of the public, who are sufficiently well educated to perceive in some sense the qualities good and bad in the sensational novel, are still in ignorance as to the aims of medicine, scientific and sociological. They still believe, when the novelist bids them, that a medical student is necessarily an expert toxicologist; that to immure the sane subject in a lunatic asylum is a safe and simple proceeding; that nurses are often the mistresses of doctors; that in many diseases the withholding of a dose or an injection will inevitably cause death (these latter two notions pave the way to frequent situations); and that familiarity with sorrow produces greed and callousness. It is suggested, here and now, to novelists that these things are all untrue; that the very occasional episodes on which statements of the sort are grounded do not warrant the general conclusions; that the time has come when they should not be said; and, further, that it will be good business-if a vulgar appeal to profits may be pardoned-to forego certain easy effects that can be obtained by misrepresenting medicine. Scott, George Eliot, and Stevenson spoke nobly on the side of the medical profession; I believe that modern novelists who follow them here will not go urewarded. Good novelists do not wish always to write for the ignorant, and the ignorant are, or soon will be, the only persons to be thrilled by patent falsehoods. In them the slanders confirm wrong impressions and so do harm.

However, a much more usual employment of medicine in fiction is as an event in the narrative-a surgical event where an episode occurs, like an accident or a murder; a medical event where a disease is introduced so as to form part of the drawing of some character whose attitude towards life is swayed thereby. For one book which alludes to the profession of medicine

as a profession there are twenty in which such events are brought on to the scene not to illustrate the habits of doctors, but to fulfil the exigencies of the plot. To cavil at mistakes in surgery is often unfair, as they are usually mistakes in an episode not necessarily affecting the story as a whole; but we may have to ask from the author, if his book is to be credible and symmetrical, that his "internal medicine" should be accurate, for the behaviour of his sick characters ought to be in accordance with their diseases. I am making, therefore, no comments upon the surgery of the novelist, because in the instances that occur to me most readily, inaccuracy does not much matter-it does no public harm, does not spoil the tale, and should not be made the subject of serious discussion. Even when a well-known writer, as happened recently, mixed up in his surgical allusions an organ of reproduction with one of excretion, he did not make his story less probable, though, incidentally, few things could have done this. But the use of medicine in fiction may call for more serious consideration.

In medicine proper, most of the diseases whose name is not too difficult to spell or too cacophonous to pronounce, whose associations are not too revolting, and whose details are in the least familiar or are capable of explanation, have been used by story-tellers of different grades. It is obvious that no attempt can be made here to review such a mass of material, and I propose only to illustrate the uses of medicine in fiction by calling to mind the way in which certain common diseases have been employed in the course of their art by acknowledged great writers.

A general disease much used by novelists is malaria. Sometimes malaria removes an individual, and in that case the accuracy with which symptoms are rendered is not of prime concern;

sometimes we are told how the disease falls upon populations, and here it is of importance that the medical picture should be correct. Several writers of fiction have dealt with malaria under different names. Guiltless of any knowledge of the part played by the mosquito in the spread of the disease, they have none the less been able to show with accuracy the probable environment of a malarious population, and the effects upon physique and morale of what the Anglo-Indian until recently called "a touch of fever." The episode of the Valley of Eden in "Martin Chuzzlewit," drawn with exuberant picturesqueness and biting humor as it is, is on the whole an accurate description of a malarious community. There never has been any place quite as Dickens portrayed the Valley of Eden; he has used the same almost unbounded exaggeration in bringing this gruesome strand before us that he employed in drawing elaborate personages-for no one was ever quite so infernally impish as Quilp, so gorgeously benevolent as the Cheeryble Brothers, so fatuous as Mr. Dombey, or such a beast as Uriah Heep. But these personages are sublimated types, and are accepted as such; and in the same way Eden may be accepted as a sublimated type of a malarious settlement and so pass as accurate enough. The malaria which attacked the inhabitants of this valley was of a continuous form, but when they got rid of it they remained in the same place some three months more without experiencing a recurrence, nor do we learn of any later manifestation of symptoms on arrival in England. It is easy enough to criticize the Eden episode in detail, but in general spirit it is a masterly piece of writing accurate enough, and displaying in a vivid manner the hopelessness which falls upon a people that abides and strives to live under the shadow of death. The effect of his illness upon Martin plays a defi

nite part in the alteration of his character, which is very useful for the story, but medical experience does not support the view that illness often leaves a chastening effect upon man; seldom indeed is it that anyone is rendered less selfish thereby. Contrast with this the use of malaria in two popular novels, where the disease is employed to remove the heroines-and merely to remove them. I refer to Mr. Henry James's "Daisy Miller" and Marion Crawford's "Mr. Isaacs." Daisy Miller was a doomed character from the start. It was impossible not to feel that this gay and clever young rebel would become an admirably picturesque and pathetic person if she died quickly and neatly, and Mr. Henry James, most learned of all novelists in seeing when such effects will be obtained, kills her in the space of a week of "Roman fever." Her attack was without intermission, apparently without complications, but with delirium from the beginning. Now this is not a very convincing clinical picture. Katharine Westonhaugh, the heroine of "Mr. Isaacs," died of Indian "jungle fever" in much the same space of time--that is, in a week or ten days. She speaks clearly and easily from first to last, but has no recognizable sort of fever. It is my belief that Marion Crawford intended to kill her by an accident in the hunt which preceded her illness, but, seeing how very dignified a figure she had cut throughout the book, he felt that mauling by a tiger was an untidy way of disposing of her. There is a form of malaria, designated by the French accès pernicieur, which may end either in delirium and coma, or in collapse, running its fatal course in a few days. These cases occur in Africa, not India, for the most part; but I find such criticism labored. In all three cases malaria is well handled; in the first it appears as an epidemic under a pic

turesque guise, in the others as a piece of narrative machinery.

