Doctor Johnson and his ailments

Illustration of Samuel Johnson walking
Samuel Johnson, L.L.D. ca.1770. Llyfrgell Genedlaethol Cymru – The National Library of Wales. Public Domain

Samuel Johnson, one of the greatest English literary figures of all time, is remembered more for what he said than for what he wrote. Other writers may have been more successful or more profound, but none had as great a biographer as James Boswell.1 Boswell was twenty-two years old when he was first introduced to Dr. Johnson (1763) and for the next twenty-one years he recorded everything notable that the great man said.1 Boswell himself was a complex character; insultingly characterized by Lord Macauley as “a dunce, a parasite and a coxcomb,” he was a man of quick observation and retentive memory whose qualities have made him immortal.

Even Johnson’s greatest works, the essays in the Rambler (1750-52) and Idler (1758-60), the Dictionary of the English Language (1755), and Rasselas (1759) have been characterized as “little read except by professed students of literature.”1 But we know more about Johnson’s life, his illnesses, and his relation to doctors and medicine than about any other literary figure.3-7 Already by 1759 over thirty physicians had written about his health and various aspects of medicine, and there had been over eighteen biographies.5 He himself had been “a great dabbler in physic” and through his early writings had become familiar with many aspects of medicine and with the lives of notable physicians.5

Samuel Johnson was born in 1709 in Lichfield,3 roughly 16 miles north of Birmingham, and his mother at the time was already forty years old. The delivery seems to have been difficult; as a newborn, he did not cry, and he was expected not to live. Sent early to a wet nurse, he developed, perhaps from contaminated milk, what was called at the time the “King’s Evil,”3 a form of tuberculosis of the lymph nodes known as scrofula.4 At age three he was taken to London to be cured by the ancient ritual of the “royal touch.”3,4 He was touched by the elderly Queen Anne but “her hand was applied in vain.”3 Later local doctors made incisions in his arm to let out the bad humors.4 They also drained the various lymph nodes on the lower side of his face, leaving him scarred for life. He also had poor vision and impaired hearing, which may have resulted either from the scrofula or from intercurrent illnesses.4 Yet at the time of his love marriage at age twenty-five to a woman ten years his senior, he was a strong young man, described by his wife’s daughter as “lean and lank, so that his immense structure of bones was hideously striking to the eye”4

As a boy, Johnson had read voraciously. He was educated locally; and at age nineteen went to Pembroke College in Oxford. On his first day he surprised his teachers by quoting the little read Latin author Macrobius, leading them to declare that they had never known a freshman of such attainments.3 He stayed at Pembroke for three years, but unfortunately his father, a bookseller, was “more qualified to pour upon books and to talk about them, then to trade in them” and ended up in serious serious financial difficulties.3 As a result, Johnson had to leave Oxford without a degree (1731).

His life during the years that followed was a struggle with poverty and he was unable to make a living locally, his difficulties compounded by his taking a wife, with whom, however, he had a happy marriage. At last in 1737, at age twenty-eight, he “decided to seek his fortune in the capital as a literary adventurer.”3

But it was, as Macauley wrote, possibly the worst time in history to attempt to make a living by writing. Johnson endured poverty and hunger.3 This privation and suffering affected his manners and made him almost savage.3 He wore shabby clothes and a dirty shirt; and being often hungry he contracted the habit of eating with ravenous greediness, a habit that persisted throughout his life.3 Between 1737 and 1745 his life was a great struggle. He was often employed in what he considered menial jobs such as Edward Cave’s Gentleman’s Magazine, a “harmless drudge” as he later put it in his dictionary, a literary laborer working “for gain not glory” and solely to support himself.1 Later jobs served to introduce him to the medical world and expand his understanding of it. He contributed several articles and edited others for Robert James’s Medicinal Dictionary;4 and he wrote articles about Drs. Hermann Boerhaave, Thomas Sydenham, and Sir Thomas Browne, as well as making entries on doctors of antiquity and Islam that “swelled the letter A considerably” with Actuarius, Aegineta, Aesculapius, Aetius, Archagathus, Asclepiades, and Alexander, plus all the Islamic writers whose name commenced with an A such as Albucassis, Avicenna, Averroes, and Avenzoar.5

It was a long struggle, but eventually his talents prevailed and he became one of the leading literary figures in London. It was around that time, in 1763, that Boswell had “the honor and happiness to enjoy his friendship for upwards of twenty years.”1 He meticulously recorded his life and his pronouncements, often at the literary club also attended at various times by Sir Joshua Reynolds, Oliver Goldsmith, Edward Gibbon, Edmund Burke, David Hume, David Garrick, Charles Burney, James Fox, and Adam Smith.

Illustration of Samuel Johnson seated at a desk
Samuel Johnson, L.L.D. From The Miriam and Ira D. Wallach Division of Art, Prints and Photographs, The New York Public Library. 

