Popular Science Monthly/Volume 20/April 1882/Dean Swift's Disease
| DEAN SWIFT'S DISEASE. |
By Dr. BUCKNILL, F. R. S.
DURING the past autumn I received a letter from a gentleman engaged in literary work, requesting my opinion on the "mysterious disease" of the great author and wit whose name distinguishes this paper. My interlocutor particularly wished to know whether the sane part of Swift's life was likely to have been in any way affected by the latent presence of insanity; whether a correct diagnosis was possible; whether parallel cases were on record; and, finally, whether a surfeit of green fruit, at the age of twenty-three years, was capable of resulting in the absolute fatuity from which the patient suffered at seventy-five.
This questioning has stimulated me to an investigation which I had thought was already threadbare, but which I found full of interest; and when I say that, upon weighing the evidence, it will probably be acknowledged that Jonathan Swift's mysterious disease was an instance of that curious form of disease, labyrinthine vertigo, or le maladie de Menière, the knowledge of which is one of the most recent triumphs of pathological research directed by physiological experiment, it will scarcely be thought that it was needless to reopen a controversy in which already everything had been said which ought to have been said, and not a little which ought not to have been said.
When Dr. Beddoes suggested that Swift's ailments and his conduct toward women were due to dissolute habits in youth, Sir Walter Scott replied that, "until medical authors can clearly account for and radically cure the diseases of their contemporary patients, they may readily be excused from assigning dishonorable causes for the disorders of the illustrious dead." But, if Dr. Beddoes were unquestionably wrong in making such a suggestion without evidence, Sir Walter was scarcely right in making his retort too general; for, if medical opinions respecting the states of mind of persons who have departed this life must be forbidden until medical men can insure the radical cure of diseases, not only will much valuable evidence respecting the validity of wills be excluded, but the science of pathology itself, depending upon the history of diseases and verified by observations made after death, must be interrupted until an event which seems impossible has taken place.
Whether the causes of disease are or are not dishonorable, and whether the subjects of them are or are not illustrious, has nothing to do with the scientific question; and the often-quoted sneer of Swift's greatest biographer at the medical profession seems, when examined, as silly as general sarcasm usually is. Undeterred by such sarcasm, an eminent medical man did investigate the causes for the disorders of the illustrious dead in a work which he modestly called an essay, published in 1849, and entitled "The Closing Years of Dean Swift's Life," etc., by W. R. Wilde, M. R. I. A., F. R. C. S. This little work, marked by the excellences of careful research, sound reasoning, moderate opinions and fair conclusions, would have rendered further discussion needless if medical science had stood still since its publication; but the advances made in medical psychology during the last thirty-two years might give us some excuse for reconsideration even if Menière had never made his discovery of a definite form of disease previously unrecognized, which appears to conform in all important points with the life-long disease of the illustrious dean.
Even in Swift's latest biography, or rather that fragment of one which so strongly makes us feel that touch of the vanished hand of the most appreciative critic of men of letters, the late John Forster's charming volume, the author speaks of Swift's giddiness and deafness, not as symptoms of one disorder, but as "two life-long enemies," and it is a curious enough fact that Swift himself attributed the origin of these two enemies to different causes, operating at different periods. In a letter to Mrs. Howard in 1727 he writes: "About two hours before you were born I got my giddiness by eating a hundred golden pippins at a time at Richmond; and when you were four years and a quarter old, bating two days, having made a fine seat further in Surrey, where I used to read, there I got my deafness, and these two friends, one or other, have visited me one or other every year since; and, being old acquaintances, have now thought fit to come together." Mrs. Howard having been born in 1690, the date of the deafness given in this letter would be 1694, when Swift was twenty-seven years old. But in a passage quoted by Forster, page 48, Swift wrote: "In England before I was twenty I got a cold, which gave me a deafness that I could never clear myself of. . . my left ear has never been well since."—April 30, 1737.
