Hull, England, United Kingdom
|Samuel Johnson. Portrait by Joshua Reynolds, 1772. Via Wikimedia. Public domain.|
This paper reproduces in an abridged form an earlier article by its author1 appraising the evidence that Samuel Johnson suffered from Tourette’s syndrome.
Several authors have commented on the many eccentricities of Dr. Samuel Johnson (Fig 1).2 Thomas Tyers, for example, has written as follows:
His gestures, which were a degree of St. Vitus’ Dance, in the street attracted the notice of many, the stare of the vulgar, but the compassion of the better sort.3
Throughout life Samuel Johnson suffered from many illnesses.4 In childhood he had scrofula (tuberculosis of the lymph nodes) and was sent to London to be touched for the “King’s Evil” by Queen Anne. He had poor vision in one eye5 and was partially deaf. Later in life he had gout, bouts of melancholy, and insomnia. By 1774, he was “very ill of a cold and cough”6,7,8 and was breathless thereafter.9 At age 74 he had a stroke.6,7,10 In 1783 he suffered congestive heart failure with dropsy and probably unrecognized myocardial infarction. He died in London in 1784.
Rituals and tics
JAMES BOSWELL, his famous biographer
Dr. Johnson is often muttering pious ejaculations, when he appears to be talking to himself.
…Yet his appearance was rendered strange and somewhat uncouth by convulsive cramps…When he walked, it was like the struggling gait of one in fetters: when he rode he had no command or direction of his horse, but was carried as if in a balloon.
He commonly held his head on one side towards his right shoulder, and shook it in a tremulous manner, moving his body backwards and forwards, and rubbing his left knee in the same direction, with the palm of his hand. In the intervals of articulating he made various sounds with his mouth, sometimes as if ruminating, sometimes giving a half-whistle, sometimes making his tongue play backwards from the roof of his mouth, as if clucking like a hen, and sometimes protruding it against his upper gums in front, as if pronouncing quickly under his breath, ‘too, too, too’.
…He had another particularity…his anxious care to go in and out at a door or passage, by a certain number of steps from a certain point… I have on innumerable occasions, observed him suddenly stop, and then seem to count his steps with a deep earnestness; and when he had neglected, or gone wrong in this sort of magical movement, I have seen him go back again, put himself in a proper posture to begin the ceremony, and, having gone through it, break from his abstraction, walk briskly on, and join his companion. 8
FANNY BURNEY (aka Mme. D’Arblay) his long-life friend
He is, indeed, very ill-favoured! Yet he has naturally a noble figure; tall, stout, grand and authoritative: but he stoops horribly; his back is quite round: his mouth is continually opening and shutting, as if he were chewing something; he has a singular method of twirling his fingers, and twisting his hands … 9
MISS FRANCES REYNOLDS
His extraordinary gestures or anticks with his hands and feet, particularly when passing over the threshold of a Door, …On entering Sir Joshua’s house with poor Mrs Williams, a blind lady who lived with him, he would quit her hand, or else whirl her about on the steps as he whirled and twisted about to perform his gesticulations; and as soon as he had finished, he would give a sudden spring, and make such an extensive stride over the threshold, as if he was trying for a wager to see how far he could stride…
But the strange positions in which he would place his feet (generally I think before he makes his straddles, as if necessarily preparatory) are scarcely credible. Sometimes he would make the back part of his heels to touch, sometimes the extremity of his toes, as if endeavouring to form a triangle, or some geometrical figure, and as for his gestures with his hands, they were equally strange: sometimes he would hold them up with some of his fingers bent, as if he had been seized with the cramp, and sometimes at his Breast in motion like those of a jockey on full speed; and often he would lift them up as high as he could stretch over his head for some minutes.10
Miss Reynolds, walking with Johnson in Twickenham Meadows, noted:
…I well remember that they (his gestures) were so extraordinary that men, women and children gathered around him laughing…and they nearly dispersed when he pulled out of his pocket Grotius’ De Veritate Religionis, over which he see-sawed at such a violent rate as to excite the curiosity of some people at a distance to come and see what was the matter with him.
His repetitive utterances were often of a religious nature, but repeated obscenities and scatological comments (coprolalia) are probable, though doubtless the social niceties of his friends inhibited their descriptions.
Fanny Burney observed:
The careless old ejaculations have, in almost every case been modified or effaced in the manuscripts of the diaries…by Mme D’Arblay herself, even more by her niece who was editor of her later diaries. These almost unmeaning expletives seem to have passed unrebuked by Dr. Johnson.11
This, and other reports suggest that he exhibited coprolalia, compulsive swearing. There are other relevant passages in the writings of James Clifford, Fanny Burney, Miss Reynolds, and her famous brother Sir Joshua.12 Boswell mentions his symptoms in the Life, and in Tour of the Hebrides, but perhaps because of his loyal veneration is uncharacteristically brief.
