographical History of Guy's Hospital Dr. Wilks states that Sir Astley Cooper took a special interest in Keats.

What attraction could the career of an apothecary offer to a man already much 'travelled in the realms of gold', who was capable at twenty of writing such a sonnet as that on Chapman's Homer? So far as we know he never practised or made any effort to get established; and in 1817 he abandoned the profession, apparently not without opposition. In a letter to his friend Brown, dated September 23, 1819, he says, 'In no period of my life have I acted with any self-will but in throwing up the apothecary profession.'

During the next four years he led, to use his own words, 'a fitful life, here and there, no anchor.' While a student he had made friends in a literary circle, of which Leigh Hunt and Haydon, the artist, were members, and he had a number of intimates—Brown, Taylor, Bailey, Dilke, and others—among the coming men in art and science. From his letters to them, to his brother George (who had emigrated with his wife to America), and to his sister Fanny, we glean glimpses of his life at this period. His correspondence reveals, too, so far as it can, the man as he was, his aspirations, thoughts, and hopes.

 

II

The spirit of negative capability dominated these years— the capability, as he expresses it, 'of being in uncertainties, mysteries, doubts, without any irritable searching after fact and reason.' The native hue of any resolution which he may have entertained—and we shall learn that he had such—was soon sicklied o'er, and he lapsed

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into idleness so far as any remunerative work was concerned. A practical woman like Mrs. Abbey, the wife of the trustee of his mother's estate, condoned his conduct with the words 'the Keatses were ever indolent, that they would ever be so, and that it was born in them'. In a letter to his brother he uses the right word. Here is his confession:

'This morning I am in a sort of temper, indolent and supremely careless—I long after a stanza or two of Thomson's Castle of Indolence — my passions are all asleep from my having slumbered till nearly eleven and weakened the animal fibre all over me to a delightful sensation about three degrees this side of faintness. If I had teeth of pearl and the breath of lilies, I should call it languor; but as I am, especially as I have a black-eye, I must call it laziness. . . . This is the only happiness and is a rare instance of the advantage of the body overpowering the mind.'

The gospel of 'living' as against that of 'doing', which Milton preached in the celebrated sonnet on his blindness, found in Keats a warm advocate. 'Let us not, therefore,' he says, 'go hurrying about and collecting honey, bee-like buzzing here and there for a knowledge of what is not to be arrived at, but let us open our leaves like a flower, and be passive and receptive, budding patiently under the eye of Apollo, and taking truths from every noble insect that favours us with a visit.' Fatal to encourage in an active man of affairs, this dreamy state, this passive existence, favours in 'bards of passion and of mirth' the development of a fruitful mental attitude. The dreamer spins from his 'own inwards his own airy citadel'; and as the spider needs but few points of leaves and twigs from which to begin his airy circuit, so, Keats says, 'man should be content with as few points to tip with the fine web of his soul, and weave a tapestry empyrean, full of

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symbols for his spiritual eye, of softness for his spiritual touch, of space for his wanderings, of distinctness for his luxury.' All the while Keats was 'budding patiently', feeling his powers expand, and with the 'viewless wings of Poesy' taking ever larger flights. An absorption in ideals, a yearning passion for the beautiful, was, he says, his master-passion. Matthew Arnold remarks it was with him 'an intellectual and spiritual passion. It is "connected and made one" as Keats declares that in his case it was "with the ambition of the intellect ".' It is, as he again says, the 'mighty abstract Idea of Beauty in all things'. Listen to one or two striking passages from his letters: 'This morning Poetry has conquered,—I have relapsed into those abstractions which are my only life.' 'I feel more and more every day, as my imagination strengthens, that I do not live in this world alone, but in a thousand worlds. No sooner am I alone than shapes of epic greatness are stationed round me, and serve my spirit the office which is equivalent to a King's body-guard. Then "Tragedy with scepter'd pall comes sweeping by".'What the imagination seizes as beauty must be truth '—the expression in prose of his ever memorable lines,

Beauty is truth, truth beauty,—that is all
Ye know on Earth, and all ye need to know.

III

Keats's first published work, a small volume of poems issued in 1817, contained the verses written while he was a student and before he had abandoned the profession. With the exception of one or two small pieces it contained nothing of note. The sonnet on Chapman's Homer, written while he was a pupil at Guy's, was the

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most remarkable poem of the collection. In 1818 appeared Endymion, a poetic romance, an ambitious work, which, in the autumn of the year, was mercilessly 'cut up' in the Quarterly and in Blackwood. Popularly these reviews are believed to have caused Keats's early death—a belief fostered by the jaunty rime of Byron:

OLIVER WENDELL HOLMES 1

   VERY fitting indeed is it that he who had lived to be 'the last leaf upon the tree' should have fallen peacefully in the autumn which he loved so well. Delightful, too,to think that although he had, to use the expression of Benjamin Franklin, intruded himself these many years into the company of posterity, the freshness and pliancy of his mind had not for a moment failed. Like his own wonderful 'one-hoss shay', the end was a sudden breakdown; and though he would have confessed, no doubt, to 'a general flavour of decay', there was nothing local, and his friends had been spared that most distressing of all human spectacles, those cold gradations of decay, in which a man takes nearly as long to die as he does to grow up, and lives a sort of death in life, 'ita sine vita vivere, ita sine morte mori.'

Enough has been said, and doubtless well said, by those who make criticism their vocation, upon the literary position and affinities of Oliver Wendell Holmes, and I shall spare your perhaps already surcharged ears. He has been sandwiched in my affections these many years between Oliver Goldsmith and Charles Lamb. More than once he has been called, I think, the American Goldsmith. Certainly the great distinction

1 Read at the Johns Hopkins Medical Society, October 15, 1894. Those interested in the medical life of Holmes will find an excellent article on the subject by Dr. J. Mason Knox in the Johns Hopkins Hospital Bulletin, February, 1907.

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of both men lies in that robust humanity which has a smile for the foibles and a tear for the sorrows of their fellow creatures. The English Oliver, with a better schooling for a poet (had he not learned in suffering what he taught in song?), had a finer fancy and at his best a clearer note. With both writers one is at a loss to know which to love the better, the prose or the poetry. Can we name two other prose-writers of equal merit, who have so successfully courted the 'draggle-tailed Muses,' as Goldsmith calls them? Like Charles Lamb, Holmes gains the affections of his readers at the first sitting, and the genial humour, the refined wit, the pathos, the tender sensitiveness to the lights and shadows of life, give to the Breakfast Table Series much of the charm of the Essays of Elia.

While it is true that since Rabelais and Linacre no generation has lacked a physician to stand unabashed in the temple at Delos, a worshipper of worth and merit amid the votaries of Apollo, I can recall no name in the past three centuries eminent in literature—eminent, I mean, in the sense in which Goldsmith is eminent— which is associated in any enduring way with work done in the science and art of medicine. Many physicians, active practitioners—Sir Thomas Browne, for example — have been and are known for the richness and variety of their literary work; but, as a rule, those who have remained in professional life have courted the 'draggle-tailed Muses' as a gentle pastime, 'to interpose a little ease' amid the worries of practice. Few such have risen above mediocrity; fewer still have reached it. We know the names of Garth, of Arbuthnot, and of Akenside, but we neither know them nor their works. The list is a long one, for the rites

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of Apollo have always had a keen attraction for the men of our ranks, but the names fill at the best a place in the story of the literature of the country, not a place in the hearts and lives of the people. Far otherwise is it with a select group of men, Goldsmith, Crabbe and Keats, who, at the outset members of our profession, early broke away from its drudgery. In pride we claim them, though in reality no influence of their special studies is to be found in their writings. Two of these, at least, reached the pure empyrean, and to use Shelley's words, robed in dazzling immortality, sit on thrones

built beyond mortal thought,
Far in the Unapparent.

Oliver Wendell Holmes may not be placed in the same exalted sphere, but he will always occupy a unique position in the affections of medical men. Not a practitioner, he yet retained for the greater part of his active life the most intimate connexion with the profession, and as Professor of Anatomy at Harvard University kept in touch with it for nearly forty years. The festivals at Epidaurus were never neglected by him, and as the most successful combination which the world has ever seen of the physician and the man of letters, he has for years sat amid the Aesculapians in the seat of honour.

During the nineteenth century three schools in succession have moulded the thoughts and opinions of the medical profession in this country. In the early period English ways and methods prevailed, and (as in the colonial days) the students who crossed the Atlantic for further study went to Edinburgh or to London. Then came a time between 1825 and 1860 when American students went chiefly to Paris, and the pro-

BIOGRAPHICAL ESSAYS

fession of the country was strongly swayed by the teaching of the French school. Since 1860 the influence of German medicine has been all-powerful, but of late American students are beginning to learn that their 'Wanderjahre' should be truly such, and that when possible they should round out their studies in France and England.

In the thirties a very remarkable body of young Americans studied in Paris, chiefly under the great Louis—Oliver Wendell Holmes, James Jackson, Jr., Henry I. Bowditch, and George C. Shattuck, from Boston, Swett, from New York, Gerhard and Stillé, from Philadelphia, and Power, from Baltimore. They brought back to this country scientific methods of work and habits of accurate, systematic observation, and they had caught also, what was much more valuable, some of his inspiring enthusiasm. So far as I know, one alone of Louis' American pupils remains, full of years and honours—Prof. Stillé, of the University of Pennsylvania.

More than once in his writings Holmes refers to his delightful student days in France, and the valedictory lecture to his class in 1882 is largely made up of reminiscences of his old Paris teachers.

The fullness of Holmes's professional equipment is very evident in his first contributions to medicine. In the years 1836 and 1837 we find him successfully competing for the Boylston prizes, with essays on Intermittent Fever in New England, on Neuralgia, and on the Utility and Improvement of Direct Exploration in Medical Practice. Of these the essay on intermittent fever is in many ways the most important, since it contains a very thorough review of the testimony of the early New England writers on the subject, for

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which purpose he made a careful and thorough examination of the records of the first century of the settlements. Here and there throughout the essay there is evidence of his irrepressible humour. Referring to the old writers, he says, that because indexes are sometimes imperfect, he has looked over all the works page by page, with the exception of some few ecclesiastical papers, sermons and similar treatises of Cotton Mather, 'which, being more likely to cause a fever than to mention one, I left to some future investigator.' The essay shows great industry, and is of value to-day in showing the localities in which malaria prevailed in the early part of the nineteenth century, and at the time at which he wrote. The essay on neuralgia is not so interesting, but it is an exhaustive summary of the knowledge of the disease in the year 1836. The third dissertation, on direct exploration, of much greater merit, is a plea for the more extended use of auscultation and percussion in exact diagnosis. The slowness with which these two great advances were adopted by our fathers contrasts in a striking manner with the readiness with which at the present day we take up with new improvements and appliances. Auenbrugger's work on percussion dates from 1761, but it was not until the beginning of the century that the art of percussion was revived by Corvisart and Laennec; while Piorry, as Holmes says, succeeded in creating himself a European reputation by a slight but useful modification in the art; referring to his pleximeter, of which in another place he says that Piorry 'makes a graven image'. The great discoveries of Laennec made their way very slowly to general adoption, and to this Holmes refers when he says, 'it is perfectly natural that they (speaking of the older practitioners) should look with suspicion upon this introduction of

60 BIOGRAPHICAL ESSAYS

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medical machinery among the old, hard-working operatives; that they should for a while smile at its pretensions, and when its use began to creep in among them, that they should observe and signalize all the errors and defects which happened in its practical application.'

Gerhard's work on the diagnosis of diseases of the chest was published in 1836, and with this essay of Holmes's opened to the American profession the rich experience of the French school in the methods of direct exploration in all disorders of the chest and of the heart. The essay may be read to-day by the student with great profit; it is particularly rich in original references to the older writers. Readers of the Autocrat and of others of Holmes's literary works have been surprised at the readiness with which he quotes and refers to the fathers of the profession, a facility readily explained by these Boylston prize dissertations; and in their preparation he had evidently studied not only the modern authors of the day, but had read in the original the great masters from Hippocrates to Harvey.

The prize essay does not constitute the most enduring form of medical literature, and though the dissertation on Malaria is in some respects one of the very best of the long series of Boylston essays, yet we could scarcely have spoken of a medical reputation for Dr. Holmes had it to rest upon these earlier productions. A few years later, however, he contributed an article which will long keep his memory green in our ranks.

Child-bed fever was unhappily no new disorder when Oliver Wendell Holmes studied, nor had there been wanting men who had proclaimed forcibly its specific character and its highly contagious nature. Indeed, so far back as1795, Gordon, of Aberdeen, not only

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called it a specific contagion, but said he could predict with unerring accuracy the very doctors and nurses in whose practice the cases would develop. Rigby, too, had lent the weight of his authority in favour of the contagiousness, but the question was so far from settled that, as you will hear, many of the leading teachers scouted the idea that doctors and nurses could convey the disorder. Semmelweis had not then begun to make his interesting and conclusive observations, for which his memory has recently been so greatly honoured.

In 1843, before the Boston Society for Medical Improvement, Dr. Holmes read a paper entitled 'The Contagiousness of Puerperal Fever', in which he brought forward a long array of facts in support of the view that the disease was contagious, conveyed usually by the doctor or the nurse, and due to a specific infection. At the time there certainly was not an article in which the subject was presented in so logical and so convincing manner. As Sidney Smith says, it is not the man who first says a thing, but it is he who says it so long, so loudly, and so clearly that he compels men to hear him—it is to him that the credit belongs; and so far as this country is concerned, the credit of insisting upon the great practical truth of the contagiousness of puerperal fever belongs to Dr. Holmes. The essay is characterized in places by great strength of feeling. He says he could not for a moment consent to make a question of the momentous fact, which should not be considered a subject for trivial discussion, but should be acted upon with silent promptitude. 'No negative facts, no passing opinions, be they what they may or whose they may, can form any answer to the series of cases now within the

62 BIOGRAPHICAL ESSAYS

reach of all who choose to explore the records of medical science.' Just before the conclusions the following eloquent paragraphs are found, portions of which are often quoted:

'It is as a lesson rather than as a reproach that I call up the memory of these irreparable errors and wrongs. No tongue can tell the heart-breaking calamities they have caused; they have closed the eyes just opened upon a new world of life and happiness; they have bowed the strength of manhood into the dust; they have cast the helplessness of infancy into the stranger's arms, or bequeathed it with less cruelty the death of its dying parent. There is no tone deep enough for record, and no voice loud enough for warning. The woman about to become a mother, or with her new-born infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden, or stretches her aching limbs. The very outcast of the street has pity upon her sister in degradation when the seal of promised maternity is impressed upon her. The remorseless vengeance of the law brought down upon its victims by a machinery as sure as destiny, is arrested in its fall at a word which reveals her transient claims for mercy. The solemn prayer of the liturgy singles out her sorrows from the multiplied trials of life, to plead for her in the hour of peril. God forbid that any member of the profession to which she trusts her life, doubly precious at that eventful period, should regard it negligently, unadvisedly, or selfishly.'

The results of his studies are summed up in a series of eight conclusions, and the strong ground which he took may be gathered from this sentence in the last one: 'The time has come when the existence of a private pestilence in the sphere of a single physician should be looked upon not as a misfortune but a crime.' Fortunately this essay, which was published in the ephemeral New England Quarterly Journal of Medicine, was not destined to remain unnoticed. The statements

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were too bold and the whole tone too resolute not to arouse the antagonism of those whose teachings had been for years diametrically opposed to the contagiousness of puerperal fever. Philadelphia was the centre of the teaching and work in obstetrics in this country, and if we can speak at all of an American school of obstetricians it is due to the energy of the professors of this branch in that city, and for the sake of the memory of the men we could wish expunged the incident to which I will now allude.

In 1852 the elder Hodge, Professor of Obstetrics at the University of Pennsylvania, published an essay on the non-contagious character of puerperal fever, and in 1854 Charles D. Meigs, Professor of Obstetrics at the Jefferson Medical College, published a work on the nature, signs, and treatment of child-bed fevers, in a series of letters addressed to students of his class. Both of these men, the most distinguished professors of obstetrics in America, took extreme ground against Holmes, and Meigs handled him rather roughly.

Nothing daunted, in the following year (1855) Holmes reprinted the essay, calling it Puerperal Fever as a Private Pestilence. He clearly appreciated the character of the work he was doing, since in the introduction he says, 'I do not know that I shall ever again have so good an opportunity of being useful as was granted to me by the raising of the question which produced this essay.' The point at issue is squarely put in a few paragraphs on one of the first pages; the affirmative in a quotation from his essay: 'The disease known as puerperal fever is so far contagious as to be carried from patient to patient by physicians and nurses' (1843). The negative in two quotations, one from Hodge (1852), who 'begged his students to divest their minds of the

64 BIOGRAPHICAL ESSAYS

dread that they could ever carry the horrible virus'; and of Meigs (1854), who says, 'I prefer to attribute them (namely, the deaths) to accident or Providence, of which I can form a conception, rather than to a contagion of which I cannot form any clear idea.'

The introduction to the essay, which was reprinted as it appeared in 1843, is one of the ablest and most trenchant pieces of writing with which I am acquainted. There are several striking paragraphs; thus, in alluding to the strong and personal language used by Meigs, Holmes says: 'I take no offence and attempt no retort; no man makes a quarrel with me over the counterpane that covers a mother with her new-born infant at her breast.' He appeals to the medical student not to be deceived by the statements of the two distinguished professors, which seem to him to encourage professional homicide. One paragraph has become classical: 'They naturally have faith in their instructors, turning to them for truth, and taking what they may choose to give them; babies in knowledge, not yet able to tell the breast from the bottle, pumping away for the milk of truth at all that offers, were it nothing better than a professor's shrivelled forefinger.'

The high estimate in which this work of Holmes's is held has frequently been referred to by writers on obstetrics.

Some years ago in an editorial note I commented upon a question which Dr. Holmes had asked in his Hundred Days in Europe. Somewhere at dinner he had sat next to a successful gynaecologist who had saved some hundreds of lives by his operations, and he asked, 'Which would give the most satisfaction to a thoroughly humane and unselfish being, of cultivated intelligence and lively sensibilities: to have written all

OLIVER WENDELL HOLMES

the plays which Shakespeare has left as an inheritance for mankind, or to have snatched from the jaws of death more than a hundred fellow-creatures, and restored them to sound and comfortable existence?' I remarked that there was nobody who could answer this question so satisfactorily as the Autocrat, and asked from which he derived the greater satisfaction, the Essay on Puerperal Fever which had probably saved many more lives than any individual gynaecologist, or the Chambered Nautilus, which had given pleasure to so many thousands. The journal reached Dr. Holmes, and I read you his reply to me, under date of January 21, 1889:

'I have rarely been more pleased than by your allusion to an old paper of mine. There was a time certainly in which I would have said that the best page of my record was that in which I had fought my battle for the poor poisoned women. I am reminded of that essay from time to time, but it was published in a periodical which died after one year's life, and therefore escaped the wider notice it would have found if printed in the American Journal of the Medical Sciences. A lecturer at one of the great London hospitals referred to it the other day and coupled it with some finer phrases about myself which made me blush, either with modesty or vanity, I forget which.

'I think I will not answer the question you put me. I think oftenest of the Chambered Nautilus, which is a favourite poem of mine, though I wrote it myself. The essay only comes up at long intervals. The poem repeats itself in my memory, and is very often spoken of by my correspondents in terms of more than ordinary praise. I had a savage pleasure, I confess, in handling those two professors -- learned men both of them, skilful experts, but babies, as it seemed to me, in their capacity of reasoning and arguing. But in writing the poem I was filled with a better feeling -- the highest state of mental exaltation and the most crystalline clairvoyance, as it seemed to me, that had ever been granted to me -- I mean that lucid vision of one's thought and all forms of expression which will be at once precise and musical,

OSLER F

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which is the poet's special gift, however large or small in amount or value. There is more selfish pleasure to be had out of the poem—perhaps a nobler satisfaction from the life-saving labour.'

Last year at the dinner of the American Gynaecological Society in Philadelphia a letter from Dr. Holmes was read referring to the subject in very much the same language as he uses in his letter to me. One or two of the paragraphs I may quote.

