The rod-shaped parasite that causes East Coast fever is not the juvenile form of the pear-shaped parasite that causes Texas fever. That much had been established by 1904. But a good deal of confusion remained about some rod-shaped and ring-shaped parasites, often seen in the blood of animals that had been inoculated in an attempt to immunize them against East Coast fever. Moreover, the tiny cocci that Smith and Kilborne had seen in mild cases of Texas fever also remained unexplained as of 1904: unexplained in the sense that no one had questioned the original conclusion of Smith and Kilborne that those tiny cocci were the juvenile form of the pear-shaped parasite.

The second new parasite: Theileria mutans

Koch, in his efforts to devise a vaccine, had injected blood into non-immune animals. A few weeks after such injections he regularly found what he called “ring forms” in the “immunized” animals. He took the presence of those ring forms to indicate that the animals had indeed been immunized against East Coast fever. At the Bloemfontein conference of December, 1903, Theiler, apparently referring to the ring form, said that “He believed it to be a new species of piroplasma and that it had nothing to do with East Coast Fever.” In 1904 Theiler returned to the problem in his article “The Piroplasma bigeminum of the immune ox.”

Almost all of the cattle in Rhodesia died in 1896: “total annihilation of the cattle by rinderpest – no milk, no beef in a few days – but lots of lovely smells from dead cattle.” Thus Earl Grey, writing to his son from Bulawayo, Rhodesia, May 8, 1896.

Less than six years later, after a slow and costly replacement of the cattle that had been wiped out by rinderpest, another almost invariably fatal disease of cattle broke out in Rhodesia. Originally thought to be a virulent form of an already well-known disease, Texas fever or redwater, it was, in fact, a disease never before seen in Rhodesia, a disease unknown to veterinary science, a disease that we now call East Coast fever.

Stanley Portal Hyatt, who made a living by operating ox-drawn wagon trains, and who was bankrupted by the death of his oxen, later wrote:

The appearance of a new disease is a rare event, as is the identification of a previously unrecognized disease. A serious new disease, whether it affects human beings or affects animals of economic importance, presents challenges to the public, to its government and to scientists. East Coast fever, which can wipe out a herd of cattle in three weeks, was first identified in Rhodesia between 1901 and 1903. It caused problems for various governments, it caused something close to panic in the Rhodesian public, and it presented a challenge to the scientists who investigated it in the hope of finding its cause and a way to treat it or to prevent it by immunization. The scientists did discover the parasite that causes East Coast fever and they did discover the tick that transmits that parasite, but no one has yet discovered a cure or a preventive vaccine.

East Coast fever appeared at an interesting time. Modern methods of publication and communication were in place, but they had not been in place for very long. It was the age of the telegram, when long discussions, detailed analysis and thoughtful letters had their final effect only after being condensed to a few dozen words. Although the foundations of modern bacteriology and parasitology were in place, East Coast fever appeared early enough to be studied by the first or second generation of bacteriologists, by the Cape of Good Hope's first government entomologist, and by one of the two founders of scientific bacteriology, Robert Koch.

MANY OF Johnson's friends besides Levet were doctors, and many of his friendships took on a medical or therapeutic cast. As is the case with most people who suffer from chronic illness, friendship and therapy, of various kinds, became deeply intertwined. His doctors became friends, and his friends, like Mrs Thrale, became doctors. This chapter, by way of an epilogue, will examine some of the other relationships in Johnson's life which have this therapeutic aspect. Picking up threads from earlier chapters, it will glance at some of the medical figures who populated that long life, but it will also review some of the conflicts, the struggles for various forms of power, that were an inevitable part of Johnson's relationships to his medical attendants. Johnson had his own medical convictions, which he did not suppress. So I shall also discuss the way in which Johnson, by virtue of his learning and his experience of illness, became himself a counsellor, a doctor-figure for his friends, and consider especially the role he played in the sometimes complementary history of James Boswell.

Johnson's letter to Dr Lawrence announcing the death of ‘our old friend Mr Levett’ symbolises his position at the confluence of many streams of eighteenth-century medicine. Focusing on him, we can see our way through some of the labyrinthine recesses, the confusion of obsolete practices, genuine advances, preposterous claims and conflicting theories that characterised a medicine only loosely and unsatisfactorily organised as a profession, and still largely – though this took many different forms – governed by an entrepreneurial spirit.

