some remarks upon the peculiar difficulties which beset the medical
practitioner in the discharge of his laborious and important duties.
“A young friend of mine, who has taken an interest in medical studies,
happened to meet with a very familiar story about one of the greatest
and most celebrated of all English physicians, Thomas Sydenham. The
story is that, when a student asked him what books he should read, the
great doctor told him to read 'Don Quixote.'
“This piece of advice has been used to throw contempt upon the study of
books, and furnishes a convenient shield for ignorant pretenders.
But Sydenham left many writings in which he has recorded his medical
experience, and he surely would not have published them if he had not
thought they would be better reading for the medical student than the
story of Cervantes. His own works are esteemed to this day, and he
certainly could not have supposed that they contained all the wisdom of
all the past. No remedy is good, it was said of old, unless applied at
the right time in the right way. So we may say of all anecdotes, like
this which I have told you about Sydenham and the young man. It is very
likely that he carried him to the bedside of some patients, and talked
to him about the cases he showed him, instead of putting a Latin volume
in his hand. I would as soon begin in that way as any other, with a
student who had already mastered the preliminary branches,--who knew
enough about the structure and functions of the body in health.
“But if you ask me what reading I would commend to the medical student
of a philosophical habit of mind, you may be surprised to hear me say
it would be certain passages in 'Rasselas.' They are the ones where the
astronomer gives an account to Imlac of his management of the elements,
the control of which, as he had persuaded himself, had been committed to
him. Let me read you a few sentences from this story, which is commonly
bound up with the 'Vicar of Wakefield,' like a woollen lining to
a silken mantle, but is full of stately wisdom in processions of
paragraphs which sound as if they ought to have a grammatical drum-major
to march before their tramping platoons.
“The astronomer has taken Imlac into his confidence, and reveals to him
the secret of his wonderful powers:--
“'Hear, Imlac, what thou wilt not without difficulty credit. I
have possessed for five years the regulation of the weather and the
distribution of the seasons the sun has listened to my dictates, and
passed from tropic to tropic by my direction; the clouds, at my call,
have poured their waters, and the Nile has overflowed at my command; I
have restrained the rage of the dog-star, and mitigated the fervors of
the crab. The winds alone, of all the elemental powers, have hitherto
eluded my authority, and multitudes have perished by equinoctial
tempests, which I found myself unable to prohibit or restrain.'
“The reader naturally wishes to know how the astronomer, a sincere,
devoted, and most benevolent man, for forty years a student of the
heavens, came to the strange belief that he possessed these miraculous
powers. This is his account:
“'One day, as I was looking on the fields withering with heat, I felt in
my mind a sudden wish that I could send rain on the southern mountains,
and raise the Nile to an inundation. In the hurry of my imagination I
commanded rain to fall, and by comparing the time of my command with
that of the inundation I found that the clouds had listened to my lips.'
“'Might not some other cause,' said I, 'produce this concurrence? The
Nile does not always rise on the same day.'
“'Do not believe,' said he, with impatience, 'that such objections
could escape me: I reasoned long against my own conviction, and labored
against truth with the utmost obstinacy. I sometimes suspected myself
of madness, and should not have dared to impart this secret but to a man
like you, capable of distinguishing the wonderful from the impossible
and the incredible from the false.'
“The good old astronomer gives his parting directions to Imlac, whom he
has adopted as his successor in the government of the elements and the
seasons, in these impressive words:
“Do not, in the administration of the year, indulge thy pride by
innovation; do not please thyself with thinking that thou canst make
thyself renowned to all future ages by disordering the seasons. The
memory of mischief is no desirable fame. Much less will it become thee
to let kindness or interest prevail. Never rob other countries of rain
to pour it on thine own. For us the Nile is sufficient.'
“Do you wonder, my friends, why I have chosen these passages, in which
the delusions of an insane astronomer are related with all the pomp
of the Johnsonian vocabulary, as the first lesson for the young person
about to enter on the study of the science and art of healing? Listen to
me while I show you the parallel of the story of the astronomer in the
history of medicine.