'Still I was attacked in my stronghold by the two leading professors of obstetrics in this country.

'I defended my position, with new facts and arguments, and not without rhetorical fervour, at which, after cooling down for half a century, I might smile if I did not remember how intensely and with what good reason my feelings were kindled into the heated atmosphere of superlatives.

'I have been long out of the way of discussing this class of subjects. Ido not know what others have done since my efforts; I do know that others had cried out with all their might against the terrible evil, before I did, and I gave them full credit for it.

'But I think I shrieked my warning louder and longer than any of them, and I am pleased to remember that I took my ground on the existing evidence before the little army of microbes was marched up to support my position.'

Fortunately, Dr. Holmes's medical essays are reprinted with his works. Several of them are enduring contributions to the questions with which they deal; all should be read carefully by every student of medicine. The essay on Homeopathy remains one of the most complete exposures of that therapeutic fad. There is no healthier or more stimulating writer to students and to young medical men. With an entire absence of nonsense, with rare humour and unfailing kindness, and with that delicacy of feeling characteristic

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of a member of the Brahmin class, he has permanently enriched the literature of the race.

Search the ranks of authors since Elia, whom in so many ways Holmes resembled, and to no one else could the beautiful tribute of Landor be transferred with the same sense of propriety:

JOHN LOCKE

AS A PHYSICIAN¹

AMONG the great men of the seventeenth century not one has more enduring claims to our grateful remembrance than John Locke—philosopher, philanthropist, and physician. As a philosopher his praise is in the colleges. As the apostle of common sense he may be ranked with Socrates and a few others who have brought philosophy from the clouds to the working-day world. Of his special virtues and qualifications as the typical English philosopher nothing need be said, but were there time I would fain dwell upon his character as a philanthropist—in the truest sense of the word. The author of the Epistle on Toleration, the Treatise on Education, and the Constitution of Carolina, the man who pleaded for 'absolute Liberty, just and true Liberty, equal and impartial Liberty', the man who wrote, the memorable words, 'All men are naturally in a state of freedom, also of equality,' must be ranked as one of the great benefactors of the race.

With the faculty Locke's connexion has usually been described as 'loose and uncertain'. Indeed, we knew him chiefly as a friend of Sydenham. Until the appearance of Fox-Bourne's Life it had not been recognized that he was at times an active practitioner, and that

1 Read to the Students' Societies of the Medical Department of the University of Pennsylvania, January 16, 1900. Reprinted from The Lancet, October 20, 1900.

JOHN LOCKE 69

throughout the greater part of his long life he was ready to treat cases and to give advice; still less was it known that he was a writer of medical essays, and that he had left a large body of clinical reports and papers. I had become familiar with his professional relations through John Brown's essay, Locke and Sydenham, and many additional details are given in the Life just referred to, but for the more important facts I have made a careful study of the Locke MSS. in the British Museum and in the Record Office.

I. LIFE.

Let me first give a brief summary of Locke's life. He was born in the county of Somerset in 1632, the son of an attorney who at the outbreak of the civil war joined the Parliamentary side. Of his boyhood and early education but little are known. In 1646 he entered Westminster School under the famous Dr. Busby, where he had as fellow students Richard Lower, Walter Needham, and John Mapletoft, who subsequently became well-known physicians. In 1652 he entered Christ Church, Oxford, and received his B.A. degree in 1655 and the M.A. in 1658. In the following year he became senior student or Fellow of Christ Church, in 1660 Lecturer on Greek, and in 1662 Lecturer on Rhetoric. In 1665 he served as secretary to the embassy of Sir Walter Vane to the Elector of Brandenburg. Until 1660 a student of classics and rhetoric, Locke appears to have been at a loss to know exactly what calling to follow. Thoroughly disgusted, he had broken with the old scholastic philosophy and, imbued with the new learning of Bacon and Descartes, felt what Donne calls 'the sacred hunger of science'. But what probably turned his attention most

70 BIOGRAPHICAL ESSAYS

actively to medicine was the presence in Oxford of the celebrated Robert Boyle, who with his associates had formed a scientific club, the 'invisible college', which became the nucleus of the Royal Society. Letters of this period show Locke to have been busy with experimental physics, working at problems suggested by Boyle, taking daily notes on the weather (a practice which he kept up for many years), and gradually becoming well versed in the sciences cognate to medicine. Unfortunately we have very little information as to the character of his medical studies, which seem, however, to have been of a rather desultory nature, as he did not comply with the very easy requirements for the degree. On these Fox-Bourne makes the following comment: 'All that was expected from an applicant for a bachelor-ship in physic was regular attendance during three years at the lectures of the Arabic professor and of the professors of anatomy and medicine, together with participation in a certain number of disputations in the medical school, and after that little more than a delay of four years was necessary to qualify him for the doctorship. The medicine lectures, delivered every Tuesday and Friday morning during term, were limited to an exposition of the teaching of Hippocrates and Galen. For anatomy, the students had in the spring to attend the dissecting of one human body and to hear four lectures, each two hours long, upon it, and in the autumn to hear three lectures on the human skeleton.' These requirements, however, were not complied with, and in November, 1666, he attempted to have a dispensation so that he could obtain the doctorship without previously becoming a bachelor. The request of Lord Clarendon, however, was not heeded, owing probably to the fact that Locke belonged to the Puritan party.

JOHN LOCKE 71

During these years he seems to have been intimately associated with Dr. David Thomas, at that time a practitioner at Oxford. He writes to Boyle in February, 1666—7: 'Mr. Thomas presents his humble service to you. He and I are now upon a new sort of chemistry; that is, extracting money out of the scholars' pockets, and if we can do that, you need not fear but that in time we shall have the lapis, for he that can get gold and silver out of scholars cannot doubt to extract it anywhere else.' Though political influence was unavailing to procure the doctor's degree without complying with the regulations, it was potent enough to secure him in his senior studentship at Christ Church, a position usually held only by persons in holy orders, and this post, with the salary attached to it, Locke enjoyed till his expulsion in 1684.

Locke did not receive the bachelorship of medicine until 1674, in which year he was appointed to one of the two medical studentships at Christ Church, and it was supposed by his friends that this was a step preliminary to taking the doctor's degree, but to this he never proceeded. In 1666, when acting as an assistant to Dr. Thomas, Lord Ashley, afterwards the first Earl of Shaftesbury, the celebrated Achitophel of Dryden's satire, came to Oxford to drink the waters of the Astrop wells. He was the subject of a remarkable malady of which I shall subsequently give a detailed account. Dr. Thomas, to whom he had written to have the waters ready for him, was away but had left word with Locke to get them, and as there was some trouble and delay Locke called on Lord Ashley to apologize. There was a mutual attraction and from this acquaintance began a friendship between the two men which had important results, as in the following year we find

72 BIOGRAPHICAL ESSAYS

Locke installed at Exeter House, the London residence of Lord Ashley, as physician and literary factotum.

From this date until 1675 Locke lived in Lord Ashley's family, occupying himself in all sorts of miscellaneous duties, some domestic, as finding young Anthony Ashley a wife, whom he subsequently attended on several interesting occasions. One duty which interests us in America very much is the share which he took in the Carolina colony. As secretary to the Lords Proprietors he was appointed one of the Land-graves and wrote, it is supposed, the celebrated Fundamental Constitutions of the Government of Carolina, the original draft of which, in his handwriting, with many alterations and erasures, may be seen in the Record Office. The celebrated clause, 'No person whatsoever shall disturb, molest, or prosecute 'another for his speculative opinions in religion or his way of worship,' expresses the spirit of toleration for which Locke strove all through his life. Subsequently, after Lord Ashley was created Earl of Shaftesbury, Locke became Secretary of Presentations. During all this period he was deeply interested in medicine, and was in intimate association with Sydenham, Mapletoft, and other well-known physicians of the day, though it was not until 1674 that he took his M.B. at Oxford. About this time he began to suffer much in health, and in 1675 went to France, where he remained, chiefly at Montpellier and Paris, for four years. His journals during this period, which are very full, indicate his continued interest in the profession, though, as he writes to Mapletoft, 'My health, which you are so kind to in your wishes, is the only mistress I have a long time courted, and is so coy a one that it will take up the remainder of my days to obtain her good graces and keep her in good humour.

JOHN LOCKE 73

She hath of late been very wayward, but I hope is coming about again.' In another letter he says:

'For I doubt whether all the ortolans in France be able to communicate to me one grain of their fat, and I shall be well enough at my ease if, when I return, I can but maintain this poor tenement of mine in the same repair it is at present, without hope ever to find it much better. For I expect not that Dr. Time should be half so favourable to my crazy body as it has been to you in your late disease. 'Tis a good mark, but may have other dangers in it; for usually those whom that old winged gentleman helps up the hill are not yet got out of the reach of the winged boy who does such mischief with his bow and arrows.'

From 1679 to 1684 Locke was again with Lord Shaftesbury, busily occupied in public business, though still maintaining an intimate association with Sydenham and his medical friends. After Lord Shaftesbury's death Locke himself fell under suspicion of having taken part in schemes against the Crown, and from 1683 to 1689 found it safer to live in retirement in Holland. In 1684, by the peremptory order of the king, he was dismissed from his studentship in Christ Church. At the Revolution he returned to London and became actively engaged in literary and political work. Failing health compelled his retirement to Oates, in the neighbourhood of London, where, with Lady Masham and her daughter, he found a delightful home. He died quietly in 1704.

No member of our profession of any age or any country has made so many important contributions to philosophy and practical politics as Dr. Locke. Professor Fowler remarks that the views published in his treatises on Government, Religion, Toleration, Education, and Finance form new points of departure with which no writer on the history of these subjects can

74 BIOGRAPHICAL ESSAYS

dispense. The same writer says of the effect of his writings on the history of progress and civilization:

'In an age of excitement and prejudice he set men the example of thinking calmly and clearly. When philosophy was almost synonymous with the arid discussion of scholastic subtleties he wrote so as to interest statesmen and men of the world. At a time when the chains of dogma were far tighter and the penalties of attempting to loosen them far more stringent than it is now easy to conceive he raised questions which stirred the very depths of human thought. And all this he did in a spirit so candid, so tolerant, so liberal, and so unselfish, that he seemed to be writing, not for his own party or his own times, but for the future of knowledge and of mankind.'

 

II. LOCKE AND SYDENHAM

The story of the friendship of these two great men has been told in a delightful way by the late Dr. John Brown, but he knew nothing of the Shaftesbury papers or of several other important manuscripts which have come to light since his essay was published. Sydenham, eight years Locke's senior, had taken the M.B. of Oxford in 1648, four years before Locke entered Christ Church. There is no evidence to indicate that these well-paired friends, as Fox-Bourne calls them, had met before Locke went to London with Lord Ashley in 1667. In the following year we find them practising together, Locke accompanying Sydenham on his rounds and much interested in the new plan of treating smallpox. In 1668 Sydenham wrote to Boyle: 'I perceive my friend Mr. Locke hath troubled you with an account of my practice as he hath done himself in visiting with me very many of my variolous patients especially.' But the best evidence of Locke's practice at this time and of his intimacy with Sydenham is found in his own

JOHN LOCKE 75

handwriting in the British Museum in a bundle of original medical papers presented by William Seward. They consist of seventeen small quarto pages, closely written, containing the reports of interesting cases which have been well summarized as follows by Fox-Bourne:

'He was attending a kitchen-maid of the Ashley household who was afflicted with dropsy in September, 1667, and again in January, February, and March, 1667-8, and May and June, 1668. In April and May he prescribed for a hard cough with which one of his cousins, a boy of fourteen, and the son of his uncle, Peter Locke, was troubled, and he cured one young child of inflammatory fever in June and another of hysterics in November of the same year. He visited a "sturdy youth" laid up with rheumatism, every day between August 28th and September 1 ₉th, when he left him to continue using the medicine he had prescribed for him, and on March 1st, 1668—9, he was able to declare him convalescent. In the same March he treated a girl for fever, besides prescribing for two or three minor maladies; and in May, 1669, he cured a case of angina pectoris. We have no record of any other medical work done by him in 1669; but he had cases of erysipelas and gonorrhoea to deal with in January, 1669-70; one of quartan ague in March, another malady, morbilli, with which William Sydenham, apparently the son of his great friend, was afflicted, in the same month; two of dropsy in April and May, 1670; one of inflammatory fever which he treated nearly every day from the 26th of June till sits fatal issue on the 11th of July; a case of disease of the kidneys, and another of stricture, in July; one of colic in August, and one of fever which occupied him every day from the 1₉th of August till the 2nd of September, when the patient died.'

The case which Fox-Bourne refers to as angina pectons may have been of this nature, though the disease was not recognized for a little more than a century later. The phrase is 'suffocationem patiebatur et angostiam pectoris et circumcollum.' The report on the son of Sydenham, a lad, aged 11 years, who had measles,

76 BIOGRAPHICAL ESSAYS

is very complete. The case seems to have been a very characteristic one: onset with cough, a chill and fever, and with slight running at the nose. On the fifth and sixth days a very abundant rash appeared on the face first, then spread over the whole body. Quite minute details are given—-the state of the tongue, the state of the rash, and the condition of the eyes. By the ninth and tenth days the rash had disappeared. The notes are continued until the thirteenth day. Then follows a series of interrogations as to points in the case.

Evidence of their friendship exists in the comments and annotations which Sydenham has made in his own hand on some of Locke's writings, and the great interest which Locke took in those of Sydenham. In the second edition of Sydenham's Methodus Curandi Febres there is inserted after the preface a Latin poem of fifty-four lines, signed, 'J. Locke.' It was Sydenham's purpose at a later date to write a separate work on smallpox, and for this Locke prepared in 1670 a dedication and a preface, neither of which was used. They will be referred to later. Letters written by Locke during his long residence in France contain frequent references to Sydenham and frequent inquiries after his health; particularly the letters to Mapletoft, who was a common friend. He also consulted Sydenham about Lady Northumberland's illness. It was probably before leaving England that Sydenham gave Locke the advice in a letter, the original of which is in the Record Office.

'Sydenham to Locke.—Your age, ill habitt of body and approach of winter concurring,it comes to pass that the distemper you com plaine of yealds not so soone to remedies as it would do under contrary circumstances. However, you may not in the least doubt but that a steddy persisting in the use of the following direc

JOHN LOCKE 77

tions (grounded not on opinion but uninterrupted experience) will at last effect your desired cure. First, therefore, in order to the directing and subdueing also the ichorose matter 'twill be requisite to take your pills twice a weeke or for example every Thursday and Sunday about 4 o'clock in the morning and your clyster the intermitting days about 6, constantly till you are well. In the next place, forasmuch as there is wanting in bodyes broken with business and dispirited upon the before-mentioned accounts, that stock of naturell heat which should bring the matter quickly to digestion 'twill be highly necessary that you cherish yourself as much as possibly you can by going to bed very early at night, even at 8 o'clock, which next to keeping bed that is impracticable will contributt more to your reliefe than can be imagined. As to diett all meals of easy digestion and that nourish well may be allowed, provided they be not salt, sweet or spiced and altho excepting fruits, roots and such like. For wine a total forbearance thereof if it could possibly be and in its steede the use of very mild small beere, such as our lesser houses do afford, would as near as I could guess be most expedient, for thereby your body would be kept cool, and consequently all accidents proceeding from hot and strange humors grating upon the part kept off. As to injections, in your case these things dissuade the use of them—First, your more than ordinary bothe naturall tenderness and delicacy of sense. Then the blood that has twice already bin fetched by this operation, which if we are not positively certaine (as how can we be) that it proceeded not from the hurt of the instrument will (if often repeted) endanger the excoriating the part and making it liable to accidents. Besides they have bin already used (perhaps as often as is wont to be don) and this is not a remedy to be long persisted in by the confession of everybody. Sure I am as I have over and over sayd to you and you know it to be true by my written observations which you have long since seen, that I never use any where I am concerned alone, there being noe danger nor less certainty of a cure in the omitting and in relation to this business I have now asked myselfe the question that I would doe and have resolved that I would lett them alone.

'This is all that I have to offer to you and I have to

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thought of it all circumstances relating to your case, with the same intention of mind as if my life and my sons were concerned therein.

'Notwithstanding that by this way the cure is certainly to be effected, yet nevertheless I fear that in ancient bodyes, especially in the debilitating part of the year, some little kinde of gleeting or moisture (but voide of all malignity) will now and then appear by reason of the weakness of the part and will scarce totally vanish till the return of the warm spring.'

Sydenham's chief merit is that he taught the profession to return to Hippocratic methods of careful observation and study. He and Locke were kindred spirits in their manner of looking at the phenomena of disease, and in their methods of work. Nothing could be more like Sydenham's plan than that which Locke urges upon his friend Dr. Molyneux:

'I perfectly agree with you concerning general theories—the curse of the time, and destructive not less of life than of science—they are for the most part but a sort of waking dream, with which, when men have warmed their heads, they pass into unquestionable truths. This is beginning at the wrong end, men laying the foundation in their own fancies, and then suiting the phenomena of diseases, and the cure of them, to these fancies. I wonder, after the pattern Dr. Sydenham has set of a better way, men should return again to this romance-way of physic. But I see it is more easy and more natural for men to build castles in the air of their own than to survey well those that are on the ground. Nicely to observe the history of diseases in all their changes and circumstances is a work of time, accurateness, attention, and judgement, and wherein if men, through prepossession or obstinacy, mistake, they may be convinced of their error by unerring nature and matter of fact. What we know of the works of nature, especially in the constitution of health and the operations of our own bodies, is only by the sensible effects, but not by any certainty we can have, of the tools she uses, or the ways she works by.

JOHN LOCKE 79

In another place he makes use of an apt illustration, saying: 'Whether a certain course in public or private affairs will succeed well—whether rhubarb will purge or quinquina cure an ague can be known only by experience.' Locke in one place gives an excellent estimate of Sydenham (vol. ii, p. 343, Fox-Bourne): 'I hope the age has many who will follow his example, and by the way of accurate practical observation which he has so happily begun, enlarge the history of diseases and improve the art of physic, and not by speculative hypotheses fill the world with useless though pleasing visions.

Locke's personal intercourse with Sydenham came to an end in 1683, and Sydenham's death in 1689 terminated a friendship of twenty years which, as Fox-Bourne remarks, 'If it may have done much towards inclining the greatest of English philosophers to pursue his early studies in physic, cannot but have also had a considerable effect in quickening the philosophical temper of the greatest of English physicians.' With Boyle, also, Locke's relations seem to have been very intimate from the days when at Oxford he was a member of the 'invisible college'. Boyle was intensely interested in medicine, and was perhaps the best amateur student the profession has ever had. There is no work from which one can gain a better idea of the state of medicine about the middle of the seventeenth century than the Experimental Philosophy, the second part of which is a review of the state of medicine with many suggestions for its improvement. In 1683 Boyle dedicated his Memoirs for the Natural History of the Human Blood to 'the very ingenious and learned Dr. J. L.', at whose request he had undertaken the work.

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III. LOCKE'S MEDICAL REMAINS

Locke's medical remains consist of (1) the record of certain remarkable and historic cases; (2) a group of medical essays; and (3) certain journals and commonplace books which contain memoranda and notes of cases.   1. Of the notable medical cases two deserve full consideration, the hydatids of the liver in Lord Shaftesbury, and tic douloureux in Lady Northumberland.

Lord Shaftesbury's case.—The case of suppurating hydatid cyst of the liver is given with unusual fullness and accuracy. I do not remember in seventeenth-century literature a more accurately reported case. It is one of the first instances of operation on hydatid cyst; the consultation on draining of the abscess and the discussion on the propriety of wearing the silver tube give us a unique symposium of medical opinion among the leading consultants of the day, and, lastly, Shaftesbury's tap—as the silver tube was called—has an interest in the satirical literature of the day. No single circumstance better illustrates John Locke as a physician than the elaborate details which he has left on record of his most celebrated patient, the first Lord Shaftesbury. This remarkable man is satirized by Dryden in the well-known lines:--

Of these the false Achitophel was first;
A name to all succeeding ages curst:
For close designs and crooked counsels fit;
Sagacious, bold, and turbulent of wit;
Restless, unfix'd in principles and place;
In power unpleas'd, impatient of disgrace:
A fiery soul, which, working out its way,
Fretted the pigmy body to decay,
And o'er-inform'd the tenement of clay.

