Stevenson Bio

The Health Biographies

Of Alexander Leeper, Robert Louis Stevenson, And Fanny Stevenson © 2001

By Max Banfield

Now available as an eBook here and from Amazon.com here

The following quote is from a letter sent to me by James S. Winegar, President of The Robert Louis Stevenson Museum, International Offices , Phoenix, Arizona, U.S.A.

“ The Minister of Youth Sports and Culture in Samoa loves the book. We presented him with his own copy and he devoured it .” (end of quote).

The book is aimed at providing modern readers with an insight into the causes of health problems of the past, so that they can better understand the cause, effect, and methods of treating illnesses, particularly obscure ones, today .

Introduction

There are other biographies which present the idea that the health problems of Leeper, Louis, and his wife Fanny were due to depression, stress, or hypochondria, but this web page examines how their physique, their personal and food hygiene, their housing and sanitation, the industrial pollution of the nineteenth century, and the epidemic contagious illnesses of that pre-antibiotic era influenced their health.

In the case of Robert Louis Stevenson his main illness was tuberculosis which he would have been disposed to get by his thin and gangly physique, and poor chest shape, and consequent constricted lung space , combined with the industrial pollution from the dust in his family’s factories where they ground stones to build lighthouses, and the coal dust in the air and fog which Edinburgh had a reputation for, and where all of the buildings were blackened by soot.

He traveled extensively on his fathers wealth, and learnt from experience that whenever he was away from Edinburgh and large industrial cities like London and Sydney his symptoms would ease, so he ultimately decided to live on an island in the South Pacific.

He didn’t know why, and neither did his doctors, but it would have been because of the fresh sea, forest, or mountain air, which cleared the soot from his contaminated lungs in much the same way as the sea clears debris from the beach as the tide comes in an out to produce clean beaches . That is my conclusion and is my copyright together with other information on this webpage and in my book.

Many other people have given a variety of reasons for his health problems, treatment and death, such as contained in this book about “The Wilderness Cure” where many people, including Robert Louis Stevenson, were treated at a sanatorium in Saranac. here (I found this link while searching Twitter on 7-10-13, provided by GTBI – the Global Tuberculosis Institute).

He also reported relief when he was treated in the mountains of Switzerland, and his friends and companions said that, whenever he got on a boat, and was a few miles from shore (in the fresh sea air), he would be feeling in full health, while those around him were sea sick.

However, he also smoked cigarettes and drank a lot of alcohol, and died of a stroke while relaxing and drinking a glass of wine on the verandah of his island mansion, on a sunny day, at a age 44.

Alexander Leeper

Alexander Leeper was born in Ireland, where he contracted tuberculosis and had to travel to Australia in search of a warmer climate which was more suitable to his health. During his lifetime he achieved a first in Classical Moderations at Oxford University and became a leading educator, librarian and churchman in Melbourne.
He developed tuberculosis because it was a common and contagious illness that occurred in epidemics in the industrial cities of the nineteenth century, and it probably affected his right lung because he had sideways curvature of the spine to the right which would have congested the lung on that side, making it more vulnerable. He had a lot of problems with his ailment because most people did, because there was no cure at that time, so it was chronic and usually featured severe relapses and resulted in early death. However Leeper read many medical books and experimented with many remedies, including the Alexander Technique , which he recommended for school students and military recruits . The Alexander technique was developed by Frederick Matthias Alexander of Tasmania and was a method of improving posture to cure the problem which he had with voice loss while reciting, and to remove pressure from the lungs and prevent or relieve respiratory diseases. Leeper met Frederick Alexander, championed his method, and lived to the age of 86, when most men under conventional medical treatment died in their 30’s.
He is mentioned in this set of biographies because his personality and achievements were the exact opposite of the medical stereotype of hypochondriacs, where poor character, cowardice, laziness, and ignorance of literature and history were described as prominent characteristic features.

