wants, or have been too ill to remember enough of his symptoms and surroundings to turn them into copy, or he may feel that there is something inartistic, trivial, ridiculous, in giving to a slight ailment, such as a bilious headache, its true position as a cause affecting the future of the puppets of his play. Should he of necessity have drawn his knowledge of pathology from medical works, certain broad ideas will be found to have guided him in his selection, these ideas evidently arising partly from the way in which special diseases seem to attract attention, partly from the limits imposed by good taste.

The illnesses introduced must have some striking character, something remarkable in the mode of onset or termination, and the symptoms must not be repulsive. The practical value of a real disease to a novelist depends very largely on the presence or absence of symptoms calculated to produce a shiver of disgust. We can tolerate paralysis from accidents in the hunting-field or from overstrain of business worry, but we do not relish in fiction any accident involving amputation. Dickens deprived Joe Willett of an arm in battle; but, in spite of the eloquence of its fellow, every one sympathises with poor wilful Dolly Varden for having to be content with the remnant.

In the same way public feeling requires a peculiar sense of fitness to be observed in the deaths chosen by novelists. A hero may be allowed to die in great agonies from accidental injuries, but he must not be made to suffer prolonged medical pain; his body may be racked with fever or ague, but these will be transient in a novel, so we care not; but he must not, he cannot be permitted to have any gross lesion like cirrhosis, Bright's disease, or carcinoma-these involve structural changes suggestive of museum specimens, and cannot be tolerated. He may act as a host for microbes, but the hero must go no further.

With such limitations the medical path of a conscientious novelist is by no means an easy one. Sometimes he finds it convenient to clear the ground rapidly, and then is hard pressed to call up a suitable disease which shall have been lurking about without any sign until the right moment: the various forms of heart-disease, aneurysm, and apoplexy have thus all been drawn in. When it is desirable to give time for death-bed repentances or revelations, or when it is wished to tinge and alter the whole life and character by some slower form of disease, the difficulty becomes extreme, and the novelist requires careful study or guidance. He feels that precision and accuracy are of as much importance in this as in the legal terms of a will or contract. It is not necessary to name the disease referred to, still less to give all its details; but it must be a real disease in the author's mind, it must not be an imaginary conglomeration of vague symptoms.

The school represented by Harrison Ainsworth and G. P. R. James evaded study and criticism by adopting a rough-and-ready method. Their characters are frequently afflicted with a peculiar instability of life and limb, a tendency to 'rolling corpses on the plain,' and thus dispensing with surgical aid. In more recent times we can almost trace the growth of knowledge in the pages of fiction. Every disease when first discovered has its picturesque aspect, but the progress of science gradually robs it of this, and destroys its artistic value. Typhus and typhoid were once favourites, but now the widespread knowledge of their causes, and the great increase of attention bestowed on sanitary matters, make it almost impossible for them to be utilised. We all know too much about them; they are deprived of all romance; an indulgent public cannot be expected to be sympathetic when feeling that, because the drainage was imperfect or the water impure, the hero or heroine is consigned to the grave prepared by the author for the favoured few allowed to rest. When we remember too that, medically, typhus is almost synonymous with filth and famine, it is easy to see that it is now practically useless, in spite of the glorious convenience of rapid onset and rapid decline, separated by a period of high fever and delirium-a period valuable to the novelist for involuntary revelations.

The same is true of consumption; once a favourite, it is now being neglected. The glittering eye, the hectic flush, the uncertainty of its lingering course, have been depicted again and again; but a wider knowledge has led to the universal recognition of such prosaic facts as its hereditary character, and its destruction of lung-tissue, and all the symptoms are so well known at present that the subject is painful, if not actually of no value.

Injuries to the head, allowing the surgeon's instruments to make a very inferior person a valuable member of society, have frequently been turned to account. Spinal injuries, too, have long found favour with authors. The disease technically known as paraplegia gives abundant facilities for confining the most truculent hero or villain to his bed, and has the advantage of leaving him with an unclouded intellect to go through a salutary process of forgiveness or repentance. It can be brought on the scene in a moment, and it often affords an opportunity of describing a hunting-field, a race, or any other piece of brisk movement by which to lead up effectively to the contrast of the strong man humbled-a most valuable piece of light and shade, of which, for instance, the author of Guy Livingstone has availed himself.