Fox-Bourne, commenting on the physical description

JOHN LOCKE

of Lord Shaftesbury given by Dryden as a 'pigmy body', states that this must have been used by poetic licence, as 'he was reckoned a handsome man in his day'.

In the fragment of an autobiography1 there is an account of remarkable attacks of abdominal pain when Shaftesbury was only eighteen years of age. 'At the hunting I was taken with one of my usual fits, which for divers years had hardly missed me one day, which lasted for an hour, betwixt eleven and one, sometimes beginning earlier and sometimes later betwixt those times. It was a violent pain of my left side, that I was often forced to lie down wherever I was; at last it forced a working in my stomach, and I put up some spoonfuls of clear water,and I was well, if I may call that so when I was never without a dull aching pain of that side. Yet this never abated the cheerfulness of my temper; but, when in the greatest fits, I hated pitying and loved merry company, and, as they told me, was myself very pleasant when the drops fell from my face for pain; but then, my servant near me always desired they would not take notice of it, but continue their diversions, which was more acceptable to me; and I had always the women and young people about me at those times, who thought me acceptable to them, and peradventure the more admired me because they saw the visible symptoms of my pain, which caused in all others so contrary an effect.'

Though the special malady which brought Locke and Shaftesbury into the relations of physician and patient has an extraordinarily full history, the statements with

1Memoirs, Letters, and Speeches of Anthony Ashley Cooper, First Earl of Shaftesbury, Lord Chancellor. Edited by W. D. Christie, 1859, p. 32.

OSLER G

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reference to it in the authorities are somewhat meagre. Fox-Bourne says (Life, vol. i, p. 197):

'But it would seem that Lord Ashley being himself in bad health and suffering from a malady that no physician could explain, and that was every day becoming more painful.., and having, moreover, formed a very high opinion of the mental and moral worth of his new friend—persuaded Locke to reside with him as physician to his family.'

Then, again (vol. i, p. 200):

'The internal malady from which Lord Ashley had been suffering ever since 1661, and which had been the accidental ground of his acquaintance with Locke in 1666, now caused him great agony, and in spite of all Locke's efforts to alleviate it by medicinal treatment, threatened to kill him. "My Lord Ashley is like to die," wrote Pepys on the 1₉th of June, 1668, "having some imposthume in his breast, that he hath been fain to cut into his body." That operation was performed, and Ashley's life was saved, by Locke.'

It is often referred to as an abscess of the side or as an empyema and is spoken of as following an accident.

In the Record Office there are four transcripts of the case in Locke's handwriting. The most complete is in Latin, of which the following is a translation:--

'The case of the most Noble Lord Anthony Ashley, Baron of Winburne, St. Giles, & c.—This most noble lord, aged 45, of very slight build and delicate constitution, had been an invalid for many years, and was exceedingly subject, upon the slightest cause, to a recurrent yellow jaundice. There was a painless internal tumour, broad, and slightly projecting, about the anterior region of the liver, and his hypochondria was very apparent to the touch. Although it had been observed 12 years before, the exact time when the tumour first began is uncertain. For since the colour of the skin was unchanged and no swelling was apparent externally, unless the hand were applied it easily escaped the eye; nor through the whole 12 years did it seem to change in the least. The doctors called into con-

JOHN LOCKE 83

sultation on this point, amongst whom were some from the excellent London college, were inclined to the opinion that this firm and unchanging extuberance was not a morbid tumour, but rather some congenital and unusual malformation of the liver. However the patient himself suspects, not without reason, that the tumour first came into existence in the year 1656, especially as at that time... he used to fatigue himself overmuch. By too frequent over-exercise his blood became so heated that his skin would immediately be suffused with a deep redness, and his whole body seemed to be inflamed, all which gave rise to a burning fever. From this time on he was conscious of a complete change in the general condition of his body. Whereas before he was troubled more frequently with pains in the left side, and other splenic symptoms, from now on he escaped absolutely free from these troubles, and in their place acquired a constitution prone to other disorders, and especially susceptible to morbus regius1. From the prolonged languor brought on by this disease, when his emaciated body and impaired strength would threaten death, he was frequently restored by the timely use of acidulae, by means of which he obtained relief for one or two years, and was carried through so many vicissitudes of health, scarcely escaping with his life, until last summer. Then, happily, an internal abscess at last broke out, bringing to a head the source of so many disorders. There is one thing here which I cannot pass by, and that is that the patient's head never once ached though more than fatigued by disease. This, however, is not the only marvel displayed by that head.

'During a bad night about the end of May, 1668, he was suddenly seized with excessive vomiting, accompanied by much disturbance. Everything he had eaten in the preceding meal was rejected, still raw and undigested, in repeated vomitings. He was purged next day by Dr. Glisson, the learned physician-in-ordinary. On the following morning he appeared discoloured a rusty red, which the physician tried to remedy with suitable drugs. But although the face seemed to return a little to its proper appearance, so

1 Jaundice.

G2

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that he could go about the ordinary duties of life, nevertheless, the languor and loss of appetite returned, anti-icterics and chalybeates being administered in vain. Moreover, about the beginning of June, since all the symptoms were running from bad to worse, the physician prescribed a purging pill to be taken at bedtime. When the patient raised himself up in bed to pass his urine about midnight he was suddenly seized about the region of the stomach and liver with a most acute pain which lasted the greater part of an hour and was finally relieved by resting comfortably in bed. When after an hour or two he again sat up in bed the same excruciating pain returned. Again one hour afterwards he got up, and in the same way when he raised himself upon his buttocks the pain attacked him for the third time, and after a like interval left him. Next morning at 8 o'clock, shortly after taking a purging potion he vomited it up mixed with viscid phlegm. After a while he left his bed, his servants taking him in their arms and placing him upright on his feet, so that his body should nowhere be bent. The cathartic had a satisfactory effect and he was purged. However, though he turned his body, he did not dare bend it, lest the severe pain should come on again. In the evening he began to suffer most acute pain in the back about the loins. This ceased after a quarter of an hour, and at the same there suddenly sprung up below the ensiform cartilage a soft tumour the size of an ostrich egg. It was yielding to the touch, but on being compressed it did not for a moment retain any traces of the fingers. The skin was a brown (?) colour. There was hardly any pain, and no inflammation. This tumour could not be broken up by the drugs which were administered for six or seven days. Then physicians and surgeons were called into consultation and on June 12th it was opened by the application of cautery. This fact is worthy of observation: before the opening of the tumour a somewhat tenacious and flexible plaster fastened itself so firmly to the skin at the border of the tumour that it could not be torn away without leaving behind a large part of its substance; while, on the other hand, the top of the tumour, about the width of an English half-crown or more, was not even discoloured by it, nor was the plaster at all adherent in that part.'

JOHN LOCKE 85

The daily record of the case is in English.

'The 12th of June, 1668, in ye morning a caustick was applied and ye same opened in ye afternoon, at wh. dressing besides a large quantity of purulent matter, many bags and skins came away. The like hapned the next day (being Saturday) both in ye fore and afternoon. On Sunday morning (being ye 14th) at ye first drawing out ye tent, a great quantity of yellow choler gushed out and two or three sluffs, wth some tollerable matter at ye latter end, for ye evening only a little matter came forth. And ye like on Monday both morning and evening.

'On Tuesday morning a great quantity of matter came forth, with many bags to ye number of at least 8o, for ye afternoon little or nothing, and so also on Wednesday.

'On Thursday morning we had a new flux, both of matter and skin, in ye afternoon nothing considerable.

'A Friday a wax candle was put deep into ye abscesse, and after ye drawing it out some matter and divers sluffs proceeded, in ye afternoon nothing.

'20. On Saturday morning and eveninge some matter followed and above 10 bags. The passage could not be found.

'21. On Sunday a wax candle put in of four and three-quarter inches and there left until evening, then drawn out without matter.

'22. Monday morning. No running: a sponge tent put in for ye afternoon iii [electronic editor's note: we are unable to render this quantitative symbol.] matter, bags above 20.

'23. Tuesday morning. No running, [electronic editor's note: we are unable to render this quantitative symbol.] i of injection for ye evening [electronic editor's note: we are unable to render this quantitative symbol.]iii or iiii injection, part whereof wh. some matter came away and aboyt 10 bags. About two hours after more came and so ye next morning, at my Lds. rising and about 10 bags at both times.

'24. At ye dressing in ye morning, nothing came. Of injections [electronic editor's note: we are unable to render this quantitative symbol.] v or vi, about three in ye afternoon a great flush brought away about 50 sluffs, whereof most were bags (but not red as formerly by reason of the injection) and some like jelly. At ye evening dressing no running. A glove thick spung tent left in ye orifice.

'25. Morning. It ran of itselfe a little before dressing.

86 BIOGRAPHICAL ESSAYS

Injection being made there came forth much thin digested looking matter, somewhat foetid with about 12 bags, whereof one very large. A spung tent put in. In ye evening injection, which came away next morning before dressing wth four or five sluffs.

'26. A Friday morning, injection was made & some thin matter came forth. A short spung tent put in: in ye afternoon some matter, but no sluffs.

'27. Upon ye drawing out ye spung tent matter followed wth six or seven sluffs. 0 i injection being made whereof much stayed behind, in ye afternoon ye spung tent being pulled out, a great flush of matter followed, wth almost 20 sluffs. 0 i injection was made whereof a great part staid in. A hemp tent was put in. Some matter came out in ye night & left a yellow tincture on ye cloths.

'28. Pulling out ye tent, some yellow matter came out wth three or four skins. A spung tent put in. The like issued in ye afternoon. 0 i injection was made & a flax tent put in.

'29. It ran in ye night. Next morning after injection a flush of yellowish matter issued wth 18 sluffs. A spung tent put in, after injection, whereof a considerable part remained. In ye afternoon upon ye drawing out ye spung tent, much matter gushed forth, being somewhat fetid, with 12 or 14 sluffs and bags. On injection being made ye same came freely forth, tinctured with matter. A flax tent was put in.

'30. In ye morning little matter came out, yellow tinctured, wth one or two skins. A spung tent was put in. For ye afternoon a little matter, wth two or three small sluffs. A flax tent put in.

'July 1st. A Wednesday morning. After a second injection much yellow matter came forth wth three or four yellow sluffs, & at last a considerable quantity of whitish well digested matter came out. A flax tent put in. At ye pulling out whereof in ye afternoon some thin matter proceeded & after injection more but little discolored & only two sluffs. A flax tent put in. My Ld. complained of a little paine, lower towards his right side.

'2. Upon ye opening on Thursday morning, some little matter came away, but not fetid, rather of ye smell of wine, wth one small sluff. A spung tent put

JOHN LOCKE 87

in. In ye evening little came forth, no bags. A spung tent put in wth one injection.

'3. The spung tent being pulled out two yellow bags gushed out, without any considerable injected matter, and afterward five or six small sluffs with a little tinged liquor. Injection was made and spung tent put in.

'4. Saturday morning. Upon pulling out ye tent little proceeded. After ye putting in ye small catheter & injection made considerable quantity of matter issued. A spung tent was put in; for ye afternoon a large quantity of well digested matter came out. Nq injection made. A spung tent put in.

'5. Yellow matter came forth with four or five sluffs, whereof one great one suckt into ye end of ye siphon. After injection a spung tent put in, wh. in ye afternoon being pulled out a good quantity of matter followed, well digested, especially through ye small catheter and siphon. A few sluffs came out, one great one. A spung tent put in.

'6. In ye morning ye small catheter & siphon were put in; divers sluffs, some after injections, came forth, whereof three or four large ones. A hollow tent was put in upon ye pulling out whereof a sluff came forth, wth divers very little ones; more seemed to stop ye passage but could not issue, because ye thinner parts did run out before through ye hollow pipe. Neither did injection promote their coming forth, though some matter of a brownish colour came out.

'7. Much yellow matter ran in ye night and some more this morning, with two or three sluffs. Injection was made, whereof ye greatest part came forth. A spung tent was put in. At night a sluff stuck to ye tent at its pulling out & 4 or 5 more where very yellow came afterwards. No injection. A silver hollow tent put in.

'8. It run very much in ye night, ye napkin was stained with yellow and green, one bag. A spung tent put in. In ye evening 4 or 5 sluffs, some matter. An open pipe put in.

'9. Little run all night and sluff stopt ye pipe. One or two more followed, a considerable quantity of atheromatous matter. At night two sluffs; very little atheromatous matter.

88 BIOGRAPHICAL ESSAYS

'1O.1 A great running through ye hollow pipe, two or three sluffs. The matter at last being whiter and more even than before. Much running till night. Some sluffs. Injection made and a hollow pipe put in, after most of ye injection was discharged. After this a pain supervened in my Ld's. back about ye region of his liver, & at night he vomited; and had a cold shivering; wh. seemed to proceed from somewhat too liberal diet that day & catching some cold.

'11.1 After a little sweat in ye morning, my Ld. was better. He was not drest till ye afternoon: ye ulcer having very much discharged itselfe in ye meantime; wth some few sluffs.

'12.1 A little matter wth few sluffs. Injection made. A hollow pipe. At night run very little. Two sluffs.

'13. Not drest in ye morning. Ran much. At night little matter, 2 or 3 sluffs.

'14. It ran much yellowish gleet and matter in ye night. But upon ye opening no matter nor sluffs issued, though injection were made. At night one yellow sluff & a little good whitish matter.

'15. In ye night it ran much yellow matter & about six small sluffs. Injection made. No meeting in ye afternoon.

'16. Upon opening much running of yellow matter appeared, with 4 or 5 yellow sluffs.

'17. A large flux of yellow liquid, wth 4 or 5 yellow sluffs, whereof two large ones sticking in ye pipe. Injection made.

'18. It had run somewhat copiously before dressing, wth ye ejection of one very small yellow bag. Injection being made brought forth some matter & a considerable quantity of very yellow liquor.

'19. Little running before dressing, after it none, no injection.

'20. Small quantity (?) of lesse yellow liquor run before dressing, 4 or 3 sluffs. Injection made.

'21. Yellow liquor has continued running. No sluffs nor injection.

'22. Some pretty laudable yellowish matter came out upon dressing. Injection was made.

1 The sympathetic powder made use of.

JOHN LOCK 89

'23. A little matter issued upon coughing. No injection.

'24. The like today.

'25. A few small sluffs. Little matter & not yellowish. No injection.'

From the long-standing character of the tumour and the character of the material which escaped—the innumerable bags—there can be no doubt that the disease was hydatids of the liver, which, remaining quiescent from 1656, had, as is so often the case, suppurated. It is one of the first instances on record in which the abscess was opened. The use of the sympathetic powder on the 10th, 11th, and 12th shows how strongly popular feeling had affected the profession.

Naturally, from the prominent position of the patient and the strange character of the disease, the case attracted unusual attention. The point that concerned Lord Shaftesbury himself most acutely was whether it was better to remove the silver drainage-tube or to keep it in. To get the opinion of the faculty on the subject, he sent, with Locke's assistance, a circular letter containing the following questions

'1. Which is most advisable, to resolve to keep it constantly open, or to heal it up as soon as conveniently may be?

'2. Whether, if it be healed up at all, one of these two dangers is not like to follow; either a new collection of matter, the imposthume lying below ye orifice by which it vents itself, or a feaver upon stopping of so considerable an issue?

'3. Whether if it be to be healed up at all it be not necessary to keep it open as long as any flux of matter comes through the pipe more than would be from an issue of the Depth and Bigness of ye pipe?

'4. Whether the pipe that is now in be not of the fittest length and bigness to be worne constantly to keep it open?

90 BIOGRAPHICAL ESSAYS

'5. Whether whilst it is best open it be not best to dresse it but once in two days, especially in cold weather?

'6. Whether whilst it is best open it be convenient to use any Injection, how often & of what sort & to what purpose?

'7. Whether if it be kept long open it will be in danger of growing in a worse condition than a simple issue of that depth, either by turning to a foule ulcer or a fistula or any other way, and if there be any such danger how to be prevented?

'8. Whether the bare keeping in a Silver pipe will, without paine, keep it open as long as one pleases?

'9. Whether I may travel in a coach, ride on horseback, boate, or use any such exercise safely with a pipe in of this length?

'10. Whether if it be kept long open Nature will not in time so fortify the parts about the end of the Pipe as to make the danger it may bring by rubbing upon them in any exercise, very little or none at all?

'11. Whether during the time it is kept open frequent pergeing be necessary and how often?

'12.Whether if it should be kept always open it is not to be feared that a constant flux of matter from it, especially if it should continue to be of any considerable quantity, may very much weaken and emaciate the body, & how to be prevented?' (Handwriting not Locke's.)

To this circular there are among the Shaftesbury papers the replies of Locke, of Sydenham, of Glisson, of Sir George Ent, of Micklethwaite, of Timothy Clark, and of the Abbe Beaupreau of Angers, an eminent French physician. With the exception of Clark, who urged that the issue should be healed, the opinions agree in the main. They are too long to quote at length, but those of Locke and Sydenham are of sufficient historical interest to be given.

'Consilium Abscessus (Locke).

'1. It is better to heal it up as soon as it may safely be done. Because it is not convenient to have a con-

JOHN LOCKE 91

stant issue of that depth in that place if it might be remedied.

'2. To secure from the danger of a new collection of matter I think it will be

'3. Convenient not only till the flux of matter be no more than may be well expected from a flesh issue of that depth, but after it hath gradually decreased to that small thing, it be kept open at least three or four months at what time soever the flux come to that low ebb, but if it happen after Xmas, as in the spring, that it be kept open till the beginning of the next winter, that the flux be constantly and warily observed, and that it be sometimes diligently searched, so that by these ways all the security possible may be had that there is not the least sore or hollow left behind unhealed up. And to prevent a fever or other disorder in the blood upon its stop ping up, it will be necessary then and sometimes a fter to use a spare diet with frequent purging, till Nature, used to the convenience of this discharge, may by degrees accustom herself either to master or vent her humours some other way.

'4. The pipe now in I conceive to be of the proper length and bigness that may be to keep it open, which is not at all to be altered or shortened till you resolve to heal it up, for if you shorten it sooner you heal it sooner too, for the flesh will certainly grow up still & close the end of the pipe, though all is not secure behind. Nor do I see what harm the pipe can do in touching the bottom of the issue more than the sides, where nature equally endeavours to generate flesh to fill up the cavity as it does at the end. And if the pipe upon any motion of the body should perhaps grab a little (which I believe it will not be very apt to do) all the danger will be the filching a little blood from this new-grown flesh (for there can be no great vessels in that which may be in danger to be broken), which is not of half so much hazard, if any at all more than the pain, as to let it close up but one minute before the time. And to prevent any injury from the stiff silver pipe you may in travel or exercise use a wax candle tent exactly of the length and thickness of the silver pipe.

'5. In cold weather once a day at most will be enough to dress it, and then the air of the room where it is dressed to be made as warm as conveniently may be.

92 BIOGRAPHICAL ESSAYS

'6. In cold weather an injection warming and strengthening and resisting of putrefaction to prevent the harm that may come from the cold air may be convenient to be made use of as often as it may be dressed, but in warm weather may be wholly omitted. And certainly all the year once a week or fortnight an injection to prevent the growing of a fistula, putrefaction and a fistula being the two great evils that are to be feared and prevented in the long keeping of it open, which is also an answer to the

'7. Seventh.

'8. I suppose the silver pipe that is now in may be kept in as long as one pleases without danger or pain.

'9. Travel & exercise with a tent of wax, or any such matter as will resist the closing of the sides but be pliant to the motions of the body, may be not only safe but usefull.

'10. The longer the parts are used to the pipe the less danger will be from its hurting it, the parts accommodating themselves to the figure of the pipe which it constantly uses, and by degrees growing stronger and harder where they are pressed by it.