  Robert Louis Stevenson

“Robert Louis Stevenson” (Louis) was born in Edinburgh, Scotland, where he qualified in law at Edinburgh University and went on to become one of the most famous Scottish writers with his books such as Treasure Island, and Kidnapped. He developed chronic tuberculosis of the lungs but many other biographers have doubted this because there were no blood tests or X-rays available in the nineteenth century and various doctors of the time provided uncertain and contradictory diagnoses, where they often referred to his ailments as mysterious. He also had many relapses but always seemed to recover so his ailments have been interpreted as being trivial. Further doubt is expressed by the idea that he died of a stroke rather than tuberculosis and it has been suggested that this was brought on by stress.
However Louis family were lighthouse builders which required them to quarry, cut, and grind thousands of tons of granite blocks for the lighthouse towers. This was a dusty occupation in which many workers developed silicosis of the lungs which was often followed by tuberculosis and early death. Thomas Stevenson had the symptoms of tuberculosis which was probably contracted in this way, and then the tuberculosis germs were exhaled in the breath which is how many close family members contracted the ailment, and this may have been how his son Louis first contracted the illness as a teenager. Louis condition was aggravated by a 6000 mile journey by ship and train to meet his future wife Fanny, during which he was exposed to cold, cramped, and unsanitary train cabins which were crowded with foreigners who carried all sorts of exotic infections, including tuberculosis.
Several doctors diagnosed severe tuberculosis including some who were world authorities on the subject, and he was advised to leave his misty and smoggy and polluted home in Edinburgh and seek the pure mountain air, or the fresh sea air of the Swiss Alps, the south of France, or the tropical Pacific islands. In his journeys to find a climate more suitable to his health he stayed in many countries where epidemics were rife, and were killing millions of people, and he contracted some of those illnesses which included pneumonia, bronchitis, malaria, meningitis, and probably also typhus, typhoid, cholera, and brucellosis.

He eventually settled in the island paradise of Samoa, but died of a stroke at the age of 44 because of the combined effect of his thin and stooped physique and his sedentary occupation as a writer, and because of chain smoking, and drinking alcohol and coffee to excess, and spending too much of his life consuming a high cholesterol diet, and because of the accumulated effect of many bouts of meningitis on the arteries of his brain.

Fanny Stevenson

Fanny Stevenson was born in Indiana in the U.S.A. and met Louis while they were both staying in Europe. Several years later Fanny sent Louis an urgent telegram asking him to come and help her because she was suffering from brain fever, which was the nineteenth century medical word for meningitis, probably affecting her as a complication of malaria or brucellosis.
The couple married soon after and travelled together in search of a climate suitable for Louis health, and on the way she had to nurse him through his many fevers which were caused by a variety of infectious illnesses, and after an incubation period of several days or weeks she would come down with the illness herself. This is one reason why other biographers have portrayed her as a sympathy seeking hypochondriac who complained about trivial or imaginary ailments, where it has been said that whenever Louis became ill, she would predictably dash into the sick bed herself as if it was a jolly old game of musical chairs. However the nineteenth century feverish illnesses were highly contagious ailments which caused severe debility and killed millions.
Fanny read many articles about health, including some in the British Medical Journal called The Lancet, in an attempt to prevent or treat the many illnesses that Louis suffered from, which is another reason why she has been described as a hypochondriac. However, she had to deal with doctors who gave contradictory diagnoses, and who were unable to give cures. She would also take the precaution of ensuring that visitors had clean handkerchiefs, and would prevent doctors from entering Louis sick room snorting and sneezing. These ideas were well ahead of the medical thinking at that time when a lot of doctors dismissed the idea that germs
When Fanny’s five year old son Hervey died of Scrofula, an infectious illness, Fanny became ill herself but this has been described as the psychosomatic illness of a grieving mother which set up a neurosis which was responsible for her future illnesses. The symptoms were probably those of Antwerp fever, which was a name given to several different epidemic illnesses such a tuberculosis, typhoid, and typhus, because doctors could not distinguish the difference at that time. Many of her subsequent illnesses were the same as those of Louis which were contracted after an incubation period for the particular infection.
Fanny also had a severe illness in March 1893 which has been described as a spectacular breakdown and a mental white out which she suddenly snapped out of because of an obscure change of attitude that she supposedly had at that time. However she was probably suffering from typhoid, which was followed by meningitis when the infection spread to the lining of her brain, and this produces wild, argumentative, uncooperative, and violent outbursts with fever, fits and hallucinations. Such severe infectious illnesses usually ended suddenly in death or complete recovery. Typhoid germs collect in the gallbladder, and the puss later coagulates into gallstones, which can eventually block the gallducts and cause pain which is relieved by surgery. Fanny had gallbladder surgery a few years after her so called ‘breakdown’.

The Robert Louis Stevenson And Fanny Stevenson Health Controversies

Robert Louis Stevenson was born in Edinburgh Scotland on 13-11-1850 and became one of the world’s most famous writer’s with books such as Treasure Island, Kidnapped, and The Strange Case of Doctor Jekyll and Mr. Hyde. He died in his mansion home of Vailima on the South Pacific island of Samoa on 3-12-1894 at the age of 44.

However, some modern biographers have interpreted him as a whinging, sympathy seeking hypochondriac, who spent most of his life complaining about trivial or imagined illnesses.

I can only assume that such writers have lead lives of privilege and good health which has left them ignorant of the realities and complications of disease.

Louis wife noted that he seemed, from a superficial view of his life, to have been constantly plagued by ill health, but, in fact, in his short 44 years, he was probably only ill for an average of 6 weeks per year, and despite his ailments he achieved more than most healthy people of his time.