One can not but concur in Johnson's remark on the above, that "the original of diseases is commonly obscure, and almost every school-boy eats as much fruit as he can get, without inconvenience." But it may also be remarked that if Swift had been "a contemporary patient," although we might not have effected a radical cure of his disease, we should at least have understood enough of its origin and nature to have saved him from tormenting himself by a life-long abstinence from fruit, of which he was passionately fond, under the belief that it had caused and continued to excite his disease by inducing that "coldness of stomach to which he attributed his vertigo and its accompanying sickness."
In a letter of 1708 he says that, "I was through a long time pursued by a cruel illness that seized me at fits and hindered me from pursuing any business." It is possible that this illness was but a return of the dangerous colic from which he suffered in 1696; and it is not until 1710 to 1713, and while residing in London, that he describes in some detail the symptoms of his life-long complaint in his "Journal to Stella." The most descriptive passage is perhaps the one dated October 31, 1710:
"This morning, sitting in my bed, I had a fit of giddiness; the room turned round for about a minute, and then it went off, leaving me sickish, but not very. I saw Dr. Cockburn to-day, and he promises to send me the pills that did me good last year; and likewise has promised me an oil for my cars, that he has been making for that ailment for somebody else."
A fit of giddiness, with sickness and ear-disease, is not this labyrinthine vertigo?
On different days in January, 1711, he writes:
"I had an ugly fit in my chamber last night. . . . My head is not in order, and yet is not absolutely ill; but giddyish, and makes me listless. . . . One fit shakes me a long time."
February 1st.—"I walked into the City to dine, but I walked plaguy carefully, for fear of sliding against my will."
April 18th.—"I did not go to the House of Commons about the yarn: my head was not well enough. I know not what is the matter. It has never been thus before; two days together giddy from morning till night, and I totter a little, but can make a shift to walk."
In May: "I do not totter as I did, but walk firm as a rock, only once or twice for a minute."
September 1st, he notes an important peculiarity, distinguishing cerebral from stomachic vertigo: "My head is pretty well; only a sudden turn at any time makes me feel giddy for a moment, and sometimes it feels very stuffed."
The journals of October show that he distinguished ordinary from vertiginous headache: "My head has ached a little in the evening, but it is not of the true giddy sort, so I do not much value it. . . . I had a little turn in my head this morning, which, though it did not last above a minute, yet being of the true sort, has made me as weak as a dog all this day."
During the years of residence in London which embrace the period of the "Journal to Stella," his other enemy, deafness, is only referred to incidentally, as when he compares it to that of the Lord Treasurer; but, after his return to Ireland, his deafness becomes sufficiently severe to make him complain.
In 1720 he writes, "What if I should add that once in five or six weeks I am deaf for three or four days?"
In 1724 he writes, "I have been this month past so pestered with a return of the noise and deafness in my ears that I had not the spirit to perform the common offices of life." Subsequently, in the same year, "My deafness has left me above three weeks, and therefore I expect a visit from it soon." It was evidently periodic and paroxysmal, like the giddiness.
He complains in another letter of an old vexatious disorder of a deafness and noise in the ears. In 1727, in a letter to Sheridan, he says that his deafness is worse than it ever before had been, and that it is accompanied by giddiness and tottering. "I believe," says he, "that this giddiness is the disorder which will at last get the better of me." And again, "I walk like a drunken man, and am deafer than ever you knew me."
In 1728, in "about eight months," says Wilde, "he had half a dozen attacks of the giddiness and sickness, each of which lasted about three weeks." But in 1731 he wrote to Mr. Gay, "The giddiness I was subject to, instead of coming seldom and violent, now constantly attends me more or less, though in a more peaceable manner, yet such as will not qualify me to live among the young and healthy." In 1736, writing to Pope, "years and infirmities have quite broke me. I mean that continual disorder in my head." In 1737, to Alderman Barker, "I am forced to tell you my health is much decayed; my deafness and giddiness more frequent; spirits I have none left; my memory is almost gone."
Long before, however, these symptoms had commenced. Impairment of memory he complained of as early as 1713, after the attack of shingles; and later on in the same year he speaks of his horrible melancholy changing into dullness, and from thenceforth increasing irritability of temper and mental depression are traceable throughout his history and correspondence. Not that he was at any time really of unsound mind or incapable; for, when in 1737, in the Bettesworth affair, a gratifying address was presented to him, it i s recorded that "when this paper was delivered Swift was in bed, giddy and deaf, having been some time before seized with one of his fits; but he dictated an answer in which there is all the dignity of habitual pre-eminence and all the resignation of humble piety."