“This history is luminous with intelligence, radiant with benevolence,
but all its wisdom and all its virtue have had to struggle with the
ever-rising mists of delusion. The agencies which waste and destroy
the race of mankind are vast and resistless as the elemental forces of
nature; nay, they are themselves elemental forces. They may be to some
extent avoided, to some extent diverted from their aim, to some extent
resisted. So may the changes of the seasons, from cold that freezes
to heats that strike with sudden death, be guarded against. So may the
tides be in some small measure restrained in their inroads. So may the
storms be breasted by walls they cannot shake from their foundations.
But the seasons and the tides and the tempests work their will on the
great scale upon whatever stands in their way; they feed or starve the
tillers of the soil; they spare or drown the dwellers by the shore; they
waft the seaman to his harbor or bury him in the angry billows.
“The art of the physician can do much to remove its subjects from deadly
and dangerous influences, and something to control or arrest the effects
of these influences. But look at the records of the life-insurance
offices, and see how uniform is the action of nature's destroying
agencies. Look at the annual reports of the deaths in any of our great
cities, and see how their regularity approaches the uniformity of the
tides, and their variations keep pace with those of the seasons. The
inundations of the Nile are not more certainly to be predicted than the
vast wave of infantile disease which flows in upon all our great cities
with the growing heats of July,--than the fevers and dysenteries which
visit our rural districts in the months of the falling leaf.
“The physician watches these changes as the astronomer watched the
rise of the great river. He longs to rescue individuals, to protect
communities from the inroads of these destroying agencies. He uses all
the means which experience has approved, tries every rational method
which ingenuity can suggest. Some fortunate recovery leads him to
believe he has hit upon a preventive or a cure for a malady which had
resisted all known remedies. His rescued patient sounds his praises, and
a wide circle of his patient's friends joins in a chorus of eulogies.
Self-love applauds him for his sagacity. Self-interest congratulates him
on his having found the road to fortune; the sense of having proved a
benefactor of his race smooths the pillow on which he lays his head
to dream of the brilliant future opening before him. If a single
coincidence may lead a person of sanguine disposition to believe that he
has mastered a disease which had baffled all who were before his time,
and on which his contemporaries looked in hopeless impotence, what must
be the effect of a series of such coincidences even on a mind of calmer
temper! Such series of coincidences will happen, and they may well
deceive the very elect. Think of Dr. Rush,--you know what a famous man
he was, the very head and front of American medical science in his day,
--and remember how he spoke about yellow fever, which he thought he had
mastered!
“Thus the physician is entangled in the meshes of a wide conspiracy,
in which he and his patient and their friends, and Nature herself, are
involved. What wonder that the history of Medicine should be to so great
an extent a record of self-delusion!
“If this seems a dangerous concession to the enemies of the true science
and art of healing, I will remind you that it is all implied in the
first aphorism of Hippocrates, the Father of Medicine. Do not draw a
wrong inference from the frank statement of the difficulties which
beset the medical practitioner. Think rather, if truth is so hard of
attainment, how precious are the results which the consent of the wisest
and most experienced among the healers of men agrees in accepting. Think
what folly it is to cast them aside in favor of palpable impositions
stolen from the records of forgotten charlatanism, or of fantastic
speculations spun from the squinting brains of theorists as wild as the
Egyptian astronomer.
“Begin your medical studies, then, by reading the fortieth and the
following four chapters of 'Rasselas.' Your first lesson will teach
you modesty and caution in the pursuit of the most deceptive of all
practical branches of knowledge. Faith will come later, when you learn
how much medical science and art have actually achieved for the relief
of mankind, and how great are the promises it holds out of still larger
triumphs over the enemies of human health and happiness.”
After the reading of this paper there was a lively discussion, which we
have no room to report here, and the Society adjourned.