AS WE have seen, Johnson's medical history has attracted a good deal of attention during the last 200 years, and doctors specialising in a multitude of different ailments have written on his case. Little, though, has been written about his medical interests and beliefs. Occasional articles in medical journals have reminded us of Johnson's life-long interest in medicine and have cited some of his experiments and views, but there has been no attempt to reconstruct the system of beliefs that lies behind Johnson's very frequent medical advice, and without this much of what he said and practised must remain unintelligible. This has been partly, no doubt, because until quite recently a medicine confident of its own onward progress has deemed superseded therapeutics and their rationales hardly worth remembering, and partly because, of all therapeutic practices those of the early and mid eighteenth century, that ‘chaotic mixture’ as the medical historian Erwin Ackerknecht calls it, of notions and procedures, has seemed most recalcitrant to investigation and perhaps least worth attempting to understand. But to see Johnson in the midst of that ‘chaos’, that confused mixture of traditional procedures, empirical remedies and gropings towards a new more ‘scientific’ orientation may enable one not only to illustrate a comparatively neglected area of his intellectual interests, but to throw light – more generally – on the nature and constraining conditions of medical thinking in that era. ‘Even the mind of Newton’, Johnson observed in a review, ‘gains ground gradually upon darkness.’

AFTER JOHNSON'S death in 1784, the surviving members of his last club met to discuss what kind of monument to erect to him in St Paul's Cathedral. Some of Johnson's friends were apparently disturbed at the proposal to erect a full-length statue, ‘to transmit to posterity’, as Malone wrote to Sir Joseph Banks, ‘a true and perfect exhibition of the entire man’, because, in the fashion of the time, it was to show Johnson attired only in a Roman toga. Sir Joshua Reynolds, who had disapproved of Pigalle's famous statue of Voltaire showing the philosopher ‘not only nude but with the withered shanks and scrawny torso of a septuagenarian’ was able to reassure them. ‘Johnson's limbs’, he declared, ‘so far from being unsightly’, were ‘uncommonly well-formed & in the most exact & true proportion’.

Seeing Johnson swim in the sea at Brighton in 1766 the ‘dipper’ (‘Dr Naked’, Johnson and Mr Thrale called him) declared, ‘Why, Sir, you must have been a stout hearted gentleman forty years ago.’ ‘His stature was remarkably high, and his limbs exceedingly large’, according to Mrs Thrale. When he was first introduced to his future wife, Elizabeth Porter, in 1734, at the age of twenty-five, he was then, according to her daughter, ‘lean and lank, so that his immense structure of bones was hideously striking to the eye’, but in later years he got more to eat, put on weight and in 1773 Bos well described him as ‘large, robust, I may say approaching to the gigantick, and grown unweildy from corpulency’.

THIS BOOK considers Samuel Johnson as a patient, as an amateur doctor, and as a writer about medicine. Everyone calls him ‘Doctor Johnson’ and the title no doubt acknowledges his scholarship, his learning and authority. But it also suggests how persistently he is thought of as a sage, and – perhaps less consciously – as a healer. To look at Johnson as a sufferer, and as physician, both of the body and the mind, becomes inseparable, then, from thinking about the sources and nature of that cultural authority.

In the first of these roles Johnson has gained some fame or notoriety among doctors. A continuous stream of articles on his melancholy and depression, his gout, his abnormal movements, his ‘alcohol problem’ (to give only some more recent examples), has appeared in the pages of medical and medical-historical journals. That Johnson was a ‘dabbler in physick’ and that he cultivated the acquaintance of doctors is almost as well-known, though neither the extent of his medical friendships, nor the nature of his medical knowledge is much recognised. You would not guess from Boswell, or from modern biographies, that at least four of his closest friends were doctors, and that three of these friendships lasted over decades. But it is in the third role, as a writer about medical matters, that Johnson is so often overlooked. As I will show, he wrote a good many pieces which touch on or discuss doctoring, medicine, hospitals and medical experimentation.