The above quotations are but a selection from a far greater number of references which might be made to Swift's letters and journals, affording conclusive evidence, as I venture to think, that he suffered from twenty years of age from the disease, whose characteristic symptoms are, "that the patient is suddenly seized with vertigo and a feeling of nausea or positive sickness, with great constitutional depression and faintness. Usually the giddiness comes on simultaneously with ringing or buzzing in one or, it may be, both ears."—Ferrier.
It has this year been pointed out by Féré, in the "Revue de Médecine," that there are two forms of the disease to be recognized, "une forme grave avec état vertigineux à peu près permanent interrompu par les paroxysmes, et une forme moins fâcheuse, constitutée par des accès séparés par des périodes de santé parfaite. . . . Dans la forme bénigne [of which Swift's was an example] les accès ne se produisent quelquefois qu'à des distances très éloignées. E. Ménière cite une malade qui eut une rémission de onze mois. Pendant ces périodes d'accalmie, la surdité persiste avec une intensité variable, et elle s'accompagne souvent des sensations subjectives intermittentes de l'ouïe. La maladie elle-même dure tant que la surdité n'est pas absolue."
Up to the date to which we have traced the progress of the disease, it appears to have been purely a physical malady, with no mental symptoms, unless some degree of loss of memory can be so called. Swift, indeed, complains bitterly of the impairment, as if memory were gone, and in his declining years of age and sickness it may have been a dull function compared with the brilliant faculty he once possessed. But clearly the memory was still serviceable which enabled him to compose, with wonderful vivacity, even such poetry as that outburst against political and social corruption—"The Legion Club"—which Jeffrey thinks "deserving of attention as the most thoroughly animated, fierce, and energetic of all Swift's metrical compositions; and though the animation be altogether of a ferocious character, and seems occasionally to verge upon absolute insanity, there is still a force and a terror about it which redeems it from ridicule, and makes us shudder at the sort of demoniacal inspiration with which the malison is vented." This poem, written in 1736, was his last work; its appreciation by his most hostile critic will show how little he suffered from loss of any mental faculty when he wrote it. That disease and grief had made him irritable and passionate, and often desponding, is clear enough from his correspondence and the accounts of him which have come down to us; but that there was any failure of mind this "Legion Club" fully disproves; and, if fiercely expressed hatred is any evidence that an author is on the verge of insanity, Jeffrey must have been curiously insensible to the testimony he was bearing against his own soundness of mind in his criticism of the greater master of his own art.
Between 1736, when Swift wrote "The Legion Club," and 1741, when the outbreak of insanity really took place, there can be no doubt that he passed through a period of great wretchedness and depression—he was "miserably ill." He had lost to a great extent two of his senses, for he was deaf and his eye-sight failed; his dearest friends had died before him, and his public sympathies were constantly outraged.
In 1738 he wrote to Alderman Barker: "I have for almost three years past been only the shadow of my former self, with years of sickness and rage against all public proceedings, especially in this miserably oppressed country. I have entirely lost my memory, except when it is aroused by perpetual subjects of vexation."
Two years later he wrote the following pathetic letter to his old friend Mrs. Whiteway:
"I have been very miserable all night, and to-day extremely deaf and full of pain. I am so stupid and confounded that I can not express the mortification I am under, both of body and mind. All I can say is that I am not in torture, but I daily and hourly expect it. Pray let me know how your health is, and your family. I hardly understand one word I write. I am sure my days will be very few; few and miserable they must be. I am for these few days yours entirely, J. Swift.
"If I do not blunder it is Saturday."
A very pitiful state this period of becoming insane, and yet not having become so. But even at this late date one can not recognize the invasion of mental disease. Misery and despondency there was, more than enough, but not madness, unless Job was mad. But Swift was rapidly tending toward madness, and he knew it, for strong forebodings of insanity, which are not common, existed in him in a remarkable degree. Sir Walter Scott says that "his first state was that of violent and furious lunacy"; but Sir William Wilde points out that all the biographers have had no other sources of information as to the outbreak and history of his insanity than two letters; one from Mrs. Whiteway, and one from his cousin, Mr. Deane Swift.