Cholera and plague both put in appearances in novels, an excellent though flamboyant account of the progress of the former disease being contained in Charles Kingsley's "Two Years Ago." The terrific mortality and unrelenting march of an epidemic of plague has made this disease a favorite one with writers of romance from Homer and Sophocles, through Boccaccio, down to to-day. Everybody will remember the picturesque and effective account of the Great Plague of London in Harrison Ainsworth's "Old St. Paul's." Ainsworth was a conscientious writer, and clearly had consulted the authorities before writing his description. In the preface to the first edition of his work he says that he has followed closely a rare narrative, which he attributed to Defoe, en titled “Preparations against the Plague both of Soul and Body." I have never seen the book, but all the historical background to "Old St. Paul's" can be found in Defoe's "Diary of the Plague." The maniacal behaviour of Solomon Eagle, the murderous inclinations of some of the plague-nurses, the roaring trade done by quacks, the blasphemous orgies of the half-terrified, half-defiant loose-livers all this, which is so effective in Ainsworth's romance, finds a place in the "Diary," and, moreover, is all historically sound. Defoe's consummate and particular literary skill led him to tell the story of the plague as though he had been an eye-witness, when in truth he was only six years old in the terrible year of its occurrence. But his chronicle is essentially accurate, for he had access to genuine diaries of the time, to Dr. Hodges's "Loimologia," to Vincent's "God's Terrible Voice in the City," and notably to the "Collection of the Bills of Mortality for 1665"; while seniors in his family or among his acquaint

ances would have certainly narrated their personal experiences before him. The famous "Diary" has notable exaggerations, and not being written until Defoe was sixty years of age, he could not refer doubtful passages to those who had given him personal information; but the story of the epidemic is on the whole trustworthy, and Ainsworth, by tracking Defoe so closely, achieved a well-deserved success. The account of one of the epidemics of plague which in the seventeenth century fell on Naples, as given in "John Inglesant," is a notable piece of writing. Here we have the apalling state of a plague-stricken city standing out in contrast with the beauty of the South Italian climate and the wonderful color of the sea and the sky; the dead are lying in the streets, which are still decorated for some popular festival; business is at a stand, for the houses are full of infection, but a terrible restlessness drives every lazy Neapolitan here and there. This restlessness has often been observed in epidemics, and nowhere, perhaps, would it be more obvious than among an unstable superstitious people like that of Southern Italy. In London during the Great Plague this restlessness was counteracted by the drastic orders confining the inhabitants of a plague-stricken house to that house-orders which terribly added to the horror and destructiveness of the disease. Another novelist who has used an epidemic of plague with striking success is that singular writer, Charles Brockden Brown, who never could have been very readable, and who has now, I think, fallen into complete oblivion. But there is much in Brown that is fine. He had a great eye for a situation, a thorough and wholesome interest in psychological problems, and a powerful as well as a cultivated pen. In many ways he deserves better of posterity than the scant reference

which he obtains in such phrases as "the successful copyist of Godwin" or "the father of the American novel." Brown was born in Philadelphia in 1771, and was twenty-two years old when the plague fell upon that city. He had therefore been an eye-witness of the scenes which he describes in his best-known novel, "Arthur Mervyn," and there are two or three chapters in this book which bring home to the imagination of the dullest what a plague-smitten community really suffers. Plague has been well treated by novelists.

Among regional diseases it is natural that little use should be made of disorders of the stomach, liver, kidney, and spleen. Their manifestations would not make polite reading, so the novelist seldom hits below the belt. Many dyspeptics cross the novelist's stage, but the victims of indigestion are nearly always subsidiary characters furnishing food for ridicule. But heart-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 dilation of the heart are given perfectly. The baroness is а 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.

ment-two 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 labor 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.

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. I 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. The orphan had spots which came out on his chest. They were very red and large, and he caught them from some other children. So the orphan was driven to the Children's Hospital, where he was nursed in a general ward, and died shortly afterwards, conscious to the last, and bequeathing toys (and infection) to his room-mates, and a kiss to "the boofer lady." Fevers seldom receive closer observation than that given to them by the greatest romancer in our language, but Thackeray knew a surer way of treating them, having a different object in view. Dickens was out to create sympathetic interest. It is perfectly easy to say that he was sentimentally inaccurate, but it will be a bad day for human nature when the abounding grace of Mrs. Boffin's charity fails to draw from the reader its tribute of tears, because for the minute the great writer, who was also a great sanitary reformer, forgot that contagious and spotty things, whatever their names, ought not to be nursed in the general wards of hospitals. Thackeray, in describing the epidemic of small-pox which falls so suddenly and with such appalling results upon Castlewood, is not attempting to enlist our sympathies with the sick: he designs only to show us how people behaved in such circumstances in the reign of Queen Anne. The epidemic is