THE MORAL climax to Rasselas (1759) is the chapters (40–4 and 46) describing the astronomer. The young prince, who has been searching for the ideally happy way of life, one day declares that he intends ‘to devote himself to science, and pass the rest of his days in literary solitude’. ‘Before you make your final choice’, replies Imlac, the poet, philosopher and man of the world who is his mentor, ‘you ought to examine its hazards, and converse with some of those who are grown old in the company of themselves. I have just left the observatory of one of the most learned astronomers in the world, who has spent forty years in unwearied attention to the motions and appearances of the celestial bodies, and has drawn out his soul in endless calculations.’ Imlac then tells the history of his acquaintance with this astronomer of Cairo: how he first visited him, how they gradually became more intimate, how Imlac's admiration grew until he ‘thought him the happiest of mankind, and often congratulated him on the blessing that he enjoyed’. But the astronomer has evidently some secret anxiety, and one night when they are sitting together ‘in the turret of his house’, in the darkness, he declares: ‘Hear, Imlac, what thou wilt not without difficulty credit.

IN HIS Dissertation on the Gout and Rheumatism of 1745 Robert James explained why he included no detailed prescriptions:

Diagnosis and prognosis, James declares, have scarcely been improved beyond their sources in Hippocrates and his followers, and he warms to the attack:

James' comments reflect the orthodox and academic medicine of the period in their stress on classical learning as well as on the doctor's reasoning from sound ‘doctrines’ of physic.

Fortune of physicians

JOHNSON'S KNOWLEDGE of medicine, then, often brought him into conflict with the professional opinions of his physicians. His medical learning may have been unique among eighteenth-century amateurs, but he was of course far from the only ‘dabbler’ in medicine who took it upon themselves to dictate treatment:

Baretti's libellous account of Mrs Thrale clearly implies that it would be thought scandalous for her to take the treatment of her children out of the hands of Jebb. We have no way of knowing whether eighteenth-century ladies often treated their doctors in this fashion, or how much eighteenth-century patients obeyed and how much they disregarded their medical advisers, or whether selfmedication was less or even more prevalent than today.

‘JOHNSON'S MEDICINE looks backward’, declared W. K. Wimsatt. He was discussing the evidence of Johnson's medical interests contained in the Rambler series of essays, written and published between 1750 and 1752, whilst Johnson was also engaged on the Dictionary. The only medical writers mentioned there by name are Hippocrates, Celsus and ‘old Cornaro’. Boerhaave, ‘the learned, the judicious, the pious Boerhaave’, is, it is true, cited, but as a moral rather than as a medical hero; William Harvey is mentioned, too, but that is part of a joke about ‘a late writer’ who ‘has put Harvey's doctrine of the circulation of the blood into the mouth of a Turkish statesman, who lived near two centuries before it was known even to philosophers or anatomists’. (Rambler 140), which writer, of course, was Johnson himself, in the tragedy Irene (1749). But Johnson's medical knowledge may be detected in the Rambler all the same, beneath that grandeur of generality which characterises Johnson's prose in this enterprise. No. 85, for example, which is in praise of health and exercise, remarks that ‘very learned treatises have been produced upon the maladies of the camp, the sea, and the mines’ and contains the following paragraph:

MEDICINE HAS been written as the story of doctors, their practices and achievements. Recently, there has been a shift to the patient. Writers from widely different fields – neurology (Oliver Sacks, Awakenings, 1973, revised edition 1982), literary criticism (Elaine Scarry, The Body in Pain, 1985), medical history (Roy Porter, Patients and Practitioners, 1985; Mind Forg'd Manacles, 1987) and anthropology, (Arthur Kleinman, Social Origins of Distress and Disease, 1986; The Illness Narratives, 1988) – have converged to focus upon the history and experience of the individual sufferer. This book seeks to build upon and augment their work by examining the words and experience of a major writer and spectacular patient.

I wish to acknowledge the help of the following scholars and medical historians in preparation of this book: Miss E. Allen, Curator of the Hunterian Museum; Professor Harold Attwood; Dr C. H. Brock; the late Professor Kenneth Dewhurst; Dr J. D. Fleeman; Dr Graham Nicholls of the Birthplace Museum. I am especially indebted to Dr Dennis Gibbs of the London Hospital.

The editors of the Australian journals The Critical Review and Meridian published earlier versions of parts of chapters 6 and 7 respectively, and I thank them. The Research Grants Committee of the School of Humanities, La Trobe University, gave me a travel grant which allowed me to research part of chapter 3.

My colleagues and friends in the English Department, La Trobe University, have helped me in dozens of ways, with suggestions and comments, criticisms and translations, and not least in enduring the papers in which I tried out parts of this book.