Mrs. Whiteway wrote November 22, 1742, as follows, omitting some expressions of feeling:
"I was the last person whom he knew, and when that part of his memory failed he was so outrageous at seeing anybody that I was forced to leave him, nor could he rest for a night or two after seeing any person. He walked ten hours a day, would not eat or drink if his servant staid in the room. His meal was served ready cut, and sometimes it would be an hour on the table before he would touch it, and then eat it walking. About six weeks ago, in one night's time his left eye swelled as large as an egg, and the lid, Mr. Nicholls [his surgeon] thought would mortify, and many large boils appeared on his arms and body. The torture he was in is not to be described. Five persons could scarce hold him, for a week, from tearing out his own eyes; and for near a month he did not sleep two hours in twenty-four. Yet a moderate appetite continued; and, what is more to be wondered at, the last day of his illness he knew me perfectly well, took me by the hand, called me by my name, and showed the same pleasure as usual in seeing me. I asked him if he would give me a dinner? He said, 'To be sure, my old friend.' Thus he continued that day, and knew the doctor and surgeon and all his family, so well that Mr. Nicholls thought it possible he might return to a share of understanding, so as to be able to call for what he wanted, and to bear some of his old friends to amuse him. But alas! this pleasure to me was but of short duration; for the next day or two it was all over, and proved to be only pain that had roused him. He is now free from torture, his eye almost well, very quiet, and begins to sleep, but can not without great difficulty be prevailed upon to walk a turn about his room; and yet in this way, the physicians think, he may hold out for some time."
The only other authentic account from personal knowledge is contained in the letter of Mr. Deane Swift to Lord Orrery, dated April 4, 1744. After stating that a thousand stories of the illness had been invented and imposed upon the world, he proceeds to state some facts witnessed by himself:
"On Sunday the 17th of March, as he sat in his chair, upon the housekeeper removing a knife from him as he was going to catch at it, he shrugged his shoulders, and rocking himself, he said, 'I am what I am. I am what I am'; and about six minutes afterward repeated the same words two or three times over. Sometimes he will not utter a syllable, at other times he will speak incoherent words; but he never yet, as far as I could hear, talked nonsense, or said a foolish thing. About four months ago he gave me great trouble. he seemed to have a mind to talk to me. In order to try what he would say, I told him I came to dine with him, and immediately his housekeeper, Mrs. Ridgeway, said, 'Won't you give Mr. Swift a glass of wine, sir?' he shrugged his shoulders, just as he used to do when he had a mind that a friend should not spend the evening with him. Shrugging his shoulders, your lordship may remember, was as much as to say, 'You'll ruin me in wine.' I own I was scarce able to bear the sight. Soon after he again endeavored, with a good deal of pain, to find words to speak to me; at last, not being able, after many efforts, be gave a heavy sigh, and I think was afterward silent. This puts me in mind of what he said about five days ago. He endeavored several times to speak to his servant [now and then he calls him by his name]; at last, not finding words to express what he would be at, he said, 'I am a fool.' Not long ago the servant took up his watch that lay upon the table, to see what o'clock it was; he said, Bring it here,' and when it was brought, he looked very attentively at it. Some time ago the servant was breaking a large, stubborn coal, he said, 'That's a stone, you blockhead.' In a few days, or some very short time after guardians had been appointed for him, I went into his dining-room, where he was walking; I said something to him very insignificant, I know not what, but, instead of making any kind of answer to it, he said, 'Go, go,' pointing with his hand to the door, and immediately afterward, raising his hand to his head, he said, 'My best understanding,' and so broke off abruptly, and walked away."