These simpler diseases and injuries have now almost come to the limit of their employment, and new topics must be found. The search for material is endless, and when seriously undertaken with a full sense of responsibility, it keeps pace with the progress of science. No new disease passes unnoticed; wonderful symptoms and wonderVOL XX.-No. 116. SS

ful cures are equally laid under contribution. Aphasia, a disease of comparatively recent separation from its associates, has already been worked into the Golden Butterfly, the sudden onset and bizarre alteration of the mental atmosphere rendering it, for the present, a peculiarly suitable subject. Even the modern treatment of baths and waters for rheumatism and gout has led to the scenes in some novels being laid at fashionable resorts: witness the excellent picture of Aix and of the type of many of its invalids, drawn so faithfully by Mrs. Oliphant in her new novel Madam. Forensic medicine forms a valuable storehouse of material; already we have gone through the detection of crime by such technical details as the recognition of an assassin's instrument by the examination of a wound, the estimation of the precise position of the person firing a pistol, as in the Leavenworth Case, and the whole question of homicide or suicide. It has supplied an almost dangerous knowledge of poisons and their actions, sometimes following the suggestions afforded by actual crime, or, as in Bret Harte's Mliss, introducing a reference to a particular poison (aconite), before the enormity which subsequently rendered it notorious. All this store of wealth is readily at hand in the reports of causes célèbres in the daily press, or is to be had from ten minutes' reading of any medico-legal book.

The attitude of different novelists with regard to medical matters varies in the most remarkable way; the study may be conscientiously prosecuted, and we then get perhaps a painful but true picture of some particular illness, not including every detail, but enough to make a fair addition to the facts and interests of the book. It may be briefly sketched, or a master-hand may deal with it tolerably fully, and even call to his aid a chronic disease and make it run through two or three volumes. Sometimes, on the other hand, such an account is given as might have been gathered from the chatter of the sick-room, the gossip of the nurses and neighbours, and this is replete with errors of etiology, diagnosis, and even symptoms.

It may be of interest to show by a few examples the application of these statements. Charles Kingsley, whose object in his novels was to preach sanitation, should be placed at the head of the list of those who have vividly depicted well-known diseases. In his Two Years' Ago' he gives at least three accurate studies of morbid phenomena. His account of a cholera epidemic is well worthy of being placed as an appendix to a chapter on this disease in any medical text-book. Delirium tremens is also drawn with the hand of a master, although not with the full repugnance and significance which we find in Zola's Assommoir, or in the Scenes of Clerical Life, while his careful study of the gradual development of suicidal mania reads like a clinical record of an anecdotal character.

Next to Kingsley, and indeed treading closely in his steps in this particular groove, comes George Eliot, with the truly marvellous

picture of catalepsy in Silas Marner. As in the preceding case with cholera, so here we would venture to say that any study of nervous diseases would be incomplete if this were not included.