'11. Whilst there is a design of healing of it up purging once a fortnight may be useful to divert the humours from flowing to that part, but else in respect of the health of the body I suppose there would be less need of purging during this vent (?) than at other times, and perhaps a care of diet will with more advantage to the health subtract the humours than purging, which being constant may have other inconveniency;

'Or, 'tis to be hoped that whilst by careful dressing and injecting the wound is kept in good condition, and the constitution of the body in good temper by a regular diet, the flux will rather advantage than injure the health and strength of the body.'

Sydenham's opinion is one of the few papers in his own hand. (Some of the words are very difficult to decipher.)

'I reccomend it by noe meanes saff for his Lordshipp to stopp up the abscess, triall having once bin made of the unsuccessfullness of doing it & the flux of matter as yet seeming too much in proportion to the canale, and

JOHN LOCKE 93

I judge it better to keepe it open with a silver pipe then a wax candle, in regard that from the use of a candle the matter will have the less opportunity to issue out & consequently the passage choak up. But I think 'twere better that the pipe were shorter because by the present length thereof his Lordship is liable to dangerous accidents from any unequal motion of the body which in process of time may easily happen from riding in a coach, stouping or the like: nor does it seeme to be suspected that the matter will not worke itself out when the orifice shall be kept open. I conceave it may somewhat contributt to the discharge of the matter if my Lord shall lie on his left side or much as he can in regard . . . the imposthume is depending it he shall lie with his upper parts low. I hold it very useless to use irrigations of any sort because the cavity . . . being depending, the liquor how agreeablesoever in other respects will by lodging itself in any little cavities beget new impostumortions (?) to which those irrigations administer matter and by this means the cavity still enlarged. I should thinke that a drying drinke, constantlye kept to for ordinary drinke would be more conducible to the drying up of this flux of matter and sweetening the whole mass of blood and humors than anything whatsoever. Nor do I conceave that my Lord's spare habitt of body may discourage from this course, but rather contrary when 'tis notoriouslye known that on drying diett though used with greater severity than 'twill be necessary to put my Lord upon, hath after a while rendered bodies that before were very emaciated now plumper and vigorous. But what 2 draughts in a day can signifie and those too of a liquor so compounded that the greater respect is had to the oncerteyne & constiturell virtue of & the lesser to the certeyne and sensible qualitie of Driers I canot imagine.

'This therefore with submission to those who know more I should advise.

'That nothing be done to the part saveing the use of a pipe that may be made somewhat shorter or to be lengthened with a wan (?) handle, that it be dressed once a day if the matter be much, once in 2 days if little.

'That of the stronger sort of liquor halfe a pint be taken hott every morning 1 hour before his Lordship

94 BIOGRAPHICAL ESSAYS

riseth and the same quantity at night as soon as he is in his bedd.

'That the smaller liquor be constantly drunke at his meales and at other times.

'That he purge or take a clyster every 5 [electronic editor's note: unable to render this symbol found in the original text.] or 6 [electronic editor's note: unable to render this symbol found in the original text.]day.

'Lett his Lpps. diett be in proportion to this way ... att least lett ... be avoided.'

Then follow two prescriptions of the stronger and smaller liquors. The French Abbé, whose opinion is also given, was evidently very much impressed with a full report of the case as narrated by Locke. He says: 'I can hardly determine myself whether I ought to admire more in it the wise and admirable proceedings of my Lord's physician or the exactness of the author of the relation both for the elegance of his style and his judicious remarks with which he hath illustrated his narrative.'

Locke made inquiries everywhere of his professional friends as to the existence of similar cases, and among the papers there are three very interesting reports, one of a case of empyema opened by making an issue; another the case of James Oddy, sent on Jan. 22, 1668, by T. Batteson, was in all probability a hydatid cyst, as when the side was opened matter like fish skins and white of eggs to the number of forty and to the amount of one quart came out. The greater ones had lesser ones in them, like the seeds of a lemon. A third report was sent to Locke by Thomas Strickland, of a man who fell into a languishing with great pain in his side and stomach, which persisted for a year or so. When death was expected a great swelling arose in his side with infinite torment. A neighbour cut upon the head of the swelling with a penknife, 'then came out several blathers like winde eggs, some as large as turkey eggs, others as hen eggs.' It was open for a year, in which

JOHN LOCKE 95

time over 400 of these came out. He afterwards regained perfect health.

The satirists of the day made great sport of the silver pipe which Lord Shaftesbury continued to wear for the rest of his life. The wits of the day called a sort of vessel with a turncock, constructed for holding wine, a Shaftesbury, and his common nickname was 'Tapski'. Duke, an imitator of Dryden, describes him under the name 'Antonius' in his lines—

The working ferment of his active mind
In his weak body's cask with pain confined
Would burst the rotten vessel where 'tis bent
But that 'tis tapt to give the treason vent 1.

In Act III of Dryden's Albion and Albanius the king was represented by a huge drawing of a man (meaning Shaftesbury) and several fanatical heads who sucked poison from him which runs out of a tap in his side. And again, in a mock account of an apparition stated to have appeared to Lady Gray, it says: 'Bid Lord Shaftesbury have a care of his spigot; if he is tapt all the plot will run out.'

A satire called The Hypocrite, written by Carryl, concludes thus:

The silver pipe is no sufficient drain
For the corruption of this little man.

Shaftesbury appears to have enjoyed very good health and lived a very active, energetic life. I find a statement (Raleigh Redivivus, p. 48) that in the year 1672 it (the abscess) was 'opened by Mr. Knolls, the surgeon, under the direction of Dr. Willis, and an issue inserted for the regular discharge of the humour'. This probably refers to a subsequent blocking of the tube. As to his death, Christie in his Lzfe (vol. ii, p. 455) says:

1 Anderson's Poets of Great Britain, vi, p. 628.

96 BIOGRAPHICAL ESSAYS

'He was taken ill with the gout, from which of late years he had often suffered, about the end of December. The malady flew to his stomach; he suffered excruciating agonies; and he died in the forenoon of the 21st of January' (1683). Missal 'mentions of one of the natural causes of Shaftesbury's death the sudden cessation of the discharge from his internal abscess', from which we may understand that he continued to wear the silver tube.

Lady Northumberland's case.—As this has already been published in full in the European Magazine, and as there is a note upon it in The Lancel', I will only give a brief abstract. The description is given in letters to his friend Dr. Mapletoft.

Letter IX, Dec. 4, 1677. After an apology for so unwelcome an occasion of writing, Locke says:

'On Thursday night last I was sent for to my Lady Ambassadrice, whom I found in a fit of such violent and exquisite torment that (though she be, as you know, a person of extraordinary temper, and I have seen her in the course of this distemper endure very great pain with a patience that seemed to feel nothing) it forced her to such cries and shrieks as you would expect from one upon the rack, to which I believe hers was an equal torment, which extended itself all over the right side of her face and mouth. When the fit came there was, to use my Lady's own expression, as it were a flash of fire all of a suddaine shot into all these parts, and at every one of those twitches which made her shriek out her mouth was constantly drawn on the right side towards the right ear by repeated convulsive movements which were constantly accompanied by her cries. This was all that appeared outwards in these fits according to the exactest observation I could make, having had but too many opportunities to do it. These violent fits terminated on a suddaine, and then my Lady seemed to be perfectly well, excepting only a dull

1 Vol. ii, 1828-9, p. 367.

JOHN LOCKE 96

pain which ordinarily remained in her teeth on that side and an uneasiness on that side of her tongue which she phansied to be swollen on that side, which when I looked on it, as I often did, had not the least alteration in it in colour, bignesse or any other way, though it were one of her great complaints that there was scalding liquor in her fits shot into all that half of the tongue. She had usually a precaution of the fit by a little throbbing in the upper jaw just over against it. In all this time of her being ill she has not found the least pain in all the other side of her face and teeth, which has so wholly possessed the right side that it went even to the very tip of her tongue and the last tooth before on that side. When all this torment was over there was not the least appearance of any alteration anywhere on her face, no inflammation or swelling in her mouth and cheeke; very little defluction of rheum more than what the disturbance of those parts in these fits might cause. Speaking was apt to put her into these fits; sometimes opening her mouth to take anything or touching her gums, especially in the places where she used to find those throbbings, pressing that side of her face by lying on it were also apt to put her into a fit. These fits lasted sometimes longer, sometimes shorter, were more or less violent, without any regularity, and the intervals between them at the longest not half an hour, commonly much shorter.'

Locke then describes the treatment, topical anodyne applications to the gums, which gave relief. The next day the fits returned and she was purged. Bleeding was considered, but she had been so often and so much blooded on a like occasion this summer without help that Locke thought best not to do so again. The next night she took a quieting cordial, but during the first part had the fits very severely. He says, 'I wish with all my heart you were here,' as Lady Northumberland had had so little success with the French physicians that she would not call them. He asks 'whether you do not think this to proceed from some affection in the

OSLER H

98 BIOGRAPHICAL ESSAYS

nerves in the place where the tooth was drawn, which draws all the rest into consent and convulsive motions on this side?' At one o'clock in the afternoon he writes again that a blistering plaster has been placed on the back of the neck (interscapulus). 'She has, especially when the fits are most violent, a drinesse in her lips more than ordinary.' On Sunday night he writes with great satisfaction telling of her improvement, but he asks for the 'best advice you can get'. On the 22nd he writes: 'On reading our friend's [Sydenham's] letter I was ready to cry out, "The spirit of the Prophets is upon the sons of the Prophets," I having in what I have done here not only proceeded by the same method, but used the very remedys he directed as to the maine.' He speaks of the diet and says that he had advised an open-air life to strengthen the genus nervorum, as he thought that hysterical vapours increase the tumult and disorders in the nerves, in which he suspects an ancient fault, as she has extreme and violent itching in the gums on that side long before the fits.

 

IV. MEDICAL WRITINGS

These consist of fragmentary papers, the chief interest of which to-day is that they are from the pen of the great philosopher. They are among the Shaftesbury papers in the Record Office, and I have had them copied with a view to subsequent publication. They are:

(a) Ars Medica or De Arle Medica, an introduction to a treatise on the philosophy of medicine. One cannot read the fragment without feelings of deep regret that the design was not carried out. The scope of the intended work may be gathered from the following summary: 'But, not to expatiate into the large field

JOHN LOCKE

of natural philosophy, where perhaps the foundation of the mischief was first laid, I shall, according to my design, confine myself at present to that branch of it which immediately concerns the health of men; and, in physic, shall consider: 1. The present state of the faculty of medicine as it now stands, in reference to diseases and their cure. 2. The several degrees and steps whereby it grew to that height it is at present arrived to, which I suppose are these following: (1) experience; (2) method, founded upon philosophy and hypothesis; (3) botanics; (4) chymistry; (5) anatomy; in all which I shall endeavour to show how much each hath contributed to the advancing the art of physic, and wherein they came short of perfecting it. 3. What yet may be further done towards the more speedy and certain cure of diseases; i. e. by what means and method the practice of physic may be brought nearer to perfection.' (b) Anatomia, a longer paper, in which Locke contends 'that nature performs all her operations in the body by parts so minute and insensible that I think nobody will ever hope or pretend even by the assistance of glasses or other inventions to come to a sight of them'. From the gross parts he thinks not much can be learned. We 'see not the tools and contrivances by which nature works'. 'Though we cut into the inside we see but the outside of things and make but a new superficies for ourselves to stare at.' The paper is a forcible statement against the hope that anatomy can ever show the true essential causes of disease. It is quite possible that the article was prepared at Sydenham's suggestion, or for his use, as at the top of the page, in Sydenham's handwriting, is the sentence: 'Others of them have more pomposity and speciously prosecuted the promoting of this art by searching into

H2

100 BIOGRAPHICAL ESSAYS

the bowels of dead and living creatures, as well sound as diseased, to find out the seeds of discharging them, but with how little success such endeavours have been or are likely to be attended I shall here in some measure make appear.' (c) Respirationis Usus, a short paper on the subject. (d) Tussis, an essay on coughs, in which subject Locke took a personal interest. Here, again, is evidence of Sydenham's hand, in a brief marginal note on cures done by riding in consumption and morbi obscuri. (e) A dedication and preface to a proposed work on small-pox by Sydenham. From the outset of their friendship Locke took a deep interest in the writings of Sydenham, and, as I have mentioned, he contributed a Latin poem in praise of him and of his methods to the second edition of the Methodus Curandi Febres (1668). It would appear that about 1670 Sydenham contemplated writing a separate work on small-pox, in the treatment of which he had had great success, but the physicians were at first very hostile to his new plan. Among the Shaftesbury papers are a dedication and a preface written by Locke. Sydenham had shared with his friend the professional care of the family of Lord Ashley, and had tried with happy results his cooling regimen in cases of small-pox. In the dedication he (or rather Locke) says:

'At least, my lord, I thought it reasonable to let you see that I had practised nothing in your family but what I durst own and publish to the world, and let my countrymen see that I tell them nothing here but what I have already tried with no ill success on several in the family of one of the greatest and most eminent personages amongst them.'

The preface is a sharp and stout defence of the new method, in which Locke does not spare the colleagues of his friend.

JOHN LOCKE

'How much some of my own faculty have fomented and increased these reports, they themselves know, and with what design I leave it to their own consciences to tell them, only they must give me leave to say it would have become them out of common charity as good men, as well as out of an obligation to improve their art and save men's lives as physicians, upon the first intimation of an unusual method of curing so common a disease as this is, to have inquired more particularly of the way, observed the circumstances, and informed themselves of the events before they cried it down as dangerous and fatal, and frighted all that came within their reach from an inquiry into or trial of his method by the abhorrency they had given them against so bold and hazardous a practice.'

Evidently Sydenham smarted under the calumnies and misrepresentations, and the preface speaks of 'the greatest indignities beyond almost the sufferance of a man, and the endangering not only of my reputation and livelihood, but even my life itself'. The article is chiefly valuable from the account which it gives of the steps by which Sydenham was led to adopt his cooling treatment. Neither dedication nor preface was ever used. The projected work did not appear and many years later the Observationes Medicae, which contained his matured experiences, was dedicated to Mapletoft, and another preface was used.

 

V. JOURNALS, LETTERS, AND COMMONPLACE BOOKS

A keen observer, a constant note-taker, and of most neat and accurate literary habits, Locke has left a large mass of manuscript, which has been carefully searched and sifted by Mr. Fox-Bourne, in whose Life, as well as in that by Lord King, there are many letters and extracts illustrating his work as a physician. The letters to Mapletoft about Lady Northumberland have

102 BIOGRAPHICAL ESSAYS

been referred to. Of the journals, those of his Holland sojourn, which are said by Fox-Bourne to contain much of medical interest, I have not yet seen. In the British Museum is a very characteristic journal in which one may follow Locke's medical work for the year 1679. It is bound with an Ephemeris or Calendar of the year. He was in Paris during the early months. As usual he was interested in bills of mortality, and he states (January 16) that the deaths in Paris were from 19,000 to 20,000 a year. He makes a note to ask if the deaths of Quakers, Anabaptists, and Jews are recorded in London. On April 12 he comments on the handbills set up about town with a receipt to kill lice. There are many notes on the treatment of diseases and receipts, to the collection of which he seemed very partial. He queries whether the sympathetic powder could be of any use in dentium dolor, indicating that he still had a lingering belief in it. There are many notes on various topics and memoranda about books, &c. On May 8 he sailed from Calais. On June 4 are brief notes of a Mr. N., sick of a fever, whom he bled, and afterwards jaundice appeared. Notes on vomiting, diseases of the eye, icterus, hernia, hysteria, hypochondria, rheumatism, mania, and tussis occur in June. On August 18 he was sent for in consultation in the case of Mr. Beavis, of Olanligh, Kent, and for the next six weeks the journal is very full, containing a detailed account of the symptoms of Mr. Beavis and the treatment, many notes on the practice of Dr. Jacob, the attending physician, and a characteristic description of two attacks of fever with which he was himself attacked. Mr. Beavis had a long illness, possibly typhoid fever, and it was not until the end of September that Locke left for London.

JOHN LOCKE 103

The Bodleian Commonplace Book with the Anecdota Sydenhami — This is a small folio, bound in parchment, which originally contained 400 pages, of which 248 are torn out. Dr. W. G. Greenhill published a part of the manuscript in 1845 as Anecdota Sydenhami, and the following extract from the preface may be quoted:

'They are taken from a MS. in the Bodleian Library at Oxford (Rawl. C. 406), very neatly (and for the most part very legibly) written, apparently about the end of the seventeenth century. The name of the writer is not mentioned nor is anything known of the history of the MS., except that it once belonged to Dr. Richard Rawlinson and forms part of the collection of MSS. bequeathed by him to the University of Oxford about the middle of the last century. At the beginning of the volume (of which about two-thirds have been torn away) are these words: "Extracts of Sydenham's Physick Books and some good Letters on Various Subjects." This is the whole of the external evidence respecting the genuineness of the following Anecdota; and perhaps, if there were nothing more to say in their favour, it might be doubted how far the editor was justified in giving them to the world under the sanction of the name of Sydenham: the internal evidence, however, is much more conclusive, and indeed to his own mind perfectly satisfactory. The writer professes to have been acquainted with Sydenham himself, and to have originally written the following Notes, partly from his dictation in the years 1682, 1683, and partly from some of his MSS. written chiefly in 1670. These Notes he appears to have revised and written out correctly in their present form after 1685 (as he refers to the edition of Sydenham's Work published in that year), and (if the editor's conjecture at p. 69 be correct) before 1692, as that is the date of the first edition of the Processus Integri.'

Apparently it was not until Mr. Fox-Bourne examined the manuscript that it was recognized as belonging to Locke, whose handwriting is most distinctive. While largely made up of extracts from Dr. Sydenham's physic books, the excerpta ex ore Sydenhami, dated 1682-3, show

104 BIOGRAPHICAL ESSAYS

the maintenance at this date of an intimate professional relationship between the two great men.

The other medical papers in the volume illustrate the wide scope of Locke's inquiries. There are statements about the Peruvian bark and the best methods of its preparation. But the chief interest after the Sydenham notes relates to a sort of collective investigation which Locke instituted on public health. He seems to have a deep conviction that much good would follow a careful study of the bills of mortality. His circular letter contains the following inquiries (MS., p. 68):

'1. What bills of mortality are kept in foreign countries, either as to the diseases of which persons die, or the number who die weekly or yearly in the most capital cities or towns of Europe or other parts of the world, as Paris, Madrid, Amsterdam, Venice, Hamburg, Rome, Constantinople, Smyrna, Dublin, Edinburgh, &c., as also in New England, Barbadoes, Jamaica, and other Plantations. 2. The aire of different countries, with the temper and alteration of the same at the different seasons of the year, and the diseases those countries are subject to and the time when. 3. The opinion physicians have of Jesuit's bark, and the best account they can give of it. 4. The esteem which physicians have had of Dr. Sydenham and his works. 5. The order observed in foreign countries as to physicians, surgeons, apothecaries, and herbalists for the improvement of travellers and young students.'

There are answers from several correspondents. Dr. Willoughby of Dublin (April 17, 1691) gives a tabular account of the bills of mortality between 1682—90 (inclusive), and a description of the air of the country. He speaks of the Peruvian bark as 'the only specific I know in nature'. Of Dr. Sydenham he says, 'he has been very honest in rescinding from Physick all the unnecessary pomp of alteratives and preparatives, and reducing it to the use of the grand remedies which in Physick do

JOHN LOCKE 105

justly fill both sides of the loafe.' In another place is an account of Dr. Willoughby's proposal for the improvement of agriculture in Ireland, the important part of which was that every proprietor who will not improve his waste land shall make over four-fifths of it to the Crown. There is a brief statement of the Amsterdam bills of 1691 and 1693, and an account of Dr. Bett's proposal to the Lord Mayor for the improvement of the returns in London. There are letters from James Young of Plymouth about various diseases, and one from Dr. Eales (?) giving an account of Dr. Morton's books, in which 'he has improved the hints of our good friend the great Dr. Sydenham admirably well'. Dr. Patrick Dun sends a full statement about the mortality bills of Dublin, and pp. 93—6 of the MS. contain in extenso the death-rates from January, i69~, to April, 1698. Pages 110-357 are torn out, but from the index, pp. 369—71, we can glean the contents of the missing leaves—books whose authors are unknown, 'books to be wrote,' and 'books wrote in defence of the murder of King Charles I', with a long list of the authors, and about the Eikon Basilike and the various controversies upon it, extending from pp. 199-236.