These two letters are stated by Sir William Wilde to be the only account of the last three years of Swift's life that has come down to us. He died October 19, 1745, in the seventy-eighth year of his age. His death, according to Lord Orrery, being easy, without the least pang or convulsion; but according to Faulkner, being one of "great agony, with strong convulsive fits" for thirty-six hours before. The only record of the autopsy which was made is that Mr. Whiteway "opened the skull, and found much water in the brain." A more interesting record, however, remains in the plaster cast of Swift's head. Of this Sir Walter Scott says that "the expression is most unequivocally maniacal, and one side of the mouth horribly contorted downward as if in pain." But Sir William Wilde, whose observation we greatly prefer in such a matter, says: "The expression is remarkably placid, but there is an evident drag on the left side of the mouth, exhibiting a paralysis of the facial muscles to the right side. Upon the back of the cast are two lines of writing, greatly defaced, of which this much can still be read: 'Dean Swift, taken off his * * * * the night of his burial, and the f * * * * one side larger than the other in nature * * Opened before * * * The mould is in pieces.'" A deep indentation, says Wilde, shows where the calvarium had been sawn; and accurately corresponds with the division of the skull found in Swift's coffin in 1835. On the same excellent authority we know that the cast of the interior of Swift's skull is remarkable as showing the enormous development of the vessels within the cranium, the very small anterior lobes, the great size of the glandulæ Pacchioniæ, the exceedingly small cerebellum, a natural formation as may be seen by the very low position of the tentorium, the immense size of the posterior and middle lobes, particularly the former, and the absence of any appearance of disease in the anterior lobes, as far at least as this cast of the interior of the skull is capable of demonstrating.
Swift of course was not exempt from intercurrent diseases, the most important of which appear to have been a severe colic in 1696, which brought him to extremity, "so that all despaired of my life, and the newspapers reported me dead"; an attack of herpes zoster of the left neck and shoulder, with its atrocious after-pains, in 1712; and a severe attack of ague in 1720, which lasted a whole year. But these maladies appear to have passed away without permanent injury, and it is to the cold which, before he was twenty, gave him a deafness and an ear "which has never been well since," to which we must look as the origin of his physical and ultimately of his mental miseries, and which made him often describe himself as
"Vertiginosus, inops, surdus, male gratus aniicis."
He does not appear ever to have guessed that his vertigo was due to the state of the auditory organ, nor indeed did any physician ever suspect that such was the case in any one suffering from ear-giddiness, until, led to reflect on the subject by Fleurens's experiments on the semicircular canals of pigeons and rabbits, Ménière recognized the causal connection in 1861. The paroxysmal nature of the affection, with long intervals of immunity, is well marked in Swift's case, although it would appear from a quotation made by Forster, p. 253, from one of his note-books, that the fits were pretty frequent, the reference to fits in his journal and correspondence only applying to the more serious occasions. The quotation is as follows:
"1708. Nov. From 6th to 16, often giddy. Gd help me. So to 25 less. 16, Brandy for giddiness 2s. Brdy 3d. Dec. 5.—Horribly sick. 12th.—Much better, thank God and M. D.'s prayers. 16th.—Bad fit at Mrs. Barton's. 24. Better; but dread a fit. Better still to the end. 1709, Jan. 21st.—An ill fit but not to excess. 29. Out of order. 31. Not well at times. Feb. 7.—Small fit abroad. Pretty well to the end. March.—Headache frequent. April 2nd.—Small giddy fit and swimming in the head. M. D. and God help me. August.—Sick with giddiness much. 1710. Jan.—Giddy. March.—Sadly for a day. 4th. Giddy from 4th. 14th.—Very ill. July.—Terrible fit. Gd knows what may be the event. Better towards the end."
It is true that the paroxysms were not so numerous as those of most other cases of the disease which are on record, and also that the deafness never became absolute, and therefore that the disease never ceased. It increased in intensity as life advanced, until it confined him to his chamber for weeks at a time. It is also to be remarked that a slight degree of vertigo caused great constitutional disturbance. "I had a little turn in my head this morning, which, though it did not last above a moment, yet, being of the true sort, has made me as weak as a dog all this day."—Journal, October 23, 1711. "This morning I felt a little twitch of giddiness, which has disordered and weakened me with its ugly remains all this day."—Journal, January 25, 1812. Another characteristic of the vertigo, noted in a quotation already given, is that at one time any slight movement of the head brought it on.