Johnson’s many medical friends and non-medical cognoscenti had noted his tics, mannerisms and ritualistic behaviour. Boswell, Thomas Tyers, and Pope regarded the malady as organic: “infirmity of a convulsive kind” (Pope); “the nature of the distemper called St Vitus’s dance.”13 An organic basis is now also generally accepted14,15,16 and Dr. Johnson’s complex rituals, compulsions, dystonic tics, gesticulations,17 and a wide variety of antics are now regarded as characteristic18 of the syndrome described in 1885 by George Gilles de la Tourette (1857 – 1904):
“About the age of 7 or 8, a child commonly with a wretched family history, begins to exhibit a series of tics…The movements may be confined for a long time to the face, but later they gradually invade the shoulders and arms…The inarticulate laryngeal sound becomes organized:…this being pathognomonic of the disorder…the patients give vent one day to a word or short phrase of quite special character, inasmuch as its meaning is always obscene. These words or phrases are exclaimed in a loud voice, without attempt at restraint… Another physical stigma, echolalia is occasionally, though less frequently observed.”19
Tourette presented nine patients with persisting tics, beginning in childhood, five of whom had coprolalia and echolalia. Hughlings Jackson described an example in 1864 and many cases had been reported since.20,21 Several descriptive passages from a huge volume of Johnsoniana fit well with current criteria for the Tourette syndrome.22,23 He also displayed many of the associated obsessional-compulsive traits and rituals.
Oliver Sacks drew attention to the boundless mental energy, imaginative outbursts of inventiveness and creativity characteristic of certain Tourette patients.24 We might speculate that without this illness Dr. Johnson’s literary achievements, his dictionary, philosophical deliberations and conversations may never have happened; and James Boswell, the author of the “greatest of biographies”, would have been unknown.
- Pearce JMS. Doctor Samuel Johnson: “The Great Convulsionary” A Victim Of Gilles De La Tourette’s syndrome. Journal Royal Society of Medicine 1994; 87: 396-99 and Pearce JMS. Fragments of Neurological History. Imperial College Press 2003, 602-14.
- Brain R. The Great Convulsionary. In: Some Reflections on Genius. London: Pitman.1960 pp. 66-92.
- Tyers Thomas. 1897 A Biographical sketch of Dr Samuel Johnson. Gentleman’s magazine, December 1784. Reproduced In: Hill GB. Johnsonian Miscellanies II, 274-5. London: Constable & Co, reprint 1966.
- Boswell James. The Life of Samuel Johnson LL.D. p. 4. London: James Blackwood & Co. 1791.
- Boswell James. The Life of Samuel Johnson LL.D. London: James Blackwood & Co. 1791, p. 11.
- Critchley M. Dr Samuel Johnson’s aphasia. In: The Black Hole and other essays, pp. 30–45. London: Pitman. 1964.
- Johnson Samuel. Prayers and Meditations: 127. London: T.Cadell and W. Davies. 1817.
- Boswell James. 1785 The Journal of a Tour of the Hebrides with Samuel Johnson LL.D. London: Everyman edn 1948. p. 8.
- Burney Fanny. Letters and Diaries. London: G. Bell. 1846.
- Reynolds Frances. 1897 Recollections of Dr Johnson. Now in the Hyde collection extracted by George Birkbeck Hill In: Johnsonian Miscellanies II, 274-5. London: Constable & Co, reprint 1966.
- Burney Frances. 1846 Early Diary of F. Burney. 2 : 234. cited by George Birkbeck Hill. In: Johnsonian Miscellanies II, 274-5. London: Constable & Co 1897, reprint 1966.
- Clifford JL. In: Dictionary Johnson, The middle years pp.27-8. New York: McGraw Hill. 1979.
- Boswell James. The Life of Samuel Johnson LL.D. p.35. London: James Blackwood & Co. 1791.
- Jankovic J Stone L. Dystonic tics in patients with Tourette’s syndrome. Mov Disord 1991; 6/3: 248-252.
- Drake ME Jr Hietter SA Padamadan H Bogner JE. Computerized EEG frequency analysis in Gilles de la Tourette Syndrome. Clin EEG Electroenceph 1991; 22/4: 250-253.
- Erenberg G Cruse RP Rothner AD. The natural history of Tourette syndrome: A follow-up study. Ann Neurol 1987; 22/3: 383-385.
- McHenry L. Samuel Johnson’s tics and gesticulations. J Hist Med 1967; 22: 152-68.
- Murray TJ. Dr Samuel Johnson’s movement disorder. Brit Med J 1979; 1: 1610-4
- Tourette Gilles de la. Etude sur une affection nerveuse caractérisée par l’incoordination motrice accompagnée d’écholalie et de coprolalie. Archives de Neurologie 1885; 9: 19-42, 153-6.
- Robertson MM Schnieden V Lees AJ. Management of Gilles de la Tourette syndrome using sulpiride. Clin Neuropharmacol 1990; 13/3: 229-235.
- Robertson MM Trimble MR Lees AJ. The psychopatholgy of the Gilles de la Tourette syndrome. A phenomenological analysis. Br J Psychiatry 1988; 152: 383-390.
- American Psychiatric Association. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.
- Leading article. Tourette syndrome. Lancet 1987; 1/8528: 308.
- Sacks O. Tourette’s syndrome and creativity. British Med J 1992; 305: 1515-6.
JMS PEARCE is a retired neurologist and author with a particular interest in the history of medicine and science.