XIV. MISS VINCENT'S STARTLING DISCOVERY.
The sober-minded, sensible, well-instructed Dr. Butts was not a little
exercised in mind by the demands made upon his knowledge by his young
friend, and for the time being his pupil, Miss Lurida Vincent.
“I don't wonder they called her The Terror,” he said to himself. “She is
enough to frighten anybody. She has taken down old books from my
shelves that I had almost forgotten the backs of, and as to the medical
journals, I believe the girl could index them from memory. She is in
pursuit of some special point of knowledge, I feel sure, and I cannot
doubt what direction she is working in, but her wonderful way of dealing
with books amazes me.”
What marvels those “first scholars” in the classes of our great
universities and colleges are, to be sure! They are not, as a rule,
the most distinguished of their class in the long struggle of life.
The chances are that “the field” will beat “the favorite” over the long
race-course. Others will develop a longer stride and more staying power.
But what fine gifts those “first scholars” have received from nature!
How dull we writers, famous or obscure, are in the acquisition of
knowledge as compared with them! To lead their classmates they must
have quick apprehension, fine memories, thorough control of their
mental faculties, strong will, power of concentration, facility of
expression,--a wonderful equipment of mental faculties. I always want to
take my hat off to the first scholar of his year.
Dr. Butts felt somewhat in the same way as he contemplated The Terror.
She surprised him so often with her knowledge that he was ready to
receive her without astonishment when she burst in upon him one day with
a cry of triumph, “Eureka! Eureka!”
“And what have you found, my dear?” said the doctor.
Lurida was flushed and panting with the excitement of her new discovery.
“I do believe that I have found the secret of our strange visitor's
dread of all human intercourse!”
The seasoned practitioner was not easily thrown off his balance.
“Wait a minute and get your breath,” said the doctor. “Are you not a
little overstating his peculiarity? It is not quite so bad as that.
He keeps a man to serve him, he was civil with the people at the Old
Tavern, he was affable enough, I understand, with the young fellow he
pulled out of the water, or rescued somehow,--I don't believe he avoids
the whole human race. He does not look as if he hated them, so far as I
have remarked his expression. I passed a few words with him when his man
was ailing, and found him polite enough. No, I don't believe it is much
more than an extreme case of shyness, connected, perhaps, with some
congenital or other personal repugnance to which has been given the name
of an antipathy.”
Lurida could hardly keep still while the doctor was speaking. When he
finished, she began the account of her discovery:
“I do certainly believe I have found an account of his case in an
Italian medical journal of about fourteen years ago. I met with a
reference which led me to look over a file of the Giornale degli
Ospitali lying among the old pamphlets in the medical section of the
Library. I have made a translation of it, which you must read and then
tell me if you do not agree with me in my conclusion.”
“Tell me what your conclusion is, and I will read your paper and see for
myself whether I think the evidence justifies the conviction you seem to
have reached.”
Lurida's large eyes showed their whole rounds like the two halves of a
map of the world, as she said,
“I believe that Maurice Kirkwood is suffering from the effects of the
bite of a TARANTULA!”
The doctor drew a long breath. He remembered in a vague sort of way the
stories which used to be told of the terrible Apulian spider, but he had
consigned them to the limbo of medical fable where so many fictions have
clothed themselves with a local habitation and a name. He looked into
the round eyes and wide pupils a little anxiously, as if he feared that
she was in a state of undue excitement, but, true to his professional
training, he waited for another symptom, if indeed her mind was in any
measure off its balance.
“I know what you are thinking,” Lurida said, “but it is not so. 'I am
not mad, most noble Festus.' You shall see the evidence and judge for
yourself. Read the whole case,--you can read my hand almost as if it
were print, and tell me if you do not agree with me that this young
man is in all probability the same person as the boy described in the
Italian journal,
“One thing you might say is against the supposition. The young patient
is spoken of as Signorino M---- Ch------ But you must remember that ch
is pronounced hard in Italian, like k, which letter is wanting in the
Italian alphabet; and it is natural enough that the initial of the
second name should have got changed in the record to its Italian
equivalent.”