Though qualified and deeply interested in both the science and the art of medicine Locke never became, as Fox-Bourne says, 'in any orderly way a physician.' Until he left England in 1683 'he was still waiting for an opportunity of devoting himself steadily to his favourite occupation. He was still generally spoken of by his friends as Dr. Locke, and he still regarded himself as before everything else a doctor.' Hereafter questions of philosophy, finance, education, trade, theology, &c., occupied his busy life, but through it all, and to the very end, there are references in his letters and

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journals to show that his first love was not forgotten. In the memorable and oft-quoted letter to Dr. Thomas Molyneaux in praise of Sydenham's method, January 20, 1692-3, he speaks of himself as one who wishes well to the practice of physic 'though he meddles not with it', yet in the same year we find him prescribing for a friend's wife. In 1694 he is corresponding with Dr. Hans Sloane on medical matters. In January, 1697-8, King William consulted him, believing that they suffered from similar diseases. In 1701 he writes again to Sloane about a patient with an obstinate fever, and in the following year he gives very wise advice to his old friend Lomborch, who was ill. Evidently Locke's clear, strong judgement was valued by his friends in all relations of life, and as Somers and other politicians turned to him for instruction in questions of trade and finance, so his friends and others insisted upon utilizing his medical knowledge. Sydenham, Boyle, Thomas, Mapletoft, and Molyneaux had been his intimate associates. In Montpellier, in Paris, and in Holland he had been a welcome guest in medical circles, and in London we have met him in consultation with the most eminent practitioners of the day upon a most important case, and handing in a written opinion as their colleague and equal.

For each one of us there is still a 'touch divine' in the life and writings of John Locke. A singularly attractive personality, with a sweet reasonableness of temper and a charming freedom from flaws and defects of character, he is an author whom we like at the first acquaintance, and soon love as a friend. Perhaps the greatest, certainly, as Professor Fowler says, the most characteristic, English philosopher, we may claim Dr. Locke as a bright ornament of our profession, not so

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much for what he did in it, as for the methods which he inculcated and the influence which he exercised upon the English Hippocrates. He has a higher claim as a really great benefactor of humanity, one of the few who 'reflected the human spirit always on the nobler side'. One of Locke's earliest writings was a translation for Lady Shaftesbury of Pierre Nicole's Essays, in one of which, on the 'Way of Preserving Peace with Men', Locke seems to have found a rule of life which I commend to you: 'Live the best life you can, but live it so as not to give needless offence to others; do all you can to avoid the vices, follies, and weaknesses of your neighbours, but take no needless offence at their divergences from your ideal' (Fox-Bourne).

108

.

ELISHA BARTLETT

A RHODE ISLAND PHILOSOPHER¹

.

RHODE ISLAND can boast of but one great philosopher — one to whose flights in the empyrean neither Roger Williams nor any of her sons could soar — the immortal Berkeley, who was a transient guest in this State, waiting quietly and happily for the realization of his Utopian schemes. Still he lived long enough in Rhode Island to make his name part of her history; long enough in America to make her the inspiration of his celebrated lines on the course of empire. Elisha Bartlett, teacher, philosopher, author, of whom I am about to speak, whom you may claim as the most distinguished physician of this State, has left no deep impression on your local history or institutions. Here he was born and educated, and to this, his home, he returned to die; but his busy life was spent in other fields, where to-day his memory is cherished more warmly than in the land of his birth.

I

Born at Smithfield in 1804, Bartlett was singularly fortunate in his parents, who were members of the Society of Friends, strong, earnest souls, well endowed with graces of the head and of the heart. The gentle

1 An address delivered before the Rhode Island Medical Society, December 7, 1889. Reprinted from the Transactions of the Rhode Island Medical Society.

ELISHA BARTLETT

life, the zeal for practical righteousness, and the simplicity of the faith of the followers of Fox, put a hallmark on the sensitive youth which the rough usage of the world never obliterated. No account of Bartlett's early life and school-days exists—an index that they were happy and peaceful. We may read in his poem called An Allegory, certain autobiographical details, transferring the

Meadow and field, and forest, dale, and hill;Orchards, green hedgerows, gardens, stately trees,

from the old England which he describes to the banks of Narragansett Bay. Paraphrasing other parts of the poem, we may say that auspicious stars shone over his cradle with the kindliest light and promise, and amid the genial air of a New England home, goodness, truth, and beauty were his portion. He tells of the wonder and delight stirred in his young soul by the thousand tales of 'fairies and genii, giants, dwarfs, and that redoubtable and valiant Jack who slew the giants'. Then, as the days lengthened, he came under the spell of The Arabian Nights and of Robinson Crusoe. Looking back in after years, he compared this hearty wholesome life to some bounteous spring that wells up from the deep heart of the earth. Addison, Goldsmith, and Washington Irving filled his soul with freshness like the dawn,

And led by love and kindness, ran the hours
Their merry round till boyhood passed away.

In the ruder discipline and strife of school and college he grew to manhood with (as he expressed it) 'a fine free healthfulness', and with faculties self-poised and balanced.

At Smithfield, at Uxbridge, and at a well-known

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Friends' institution in New York, Bartlett obtained a very thorough preliminary education. Details of his medical course are not at hand, but we know that after studying with Dr. Willard, of Uxbridge, Drs. Greene and Heywood, of Worcester, and Dr. Levi Wheaton, of Providence, and attending medical lectures at Boston and at Providence, he took his doctor's degree at Brown University in 1826, a year before the untimely end of the medical department1.

In June, 1826, Bartlett sailed for Europe, and the letters to his sisters, which, with other Bartlett papers, have been kindly sent me by his nephew, the Hon. Willard Bartlett, of the New York Court of Appeals, give a delightful account of his year as a student abroad. He remained in Paris until December; then, in company with his fellow student, Dr. Southwick, he visited the chief cities of Italy, returning to Paris early in March. The month of May, 1827, was spent in London, and he sailed from Liverpool June 8. Unfortunately the letters to his sisters contain very few

1 Parsons closes his Historical Tract on the Brown University Medical School with the sentence, 'Whether this city, the second in New England, shall become the seat of such a school (that is a revived department of medicine) must depend very much on the zeal, persistence, and ability of its physicians.' May I be permitted to remark, Mr. President, that the existing conditions are singularly favourable for a small first-class school. Here are college laboratories of physics, chemistry, and biology, and here are well-equipped hospitals with some three hundred beds. What is lacking? Neither zeal, persistence, nor ability on the part of the physicians, but a generous donation to the University of a million of dollars with which to equip and endow laboratories of anatomy, physiology pathology, and hygiene. These alone are lacking; the preliminary scientific school is here; the clinical school is at your doors; the money should be the least difficult thing to get in this plutocratic town. The day has come for small medical schools in university towns with good clinical facilities.

ELISHA BARTLETT 111

references to his medical studies, but I have extracted a few memoranda from them.

Writing August 24, 1826, he says:

'The celebrated Laennec died at his country residence on the 1₃th of the present month. The publication in 1819 of a new method of ascertaining diseases of the chest forms an era in the history of medicine. M. Laennec fell a victim to one of those diseases the investigation of which by himself has enriched the field of science, contributed to the alleviation of human suffering, and given his own name a high rank among the great and good men of his age.'

He asked that this memorandum should appear in the Providence papers.

Writing September 4, he speaks of attending every day at the Jardin des Plantes to hear the lectures of Cloquet and Cuvier.

One of the professors at the medical school, he says, looked more like a jolly stage-driver or a good-natured, blustering butcher than anything else.

' He lectures sometimes standing, and sometimes leaning against a post, or straddling over a high stool, flourishing a lancet in one hand and a snuff-box in the other, on the contents of which he is continually laying the most inordinate contributions. He wears during the time an old rusty-looking black cap. The familiarity of the distinguished surgeons and physicians with their students struck me at first sight very forcibly, being in such perfect contrast to the proud port and haughty carriage of some of our New England professors. I wish they might step into the Hôtel Dieu and La Charité, and take a lesson or two of Boyer and Dupuytren, barons of the Empire, and two of the most distinguished surgeons in the world.'

In the letter of October 10th, he says:

'The public lectures opened this week, and we are continually engaged from half-past six in the morning till bed-time. Visits are made at all the hospitals by

112 BIOGRAPHICAL ESSAYS

candle-light, and a lecture delivered at most of them immediately after the visit.'

He speaks of attending the lectures of Geoffroy St. Hillaire, who, he says, 'lectures very badly; his gestures, though he is a Frenchman, are exceedingly awkward, and he has a sing-song tone like that which one often hears in a Methodist or Quaker preacher.'

Like Oliver Wendell Holmes, Bartlett probably acquired in Paris three principles: 'Not to take authority when I can have facts; not to guess when I can know; not to think a man must take physic because he is sick."1

Strangely enough, I find no reference in these Paris letters to the man of all others who influenced Bartlett most deeply. In Louis, even more than in Laennec, the young American students of that day found light and leading. The numerical method, based on a painstaking study of all the phenomena of disease in the wards and in the dead-house, appealed with peculiar force to their practical minds, and Louis' brilliant observations on phthisis and on fevers constituted, as Bartlett remarked, a new and great era in the history of medical science. I cannot find any definite statement of Bartlett's relations with Louis in 1826—7, at which period the latter was still working quietly at La Charité. His monograph on phthisis had been published in 1825, and had at once given him a reputation as one of the great lights of the French school. He was at this time very busy collecting material for his still more important work on typhoid fever, and it is scarcely possible that Bartlett could have frequented La Charité without meeting the grave, unobtrusive student, who, with notebook in hand, literally lived in the wards and in the dead-house. Secluded

1 Morse's Life of Holmes, vol. i, p. 109.

ELISHA BARTLETT 113

from the world, living as a voluntary assistant to Chomel in this quiet haven of observation, apart from the turbid seas of speculation which surged outside, Louis for seven years pursued his remarkable career. Whether or not Bartlett came into personal contact with him at this time I do not know, but however this may be, subsequently the great French clinician became his model and his master, and to him he dedicated his first edition of the Fevers, and his Essay on the Philosophy of Medical Science.

For a young man of twenty-two, these letters— written off-hand—show an unusually good literary style, and many incidental references indicate that he had received a general education much above the average. The strong Christian spirit which he felt all through life is already manifest, as may be gleaned from one or two expressions in the letters. Writing on Sept. 4, 1826, to his sisters, he refers to the death of a dear friend and her little sister: 'There is a cheering consolation in the reflection that "of such is the kingdom of heaven ", and that their spirits have gone in perfect and sinless purity to their home of bliss, and we may believe that they in their turn have become guardian angels to those who cherished and protected them here:

They were their guardian angels here,
They guardian angels now to them.'

In 1827, shortly after completing his twenty-third year, Bartlett settled at Lowell, then a town of only 3,500 inhabitants, but growing rapidly, owing to the establishment of numerous mills. This was his home for nearly twenty years, and to it, and later to Woonsocket, he returned in the intervals between his college work in different sections of the country. As Dr. D. C. Patterson

Osler I

114 BIOGRAPHICAL ESSAYS

remarks, 'He became at once the universal favourite, and began to take a deep interest in the physical welfare of the townsmen.' In 1828 he delivered lectures before the Lowell Lyceum on contagious diseases, and he gave frequent popular lectures on sanitation and hygiene. In 1828 he was the orator on the Fourth of July. In 1836 he delivered a course of popular lectures on physiology.

Evidently Bartlett had the 'grace of favour' in a remarkable degree. Bishop Clark pictures him in those days in the following words:

'Some twenty-five years ago, I used to meet a young man in the town of Lowell, whose presence carried sunshine wherever he went: whose tenderness and skill relieved the darkness of many a chamber of sickness, and whom all the community were fast learning to love and honour. Life lay before him, full of promise; the delicate temper of his soul fitting him to the most exquisite enjoyment of all the pure delights of nature, and his cheerful temperament giving a genial and generous glow to the refined circles of which he was one of the chiefest ornaments.'

When only thirty-two, before he had been in Lowell ten years, he was elected by a respectable majority as the first mayor of the city, and he was re-elected the following year. A letter from the Hon. Caleb Cushing, dated April 20, 1841, gives us an idea of the estimate which a clear-headed layman placed upon him. 'Dr. Bartlett enjoys in the city of Lowell the unqualified respect of that community, and its affectionate esteem— respect and esteem due alike to his public relations to that city, as formerly its popular and useful chief magistrate, and at all times one of its most patriotic and valued citizens; to his unblemished integrity of character and amenity of deportment; to his eminence in his pro-

ELISHA BARTLETT

fession; to the endearments of private friendship; and in general to his talents, accomplishments, manners, and principles.'

To two interesting episodes in his life at Lowell I may refer at greater length. The rapid growth of the industries in Lowell had brought in from the surrounding country a very large number of young girls as operatives in the mills, and their physical and moral condition had been seriously impugned by writers in certain leading Boston papers. These charges were investigated in a most thorough way by Bartlett, who published in the Lowell Courier in 1839, and republished in pamphlet form (1841) his well-known Vindication of the Character and Condition of the Females Employed in the Lowell Mills. This very strong paper, based on careful personal investigations, really proved to be what the title indicated. It did not, however, escape adverse criticism, and among the Bartlett papers there is a review of the Vindication by a citizen of Lowell in 1842, which presents the other side of a picture, by no means a pleasant one, of the prolonged hours of the operatives and their wretched life in boarding-houses.

One of the most interesting incidents of his life at this period was the reception to Dickens, whose visit to Lowell occurred during Dr. Bartlett's mayoralty. In the American Notes Dickens speaks of the girls as 'healthy in appearance, many of them remarkably so, and had the manners and deportment of young women, not of degraded brutes of burden.' Oliver Wendell Holmes says, referring to this occasion: 'I have been told a distinguished foreign visitor (Charles Dickens), who went through the whole length and breadth of the land, said that of all the many welcomes he received from statesmen renowned as orators, from men whose

12

116 BIOGRAPHICAL ESSAYS

profession is eloquence, not one was so impressive and felicitous as that which was spoken by Dr. Bartlett, then mayor of Lowell, our brother in the silent profession, which he graced with these unwonted accomplishments.'

In 1840 he was elected to the Legislature 'of the State of Massachusetts and served two terms. In 1845 he was nominated by the Governor a member of the Board of Education of the State in the place of Jared Sparks. Holmes, who was familiar with Bartlett in this period of his career, has left on record the following charming description:

'It is easy to recall his ever-welcome and gracious presence. On his expanded forehead no one could fail to trace the impress of a large and calm intelligence. In his most open and beaming smile none could help feeling the warmth of a heart which was the seat of all generous and kindly affections. When he spoke his tones were of singular softness, his thoughts came in chosen words, scholarlike, yet unpretending, often playful, always full of lively expressions, giving the idea of one that could be dangerously keen in his judgements, had he not kept his fastidiousness to himself, and his charity to sheathe the weakness of others. In familiar intercourse—and the writer of these paragraphs was once under the same roof with him for some months— no one could be more companionable and winning in all his ways. The little trials of life he took kindly and cheerily, turning into pleasantry the petty inconveniences which a less thoroughly good-natured man would have fretted over.'

II

For many years there was in this country a group of peripatetic teachers who went from town to town, like the Sophists of Greece, staying a year or two in each, or divided their time between a winter session in a large city school and a summer term in a small country one.

ELISHA BARTLETT 117

Among them Daniel Drake takes the precedence, as he made eleven moves in the course of his stirring and eventful life. Bartlett comes an easy second, having taught in nine schools. Dunglison, T. R. Beck, Willard Parker, Alonzo Clark, the elder Gross, Austin Flint, Frank H. Hamilton, and many others whom I could name, belonged to this group of wandering professors. The medical education of the day was almost exclusively theoretical; the teachers lectured for a short four months' session, there was a little dissection, a few major operations were witnessed, the fees were paid, examinations were held—and all was over. No wonder, under such conditions, that many of the most flourishing schools were found amid sylvan groves in small country towns. In New England there were five such schools, and in the State of New York the well-known schools at Fairfield and at Geneva. As there was not enough practice in the small places to go round, the teachers for the most part stayed only for the session, at the end of which it was not unusual for the major part of the faculty, with the students, to migrate to another institution, where the lectures were repeated and the class graduated. T. R. Beck's introductory lecture, in 1824, at Fairfield, On the Utility of Country Medical Institutions, pictures in glowing terms their advantages. One sentence brought to my mind the picture of a fine old doctor, on the Niagara peninsula, a graduate of Fairfield, who possibly may have listened to this very address. Dr. Beck asks: 'What is the clinical instruction of the country student? It is this—after attending a course of lectures on the several branches of medicine and becoming acquainted with their general bearing, he during the summer repairs to the office of a practitioner; attends him in his visits to his patients; views the

118 BIOGRAPHICAL ESSAYS

diseases peculiar to the different districts; observes the treatment that situation or habits of life indicate, and from day to day verifies the lessons he has received. Here, then, is a direct preparation for the life he intends to pursue.' And I may say that it was just this training that made of my old friend one of the best general practitioners it has ever been my pleasure to know.

In the letters we can follow Bartlett's wanderings during the next twenty years, from the time of his appointment to one of the smallest of the schools to his final position as one of the chief ornaments of the leading school of New York. In 1832 he held his first teaching position, that of professor of pathological anatomy and of materia medica in the Berkshire Medical Institute, at Pittsfield. The following is an extract from a letter to Dr. John Orne Green, dated Pittsfield, November 25, 1833:

'The character of the class is said to be superior even to that of last year. We have a large number of excellent students. Parker is as popular as ever, and Professor Childs has the credit of having improved very much in his manner of teaching. The members of the class are attentive to their studies, eager for knowledge, and regular in their attendance on the lectures. I have lectures, most of the time, twice a day, at 10 a.m. and at 2 p.m. I shall finish my course on materia medica by the middle of this week, and the remainder of my time will be occupied with lectures of medical jurisprudence and pathological anatomy. The commencement will be on Wednesday of week after next.'

He held the chair at Pittsfield for eight sessions. Among his colleagues were Childs, Dewey, and Willard Parker, who was a very special friend. In a letter of October 2, 1836, he says: 'Parker, with his sunny face and his hearty welcome, was in a few minutes after my arrival. It does one good to meet such men.'

ELISHA BARTLETT 119

In 1839 he was appointed to the chair of practice in Dartmouth College, Hanover, N.H., the school founded by Nathan Smith in 1798. In a letter to his friend, Green, dated September 8, he gives brief sketches of some of his colleagues, among them a delightful account of Oliver Wendell Holmes, then a young man of thirty.

'Dr. Holmes you know something of. As a teacher there is no doubt of his success, although he will not show himself during this his first course. He has his anatomy—some of it at least—to study as he goes on, and he has not yet got the whole hang of the lecture-room — he does not give himself his whole swing. His attainments in medical science are extensive and accurate, and his intellectual endowments are extraordinary. His mind is quick as lightning and sharp as a razor. His conversational powers are absolutely wonderful. His most striking mental peculiarities consist in a power of comprehensive and philosophical generalization on all subjects, and in a fecundity of illustration that is inexhaustible. His talk at table is all spontaneous, unpremeditated, and he pours himself forth—words and thoughts—in a perfect torrent. His wit and humour are quite lost in the prodigal exuberance of his thoughts and language.'

In this same letter is the following characteristic memorandum, illustrating his desire to see the schoolhouses beautified and adorned.

'One word about the High School House. Pray, don't forget in the planning of the rooms my plan for some embellishments. Even if we should get some busts I do not know that niches would be any better than suitable stands or shelves. I hope we shall raise, by a fair, from five hundred to one thousand dollars for pictures, &c., for ornaments to the two principal rooms.'