The weak chested Stevenson family

Robert Louis Stevenson has been described as descending from a family of weak chested hypochondriacs. However he was born into a family of Lighthouse engineers, who built and supervised the lighthouses around the Scottish coast. This required working in cold, wet, and arduous conditions, and also in the grinding of granite blocks for the lighthouse towers. This commonly produced occupational illnesses related to working in very rough weather, and to chest diseases resulting from the inhalation of granite dust. For example, late in life, Louis uncle, Alan Stevenson (the weak chested hypochondriac ?) developed a bout of rheumatism after rowing a boat thirty six miles across the sea during a storm, and then climbing 200 feet up a rock cliff to reach a lighthouse.

When Louis was 12 his father was spitting blood, which is a symptom of tuberculosis and one of several possibilities is that Louis first contracted the condition then because, after weakened lungs have become infected, the illness, which is contagious, is often passed on to close family members. His father may have recovered but Louis condition became chronic.

Stevenson’s gangly physique

RLS had a gangly physique which other writers have attributed to thyroid problems but it is unlikely that he had that illness, and his physique can be easily accounted for in other ways. As an infant he had many infectious illnesses related to the pollution of the river, drinking water, and food supply, and the industrial air pollution of Edinburgh, and Chicken pox, whooping cough, feverish colds, bronchitis, pneumonia, digestive upsets and gastric fever, and probably diphtheria and infantile cholera were among his feverish ailments which are commonly accompanied by a loss of appetite which would adversely affect the physical development of a growing child.

In this illustration he can be seen as thin and stooped and he has one shoulder lower than the other indicating sideways curvature of the spine . With this physique his lungs would be compressed and poorly ventilated and easily congested, disposing to the contraction and persistance of respiratory infections in adulthood.

THE COMBINATION OF FACTORS THAT PROBABLY CAUSED STEVENSONS TUBERCULOSIS

(IN THE CITY OF EDINBURGH NICKNAMED “OLD SMOKY” FROM THE SMOKE IN THE AIR)

Robert Louis Stevenson’s tuberculosis was probably the result of the combined factors of his thin and stooped physique which compressed his lungs, dust from the factories owned by his family where they ground stone for use in lighthouses, and the smoky atmosphere of the cities of the industrial revolution, and bacteria which more readily infected lungs that were already congested. His birthplace was Edinburgh and he grew up in that city which had the nickname of Auld Reekie, which is Scottish for Old Smoky, which comes from the fact that the houses and factories were heated by coal and wood fires which billowed smoke out of their chimneys and filled the surrounding atmosphere. The problem would have been made worse by the fact that Louis was a chain smoker.

The following quote comes from the BooksfromScotland.com website . . . “The young Stevenson spent much of his time away from Edinburgh’s smoky atmosphere in the hope that fresher air would alleviate his chest complaints” here

The RLS neurosis???
Other writers have suggested that the ailments that RLS had as an adult were psychosomatic and depressive illnesses which were part of a neurosis which was related to the nightmares which he had when he was a young boy and was told biblical horror stories by his nurse Cummy. One writer said that his adult illnesses were always and without exception preceded by stress. However nightmares in childhood are a common accompaniment of many feverish illnesses because the infection sometimes spreads to the brain. Furthermore, as an adult Louis was a fearless adventurer compared to most people of his day. Nevertheless he sometimes reported that he suffered from depression but this was almost always the result of the distressing aspects of his relapsing bouts of tuberculosis, and not the cause of them, and although he suffered from rare instances of depression for other reasons, as occurred briefly when his father died, these are normal responses to a death in the family etc. However, for the majority of the time Louis was cheerful and resilient in the most harrowing situations. Furthermore, there is considerable evidence that the adult illnesses which he survived were part of epidemics which killed millions of less resilient people.

The RLS tuberculosis controversy
Some writers have questioned whether RLS actually had tuberculosis or some other less severe lung disease and some nineteenth century writers have even suggested that tuberculosis was a psychosomatic disorder with no organic basis. However many of the top tuberculosis experts in the world diagnosed Louis as having, or as being in remission of severe tuberculosis. Their medical experience would have given them the ability to diagnose the condition with some certainty, despite the fact that there were no x-rays or blood tests available at the time to absolutely confirm this. The suggestions that Louis had some other lung disease are speculative and have much less evidence to support them. Of course, the nineteenth century idea that tuberculosis had no organic basis was ridiculous and has since been discredited by advances in medical knowledge and technology, and further discredits any claims that Louis had psychosomatic complaints. (It also sheds doubt on some of the modern application of psychosomatic concepts).