Before inviting the reader to follow the details of this extraordinary
case as found in a medical journal, the narrator wishes to be indulged
in a few words of explanation, in order that he may not have to
apologize for allowing the introduction of a subject which may be
thought to belong to the professional student rather than to the readers
of this record. There is a great deal in medical books which it is very
unbecoming to bring before the general public,--a great deal to repel,
to disgust, to alarm, to excite unwholesome curiosity. It is not the men
whose duties have made them familiar with this class of subjects who
are most likely to offend by scenes and descriptions which belong to the
physician's private library, and not to the shelves devoted to polite
literature. Goldsmith and even Smollett, both having studied and
practised medicine, could not by any possibility have outraged all the
natural feelings of delicacy and decency as Swift and Zola have outraged
them. But without handling doubtful subjects, there are many curious
medical experiences which have interest for every one as extreme
illustrations of ordinary conditions with which all are acquainted. No
one can study the now familiar history of clairvoyance profitably who
has not learned something of the vagaries of hysteria. No one can read
understandingly the life of Cowper and that of Carlyle without having
some idea of the influence of hypochondriasis and of dyspepsia upon the
disposition and intellect of the subjects of these maladies. I need
not apologize, therefore, for giving publicity to that part of this
narrative which deals with one of the most singular maladies to be found
in the records of bodily and mental infirmities.
The following is the account of the case as translated by Miss Vincent.
For obvious reasons the whole name was not given in the original paper,
and for similar reasons the date of the event and the birthplace of the
patient are not precisely indicated here.
[Giornale degli Ospitali, Luglio 21, 18--.] REMARKABLE CASE OF
TARANTISM.
“The great interest attaching to the very singular and exceptional
instance of this rare affection induces us to give a full account of the
extraordinary example of its occurrence in a patient who was the subject
of a recent medical consultation in this city.
“Signorino M... Ch... is the only son of a gentleman travelling in
Italy at this time. He is eleven years of age, of sanguine-nervous
temperament, light hair, blue eyes, intelligent countenance, well grown,
but rather slight in form, to all appearance in good health, but subject
to certain peculiar and anomalous nervous symptoms, of which his father
gives this history.
“Nine years ago, the father informs us, he was travelling in Italy with
his wife, this child, and a nurse. They were passing a few days in a
country village near the city of Bari, capital of the province of the
same name in the division (compartamento) of Apulia. The child was in
perfect health and had never been affected by any serious illness. On
the 10th of July he was playing out in the field near the house
where the family was staying when he was heard to scream suddenly and
violently. The nurse rushing to him found him in great pain, saying that
something had bitten him in one of his feet. A laborer, one Tommaso,
ran up at the moment and perceived in the grass, near where the boy
was standing, an enormous spider, which he at once recognized as a
tarantula. He managed to catch the creature in a large leaf, from which
he was afterwards transferred to a wide-mouthed bottle, where he lived
without any food for a month or more. The creature was covered with
short hairs, and had a pair of nipper-like jaws, with which he could
inflict an ugly wound. His body measured about an inch in length, and
from the extremity of one of the longest limbs to the other was between
two and three inches. Such was the account given by the physician to
whom the peasant carried the great spider.
“The boy who had been bitten continued screaming violently while his
stocking was being removed and the foot examined. The place of the bite
was easily found and the two marks of the claw-like jaws already showed
the effects of the poison, a small livid circle extending around them,
with some puffy swelling. The distinguished Dr. Amadei was immediately
sent for, and applied cups over the wounds in the hope of drawing forth
the poison. In vain all his skill and efforts! Soon, ataxic (irregular)
nervous symptoms declared themselves, and it became plain that the
system had been infected by the poison.