It is quite possible that Bartlett lectured both at Woodstock and at Pittsfield, as the terms were pur

120 BIOGRAPHICAL ESSAYS

posely arranged so as not to clash, and in the catalogue of the Vermont Medical College, 1844, there is an advertisement of the Berkshire school. The names of Bartlett and Holmes occur only in the 1839-40 and 1840-1 announcements.

In 1841 he accepted the chair of the theory and practice of medicine in the Transylvania University, Lexington, at that time the strongest and best equipped school in the West.¹ On his way to Lexington he visited New York, Philadelphia, Washington, and Baltimore, and in a letter to Green, of September 7, 1841, he gives an interesting account of the men he met in these cities. One item is of interest to Baltimoreans

'Day before yesterday I spent with Dr. Nathan R. Smith, at Baltimore, on my return from Washington. I found him very attentive and hospitable. He took me into his gig and went to see some of his patients. He has a pretty large surgical practice, and is, I should think, a man of excellent sound sense, industrious and devoted to his profession—not so great a man as his father, but a very capital good fellow. He speaks well of Lexington and the school—says it is the best appointed school in the country.'

In his letters there are interesting descriptions of his life in Lexington, some of which are worth quoting:

'In the school we are getting on very well. The class is of a good size, rather larger than last year, worth a little over $2,000, intelligent, attentive, well-behaved. I have given fifty-eight lectures, and we have just six weeks more. My own success has been good enough, I think. So far as I have means of judging, my instruction is entirely satisfactory, to say the least. My colleagues—Dudley, you know, is the great man here. He has many peculiarities. He is very much pleased with me. He teaches singular doctrines, and

1 History of the Medical Department of Transylvania University and its Faculty, by Dr. William J. Calvert, Johns Hopkins Hospital Bulletin, August, September, 1899.

ELISHA BARTLETT 121

follows, in many things, a practice very peculiar to himself. The other day he tied the common carotid before the class in an anastomosing aneurism in the orbit; patient from St. Louis. Day before yesterday he cut for the stone; patient a lad from Mississippi. He has two more cases of stone here for operation. He is exceedingly cautious; sends many patients, of all sorts, away without operation. Uses the bandage for everything almost in surgery—tart. ant. and starvation, or low diet, in most diseases. He had a pretty large property, "a garden" as he calls it, of 150 acres or so, a mile from the city. Richardson, in obstetrics, boards with me, a plain common-sense man, who fought a duel in early life with Dudley; has made a pretty large fortune here in practice, and now lives in the country eight miles or so from here, on a farm of 500 acres. The style of lecturing here is quite different from what it is in the East—more emphatic, more vehement. It is quite necessary to fall somewhat into the popular style. We stand, in the lecture room, on an open platform with only a little movable desk or table, on which to lay our notes. On the whole I like it better than being seated in a desk, as they are in Boston.' (December 21, 1841.)

In March, 1843, he writes to Green that his receipts for the session have been more than $2,000.

'There are a few good families who send for me, and I get occasionally a consultation. We never make a charge less than a dollar; and consultation visits in ordinary cases—the first visit—are $5.00. These few enable me, situated as I am, to make even a small and easy business somewhat profitable. I have made one visit twenty-five miles distant, for which the fee was $25; and saw a second patient, at the same time, incidentally, for $5.00 more. You see from all this, that my place gives me rather more money than I could earn in Lowell, for a much smaller amount of responsibility and labour. I have hardly, indeed, been called out of bed during the winter. In a business point of view I feel quite content with my situation.'

From an interesting account of a consultation in the

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country we can gather how the planters of those days did their own doctoring:

'Col. Anderson belongs to a class of men, pretty large, I think, in this State,—rather rough, with a limited school education, but intelligent, shrewd, clear-headed, and enterprising. He has a farm, entirely away from any travelled road, of 500 acres; but his principal business is that of bagging and soap manufacturing, his farm serving only to feed his family. This consists of about one hundred, eighty or more of which are his negroes. He has no physician, whom he is willing to trust, nearer than Lexington; and in nearly all common acute diseases treats the patient himself. His daughter, Mrs. Breck, was seized with acute pleurisy, soon after miscarriage, and her father had bled her twice, pretty freely, and given calomel and antimony, before any physician had seen her. He had followed the same course a year ago in the case of his wife.' (February 18, 1844.)

In the same letter he says:

'Typhoid fever has been very widely prevalent in many parts of Kentucky for the past year. There were, it is said, 200 deaths in an adjacent county last summer and fall. It is evidently the common fever of this country, with all the features so familiar to us at the East.'

In the autumn of 1844 he accepted the chair of the theory and practice of medicine at the University of Maryland. Among the letters I find but one from Baltimore, and that is to Oliver Wendell Holmes about a review of his book, The Philosophy of Medical Science, which had appeared that year.

In 1844 he accepted the chair of materia medica and obstetrics in the Vermont Medical College, the session of which began in March and continued for thirteen weeks. Among his colleagues were Alonzo Clark, Palmer, and Edward M. Moore, and later John C. Dalton. Bartlett's name occurs in the catalogues of the school until 1854,the year before his death.

ELISHA BARTLETT 123

In May, 1845, he and Mrs. Bartlett sailed for Europe. In a letter to Green, July 12, there is an interesting reference to Louis and James Jackson, jun.:

'I have seen a good deal of Louis, who has been very civil and attentive. I dined with him soon after my arrival, and met there, amongst others, Leuset and Grisolle, two of his most intimate medical friends. I never see him that he does not speak of young Jackson—ce pauvre Jackson, as he calls him. He told me, with a great deal of feeling, that Jackson, the last night that he spent in Paris, wrote him a letter from his hotel, which was moistened with his tears, and that he thought Jackson was almost as much attached to him as to his father.'

In another letter he speaks, too, of his very cordial reception by Louis.

They spent the winter on the Continent, travelling about, chiefly in Italy, and in the spring went to London. In a letter dated June 17, 1846, there is an interesting sketch of a magnetic seance at the house of Professor Elliotson, of University College, who subsequently came to such grief over hypnotism.

'And then he ran full tilt off upon his hobby, "animal magnetism," calling it one of the most sacred and holy of all subjects, one of the greatest truths, and so on. Dr. Forbes, the editor, he spoke of as "a wretch ", all because the doctor has shown up some of Elliotson's magnetic operations. Dr. E. afterwards invited me to see some magnetic phenomena at his house. I went about 3 o'clock in the afternoon, and found his spacious and elegant drawing-room quite filled with well-dressed gentlemen and ladies, assembled for the same purpose. The doctor had two subjects, one a young, delicate-looking girl, and the other a damsel of a certain age, upon whom he performed the standard and stereotyped experiments—putting them into the magnetic sleep, stiffening their limbs, leading them round the room with a common magnet, exciting their phrenological

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organs, and so on. I can only say that I was not specially delighted with Elliotson s manner, and that if I was to choose a man by whom I should swear, without using my own eyes, certainly it would not be him.'

In the same letter he speaks of having seen a great deal of Forbes, editor of the Medico-Chirurgical Review; of Marshall Hall, of Walshe, 'a young man and a good fellow'; of Sir Henry Holland, and of that interesting American physician, who lived so long in England, Dr. Boott, and of Dr. Southwood Smith at the Fever Hospital.

On his return from Europe we find him during the session of 1846—7 in his old chair at Lexington, whence he writes on March 18, 1847, to his friend Green, from which a paragraph relating to the second edition of his book on Fevers may be quoted:

'I have been drudging away all winter at my second edition. I do not feel any great interest in it, though I hope and intend to make a good book of it. The first edition, for a monograph, has sold very well, mostly at the South and West; so well at least that Lea & Blanchard propose publishing the second edition and paying also something for the right to do so.'

The sessions of 1847-8-9 were spent at the Transylvania University. In the spring of 1848 there is a letter from Pliny Earle, dated April 16, saying that he had received a catalogue of the Medical Department of Transylvania University, from which he had received his first intimation of Bartlett's resignation of the professorship. He asks Bartlett's advice as to the propriety of applying for the position.

On March 13, 1849, Bartlett received the appointment as professor of the theory and practice of medicine in the University of Louisville. At this time, in a letter from

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Dr. J. Cobb, we have the first intimation in the letters of ill health, as there is the sentence: 'Accept my best wishes for your complete restoration to health.' The University of Louisville had drawn heavily upon the classes of the other Western schools, chiefly at the expense of Lexington, and the Faculty when Bartlett joined it was very strong, comprising such well-known men as the elder Gross, the elder Yandell, Rogers, Benjamin Silliman, jun., and Palmer.

The condition of medical politics at that time in the town of Louisville was not satisfactory; a new school had been started in opposition to the University, and among the Bartlett letters are a number from the elder Yandell which show a state of very high tension. Bartlett spent but one session in Louisville. He and Gross accepted chairs in the University of New York. The appointment of the former to the chair of the institutes and practice of medicine is dated Sept. 19, 1850. From some remarks in a letter from Yandell it is evident that Bartlett did not find the position in New York very congenial. Gross found his still less so, and returned to Louisville the following year. J. W. Draper, the strong man of the University School, had secured Bartlett, and in a letter dated Aug. 12, 1850, he promised him a salary of at least $3,500. The same letter shows how thoroughly private were the medical schools of that day:

'It perhaps may be proper to repeat what is the condition of the real estate. The college building is owned equally by the six professors. Its estimated value when Dr. Dickson left us in the spring was $78,600, and there is a mortgage upon it of $48,000, bearing interest of six per cent. Excluding this mortgage the share of each professor is therefore $5,000, and a mutual covenant exists among us that on the retirement or

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decease of one of the Faculty his investment shall be restored to him or his heirs—the new-comer starting in all respects in the position he occupied.'

During these years Bartlett seems to have been very busy at work at the microscope, and there is a letter from Alonzo Clark, dated June 15, 1848, descriptive of a fine new Oberhauser (the Zeiss of that day), and in 1851 there is an interesting letter from Jeffries Wyman, giving a list of the most important works on invertebrate zoology.

Among his colleagues in the University were Draper, Martyn Paine, and Granville Sharp Pattison. Things do not seem to have worked very smoothly. In the spring of 1851 overtures were made to him from the College of Physicians and Surgeons of New York, in which Faculty were his warm friends, Alonzo Clark and Willard Parker, and he was elected to the chair of materia medica and medical jurisprudence in the following year, 1852. Here he lectured during the next two sessions until compelled by ill health to retire.

I may fittingly conclude this section of my address with a sentence from a sketch of Bartlett's life by his friend Elisha Huntington:

'Never was the professor's chair more gracefully filled than by Dr. Bartlett. His urbane and courteous manners, his native and simple eloquence, his remarkable power of illustration, the singular beauty and sweetness of his style, all combined to render him one of the most popular and attractive of lecturers. The driest and most barren subject, under his touch, became instinct with life and interest, and the path, in which the traveller looked to meet with briars and weeds only, he was surprised and delighted to find strewn with flowers, beautiful and fragrant. There was a magic about the man you could not withstand; a fascination you could not resist.'

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III

Bartlett began his career as a medical writer with the Monthly Journal of Medical Literature and American Medical Students' Gazelle, only three numbers of which were issued. He says in the introductory address, dated Oct. 15, 1831, that there are plenty of practical journals of high character and extensive circulation, but he wishes to see one devoted to

'medical history, medical literature, accounts of medical institutions and hospitals, medical biography, including sketches of the character, lives, and writings of the chief masters of our art, and of all such as have in any way influenced its destinies and left the deep traces of their labours on its history. . . . To the medical student and the young practitioner, to all those who aspire to any higher acquisitions than the knowledge that calomel purges and salivates, and that tartarized antimony occasions vomiting, who are not willing to rest supinely satisfied in a routine familiarity with doses and symptoms — a familiarity which practice and habit render in the end almost mechanical—we cannot but think these matters must be interesting.'

And he adds:

'The devotion of an occasional hour to such pursuits must have a tendency to enlarge and liberalize the mind. It will help to keep alive and stimulate in the young medical scholar the sometimes flagging energies of study. By calling his attention and directing his desires to high standards of acquisition and excellence, it will urge him on towards their attainment. Delightful and fascinating, in many respects, as the study of his profession may be to him, there are many hours which must be occupied with mental and bodily drudgery. He must make what to others would be loathsomeness pleasure to himself. Amid the wear and tear, the toil and fatigue of such pursuits, he needs at times some intellectual recreation and stimulus, and where can he find one pleasanter or more appropriate than in surveying the career, and studying the characters of those who have trodden before him the same laborious path,

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and who have followed it on to its high and bright consummation? If our profession ever vindicates its legitimate claim to the appellation of liberal, it must be cultivated with some other than the single aim of obtaining patients for the sole purpose of getting for services rendered an equivalent in fees.'

In the first number there is a statement that on a future occasion the Journal will give a 'detailed consideration of the character of the old physician of Cos— the venerable father of physic, and of the reform which he effected in medical science', a promise which was not fulfilled to the profession for many years, as Bartlett's well-known lecture on Hippocrates, the last, indeed, of his professional writings, was not issued until 1852. The literature of science, its philosophy, its history, the history of the lives and labours of the founders and cultivators—these he believed it important for the student to cultivate.

Among the articles in these three numbers there are some of special merit. One signed S. N., On the Claims of Medicine to the Character of Certainty, may have suggested to Bartlett his well-known essay, On the Degree of Certainty in Medicine. The enterprise was not a success, and as Bartlett had said in his introductory address, 'of all weakly things we most heartily pity weakly periodicals,' he had the good sense after three numbers had been issued to give up a publication which the profession did not sustain.

In July, 1832, he became associated with A. L. Pierson and J. B. Flint in a much more pretentious and important journal, the Medical Magazine, a monthly publication which continued for three years. It was a very well-conducted periodical, with excellent original articles and strongly written editorials. John D. Fisher's original paper on The Cephalic Brain Murmur occurs

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in volume ii, and in the same one is an excellent paper by E. Hale, jun., on The Typhoid Fever of this Climate, which is of special interest as containing very accurate statements of the differences between the common New England autumnal fever and the typhus as described by Armstrong and Smith. There are also reports of three autopsies giving an account of ulceration in the small intestine, among the first to be published in this country. There are in addition numerous well-written critical reviews. Among the latter is one of the most virulent productions of that most virulent of men, Dr. Charles Caldwell. It is entitled Medical Language of Literature. I have heard it said in Philadelphia that Dr. Samuel Jackson never forgave the bitterness of the attack in it upon his Principles of Medicine.

In volume iii there was the interesting announcement that a dollar a page would be paid for all original communications.

In 1831 appeared a little work entitled Sketches of the Character and Writings of Eminent Living Surgeons and Physicians of Paris, translated from the French of J. L. H. Peisse. Of the nine lives, those of Dupuytren and Broussais are still of interest to us, and there is no work in English from which one can get a better insight into the history of medicine in Paris in the early part of the nineteenth century. One little sentence in the translator's preface is worth quoting:

'After making all reasonable allowance for natural tact or talent, and for the facilities and advantages of instruction to be had in extensive medical establishments, it will be found that study, intense, untiring, unremitted study, is the only foundation of professional worth and distinction.'

A great stimulus had been given to the study of phrenology by the visit of Spurzheim to this country.

OSLER K

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He gave a course of six lectures on the anatomy of the brain and spinal cord at one of the apartments of the Medical College in September of that year, and subsequently a popular course of lectures on phrenology. In 1832 he died in Boston of typhus fever. His brain, it is stated, was in the possession of the Boston Phrenological Society, before which, in January, 1838, Bartlett gave an interesting address on scientific phrenology.

In 1839 Bartlett edited Paley's Natural Theology, that delightful book, dear especially to those of us who were trained in religious colleges. To some of us at least the freshness of the natural theology, which in Paley's hands was really a delightful commentary on anatomy and physiology, was a happy change from artificial theology, or even from the Horae Paulinae of the same author.

Bartlett's claim to remembrance, so far as his medical writings are concerned, rests mainly on his work on Fevers, issued first in 1842, and subsequently in the years 1847, 1852, and 1857. It remains one of the most notable of contributions of American physicians to the subject. Between the time of Bartlett's visit to Paris and 184o, a group of students had studied under Louis, and had returned to this country thoroughly familiar with typhoid fever, the prevalent form in the French capital at that time. In another place 1 I have told in detail how largely through their labours the profession learned to recognize the essential differences between the two prevalent forms of fever, typhoid and typhus. The writings on fever chiefly accessible to the American reader of that day were the English works of Fordyce,

1 'Influence of Louis on American Medicine,' Johns Hopkins Hospital Bulletin, August-September, 1897 (printed at p. 189 of this volume).

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Armstrong, Southwood Smith, and Tweedie, in which, as Bartlett says, 'they describe a fever or form of fever (that is typhus) rarely met with in this country,' and the writings did not actually represent the state of our knowledge upon the subject. Indeed, for a number of years later a chaotic condition of mind prevailed among writers in Great Britain, and it was not until 1849—50 that William Jenner, by a fresh series of accurate observations, brought the British medical opinion into line. As the British and Foreign Medico-Chirurgical Review, in a most complimentary notice of Bartlett's work, said, 'A history of British fevers such as Louis has furnished to France, or such as given in the volume under discussion, did not exist.' Still, even at that date, 1844, the Review expressed the ultra-conservative opinion held in England, that the common continued fever, or the low nervous fever of Huxham, was only a mild form of typhus fever. The work is dedicated to his friends, James Jackson, of Boston, and W. W. Gerhard, of Philadelphia; it is, he states, 'a history of two diseases, many points of which they, especially among his own countrymen, have diligently and successfully studied and illustrated.'

The chief interest of the work to-day lies in the remarkably accurate picture which is given of typhoid fever—a picture the main outlines of which are as well and firmly drawn as in any work which has appeared since. It is written with great clearness, in logical order, and he shows on every page an accurate acquaintance with the literature of the day, and, as the author of the review already mentioned remarks, a knowledge also of that best of books, the book of nature.

The practical character of Bartlett's mind is indicated by the briefness with which he discusses the favourite

K2

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topic of the day, namely the theory of fever. He acknowledged at the outset that the materials for any satisfactory theory of typhoid fever did not exist. He went so far as to claim that the fundamental primary alteration was in the blood, and that the local lesion was really secondary, and he refers to the prevalent theory of fever as 'wholly a creation of fancy; the offspring of a false generalization and of a spurious philosophy. What then can its theory be but the shadow of a shade?' This work immediately placed Bartlett in the front rank of American physicians of the day. It had a powerful influence on the profession of the country. Among his letters there is an interesting and characteristic one from James Jackson, already referred to in the dedication. Acknowledging the receipt of a copy, he says:

'I am now writing to express to you the great satisfaction the book has given me. I think that it entirely answers the end that you proposed. It, in fact, translates to the common reader, in a most clear style and lucid method, the acquisitions which science has made on its subjects within the last few years. Nowhere else can the same comprehensive view of those subjects be found. What may be the conclusions of medical men in regard to essential fevers twenty years hence I would not pretend to say. It is certain their views have changed very much within a shorter period, and if new discoveries are made in ten years to come I doubt not you will be ready to change yours. We must take to-day the truth so far as we know it, and add to it day by day as we learn more.'

It is evident from his letters that the success of the work on fevers was a great gratification to Bartlett.The second edition was issued in 1847, and while the history of typhoid and typhus fever remained much in the same state, with certain additions and developments, the subject of periodical and yellow fevers was greatly

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extended. The third edition was issued in 1852. The fourth edition was edited by Bartlett's friend, Alonzo Clark, of New York. The dedication of the second, third, and fourth editions was to Dr. John Orne Green, of Lowell, 'with whom the early and active part of the writer's life was passed; in a personal friendship which no cloud, for a single moment, ever shadowed or chilled; and in a professional intercourse whose delightful harmony no selfish interest or personal jealousy ever disturbed.'

From every standpoint Bartlett on Fevers may be regarded as one of the most successful works ever issued from the medical press, and it richly deserves the comment of the distinguished editor of the fourth edition:

'The question may be fairly raised whether any book in our profession illustrates more clearly the beauties of sound reasoning and the advantages of vigorous generalization from carefully selected facts. Certainly no author ever brought to his labour a more high-minded purpose of representing the truth in its simplicity and in its fullness, while few have been possessed of higher gifts to discern, and gracefully to exhibit it.'