6

Thackeray is sure to be always popular with medical men; he understands them, he sympathises with them, he speaks genially of their work and liberality; he was evidently on the best of terms with some practitioner whom he impressed into his service as that most excellent, gruffly good-humoured Dr. Goodenough, and he very justly puts into his hands most of the well-merited invective and sarcasm which he launches against the petty pretences of a fashionable quack. On medical matters, although he uses his knowledge sparingly, Thackeray knows precisely what he is talking about, and he knows, too, what to tell and what to omit. His death-bed scenes are always truthful without repulsiveness; the deaths of Colonel Newcome and of General Baynes of course owe their interest less to the actual diseases concerned than to the attendant circumstances, but in both there is nothing unnatural to vex a medical mind. We can follow the symptoms easily, and yet the pathos of the deaths is too great to allow the most fastidious of the laity to be offended by any details. One of the most interesting cases' medically is the illness of Arthur Pendennis in his rooms in the Temple. There can be no doubt that this is intended for typhoid fever. The facts given us are briefly the following:-An illness of a week or so before total incapacity for work; one night he went to bed ill, and the next day awoke worse; 'his exertions to complete his work rendered his fever greater;' then a gradual increase of fever for two days, and we come to Captain Costigan's visit, the patient being in a very fevered state,' yet greatly pleased to see him, his pulse beating very fiercely, his face haggard and hot, his eyes bloodshot and gloomy. Matters are protracted for a week, and then he is delirious and is bled, and two days later the selfish old Major and the mother and Laura are summoned to town. Antiphlogistic remedies are employed, and the lapse of time is left doubtful, but spoken of later as a few weeks, until we are informed that the fever had left the young man, or 'only returned at intervals of feeble intermittence; 'reference is made to the recovery of his wandering senses, to his lean shrunken hands, his hollow eyes and voice, and then our hero 'sank into a fine sleep, which lasted for about sixteen hours, at the end of which period he awoke, calling out that he was very hungry.' After about ten days of convalescence in chambers, the patient is moved out of town, and later taken abroad. In all this there can be no reason for hesitation in arriving at a diagnosis; the onset is too gradual, the duration too long for typhus; and, moreover, Thackeray is too fine an artist to allow his reader to form a mental picture of the hero spotted like the pard. We may question Dr. Goodenough's treatment of blisters, bleeding, and antiphlogistics, which would have been more suitable for a case

of pneumonia, but the hunger is too true a touch to be mistaken, as all who have had typhoid fever would at once realise. Compared with this careful study the death of Mrs. Pendennis appears medically feeble; it is strictly analogous to a similar death from heart disease in the Sea Queen of Clark Russell. In both we have a short period of intense mental anxiety followed by a time of rest and peace from which the fatal termination rouses us with an unpleasant shock, but the details are meagre, and the effect produced is purely that attending any sudden catastrophe. Thackeray's chronic invalids, Miss Crawley, Jos Sedley, Major Pendennis, and others, are all stamped with that assiduous care for their own health, that selfish disregard for others, which so often results from the concentration of the mind. on the physical condition of the individual; he tells us plainly when they have been over-eating or indulging in too much punch; he does not spare them, he holds them up to ridicule and scorn. Thus in all his dealings with medical topics we feel he is treading on sure ground, and that he never forgets that as an artist it is impossible for him to write in a loose way, as though it did not matter what diseases his characters die of, provided only that they die. He makes us believe fully in his work; all removed from his pages pass out naturally; for though he may not trouble to tell us of the disease, in one way or another he has led up to the death, so that little surprise is excited.

At the risk of treading in well-worn paths, it is natural to turn from Thackeray to Dickens, and the change is not gratifying. He can scarcely be civil about doctors, he appears to have had some grudge against the medical profession which he worked off by instalments whenever his pages required mention of a doctor; exceptions, perhaps, being made in favour of the shadowy Allan Woodcourt, and of that meek and mild Mr. Chillip, who superintended David Copperfield's entrance into the world, and who endured Miss Betsy Trotwood's wrath. Otherwise from Ben Allen and Bob Sawyer onwards he has waged pitiless warfare. With this unfortunate bias, this moral twist, he cannot be expected to trouble himself with medical lore; he did not believe in it sufficiently to appreciate the importance of being correct, and as a consequence we find that the lines become more hazy and indefinite, the deaths and cures more incomprehensible. When disease of a chronic form is introduced, however, Dickens may mostly be trusted, especially when the character is influenced by it. The demoralising effect of one class of sick-room work is drawn from the life by him in the immortal Mrs. Gamp,-the mind of a woman originally grasping and of a low type getting thoroughly subordinated to professional aims. On her particular topic she is as never-ending and troublesome as any fanatic when once started on his hobby, and yet the picture is faithfully drawn, its truth arrests attention, and even if a little shocked, we cannot but be amused with her rebuke to poor Pecksniff for terrifying the