The death of Robert Louis Stevenson at age 44
Some authors have argued that if RLS actually had tuberculosis he should have died of it, but, as he died of a stroke, he therefore did not ever have tuberculosis, and that his stroke was brought on by stress. However the main reason that Louis did not die of tuberculosis like many others, was because he was intelligent and wealthy and could afford to leave the industrial pollution of Edinburgh and go to a country with a clean air environment, such as Samoa, to relieve the strain on his lungs, as was recommended by every top tuberculosis expert in the world at that time. It is highly unlikely that he died as the result of stress, because at that time he was 44 years old, living as a virtual millionaire by today’s standards, in a mansion, with 19 servants, in the Pacific island paradise of Samoa, doing the work that he enjoyed. The family disputes which were said to bring on his stroke were rather petty and very common, and would not produce a stroke in a healthy person. However, Louis was a chain smoker, and a prolific drinker of alcohol and coffee. He was a whiskyfied Scot, and in Samoa he had a cellar which was stocked with the finest French wines that money could buy and he died with a glass of claret in his hand. Smoking and drinking causes hardening of the arteries which commonly results in heart attacks or strokes which kill people in their mid forties. Furthermore Louis had many feverish illnesses which terminated in meningitis, which also damages the arteries of the brain and can cumulatively result in a stroke.

The Fanny Stevenson neurosis controversy

Fanny Stevenson suffered from many illnesses which some other authors have suggested were due to a neurosis which can be traced back to the giddy spells, blackouts, and hallucinations which she had after the death of her infant son Hervey. However, her son died of Scrofulous tuberculosis which was one of the Antwerp fevers. Most doctors of that time could not easily distinguish between illnesses such as scrofula, typhoid, and typhus, and all were highly contagious. Fanny probably had one of those illnesses which produced the giddy spells at the time of her sons death, and the illnesses which she had later in life can be reasonably easily accounted for in other ways as the infectious ailments of the nineteenth century. It has also been suggested that her so-called neurotic or depressive illnesses which only occurred after she married Louis were related to the conflicts in her relationship with him. However a review of her biography reveals that she was unhappy with her former husband, and very happy with her relationship with Louis.

Fanny Stevenson’s hypochondria???

There have been suggestions that Fanny Stevenson was a hypochondriac who would become ill whenever Louis became ill because she was a neurotic sympathy seeker. However, the illnesses which Louis contracted were related to his travels through many exotic countries at a time when immunisations and antibiotics were not available, and as Louis had poor health due to his chronic tuberculosis he also contracted many other infections. These were contagious and were commonly passed on to close family members because of body contact etc. Furthermore, when Louis became ill, his infections would have had an incubation period of days or weeks, and Fanny had to nurse him, so it would be expected that during or shortly after that period she would succumb to the illness herself. Also, often when Louis and Fanny were ill, the maid, servants, or visitors also became ill, indicating the highly contagious nature of these epidemic ailments.

The Fanny Stevenson temporary insanity and spectacular mental breakdown controversy

Fanny Stevenson has been described as having an 18 month period of temporary insanity which terminated in a spectacular mental breakdown in 1893, and which she suddenly snapped out of. However, she probably had a severe relapsing fever, such as typhoid or typhus, or a series of different opportunistic feverish illnesses. Each of these infections, or relapses of the same infection, can spread to the brain to cause the delirium of meningitis in which people can become quite belligerent and have fits and hallucinations, and meningitis characteristically ends abruptly in death or rapid recovery.

The Alexander Leeper Hypochondria Controversy

The ancient Greeks coined the word hypochondria because of their assessment that the many and varied symptoms were caused by a disorder originating beneath the cartilages of the lower ribs, however throughout the twentieth century the prevailing view was that the set of symptoms were related to a fear of imaginary illnesses which produced an unwarranted and irrational interest in health. Nevertheless in my assessment the primary factor which generated an interest in health was the fact that doctors were unable to provide a plausible explanation for a persons symptoms and because the person had not achieved a cure despite the fact that they had diligently followed medical advice and taken the prescribed treatment for many years.

This page contains two primary quotes. The first quote represents the medical opinion about hypochondria which prevailed throughout the twentieth century with some minor variations on the general theme, and which was generated by the medical literature and is evident from the newspaper, radio, and television portrayal of the complaint, and which generated the common public understanding (misconception) of the condition. This specific medical opinion was published in London in1928, during the lifetime of Alexander Leeper, and was widely distributed as a medical reference book for the general public. Thirteen doctors contributed to this book which was called “The Modern Family Doctor”.

The second quote gives an account of the actual life and achievements of Alexander Leeper who was described as having “massive hypochondria”. He kept extensive diaries in which he recorded everything about his life and his health.