An Essay on the Philosophy of Medicine, 1844, a classic in American medical literature, is the most characteristic of Bartlett's works, and the one to which in the future students will turn most often, since it represents one of the most successful attempts to apply the principles of deductive reasoning to medicine, and moreover illustrates the mental attitude of an acute and thoughtful observer in the middle of the century. The work consists of two parts: in the first science is defined and its canons laid down. Ascertained facts, with their relations to others, obtained by observation or experience, and generalized into laws and principles—this constitutes

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science. He dwells upon the hurtfulness of theories, and sketches in an interesting manner Newton's position as an observer and as a theorist: 'If he (Newton) bowed at any time or in any degree his strong neck to the yoke of hypothesis, it was always with a perfect consciousness of his ability at will to shake it off, as the lion shakes the dew-drop from his mane.' He quotes from Sir Humphrey Davy: 'When I consider the variety of theories that may be formed on the slender foundation of one or two facts, I am convinced that it is the business of the true philosopher to avoid them altogether.'

Bartlett is the strongest American interpreter of the modern French school of medical observation, which

'is characterized by its strict adherence to the study and analysis of morbid phenomena and their relationships; by the accuracy, the positiveness, and the minute detail which it has carried into this study and analysis; and by its rejection as an essential or legitimate element of science of all apriori reasoning or speculation. The spirit which animates and guides and moves it is expressed in the saying of Rousseau, "that all science is in the facts or phenomena of nature and their relationships, and not in the mind of man, which discovers and interprets them." It is the true protestant school of medicine. It either rejects as apocryphal, or holds as of no binding authority, all the traditions of the fathers, unless they are sustained and sanctioned by its own experience.'

There are weak points in his arguments, some of which are well pointed out in an able article in the British and Foreign Medico-Chirurgical Review (July, 1845); but it is the work of a strong and thoughtful mind, and for a time, at least, it had a powerful influence in the profession. A contemporary writer. Samuel Henry Dickson1, speaks of it in the following terms:

1Gross, American Medical Biography, 1861, p. 750.

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'It was particularly well-timed, and addressed effectively to the requirements of the profession, at the period of its publication, It breathes a spirit of thoughtful and considerate scepticism, which was then needed to temper the headlong habit of confident polypharmacy prevalent over our country... . When addressed, however, by Bartlett, on this side of the Atlantic, and on the other by Forbes, he (the orthodox disciple) stopped to listen and consider. These gifted men spoke with authority; they pleaded impressively, eloquently, wisely. If, in the natural ardour of controversy, they went somewhat too far, let that slight fault be forgiven for the great good they accomplished. Nay, let them be honoured for the courage and frankness with which they attacked prevalent error, and risked their popularity and position by assailing modes of practice rendered familiar by custom, and everywhere adopted and trusted to.'

In 1848 appeared one of Bartlett's most characteristic works, a little volume of eighty-four pages, entitled, An Inquiry into the Degree of Certainty of Medicine, and into the Nature and Extent of its Power over Disease. The iconoclastic studies of Louis and certain of the Paris physicians, and the advocacy of expectancy by the leaders of the Vienna school, had between 1830 and 1850 disturbed the profession not a little, and in 1846 appeared an article by Dr. Forbes, in which, as Bartlett said, were drawn 'in strong and exaggerated colours the manifold imperfections of medical science and the discouraging uncertainties of medical art.' These circumstances had combined to shake and disturb the general confidence in the profession, with the effect that 'the hold which medicine has so long had upon the popular mind is loosened; there is a widespread scepticism as to its power of curing diseases, and men are everywhere to be found who deny its pretensions as a science, and reject the benefits and blessings which it proffers them as an art.' To Bartlett it appeared

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high time to speak a clear and earnest word for the science which we study and teach, and for the art which we inculcate and practise, and in this essay he set himself the task of vindicating the claims of medicine to the regard and confidence of mankind. In his endeavour 'to show how far and with what measure of certainty and of constancy we are able to control, to mitigate, and to remove disease' Bartlett occupied at the outset very advanced ground for that date. We must remember that the general body of the profession had the most implicit confidence in drugs, and polypharmacy was almost as much in vogue as in the seventeenth and eighteenth centuries. The reception of the essay in certain quarters indicates how shocking its tone appeared to some of the staid old conservatives of the day. I have a review of it in the Medical Examiner, November, 1848, from which I give the following extract:

'This is a curious production, the like of which we have seldom seen from the pen of any one who had passed the age of a sophomore. What makes it the more remarkable is the circumstance that the writer is a gentleman of education and experience, and the author of works which have given him a wide reputation.'

The force of the rebound sufficiently indicates the intensity with which the attack was felt. Bartlett's position, however, reminds one somewhat of the sermonof the liberal Scotch Presbyterian on 'things which cannot be shaken', in which he proceeded at the outset to shake off three-fourths of the cherished beliefs of Evangelical Christianity.

After a preliminary discussion on anatomy and physiology, and on the remarkable rapidity with which these sciences were progressing, he proceeds to speak of

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the state of pathology and therapeutics as illustrated in the well-known disease pneumonia. Time will not permit me to do more than to refer to the result of his analysis of the evidence. He classifies the cases into, first, those which terminate naturally and spontaneously, quite independent of any active medical treatment, a proportion 'probably large'; second, a group which will terminate fatally notwithstanding any assistance which art may furnish; they are, as Sir Gilbert Blane said of the worst forms of yellow fever, 'determinedly fatal'; and, finally, a third class, 'not tending necessarily either in one direction or the other,' in which the issue depends upon the treatment of the disease. 'In these cases, art, judiciously applied, saves the life of the patient; the issue of the cases, in death or in recovery, is dependent upon the treatment of the disease.' Then follows a discussion on the nature and limits of the medical art in the various groups of diseases, and he concludes with a section on the triumphs of preventive medicine.

The initials 'A. S.' at the end of a review in the American Journal of the Medical Sciences, October, 1848, enables us to estimate the impression which the book made upon a kindred spirit. Professor Alfred Stillé, of the University of Pennsylvania (still with us, I am happy to say), wrote, 'He has done a good work, a work for which he deserves the respect and gratitude of the medical profession, and of all sound-hearted men, whatever their pursuits, who fight under the banner of truth, and are the sworn foes of all imposture, the determined opponents of all error.'

At times, and in degrees differing with our temperaments, there come upon us bouts of depression, when we feel that the battle has been lost, and that

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to fight longer is not worth the effort, periods when, amid the weariness, the fever and the fret of daily practice, things have gone against us; we have been misunderstood by patients, our motives have been wrongly interpreted, and smitten perhaps in the house of our friends, the worries of heart to which we doctors are so subject make us feel bitterly the uncertainties of medicine as a profession, and at times make us despair of its future. In a voice that one may trust Bartlett concludes his inquiry with these memorable words, which I quote, in the hope that they may soothe the heartache of any pessimistic brother:

'There is no process which can reckon up the amount of good which the science and art of medicine have conferred upon the human race; there is no moral calculus that can grasp and comprehend the sum of their beneficent operations. Ever since the first dawn of civilization and learning, through "the dark backward, and abysm of time', they have been the true and constant friends of the suffering sons and daughters of men. Through their ministers and disciples, they have cheered the desponding; they have lightened the load of human sorrow; they have dispelled or diminished the gloom of the sick-chamber; they have plucked from the pillow of pain its thorns, and made the hard couch soft with the poppies of delicious rest; they have let in the light of joy upon dark and desolate dwellings; they have rekindled the lamp of hope in the bosom of despair; they have called back the radiance of the lustreless eye and the bloom of the fading cheek; they have sent new vigour through the failing limbs; and, finally, when exhausted in all their other resources, and baffled in their skill—handmaids of philosophy and religion—they have blunted the arrows of death, and rendered less rugged and precipitous the inevitable pathway to the tomb. In the circle of human duties, I do not know of any, short of heroic and perilous daring, or religious martyrdom and self-sacrifice, higher and nobler than those of the physician. His daily round of labour is crowded with beneficence, and his nightly

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sleep is broken, that others may have better rest. His whole life is a blessed ministry of consolation and hope.'

The last of Bartlett's strictly medical publications was a little monograph on the History, Diagnosis, and Treatment of Edematous Laryngitis, published in Louisville at the time he held the chair of practice at the University, in 1850. It is a carefully prepared monograph, based largely on the studies of Valleix; a fresh interest in the subject had been given him by the observations of Dr. Gurdon Buck, of New York, who had cured several cases by directly scarifying the oedematous membranes.

IV

Naturally studious, fond of poetry, history, biography, and literature in general, and not for long tied and bound in the chains of general practice, Bartlett had ample opportunities to cultivate his mind. He says in one of his letters to Green (dated Pittsfield, Nov. 1, 1835): '1 pass a good deal of my time here quite alone, so that I find myself whiling away the hours in meditation much oftener than when engaged in the more varied and active affairs of business at home. I think that I always leave Pittsfield with the better and purer part of my being somewhat strengthened.' Burton concludes his immortal treatise with the advice: 'Be not solitary, benot idle', but the true student, in some part of his life at least, should know the 'fruitful hours of still increase'. For many years Bartlett enjoyed a leisure known to-day to few professors of medicine, the fruits of which are manifest in his writings. Among his contemporaries in the profession there were brilliant writers—Samuel Henry Dickson, Jacob Bigelow, J. K. Mitchell—but in a style so uniformly high and polished,

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yet withal so plain, not one of them approached Bartlett. Compare, for example, Samuel Jackson's Principles of Medicine, written in 1832, with the first edition of the Fevers (1842)—the one pompous, involved, obscure; the other clear, direct, simple. For style in his medical writings Bartlett may be called the Watson or the Trousseau of America.

Bartlett was at his best in the occasional address, and, as we have noticed already, this talent was cultivated very early in his career, since we find him giving the Fourth of July oration before his fellow citizens when he had been scarcely a year in Lowell. All of the lectures and addresses illustrate, as Holmes said, 'that easy flow of language, that facility of expression, that florid warmth when occasion offers, which commonly marks the prose of those who are born poets.' Among these addresses there are four or five worthy of a permanent place in our literature. Perhaps the most characteristic is one entitled, The Head and the Heart or the Relative importance of Intellectual and Moral Education, which is a stirring plea for a higher tone in social and political morality. In the same clear, ringing accent he speaks in his address on Spurzheim of the dangers of democracy. In a lecture on The Sense of the Beautiful, delivered in 1843, Bartlett appears as an apostle of culture, pleading in glowing language for the education of this faculty. One short fragment I must quote:

'Amongst the Hebrews, and in the age of Moses, it was linked to religion; it dwelt amidst the mysteries of Worship and Faith. It brought costly offerings to the costlier altar; it hung the tabernacle with its curtains of fine twined linen, and blue, and purple, and scarlet; and with cherubim of cunning work; it arrayed the high priest of Jehovah in his gorgeous and consecrated gar-

ELISHA BARTLETT

ments, and on the mitre of pure gold upon his forehead, it graved, like the engraving of a signet—Holiness to the Lord. At a later day, and amongst a widely different people, it became the handmaid of a refined and luxurious sensuality. It lapped the soul of Greece in a sensual elysium. Its living impersonations were Pericles and Aspasia. It called the mother of love from the froth of the sea, and bound her zone with its cestus; it filled the hills of Arcady with fleet Oreads; it graced with half-naked Naiads the fountains and the rivers. It crowned the Acropolis with the Parthenon, and it embodied its highest conceptions of physical grace and beauty in the Venus and the Apollo. At other periods during the history of our race, it has manifested itself in other forms than these; under other circumstances, aspects, and influences, and with other results.'

In 1848 he delivered the Fourth of July oration before his old friends in Lowell. At the opening he refers to the fact that twenty years before he had occupied the same position.

'It was the dewy morning of my manhood; "time had not thinned my flowing hair"; life, with its boundless hopes and its golden visions, spread far and fair before me; and cheered by your words of encouragement, and aided by your helping hands—your associate and co-worker, and in your service; a stranger, but welcomed with frank confidence and trust—I had just entered upon its arduous and upward pathway.'

In 1849 appeared a Brief Sketch of the Life, Character, and Writings of William Charles Wells, the South Carolinian Tory, who subsequently became a distinguished man of science in London, and who was well known for his researches on the phenomena of dew.

One of the last of Bartlett's publications was A Discourse on the Times, Character, and Writings of Hippocrates, delivered as an introductory address before the trustees, faculty, and medical class of the College of

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Physicians and Surgeons, at the opening of the session of 1852—3. The three pictures¹ which he gives of Hippocrates, as a young practitioner in the Isle of Thasos, at the death-bed of Pericles, and as a teacher in the Isle of Cos, are masterpieces worthy of Walter Savage Landor. In no words of exaggeration the late George D. Prentice said, 'There are but few word pictures in the English language that exceed the grandeur and loveliness of that one called into being by Dr. Bartlett, in which he imagines Pericles upon his death-bed with Hippocrates in attendance.'

It is remarkable how many physicians write poetry or what passes as such. I have been told of a period in the history of the Royal College of Physicians of London when every elect (censor), as they were called, had written verses. Some begin young, as did Bartlett; others become attuned in the deep autumnal tone of advancing years, when, as Plato tells us in the Phaedo, even Socrates felt a divine impulsion to make verses before quitting the prison house. Those of us who have read the epic of the late distinguished Professor George B. Wood, of the University of Pennsylvania entitled First and Last, published when he was sixty-four, will devoutly hope that professors of medicine, when afflicted with this form of madness, will follow his example and publish their poems anonymously and in another country. Jacob Bigelow, too, when nearly seventy, 'darkened sanctities with song' with his American Rejected Addresses (Eolopoesis).

Dr. Bartlett had poetical aspirations early in life. In a letter to his sister of Dec. 3, 1826, he speaks of having seen in New York, in the Garland, 'two fugitive

1 The reader will find these pictures in an appendix to this lecture.

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pieces which some months before I had made use of to fill up the corner of a newspaper, but what sense they might have contained had been turned into nonsense, and I blushed for my wandering orphans, notwithstanding they had been so well dressed, and though they had found their way into pretty respectable company. I should have blushed for myself had they been exhibited to the public as my offspring.' In another letter of the same period we see how completely he had passed beneath the yoke of Byron.

In December, 1854, Bartlett issued a little volume entitled, Simple Settings in Verse,for Six Portraits and Pictures from Mr. Dickens's Gallery, the inditing of which had been, as he says, a pleasant occupation which had helped to while away and fill up many an hour which would otherwise have been weary or vacant in his invalid life. I have already spoken of one, An Allegory, in which are autobiographical details. I cannot do better than quote from an appreciative notice which his friend Oliver Wendell Holmes wrote of the little volume.

'When, to the friends he had loved, there came a farewell gift, not a last effort of the learning and wisdom they had been taught to expect from him, but a little book with a few songs in it, songs with his whole warm heart in them, they knew that his hour was come, and their tears fell fast as they read the loving thoughts that he had clothed in words of natural beauty and melody. The cluster of evening primroses had opened and the night was close at hand.'

Of a warm, affectionate nature—a manhood fused with female grace—to judge from the statements of contemporaries and friends, to know Bartlett was to love him. Alonzo Clark writes to him always as 'Dear Brother', and says in one place, 'We all wish that yoti

144 BIOGRAPHICAL ESSAYS

were among us—not to work unless you choose, but that we might see that face of yours, and feel the influence of the mind that shines through it.' His confreres, John Orne Green and Alonzo Clark, are invariably addressed as 'Dear Brother'. Among the letters is one of sympathy to Dr. Green, the desire of whose eyes had been taken away at a stroke. In it Bartlett unlocked his heart in a most touching and human appeal to the afflicted soul. It seems almost too sacred to quote, but after listening you will forgive me:

'My DEAR BROTHER: What shall I say to the melancholy allusion, in the close of your letter, to the death of our dear Minerva? What poor words of mine can be of any service to one on whom the hand of the Great Chastener has been so heavily laid? How shall I, whose life has been comparatively so cloudless and serene, come, with the message of solace and encouragement, into the presence of one whose meridian sun has been shrouded in such utter and dreadful eclipse? But why should I not? Am I not a brother and a man? Has not bereavement been a guest in the dwelling of my childhood; has not death been a familiar visitor amid the scenes of my early friendships and happiness and hopes? And where, too, is the future—for us all—for me, as well as for yourself? We but follow each other through the furnace of affliction, as we follow each other to the grave. Who of us has so hedged in his earthly treasures that the spoiler cannot easily break through the frail enclosure, and rifle him, in a moment, of the choicest and best? The lines of the Christian poet, familiar to me, chiefly, from the lips of a now sainted mother, occur to my memory here:

The spider's most attenuated thread
Is cord, is cable, to man's tender tie
On earthly bliss ;—it breaks at every breeze.

We are brothers, then, in all the liabilities and contingencies and uncertainties of the future. Let us be brothers and fellow helpers, also, in its hopes and its duties. There can be no entire and hopeless wretchedness for the soul of man, except that which arises from

ELISHA BARTLETT 145

its self-inflicted degradation. The sweet sister, the affectionate daughter, the beautiful bride, and the young mother, was taken away in the clear, unclouded morning of her life—taken away, but where? And by whom? The flower was transplanted from an earthly garden— a fair and sunny one, it is true, but from an earthly garden—to be set forever, where no worm can feed on its root, where no decay can ever dry up its bloom—in the Paradise of God. By whom? Taken away—by her Father, from a far-off country, where she was only a sojourner or a pilgrim—to her beautiful and eternal home. Take these thoughts into your heart, and they shall lighten up, or drive away, the darkness of the past, and, what is better, they shall again cheer your future with the once familiar forms and faces of Happiness and Hope. How can we know what, even of present good, our indulgent Father may have in store for us? He may have allotted to you many long years, to be filled up first with duty, and, if filled with duty, to be crowned, also, with the cheerful light of social and domestic joy. You may say, perhaps, that this is all very well for me to say, but that I know nothing about it. But I do know something of the mutability of all earthly things. This uncertainty has long been to me a daily theme of meditation; so I am not wholly a stranger. But I have found an antidote to the gloom and sadness which would otherwise occasion in remembering that all things are in the hands of a Wise Disposer, and the surest way to please Him, as well as to secure our own present as well as future peace, is to submit to His dispensations and to follow on in the course of active and cheerful duty to Him, to our fellows, and to ourselves.'

When at Louisville some obscure nervous trouble, the nature of which I have not been able to ascertain, attacked Dr. Bartlett. Against it in New York he fought bravely but in vain, and after the session of 1853—4 retired to Smithfield, his native place. The prolonged illness terminated in paralysis, but, fortunately, did not impair his mental faculties in the slightest degree. He died on July 19, 1855.

OSLER L

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From the many eulogies which appeared after Bartlett's death, I select a portion of one written by his dearest friend, Alonzo Clark, as the preface to the fourth edition of the Fevers.

'Sixteen months ago, he closed his brilliant professional career, after years of growing bodily weakness and pain; his mind not dimmed by his physical infirmities, but bright and comprehensive, glowing with the memories of the past, and the visions of the future. He died too soon for the profession he adorned. The clock had hardly marked twelve at noon, on the dial plate of life, when its pendulum strokes grew faint and gradually fainter to the ear; and now, at length, when all is still, the hand that notes the hours points sadly upward, to indicate how much of daytime still remained to reap the harvest of affection and honour, in those fields from which he had alreadv garnered up so many golden sheaves. He died, alas! too soon. The whole profession are his mourners; for conspicuous as he had become by his medical writings and his extended professional labours, his acknowledged worthiness, his innate gentleness and modesty disarmed envy. He left no enemies. His mind and purpose were pure, almost beyond example. His high mental endowments were controlled and directed by a considerate judgement and an earnest, benevolent heart; and as the laws of refraction, wrought out into mathematical formulae, enable the lapidary to construct the facets which open the fountains of the many-coloured diamond, so, for him, cultivation and elegant taste had brought out the varied and winning native lights of his rich, intellectual, moral, and social nature.'