It is certain that this fearful disease, aggravated with the increase of years, had an influence in the causation of Swift's insanity; but that its influence was direct—that is to say, by the extension of the local disease to the brain—is by no means so sure as its indirect effect as one source of the profound depression which marked the latter years of his sane life. We have no authentic account of the first outbreak of insanity, and Sir Walter's statement that, after his understanding failed, "his first state was that of violent and furious lunacy," would seem to have been applicable only to that later period when he suffered indescribable torture from some unknown local disease, producing exophthalmos of the left eye. It is clear there was emotional depression amounting to melancholia, and "much water in the brain," which was probably sub-arachnoid effusion, is sufficient evidence of dementia. But there was also that form of aphasia in which scraps of reasonable language come automatically, though intentional effort can produce no words, and very curiously, in connection with this fact, comes the evidence of the plaster-cast, "brought to light a hundred years after death," that there was right-sided hemiplegia. The knowledge of the importance of this fact also has been acquired since Sir William Wilde wrote his work, and it is not, therefore, surprising that while he so carefully and skillfully marshals the data upon which our diagnosis is now made, he does not connect the right-sided hemiplegia with the very peculiar affection of speech recorded by one of the two authentic witnesses above quoted. Sir William Wilde expresses the opinion that the hemiplegia had existed for several years before death, "for we find the same appearance much glossed over by the artist, together with a greater fullness or plumpness of the right cheek shown in a very admirable bust, probably the last ever taken." But as Wilde admits, the "six well-known busts of Swift, undoubtedly taken about the same time, exhibit six different forms of head bearing but little resemblance to each other," the much-glossed-over appearance can, therefore, scarcely be admitted as evidence. Probably the stroke of palsy recorded in the plaster-cast had taken place unobserved at or about the time of the actual outbreak of the mental disorder, which might have masked the physical symptoms from observation.
When "the Vandal desecration of monuments" in 1835 exposed Swift's skull to the phrenologists, the great Dublin aurist might possibly have found in the bones of the ear traces of the cause of his giddiness. When Mr. Whiteway examined the brain he might have found the cause of Swift's right-sided hemiplegia and his aphasia. It is enough now that we can diagnose his life-long disease as labyrinthine vertigo, and his insanity as dementia with aphasia; the dementia arising from general decay of the brain from age and disease, the paralysis and aphasia from disease of one particular part of the brain.
With all the tortures of the life-long disease from which he suffered and its obvious effect upon his temper in his later years, it is wonderful that Swift did retain his reason until, in the seventy-fourth year of his age, he was in all probability struck down by a new disease in the form of a localized left-side apoplexy or cerebral softening, which determined the symptoms of his insanity.
That Swift's works contain no indications of insanity appears to me certain. As well say that Shakespeare was mad because he wrote a good deal which we think nasty. In the fashion of the day, Swift was too prone to make what may be called excrementitious jokes and gibes. But that perfect gentleman Antonio voided his rheum upon Shylock's beard; and the same kind of thing runs through our literature, no one objecting, until we rather recently began to become less natural and more nice. Some of our smaller humorists and men of letters have criticised this great king of humor as if he were both bad and mad, not perceiving that if he were really insane he must be pitied and not cursed. But it is the weakest of arguments to say, with Festus, for want of argument, "Much learning doth make thee mad." There is always weakness in madness, but there is little sign of this in Swift's works. There is always some inconsequentness or incoherency in madness, but there is none of this in Swift. Down to that last letter to Mrs. Whiteway he is most wretched, but he is still collected and wholly himself.
One final consideration is that the oppressive and disabling nature of Swift's life-long disease has been greatly underrated in the more severe of the criticisms which have been made with regard to his conduct to Esther Johnstone. I do not know that labyrinthine vertigo would necessarily incapacitate a man for the performance of marital duties, but it certainly might be a barrier to them more formidable than unprofessional critics are likely to suppose possible. Dr. Beddoes suggested that Swift was impotent from youthful dissipation, of which there is not a tittle of evidence. May not the great and grave disease of which I have adduced such copious evidence have been the real reason why Swift did not live with the woman whom it is certain that he loved with the most tender and persistent devotion?—Brain.