By comparing these two quotes the extremes of the discrepancy can be clearly seen, and are very easily found in the biographies of other famous people such as Charles Darwin, the genius, Florence Nightingale, the founder of modern nursing, Howard Hughes, the American Billionaire, Napoleone, the French Emperor, and Moliere, the French author of comedy plays.

At the end of this page I provide some other relevant quotes which will be of interest to people who wish to study this subject.

The prevailing account of hypochondria in the twentieth century

The stage of adolescence is the period of “man in the making” and lasts about 10 years, during which time the higher mental qualities are formed and character and conduct take their final shape. “It is the critical period of life and the good or evil habits now acquired remain until the end.”
With the arrival of manhood there should be altruism which is the quality that organised society is built upon, and as Martial said long ago men should be able “To look on death with placid eye, And neither fear nor wish to die.”
“With the neurasthenic and hypochondriac it is quite the opposite. “To both a morbid fear of death is ever present, although usually not admitted, perhaps not even realised. This obsession colours the entire outlook on life.”
Most children develop into mature adults with courage and wisdom but neurasthenics and hypochondriacs remain childlike, egoistic, and self-centered, and they may be specious, plausible, and good at making excuses.
If the minds of these patients is deeply probed they can be found to have had all healthy inclinations starved and withered, and to be like unweeded gardens “in which envy, hatred, malice, and spite have been allowed to flourish”, and they are so self-absorbed that there is no room for outside interests.
These patients have “no kindliness of heart, no love of country” and no generosities, and if they have any friends at all they have no real affection for them. They vegetate in selfishness and are usually moral and physical cowards. “Although history for him has no meaning, and literature no existence, and ignorant of his own ignorance, and most ignorant of what he’s most assured, yet he has very decided opinions, and is good at making a platitude plausible by making it pompous, but he never really thinks; he only thinks he thinks.”
In vengeance for this nature might bring about what is politely called a nervous breakdown, and the patient may whine that fate has been unkind and that he has inherited weak nerves from his parents or race. He may acquire a thorough knowledge of the latest pseudo-scientific jargon but he cannot be persuaded to understand “that his condition is the logical outcome of his wretched scheme of existence, that having graduated in the school of selfishness, he has simply educated and qualified himself for the misery which now knocks at his door. Nature does not return good for evil; she gives blow for blow.”
The only hope for this type of person is to take up religion, purge their souls, read the New Testament, pray to God, admit to the sins of their wretched lives, and to start working to improve their character.
Otherwise trying to convince these patients that their health concerns are unfounded is like trying to reason with an ass.
The conclusion to be deduced is that the conditions of neurasthenia and hypochondria are “the result of a process of wrong thinking, wrong living, and wrong feeling.”
Reference: The Modern Family Doctor (1928) p.157-158.

Alexander Leeper

Alexander Leeper has been described as having “massive hypochondria”. He kept extensive diaries in which he recorded everything about his life and his health.

The achievements of Alexander Leeper are too numerou to be comprehensively covered in a brief essay but I will describe some of them.
He showed signs of brilliance from the age of 5 and was first educated by his father at home and then sent to private schools.
At the age of 13 he topped his class in Classics, French, and Scripture.
He later sat for and passed an entrance exam for the Indian Civil Service, but he did not pursue that course probably because he would have been rejected on the grounds of his poor health.
In 1865 he won a scholarship to study at Trinity College Dublin (University of Dublin), where he completed a degree in Classics.