“The symptoms were very much like those of malignant fever, such
as distress about the region of the heart, difficulty of breathing,
collapse of all the vital powers, threatening immediate death. From
these first symptoms the child rallied, but his entire organism had
been profoundly affected by the venom circulating through it. His
constitution has never thrown off the malady resulting from this toxic
(poisonous) agent. The phenomena which have been observed in this young
patient correspond so nearly with those enumerated in the elaborate
essay of the celebrated Baglivi that one might think they had been
transcribed from his pages.
“He is very fond of solitude,--of wandering about in churchyards and
other lonely places. He was once found hiding in an empty tomb, which
had been left open. His aversion to certain colors is remarkable.
Generally speaking, he prefers bright tints to darker ones, but his
likes and dislikes are capricious, and with regard to some colors his
antipathy amounts to positive horror. Some shades have such an effect
upon him that he cannot remain in the room with them, and if he meets
any one whose dress has any of that particular color he will turn away
or retreat so as to avoid passing that person. Among these, purple and
dark green are the least endurable. He cannot explain the sensations
which these obnoxious colors produce except by saying that it is like
the deadly feeling from a blow on the epigastrium (pit of the stomach).
“About the same season of the year at which the tarantular poisoning
took place he is liable to certain nervous seizures, not exactly like
fainting or epilepsy, but reminding the physician of those affections.
All the other symptoms are aggravated at this time.
“In other respects than those mentioned the boy is in good health. He
is fond of riding, and has a pony on which he takes a great deal of
exercise, which seems to do him more good than any other remedy.
“The influence of music, to which so much has been attributed by popular
belief and even by the distinguished Professor to whom we shall again
refer, has not as yet furnished any satisfactory results. If the graver
symptoms recur while the patient is under our observation, we propose to
make use of an agency discredited by modern skepticism, but deserving of
a fair trial as an exceptional remedy for an exceptional disease.
“The following extracts from the work of the celebrated Italian
physician of the last century are given by the writer of the paper in
the Giornale in the original Latin, with a translation into Italian,
subjoined. Here are the extracts, or rather here is a selection from
them, with a translation of them into English.
“After mentioning the singular aversion to certain colors shown by
the subject of Tarantism, Baglivi writes as follows: “'Et si astantes
incedant vestibus eo colore difusis, qui Tarantatis ingrates est,
necesse est ut ab illorum aspectu recedant; nam ad intuitum molesti
coloris angore cordis, et symptomatum recrudescantia stating
corripiuntur.' (G. Baglivi, Op. Omnia, page 614. Lugduni, 1745.)
“That is, 'if the persons about the patient wear dresses of the color
which is offensive to him, he must get away from the sight of them, for
on seeing the obnoxious color he is at once seized with distress in the
region of the heart, and a renewal of his symptoms.'
“As to the recurrence of the malady, Baglivi says: “'Dam calor solis
ardentius exurere incip at, quod contingit circa initia Julii et
Augusti, Tarantati lente venientem recrudescentiam veneni percipiunt.'
(Ibid., page 619.)
“Which I render, 'When the heat of the sun begins to burn more fiercely,
which happens about the beginning of July and August, the subjects of
Tarantism perceive the gradually approaching recrudescence (returning
symptoms) of the poisoning. Among the remedies most valued by this
illustrious physician is that mentioned in the following sentence:
“'Laudo magnopere equitationes in aere rusticano factas singulis diebus,
hord potissimum matutina, quibus equitationibus morbos chronicos pene
incurabiles protanus eliminavi.'
“Or in translation, 'I commend especially riding on horseback in country
air, every day, by preference in the morning hours, by the aid of which
horseback riding I have driven off chronic diseases which were almost
incurable.'”
Miss Vincent read this paper aloud to Dr. Butts, and handed it to him
to examine and consider. He listened with a grave countenance and devout
attention.
As she finished reading her account, she exclaimed in the passionate
tones of the deepest conviction,