Johnson had now gained considerable weight.4 Boswell described him as “large, robust, approaching the gigantic, and grown unwieldy from corpulency.”4 He “wore his hair, which was straight and stiff, and separated behind; and often had seemingly convulsive starts and made odd gesticulations which tended to excite at once surprise and ridicule.”1 He dressed slovenly in a stained rusty brown suit, the wig he wore was too small for his head, and having once known poverty he ate ravenously. In his conversation, he displayed many prejudices, despised the Scots, disliked foreigners, hated slavery, and characterized Americans as descendants of convicts. Conservative in politics, he felt one should level up and not level down. He has gone down in history as writing in an elevated “Johnsonese” style, prompting Oliver Goldsmith to once observe that if were to write about little fish he would make them talk like whales.1,3

Johnson was not a physician and his doctorate was awarded to him in recognition of his dictionary. He had, however, considerable medical knowledge, some acquired from his earlier work on the writings of notable physicians, and some from his friendship with several doctors who attended to him at various stages of his life, including the famous Dr. Heberden. He seems to have had enough medical knowledge so that during his travel to the Hebrides in the company of Boswell (1773) he was able to write prescriptions. He suffered from a variety of illnesses himself. At the age of sixty-five, he developed attacks of joint pain located mainly in the lower extremities, recurring in 1776, 1779, 1781, and 1783. They “never climbed higher than [his] ankles,” and he was advised to soak his feet in cold water and even had some kind of surgery. The pain may possibly have been due to gout but more likely some form of degenerative arthritis.4

Of great interest to neurologists have been his abrupt gesticulations, tics, and other involuntary movements.6 According to Boswell “he commonly held his head to one side . . . moving his body backwards and forwards, and rubbing his left knee in the same direction, with the palm of his hand . . . [H]e made various sounds” like “a half whistle” or “as if clucking like a hen,” and “. . . all this accompanied sometimes with a thoughtful look, but more frequently with a smile. Generally when he had concluded a period, in the course of a dispute, by which time he was a good deal exhausted by violence and vociferation, he used to blow out his breath like a whale.”1 There are many similar accounts: in particular, Johnson was said to “perform his gesticulations” at the threshold of a house or in doorways. When asked by a little girl why he made such noises and acted in that way, he responded: “From bad habit.”1 Almost two hundred years after his death, in 1967, the Canadian neurologist T.J. McHenry made a posthumous diagnosis of Gilles de la Tourette’s syndrome,4 a condition which now has become widely accepted but which at the time was unknown.6 Johnson also displayed many of the obsessive-compulsive traits and rituals which are associated with this syndrome.

In addition, there have been many accounts of Johnson also suffering from bouts of depression, and what he thought might be madness. Much of this in his younger days was clearly due to his strained circumstances. It appears that at one time he strongly entertained thoughts of suicide. Boswell claimed that Johnson “felt himself overwhelmed with an horrible melancholia, with perpetual irritation, fretfulness, and impatience; and with a dejection, gloom, and despair, which made existence misery.” Depression and insomnia persisted throughout his life, but he learned to cope with it. Boswell recounts his advice to always have a lamp burning and a book opened by the bedside, and he recommended specifically Burton’s Anatomy of Melancholy despite it being heavily loaded with Latin quotations.1

Except for some arthritic symptoms, however, Johnson remained healthy until January 1782, when at the age of seventy-three his health began to deteriorate.4 In 1783 he had a paralytic stroke, perhaps a transient ischemic episode, which left him for some time unable to speak, apparently from aphasia, but from which he recovered.4 He became increasingly short of breath and developed massive swelling of his legs and the rest of the body. He thought that the swelling or edema was the underlying disease causing his symptoms, and apparently so did his doctors, who assiduously attempted to relieve him by making repeated cuts in his legs to allow the fluid to drain out as well as prescribing large doses of squill and digitalis.4 He also developed a sarcocele, a fleshy tumor of the testicle, and several days before his death he took matters in his own hands by using a lancet under the bedclothes to puncture the swollen testicle as well making three cuts in his legs to drain the edema.4 Suffering from gradually increasing shortness of breath when lying down on account of his heart failure, he died on December 13, 1784.

The autopsy showed massive cardiac enlargement, aortic lesions, and diseased lungs generally attributed to emphysema or, according to one dissenting authority, to pulmonary interstitial disease. In addition to the probable cor pulmonale (heart disease secondary to lung disease), he may well have had left heart failure from arteriosclerosis and also from hypertension, but at that time measurements of the blood pressure were not yet available. He was buried in the poet’s corner in Westminster Abbey in the company with the other great literary figures of his age. But the memory of him remains alive, “of the old philosopher in his brown coat with the metal buttons and the shirt which also be at wash, blinking, puffing, rolling his head, drumming with his fingers, tearing has meet like a tiger, and swallowing his tea in oceans. No human being who has been more than seventy years in the grave is so well known to us,” wrote Lord Macauley in 18563 concluding that the memory of him is “likely to be remembered as long as the English language is spoken in any quarter of the globe.”2

 

References

  1. A Shorter Boswell. The life of Samuel Johnson LLD. Thomas Nelson and Sons LTD, 1925
  2. Literary essays by Thomas Babington Macauley. A.L. Burt Company Publishers.
  3. Macauley’s life of Samuel Johnson. The Macmillan Company, 1903.
  4. John Wilshire. Samuel Johnson in the Medical World. Cambridge University, 1991.
  5. Lawrence C. McHenry Jr: Dr. Samuel Johnson’s medical biographies. Journal of the History of Medicine and Allied Sciences 1959; 14:298.
  6. Lawrence C. McHenry Jr: Samuel Johnson’s tics and gesticulations. Journal of the History of Medicine and Allied Sciences 1967; 22:152.
  7. T. J. Murray: Dr. Samuel Johnson’s movement disorder. British Medical Journal 1979; 1: 1610.

 


 

GEORGE DUNEA, MD, Editor-in-Chief

 

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