In 1871 R.T. Tyrrell, professor of Greek, described him as the best viva voce translator that he had ever met, and Arthur Palmer, professor of Latin, described him as the best classic he had ever examined and believed that he would eventually come to be regarded as one of the most distinguished scholars produced by the University of Dublin in modern times. The professor of Greek at Queen’s University in Galway praised his special aptitude as a teacher.
In 1872 he sat for an open scholarship to St. John’s college of Oxford University, and was granted a special exhibition of 100 pounds a year for 5 years which was the equivalent value of the scholarship. In 1874 he gained a “first” in Classical Moderations.
In Australia he became the Second Master of Melbourne Grammar School, where he was also Senior Master of Classics, and he established the school library, museum, and newspaper.
He was also appointed principal of Trinity College Melbourne, and later changed the title to Warden, and developed the college as a role model for other colleges associated with the Melbourne University.
He was on the Council of the Melbourne University where he recommended reforms which were implemented, and he was on the state Council of Public Education.
In 1880 he delivered the main speech, about university colleges, at the Social Sciences Congress, which was a by-product of an International Exhibition.
He was one of the Trustees of the Public Library, Museums, and National Gallery from the 1880’s, and was president from the 1920’s until his retirement.
In 1896 Alexander Leeper drew up the draft constitution for the Library Association of Australasia and became its new chairman and delivered speeches at its Biennial Conferences.
He “was a lover of books and a firm believer in the educational influence of the Public library”, and he suggested that there should be a closer relationship between libraries and educational institutions. He insisted on the need for administrative ability in librarians, and recommended that “Universities should honour librarians more, giving them status as professors.”
In 1908 he represented the Diocese of Melbourne at the Pan-Anglican Congress which was held in London, and which was attended by 200 bishops. He was also chairman of the Central Church League, and a lay canon at St. Paul’s Cathedral.
He was involved in the production of plays and acted in some of them, and was the director of a play called The Wasps by Aristophanes which was presented by the combined colleges as the jubilee production of the Melbourne University. He also represented the Melbourne Shakespeare Society while in the U.K.
He was president of the Classical Association of Victoria which had 300 members, which made it the largest Classical Association in the British Empire.
He had many famous, wealthy, and influential friends, and for a short time he was a member of the Melbourne Club and was involved with the Navy League.
He traveled widely throughout the United Kingdom, Europe, the Middle East, Norway, the United States, Australia, and New Zealand, and he attended meetings of the Australian Institute of International Affairs.
He was also a leader of patriotic causes, especially during World War 1 when he argued against Home Rule for Ireland, in favour of retaining it within the British Empire.
He also contributed to many charities especially the Society to Assist Persons of Education, and he visited Old Colonists Homes and was acquainted with Stanley Greg Smith who was secretary of the Charity Organisation Society, and he distributed their tickets to the needy.

Reference: Doubts and Certainties A Life of Alexander Leeper (1997).

Le Malade Au Petit Papier
(The Malady of the Little Piece of Paper)
“Axel Munthe, describing his patients at his practice in the Avenue de Villiers, says they would produce from their pockets little pieces of paper and read out an interminable list of symptoms and complaints – le malade au petit papier, as Charcot used to call it”.
From: Hysteria, Hypnosis & Healing: the work of J.M. Charcot (1971) p. 56

After many years of consulting physicians and of receiving various treatments, all of which failed, and after seeking explanations for their symptoms and not being given any, some 19th Century patients methodically prepared detailed written descriptions of their symptoms in an attempt to assist the doctor in making an accurate diagnosis so that an effective remedy could be determined.
Such written accounts were referred to as ‘le petit papier’ (the little piece of paper) and have since been used for diagnosing hypochondria ‘le malade au petit papier’ on the basis of a misinterpretation that they represented a morbid and unnecessary interest in health. M.B.

The confused facial expression of a doctor talking to a hypochondriac as depicted in The Marshall Cavendish Encyclopedia of Family Health (1988) p.772. (The patient has a considerable forward curve in his upper spine and appears to be complaining about shoulder pain which is often caused by sideways curvature of the spine.This is a common form of postural pain where there is usually no x-ray evidence of injury or disease.)

Doctors often shrug their shoulders and present a facial expression of confusion and uncertainty when dealing with patients who have the symptoms of hypochondria. They also often ask for more detailed information about the severity of symptoms, when they occur, what factors aggravate the symptoms and what relieves them. Many patients write those details down on paper so that they do not forget to mention them at the next consultation.
They assume that the doctor is giving their condition serious consideration.

Some quotes about preoccupation with health problems

Attention to too much detail??? for diseases that are not properly understood, diagnosed, or cured???

The difference between good science and bad science is that one considers every detail, and the other leaps to conclusions .

The hypochondriac …”He constantly seeks medical aid and undergoes any treatment recommended; he is a thoroughly good patient. Any new treatment suits him, but never does any good; nevertheless he comes back to his doctor to whom he is usually faithful . . . He is incurable, but should be taken care of and humoured by doctors, or he may fall into the hands of quacks and be fleeced.”
From: The Common Neuroses 2nd Edition (1937) p.60

“Letters and autobiographies from earlier centuries reveal deep preoccupation with matters of health and with attempts to plumb the sources of sickness”.
In fact “stethoscopes, ophthalmoscopes, and other gadgetry were not introduced till after 1800” so doctors had no instruments to aid in diagnosis, and, it was considered undignified to do physical examinations by touching or exposing the patients body, so the patients description of symptoms was the primary means of determining the cause of disease.
“This was achieved through the sick person relating his ‘history’: when and how the complaint had started, what might have precipitated it, the characteristic pains and symptoms, and whether it was new or recurrent. The patient would also recite the main features of his lifestyle – eating and sleeping habits, bowel motions, details of emotional upsets, and so forth”.
Treatment was usually only a matter of managing the disease with rather ineffectual drugs and the placebo affect.
Reference: The Cambridge Illustrated History of Medicine (1996) p. 96-97

“George Cheyne, a well-known eighteenth century physician, considered that one-third of his patients suffered from hypochondriasis, in those days an all embracing term, and in 1807 Trotter was of the opinion that it was two-thirds (Singer and Underwood)
Hypochondria is one of the most dreaded diseases in medical practice”.
From: Health, Sickness, and Society (1976) p. 410 & 774.

