disease and lung-disease are both frequently employed. The heart-disease of fiction is a polite sort of disease, and has few or no premonitory symptoms; it is found out suddenly by the doctor, who issues the warning that at any moment the victim may fall down dead; and sure enough, at the right moment, down he or she falls. Such patients have no dropsies or unpleasant complications, though they may suffer from anginous spasms. It is a purely novel-writer's disease, and is preluded almost invariably with that visit to the doctor to receive the unexpected verdict which has been described over and over again in novels, but which for obvious reasons happens but rarely in real life. One novel, however, occurs to my mind in which a definite description of cardiac disease is given accurately- Une Vie,' by Guy de Maupassant. Here, it may be remembered, the unlucky heroine's mother, the Baroness Adélaïde les Perthius des Vauds, has a heart-disease to which she alludes frequently as mon hypertrophie,' and the symptoms of hypertrophy with subsequent dilatation of the heart are given perfectly. The baroness is a heavy and short-winded woman, who slept stertorously, walked with difficulty, and sat down every few paces during her self-imposed tasks of exercise. We learn when the book opens that she has suffered from cardiac symptoms for some ten years, so that it is perfectly right that the failure of the heart to do its work should have begun. And with the physical decay has also arrived the inevitable moral feebleness of a starved brain. Forced to lead the life of a half-suffocated cabbage, the unfortunate woman spends her time weeping over sentimental romances and re-reading the letters which later reveal her to her daughter as the possessor of a poor past. On the occasion of her daughter's wedding she deputes to her husband the delicate task of breaking to their child the meaning of the responsibilities of marriage, with the result that the young couple make a horrible start in their joint life. The next year sees the end of her resistance to her disease; compensation fails, she becomes dropsical, is unable to walk unsupported, is troubled with dyspnoea, ages in six months more than she had done in the preceding ten years; falls into unconsciousness, and dies. This is a vivid pathological picture. Phthisis has been frequently used to account for the disappearance from the scene of young women in an agreeable and sometimes in a very prompt manner. It is in novels always fatal and usually hereditary, and we must remember here that opposite views are the outcome of completely modern work. In hereditary cases the fatal seeds germinate on exposure to a draught in a ballroom or symptoms supervene upon amatory disappointmenttwo perfectly correct observations as far as they go. A most carefully drawn description of phthisis is to be found in Mr. Henry James's Portrait of a Lady.' Ralph Tuckett would not have died nowadays from his complaint, while twenty years ago he would have died more quickly than his inventor permits him; but the progress of his disease and its influence upon character and physique are carefully set out in a true clinical portrait. Particular attention, however, may be drawn to the description of phthisis in one of Charles Reade's full-blooded novels, Foul Play,' part of which is attributed to the late Dion Boucicault. The heroine in this book has the disease, and, considering it irremediable, spares her father the shock of learning what she has discovered for herself. If he knows that she has spitting of blood he will at once know that she is doomed, inasmuch as her mother was a phthisical subject. But circumstances-and circumstances of a truly sensational kind-lead to this young lady being left on a desert island, where she has to sleep in a hastily constructed log shelter and labour all day beneath the sky in accordance with the habits of brave castaways. She puts on weight, increases from strength to strength, and utterly loses her tuberculous infection. This book was written in 1868, and at that time few save George Bodington, the first to advocate the open-air treatment of tuberculosis, would have believed the episode possible. Bodington's book was written in 1840, but his teachings were coldly received, and by 1868 were forgotten. To many medical men, in a book teeming with impossibilities, the episode of Helen Rolleston's recovery may have seemed the least credible; we now see not only its possibility, but its extreme probability. I Among general or systemic diseases a certain amount of play is made with fevers, but the pathognomonic symptoms are rarely given in sufficient detail to enable us to make a diagnosis. cannot recall any case in what may be called a standard novel where an accurate study of scarlet fever or of typhoid fever occurs, and the zymotics are generally and indifferently used to remove superfluous persons. During the evolution of that magnificent muddle, Our Mutual Friend,' Dickens in all probability changed his mind more than once, and when he decided to get rid of the Boffins' adopted orphan he did it with great celerity by fever. Fevers seldom receive them by the greatest The orphan had spots which came out on his chest. They were Into the regions of neurology I will not follow the novelist, but a protest is wanted against a certain common way of using insanity to punish ill-doers-if it cannot be dropped because it is stale, will the fact that it is also silly lead to its surcease? We must all be familiar with the sudden overthrow of reason that occurs in ill-behaving characters. The wretches become insane in a moment. This catastrophe generally comes at the end of the book or play, and mainly to villains whose schemes have miscarried piecemeal; their anxiety increases with their terrific but futile exertions to ward off the approaching Nemesis; then some wholly unexpected disaster meets them, reason totters on its throne, and they fall with a crash, to be picked up insane. Various situations lead to this kind of fit-the diamonds kept by a thief in reserve to secure flight when the worst has come to the worst at that exact juncture prove to be false or to have been stolen by a confederate; the mistress, hitherto the loving accomplice, deserts the failing fortunes of him who has sinned for her; the fatal rectitude of a wife or a son closes unwittingly the last avenue of a swindler's escape. The victims get purple, grasp their collarstuds, burst into horrid laughter, tumble to earth, and are picked up gibbering lunatics, who for many years after may be seen in an asylum going through some pantomime reminiscent of the crowning catastrophe. Who first invented this kind of thing I have no idea; it is founded on no known pathology, but novelists and dramatists believe in the force of its public appeal. The intentions of a paper whose length will, I know, put a great strain on the good-nature of the Editor of the CORNHILL have been two. First, I wished to suggest by examples from good writers that there are rules by which the medicine of a non-medical writer can be fairly tested. Second, I wished to protest against the ignorance of the medical life displayed by lesser writers. VOL. XXXI.-NO. 186, N.S. 53 BLINDS DOWN: A CHRONICLE OF CHARMINSTER. BY HORACE ANNESLEY VACHELL. CHAPTER XII. BURIED ALIVE. THE aunts were unable to dissemble their delight when Rose, after careful inspection, pronounced the Dower House and its garden to be much to her liking. After tea, Jaqueline pointed out a fairy-ring upon the smooth lawn; Rose said gravely: Yes, my dear, there are fairies in this garden. I see them. One is winking. A few minutes later she clapped hands at sight of the Char, exclaiming: Oh, what lovely ships! ' 'Ships?' repeated Jaqueline, wondering if a mud barge could be so described. 'Yes, ships, lovely ships. Look at their beautiful white sails!' 'To be sure,' said Jaqueline. And what are they carrying, my love?' 'Peacocks, parrots, and missionaries.' 'Dear me! what eyes you have! Where are they sailing to?' To the pore, blind heathen. They eat the peacocks, and sometimes they eat the missionaries, but they prefer their wives.' 'Bless me,' said Jaqueline, quite flustered, why?' His Ex.'-she invariably alluded to her father thus says that the missionaries taste of tobacco, and the pore blind heathen. don't like that.' Jaqueline, rather glad that Prudence was not listening to this risqué conversation, said pleasantly: 'We must have some nice talks, my darling.' Rose nodded. 'I'll talk to you, my fine dear, whenever you like.' Crump became her abject slave in five minutes. The child Copyright, 1911, by H. A Vachell, in the United States of America. |