In translating the Lives of Eminent French Physicians, Bartlett said he had a twofold object: 'First, the delineation of distinguished professional character and attainment, and, secondly, by the influence of such high examples to awaken in the younger members of the medical body a more devoted and worthy emulation of the great masters of our art.' In this spirit I appear

ELISHA BARTLETT 147

before you today, glad to tell over the story of your countryman—the story of 'a life in civic action warm', one that all 'the muses deck't with gifts of grace', a distinguished teacher, an author of widespread influence and distinction, a serene philosopher, but above all a man in whom you may recognize, even from the brief and imperfect sketch which I have given,

A likeness to the wise below,
A kinship with the great of old.

 

APPENDIX

A SKETCH OF HIPPOCRATES1

IN one of the years of the eighty-eighth Olympiad, in the island of Thasos, fronting the Thracian city of Abdera, there was sadness in the house of Silenus, for its young master had been seized with sudden and alarming illness—the fiery causus of the climate. The year had been marked by some meteorological and epidemic peculiarities. A little before the rising of Arcturus—that is, just previous to the autumnal equinox, and while this constellation was still upon the horizon—there had been heavy and frequent rains, with winds from the north. Towards the equinox, and up to the setting of the Pleiades, there were light rains with southerly winds. During the winter, the winds were cold, strong, and dry from the north, with snow. Towards the vernal equinox, there were violent storms. The spring was cold and rather wet, with winds from the north. Towards the summer solstice, there were light rains, and the temperature was cool till near the approach of the dog-days. After the dog-days and until the rising of Arcturus, the summer was marked by great heat; not at intervals, but constantly. There was no water. Summer-

1From A Discourse on the Times, Character, and Writings of Hippocrates, by Elisha Bartlett.

L2

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etesian-winds were prevalent. From the rising of Arcturus to the time of the equinox, there were rains with the wind from the south.

During the winter, the general health of the Thasians was good, excepting an epidemic prevalence of paralysis. At the opening of spring, the causus showed itself; and continued to prevail up to the autumnal equinox. During the early part of the season, the disease was mild; but after the autumn rains, it became more severe, and carried off a great many of its subjects... Dysenteries prevailed also during the summer; and some patients with fever even, who had had hemorrhages, were attacked with dysentery: this happened to the slave of Eraton, and to Myllus. . . . There was much sickness amongst the women. . . . Many had difficult labors, and were sick subsequently; this was the case with the daughter of Telebolus, who died on the tenth day after her confinement... When the causus proved fatal, death commonly took place on the sixth day, as in the cases of Epaminondas, Silenus, and Philiscus, son of Antagonas... The parotid glands suppurated in the case of Cratistonax, who lived near the temple of Hercules; and also in that of the servant of Scymmus, the fuller.

But omitting any further details of the prevailing diseases of the year, let us return to the bedside of the young patient in Abdera. It is the third day of his disease; he has had a restless and distressed night, with some wandering of the mind; the symptoms are all worse in the morning, and his family and neighbors are anxious and alarmed. The occupations and order of that old Thasian household are interrupted and broken up. A fresh offering has been placed on the altar of the household Jove, standing in the centre of the inner court. The sound of the flute and the cithara has ceased; there is no animated talk of the last winners at the Isthmian or the Olympian games; the clatter of the loom and the domestic hum of the spinning wheel are no longer heard; the naked feet of the slaves and the women fall carefully and silently upon the uncarpeted floors, aad an unwonted stillness reigns throughout the numerous apartments of dwelling. There is no savory steam of roasting wild boar from the

ELISHA BARTLETT 149

kitchen, and the fragrant Thracian wine stands untasted on the table, with a few plain barley-cakes and a little salt fish.

Silenus lies in his sleeping-chamber, in the quiet interior part of the house, adjoining the apartments of the women, farthest from the vestibule, and near to the garden. By the bed of the sick man, there is a small tripod stand, with a circular top, and upon it there is a statuette of Hercules, a bowl of warm barley-water, and a cup of oxymel.

Leaning her head on the foot of the bed and sobbing, sits, on a low stool, a young Greek woman, beautiful in her features, and graceful in the flowing outlines of her person, as the Thessalian maidens of Homer. There is a picturesque combination of barbarian rudeness and Grecian elegance in her appearance, not an unfitting type and expression of the age and state of society, in the midst of which she lived. Her feet and ankles are bare; she wears only a single garment—the long Ionic chiton of linen—with large sleeves reaching only a little below the shoulders, leaving uncovered, in their snowy whiteness, arms that might have rivalled those of the jealous queen of Olympus. A girdle fastens the robe loosely round a waist, like that of the Medicean Venus, innocent of the deformities of buckram and whalebone. The light auburn hair is simply parted and carried back from the forehead, gathered in a knot on the crown of the head, fastened with a golden grasshopper, and held by a coif of golden network.

At the head of the bed, watching steadfastly and earnestly the appearance of the patient, is seated his physician, the already celebrated son of Heraclides and Phenarete, Hippocrates of Cos. He has just entered the apartment, to make his morning visit. His sandals have been taken off, and his feet washed by a slave in the vestibule. He wears over his linen tunic a large flowing mantle of light fine woolen, suited to the season, not unlike the later toga of the Romans, fastened at the neck with a cameo of Aesculapius, and falling in graceful folds nearly to his feet. His hair is long, and both this and his beard are kept and arranged with scrupulous neatness and care. He is thirty years old, in the very prime and beauty of early manhood. His features, through these

150 BIOGRAPHICAL ESSAYS

misty shadows of many centuries, we cannot clearly distinguish, but we see that his face is dignified, thoughtful, and serene; and his whole aspect, manner, and expression are those of high, antique breeding, of refined culture, and of rather studied and elaborate elegance.

His examination of his patient was long, anxious, and careful. He saw at once that the gravity and danger of the disease had increased since his last visit. He inquired very minutely into the manner in which the night had been passed; and was told by the watchers that the patient had had no sleep, that he had talked constantly, had sung and laughed, and had been agitated and restless. He found the hypochondria tumefied, but without much hardness. The stools had been blackish and watery, and the urine turbid and dark colored. He noticed the temperature and feel of the skin, and he studied for a long time and with great solicitude the general manner and appearance, the decubitus, the breathing, the motions, and especially the physiognomy of the patient. The only circumstance in the examination that would have particularly attracted the attention of a modern witness of the scene, would have been his omission to feel the pulse. With this exception, no examination of the rational symptoms of disease could have been more thorough and methodical.

Having satisfied himself as to the state of his patient, he retired to an adjoining room, followed by some of the attendants, to give directions in regard to the few simple remedies that he intended to use. The patient had already been bled, and had had a purgative of black hellebore. Hippocrates directed, that instead of the strained decoction of barley, which had been the patient's drink, he should now have honey and water—the favorite hydromel—that the bed should be made softer—the windows of the room still farther darkened, and that a warm flax-seed poultice, softened with olive oil, should be applied to the abdomen.

With a sad but decided expression of his fears as to the issue of the case, and a few kindly and pious words to the weeping wife, about the dignity, the solace, and the duty, in all our trials, of submission to the will of the gods, he gathered his mantle gracefully about him, had his sandals refitted by the

ELISHA BARTLETT

slave who waited in the vestibule, and proceeded on his daily round of visits among the houses of the city.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

And now, leaving the sterile island of Thasos, let us follow the young physician to another sick chamber—to a scene of domestic life, still further illustrative of that remote and wonderful period, with which we are concerned.

The time is a year or two later—it is the house of Pericles that we enter, and we stand by the death-bed of the great and venerable Archon. Everything in the spacious apartment indicates the pervading presence—not of obtrusive grandeur, or of showy and ostentatious wealth—but of stately elegance, and of high, various, many-sided luxury, culture, and refinement. Philosophy, letters, and art breathe in the quiet atmosphere of the room; and the taste of Aspasia sheds an Asiatic grace over its furnishing and its decorations. In one corner stands a statue of Minerva, from the chisel of Phidias; and the walls are covered with pictures, fresh from the pencils of Panaenus and Polygnotus, illustrating the legendary and historic glories of Greece. There might have been seen Theseus, bearing off from the field of victory, on the banks of the Thermodon, the masculine and magnificent queen of the Amazons—half willing, perhaps, to be the captive of such a victor; Jason, in his good ship Argo, with his fifty selectest heroes, convoyed by the queen of love, the awful Here, and Apollo, winds his various and adventurous voyage, crowded with poetic imagery and romantic incident, and brings back the golden fleece from Colchis;—Helen, at her loom, is weaving into her 'golden web' the story of the Trojan wars;—the chaste Penelope, by the light of her midnight lamp, undoes the delusive labors of the day;—Ulysses, returned from his long wanderings, surveys once more, with boyish pride and delight, the dear old bow, which no arm but his could bend.

The central figure on that old historic canvas that I have endeavored to unroll before you, is that of the dying statesman. Raised and resting, in solemn and august serenity, upon its last pillow, lies that head of Olympian grandeur,

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which—— I may say it without presumption—after the lapse of nearly twenty-three centuries, now finds, for the first time, its fitting representative and likeness—as the character and career of the great Athenian find their counterparts also—in that illustrious orator and statesman, who now walks in solitary majesty amongst us—the pride, the strength, the glory, of the Republic—the Pericles of our Athens—whose Acropolis is the Constitution of his country—whose Propykea are the freedom and the federation of the States.

Added to the calamities of that long and disastrous internecine struggle between the two rival cities of Greece, which had just begun, Athens was now afflicted with that terrible visitation of the plague, the history of which has been left to us by Thucydides; and Pericles was sinking under a protracted and wearing fever—the result of an attack of the disease.

His long and glorious life is about to close. He had been, for more than an entire generation—if never the first Archon, and not always the most popular—by common consent the most eminent citizen, statesman, and orator of the republic— the great defender of her constitution—the champion of her freedom and her rights—the upholder and the magnifier of her renown. Political rivals, disappointed partisans, and a few malignant personal enemies, and professional libellers and satirists, had been hostile to his career, and had endeavored to blacken his fair fame; but his strong and unshaken democratic faith—his far-seeing sagacity—his firmness and moderation—his enlarged, liberal, humanizing, conservative, and pacific policy—his moral courage and independence, and his high public probity, had triumphed over them all; and although by braving the prejudices of his friends and supporters, in his devotion to they general weal, he had gathered over his declining sun some clouds of public disfavor—the sense of justice, and the feeling of gratitude in the minds of his countrymen were quick to return—the clouds were already scattered, or they served only to deepen and reflect the setting splendor which, for a moment, they had intercepted and obscured.

Many of his near personal friends and relatives had already

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fallen victims to the pestilence. Both his sons had perished, and the young Pericles—the child of Aspasia—had been sent away, with his mother, for safety, into Thessaly. Phidias, and his old teacher, Anaxagoras, his 'Guide, philosopher, and friend', had died a little while before the breaking out of the epidemic. Those who were left had now gathered around the bed of the dying Archon, to receive the rich legacy of his parting words, and to pay to him the last solemn and kindly offices of life.

Not often in the world's history has there met together a more august and illustrious company. These are a few of those whom we are able to recognize amongst them. Resting his head on the shoulder of Socrates, and sobbing aloud in unrestrained and passionate sorrow, leans the wild and reckless Alcibiades—just in the first bloom of that resplendent personal beauty which made him seem to the eyes, even of the Greeks, more like the radiant apparition of a young Apollo, than any form of mere earthly mould—subdued, for the first time in his life, and probably for the last-—-by the spectacle before him, of his dying relative and guardian—to reverence, tenderness, and truth. Sophocles, his old companion in arms, is there; and near him, in his coarse mantle, and with unsandaled feet, may have stood a grandson of Aristides, still poor with the honorable poverty of his great ancestor.

Conspicuous amidst this group of generals, admirals, statesmen, orators, artists, poets, and philosophers,—in rank and fortune, in social position, in reputation, in learning, culture, and refinement, their equal and associate, sits the young physician of Cos. Already had his rising fame reached Athens, and when the city, overcrowded with the inhabitants of Attica, driven from their homes by the armies of Sparta, was smitten with the pestilence, he was summoned from his island home in the Aegean, to stay, if he could, the march of the destroying angel, and to succor with his skill those who had fallen under the shadow of its wings.

On a gentle declivity, looking toward the south-west, in the small island of Cos, lying in the Aegean sea, a few stadia

154 BIOGRAPHICAL ESSAYS

from the coast of Asia Minor, stands the temple of Aesculapius. Its Ionic columns, and its ornamented friezes of Pentelican marble, glitter and flash in the sunlight, as we watch them through the swaying branches of the ancient oaks, chestnuts, and elms, that make the sacred grove of the temple. In the centre of the principal room, or cella, of the temple, and fronting the entrance, stand statues of Aesculapius, and his daughters, Hygiea and Panacea. On each side of the entrance are marble fonts of lustral water, for the preliminary purification of the sick visitors to the temple.

Near a column of the temple, and holding a roll of papyrus in his left hand, stands Hippocrates. Gathered about him, in picturesque little groups, there is a company of Greek youths. Their tasteful and elegant costumes, their earnest and intelligent faces, and their general air and bearing, all show plainly enough the superior refinement and culture of the class to which they belong. They are medical students, young Asclepiades, who have assembled here from the several states of Greece, to acquire the clinical skill and experience of the great surgeon and physician of Cos, and to listen to the eloquent lessons of the illustrious professor.

Thirty years have gone by since we met him at the bedside of the dying Pericles. The lapse of this generation has thinned his flowing hair, and sprinkled his beard with silver.

It would be gratifying if we could know something of his personal history during this long and active period of his life. We know but little, however, and this little is dim and shadowy. That he had led a life of activity and usefulness, and of growing reputation, and that he had visited various portions of Greece, is certain. What he himself had witnessed, and must have felt, we know well enough. He had seen, for this whole period, his country torn and distracted by civil war—state arrayed against state, city against city; he had mourned over the disastrous expedition of Athens against Syracuse; and shooting athwart all the murky darkness of this troubled and stormy period—instead of the benignant sun of Pericles—the baleful rays of the star of Alcibiades, setting at last, but too late for his country, in ignominy and blood.

ELISHA BARTLETT

I have not departed from the strictest limits of historical probability, in assigning to Hippocrates the high powers of didactic and persuasive oratory. One of the most potent agencies in the development of Greek intellect, and the advancement of Greek civilization, consisted in the general prevalence of public teaching and recitation. For many successive centuries, it was from the living lips of bards and rhapsodists, kindled with coals from the glowing altars of patriotism and religion,—and not through the medium of any cold and silent written records, that the immortal strains of the Iliad and the Odyssey rang through the land, and were made literally familiar as household words. Even up to an advanced period of Grecian culture, the art of writing was but little practised; and it was by speech, and not by reading, that statesmen, poets, orators, philosophers, and historians acted upon their disciples and the public. Then, the evidence derived from his writings is full and conclusive, that Hippocrates was not merely a skilful physician, but that he was learned in all the philosophy and literature of his age. Plato speaks of the Asclepiades, his cotemporaries, as men of elegant and cultivated minds, who, in the explanations they give to their patients, go even to the heights of philosophy. It is no violation, then, of historic probability, to presume that the great philosophic and practical physician—who had been trained in this unrivalled school of human speech—who had listened to the eloquence of Pericles in the public assemblies, or been charmed by the 'colloquial magic of Socrates' in the market-place, should have been himself also, a master of this high power of instructive and persuasive speech. It is by no forced or illegitimate exercise of the fancy, that we look back to the scene I have endeavored to sketch. And with little danger of departing far from the truth, we may imagine what would be likely to constitute the theme of his discourse, especially if the occasion was one of unusual interest or solemnity, such as the opening or closing of one of his courses of instruction—the Introductory Lecture—or the Valedictory Address to the graduating class of the school of Cos, at the term of the first year of the ninety-fifth Olympiad.

BIOGRAPHICAL ESSAYS

The character of Hippocrates, his position, his close observation of nature, his knowledge, his philosophy, the times in which he lived, the circumstances which surrounded him, all conspired to make him a polemic and a reformer. He would probably take such an occasion as that of which I am speaking, to lay down and to vindicate the great principles of his system; and he would be likely to begin with an exposition of the errors of medical doctrine and practice, most important and most generally prevalent. I do not suppose that our illustrious historical father was wholly exempt from the infirmities of our common nature; and it is very possible that in his animadversions upon the system of his Cnidian neighbors, there were mingled some ingredients more spicy than Attic salt; and he may have indulged, perhaps, in some allowable self-congratulation, that the class of Cos was so much larger than that at Cnidus.

I suppose, however, that as President of the college, he would, in a graceful and dignified exordium, give his greeting and welcome to the members of the class; he would express his gratification at seeing so numerous an assemblage from so many of the states of Greece—from the North and the South, the East and the West—from Attica, and Boeotia, and the Peloponnesus—from distant Sicily, and even from Egypt.

After this, or some similar appropriate introduction, he would probably continue by warning his hearers against the subtle and dangerous errors of superstition—of the old theurgic faith. He would speak of the great revolution that had so recently taken place in the Greek mind, even then only partially accomplished; he would describe in colors such as only he could use, who had felt this change in his own spirit, and who had witnessed it all about him—the gradual dawn and the final rising of the central, solar idea of a simple spiritual theism, of fixed laws, of invariable relations and sequences of events, in the economy of nature. As he sketched the outlines of this great and pregnant history, he could hardly fail to linger for a moment, with something of the passionate enthusiasm of his early years, and with something also of their strong and simple faith, upon that gorgeous theurgic and mythological creation of the Greek mind, which

ELISHA BARTLETT 157

marked its legendary and religious period. He would speak of this mythology, and its various and beautiful legends, in no cynical or bigoted tone, but with philosophical toleration, and with something even of loving sympathy and admiration. He would say it was the genial and natural product of the quick, susceptible, many-sided Greek mind, in the period of its childhood and adolescence. Kindling with his old enthusiasm, he would have likened that early age, peopled with its gods and demi-gods, its beautiful women and heroic men, to its own young Apollo—the bloom of immortal youth on his beaming forehead, his flowing locks sweet with the ambrosia of the dewy morning of life, and all his form radiant with a divine beauty. He would have said that the present high civilization of his country was in a great degree the growth of seed planted in that genial soil, and nurtured by that genial sun; that Greek character, and art, and philosophy, are all still steeped in the glorious light of the old Homeric age.

In the third place, he would have warned his hearers against the seductive but dangerous influences of the philosophers. These men, he would have said, are, for the most part, idle dreamers, and they are nothing else. I know them well. They affect superior wisdom, and they look down disdainfully upon the physician, and the patient observer of nature. They seem to think that the economy of the universe, including the human system, in health and disease, can be ascertained and understood by a sort of intellectual divination, which they call wisdom and philosophy, but which is in reality only empty hypothesis and idle speculation. He would then have entered into an examination of these systems; he would have exhibited their radical errors and defects —he would have compared them with the humbler philosophy of observation and experience, and he would have shown that they had accomplished nothing, and that in the very nature of things they could accomplish nothing, for the advancement of real knowledge.

As he gazed upon that most impressive spectacle before him,—so many of his young countrymen, gathered at the peaceful summons of science and humanity from all portions

BIOGRAPHICAL ESSAYS

of the Grecian territory, filled with hope, with ardor, with promise, life's full and radiant future stretching far and fair before them,—a cloud of sadness could hardly fail to throw its shadow over his features, as he remembered the long thirty years of civil discord, of deadly internecine strife, through which his country had just passed; and his closing words could hardly fail to rise into a patriotic and Pan-Hellenic hymn, the burden of which should be, that the glory, and happiness, and safety of Greece, were to be found in the union of her states; that they whom he addressed—his young friends and disciples—were the common and equal heirs of the glory of Marathon and Thermopyloe; that they all spoke the language of Homer; that while they need not forget, but might be proud even, that they were Spartans, or Athenians, or Thebans, or Thessalians, they ought to remember with a higher pride, that they were also, and more than all, Greeks; that they had a common country, and that a common destiny awaited them.

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