Since the influence of emotions on body functions has been recognised doctors have been less confused by many syndromes. “Although there are no over-all reliable statistics to support the following claim, many outstanding internists have estimated that as many as 50 per cent to 60% per cent of the patients whom they see suffer primarily from emotional disturbances.” “This observation has tended to cut down the number of fruitless laboratory examinations” and the previous tendency to blame the symptoms on some minor physical defect. It has also decreased the tendency to overtreat the illnesses where all too often the procedure had very serious damaging effects on the patient’s life.
In fact these practical considerations were more important to the doctor than the principles of psychiatry.”
Reference: The Specialties In General Practice (1951) p.710.

The Bird Flu Epidemic © 24-10-05

My knowledge of epidemics relates to The Black Plague of London, The Florence Nightingale methods of treating infectious illness in the Crimean Military Hospitals, and The Flu Epidemic of 1918 which contributed to the ending of World War 1.

I also became interested in the contrast between the health of Robert Louis Stevenson and his wife Fanny Stevenson. Louis was reckless with his health. He was born in a city where the air was thick with smog and the drinking water was contaminated with sewerage and toxic chemicals, and he smoked and drank excessively, and visited exotic countries and wandered through squalid suburbs, and walked through leper colonies, and contracted many plagues. His wife Fanny tended to his illnesses and contracted them after an incubation period of 1 or 2 weeks, and read medical journals to treat those conditions more effectively for Louis, herself, and the members of her household in Samoa. Louis whole life was disrupted by illness until he died of a stroke at age 44. After his death Fanny returned to England where she seems to have had perfect health until she died in her 70’s. The following comments relate to those matters which are indirectly, but importantly relevant to the Bird Flu. M.B.

To understand the bird flu is to understand the life of Robert Louis Stevenson who survived the plagues of the nineteenth century where others died in their tens of millions.

Robert Louis Stevenson lived in the nineteenth century, before microscopes could confirm a patients infection, and before x-rays could provide evidence of lung disease, and before immunisation or antibiotics were available, and when people had to survive by their power of observation and reason.

He lived in Edinburgh and visited London where the fogs were black and yellow and blue from the soot which rose from every house, train, and factory chimney, and a man could not see his hand in front of his face, and the cobblestones of the road, and the walls of buildings were black, indicating the contaminated condition of the lungs of every citizen.

He lived at a time when 50% of the population of industrial cities contracted pneumonia and most died from it, and when 97% of the population had evidence of tuberculosis antibodies in their blood, and when most of them contracted the ailment in their teens and died from relapses in their twenties.

He lived when mice and rats, and bed bugs, and lice and tics , and mosquito bread in the windowless houses, and the piles of garbage, and the open sewer drains in the city streets, and the rivers which provided domestic drinking water, and when milk, vegetables and meat were transported by horse and cart and became contaminated with horse dung dust, and when vast numbers of children contracted summer diarrhea and other infections and died in their infancy.

>He lived at a time when plagues started in the poorer suburbs of Rome where food vendors lived in underground dugouts full of mice, rats, tics, and bugs, and the contaminated food was sold to the citizens of the wealthy suburbs, and was transported by horse and cart along the coast of the Mediterranean sea from town to town, spreading the plagues in its wake.

He lived at a time when one person with a plague emptied their bowels and the contaminated feces found its way into a city drinking water and killed tens of thousands of its citizens.

He lived when Typhoid Mary, a carrier of typhoid who showed no symptoms herself, worked as a cook for wealthy families who lived in mansions, and whenever she changed jobs, she transmitted typhoid to each new family.

He lived at a time when trains had spittoons along the aisles and the majority of travelers contracted lung diseases from the dried dust of the tuberculous spit. Such trains stopped at remote hotels and restaurants where food was not fresh or refrigerated and 50% of the passengers contracted food poisoning.

(One of Stevensons many infectious illnesses was probably brucellosis caused by contact with infected goats, or from drinking goat milk, or from inhaling goat dung dust which blew in the wind on a goat farm in the mountains of California).

Robert Louis Stevenson lived at a time when pacific islanders held feasts where every native dipped his fingers into 50 bowls of food and soup. When one ship came into port and one man with small pox attended the banquet 90% of the population died of small pox because the condition was completely foreign to their immune systems and they had no defense against it.

He lived at a time when one person contracted malaria, and then one at a time, each member of the family who came into direct contact with them, or who attended to his nursing needs and handled blood, vomit, and feces soiled bed sheets, contracted the ailment in a sequence which was determined by the incubation period of the bugs development, from contraction, to latency, to symptoms, to delirium, and then death or recovery.

He lived when doctors were sceptical about the germ theory and transmitted plagues as they coughed and sneezed their way from patient to patient.

To survive the bird flu, is to understand these things from the perspective of a full strategy of prevention, interrupting the spread, escpecially in its early stages, (so that their is time to develop immunisation and treatments programmes). town planning, quarantining and housing of patients from the public, and from other patients with other illnesses, and protection of the treatment providers. A consideration of only one factor, or to ignore any factor is doomed to failure.

Those who learn from history will be best suited to avoid the mistakes of history and survive.

More information on this matter can be gleaned from this web page about the health of Robert Louis Stevenson,

Additional notes on epidemic policy and history

In the nineteenth century Crimean Military Hospitals Florence Nightingale reduced the death rate from 50% to 5% by cleaning bed sheets and floors. Prior to her policies, soldiers with bayonet wounds were put into beds which had been soiled by the sweat, urine, feces, vomit, blood, and pus of the previous patients who had died from infected wounds.

When AIDS was first discovered a policy of secrecy was introduced to prevent public panic. In the meantime the epidemic spread rapidly and globally and is still out of control nowadays.

The Three Wise Monkeys, the laughing kookaburra, and The Bird Flu ©

I don’t think that this is an original story, but I will tell it in my own words anyway.

Three wise monkeys were sitting in a clearing in the middle of an African jungle when a rogue elephant came stampeding towards them.

The first monkey pretended that nothing was happening in the hope that the elephant would ignore him and go away, and he was trampled to death.

The elephant turned around and stampeded again and the second monkey panicked and froze on the spot, and he was trampled to death.

The third wise monkey had observed that ignorance and fear didn’t solve any problems so he decided to do something, anything at all, because anything would have to to be better than nothing, and he turned around, and luckily, saw a river not far away with a rope bridge across it. He headed off at a casual pace, hoping that the elephant would see that he was no threat, and he reached the bridge and decided to walk across it in the hope that the elephant couldn’t swim, but he kept planning ahead and thought to himself “If that ruddy elephant jumps into the river and swims across, I will walk back and forth across that bridge until the silly pachyderm wears himself out and drowns”.

Unfortunately, that monkey hasn’t been seen since, and as you know, ladies and gentlemen, not even the best laid plans work as they should all the time, but we have to do something or we will all be the hopeless victims of our fate, so last week, with that in mind, an Australian kookaburra who always laughed at everything, and lived in a big chookhouse because he couldn’t fly, decided, for reasons known only to himself, to learn a bit about Avian Influenza. He paddled a row boat through torrential storms and hurricanes across the seven seas, and traipsed his way through a jungle on his way to the Central African Bird Flu Conference, and found himself in that very same clearing surrounded by a hundred man-eating lions.

They all attacked from every direction at once and as they got close enough for the kookaburra to smell their hungry breath, and then as their claws were at his belly, and their teeth were at his throat, he wondered what to do. Just then the earth began to tremble and shake, and he thought “Well then, that is typical; things always seem to get worse before they get better, and now I must be in the middle of a ruddy earthquake!!”. At that same instant every one of those lions fled in fear as a thousand angry elephants came stampeding through the jungle, and there he was, just an ordinary kookaburra, wondering “How much worse can things get before they get any better?”

He didn’t know what to do next, but he knew that he had to do something so he watched carefully as the strongest and mightiest of the elephants was leading the rest toward him, It was the big rogue elephant, and as it came thundering closer and closer the kookaburra thought to himself “I’m not dead yet, but if I don’t come up with a really good idea quick, I soon will be.”

Just then, he saw a monkey come out from behind a bush where he had been hiding from the 100 hungry lions, and as he rushed bye at break neck speed he yelled “Run for the bridge.” M.B.

Ordering Details

The Health Biogeraphies Of Alexander Leeper, Robert Louis Stevenson, And Fanny Stevenson ©

By M.A.Banfield

Full color hardback cover with 18 pages on Alexander Leeper, 90 pages on Robert Louis Stevenson, and 95 pages on Fanny Stevenson, and a 29 page index featuring more than 3000 entries

Costs

A$19.99 within Australia, NZ$24.99 to New Zealand, U.S$22.99 to the United States, & EUD$17.99 to the United Kingdom (cost per book includes postage).

Orders to

the books author: M.A.Banfield Ph. +61 (08) 82635735

Alternatively this book is available in many Australian Public Libraries.

ISBN 0 9585390 3 0

The book has been added to the Robert Louis Stevenson website here