Commentary

Cutaneous implications in Oliver Goldsmith'sThe Vicar of WakefieldRichard M. Caplan, M.D.* Iowa City, IA

Oliver Goldsmith, a famous British author of the 18th century, held himselfforth as a physician, although his preparation for that role was greatly lacking.His one novel, The Vicar of Wakefield, became enormously popular, and stillremains so. It provides an early example of the novel and has other attributesthat make it worthy of literary study. For dermatologists, however, there arepassages of special interest regarding some sentiments of the time toward"a clear complexion" and medicinal washes. Those comments, combinedwith other information we have about the potentially toxic nature of thewashes and other topical agents used then, illuminate for us both the publicand professional attitudes and behavior of that period. (J AM ACAD DERMATOL

13:1075-1078, 1985.)

Great writers are great observers. In fact, theirprowess as writers depends largely on their skillas observers. Because the skin, among all organs,is supremely available for inspection, small won­der it is mentioned so often in literary works. Howseldom Shakespeare refers to pancreas or lung,whereas his references to the skin are abundant.In The Comedy of Errors, for example, he buildsone of his enchanting chains of puns on thesubject of baldness; later, he plays on the doublemeaning of "carbuncle," offering a splendid de­scription of what we today call rosacea as hespeaks of the rubies and carbuncles on the face ofa fat kitchen-maid; and finally, he resolves theconvoluted plot viathe correct identificationof twosets of twins through their having identical molesand warts.'

One might suppose that physicians, blendingnatural talent with their training in themedical usesof observation, might enjoy a special advantagetoward becoming great writers. But only a smallnumber have attained that status. Whether thosefew make more than their randomly expected pro-

No reprints available.

*Professor of Dermatology, Associate Dean for Continuing MedicalEducation, and Director, Program in Medical Humanities, Uni­versity of Iowa College of Medicine.

portion among the population of great writers ishard to know, since' 'great writers, " asa necessarypart of both numerator and denominator for thecalculation, is a phrase yet too elusive to yieldnumerical data. Nevertheless, it is illuminating tobecome acquainted with those great writers whowere, in fact, physicians. For some, like ArthurConan Doyle or William Carlos Williams, theirmedical training and experience are often obviousthrough their choice of subject and detail. Forothers, like Keats, the medical background seemsscarcely discernible or relevant, although recentscholarship is expanding our sense of Keats' re­lationship to medical knowledge and behavior.2

Another author better placed in this second cat­egory is Oliver Goldsmith (1728-1774). In fact,controversy rages over whether he was a physicianat all, even by the vague criteria of his time. Anative of Ireland, he definitely graduated fromTrinity College, Dublin, in 1749, but no solid ev­idence has appeared to show him enrolled, letalone graduated, from any existing medical schoolof the day. He may have attended various lecturesin his years of wandering, or may have had ap­prentice-style training, but this remains conjec­ture. He did, however, hold himself forth as aphysician, and occasionally prognosticate or pre-

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scribe. In those days it was enough. And even intoday's highly credential-conscious environment,an occasional scamp-and Goldsmith probablydeserved that title-can for a time masquerade asa physician.

In spite of his unpleasant or even obnoxiouspersonal behavior, as attested amply by Boswell'and various biographers.':' Goldsmith was recog­nized by Dr. Johnson and other authorities thenand now as a graceful, elegant stylist. Ultimatelya professional writer, Goldsmith spewed forth inhis short working life a huge amount of workadaytrash, but along the way generated enough poems,essays, plays, and a novel to secure his place inthe pantheon of British writers whose works arestill read and performed over 200 years later. Histwo plays, "The Good Natur'd Man" (1768) and"She Stoops to Conquer" (1773) ignited a veri­table revolution against the pervasive sentimen­tality of contemporary drama and are still fre­quently staged.

His one novel, The Vicar of Wakefield. 6 contin­ues to sell well. Even by the month of his deathin 1773 the fifth edition was published. By thebeginning of the twentieth century it had "ap­peared in more editions and in more translationsthan any novel that was ever written."5 In manyways that is a surprise, for it is full of sentimen­tality and silliness. Perhaps those qualities can beforgiven in a relatively early work (although notpublished until 1766, it was written before 1762,when Dr. Johnson sold it to a publisher for 60guineas to relieve Goldsmith's penury and keephim from debtor's prison). The plot is so depen­dent on coincidences, distress heaped unrelievedlyon distress, the apparent triumph of evil over vir­tue (until the abrupt reversal at the very end), thatour modem experience could designate it only asbeyond melodrama. It is "soap-opera," tinged,however, with enough satire, humor, surprises,pompous homilies from the Vicar about humannature, pride and integrity, and, finally, such pleas­ing gift of expression that it continues to be notmerely tolerated but enjoyed. Further, the tale pro­vides a look at the lifestyles and mores of mid­18th century Britain. And beyond all that, it helpsus track the development of the novel as a literaryform.

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The first novel (Pamela by Samuel Richardson,1740) appeared only about 20 years earlier and soThe Vicar oj Wakefield enjoyed some popularityjust for its novelty of form. But being accustomedto the relatively sophisticated novels of the pastcentury, we smile at Goldsmith's forced twists ofthe story, the two-dimensional stereotypic char­acterizations, and the poverty of description andsetting. We easily forget how enormous has beenthe influence of such giant figures as Goethe, Tol­stoy, Dickens, Flaubert, or Hemingway in shapingour modem sense of what a novel can and, at itsbest, should be. The stream of gothic and melo­dramatic romances continues to bring commercialsuccess to some authors, but The Vicar of Wake­field surely could find no publisher or audiencetoday except for its gentle humor and graciouscharm as a period piece. Now we read it mainlyas history-of the novel, the style, and the times.In that sense it has much to teach us, even aboutskin disease.

The good Vicar-and good he was, even to anenormous fault-twice voiced opinions about theskin and its care that not only illuminate his char­acter but also provide access to some of the judg­ments and practices of the mid-18th century. Aclear complexion in a young woman was undoubt­edly well regarded: "Her youth, health, and in­nocence were still heightened by a complexion sotransparent, and such an happy sensibility of look,that even age could not gaze on with indifference"(Chapter 2). Not surprising, then, that home reme­dies or their commercial counterparts were widelyavailable to offer help to complexions less trans­parent. Special concoctions for washing the facewere extant then, as now. The Vicar expressed hissentiments clearly when he observed his two teen­age daughters "cooking something" over the fire."I at first supposed they were assisting theirmother; but little Dick informed me in a whisperthat they were making a wash for the face. Washesof all kinds I had a natural antipathy to; for I knewthat instead of mending the complexion theyspoiled it. I therefore approached my chair by slydegrees to the fire, and grasping the poker, as ifit wanted mending, seemingly by accident over­turned the whole composition ... " (Chapter 6).Later the Vicar again cited the washes to illustrate

Volume 13Number 6December, 1985

his family's disregard of his "long and painfullectures upon temperance, simplicity, and con­tentment." Pride had lain asleep, but roused: "Ourwindows now again, as formerly, were filled withwashes for the neck and face. The sun was dreadedas an enemy to the skin without doors, and thefire as a spoiler of the complexion within. My wifeobserved that rising too early would hurt herdaughters' eyes, that working after dinner wouldredden their noses, and convinced me that thehands never looked so white as when they didnothing" (Chapter 10).

Brown? has described the many advertisementsfor proprietary medicines to be found in the news­papers of Bath, a resort and spa community enor­mously popular in 18th century England. His for­mal sampling from newspapers of that periodfound advertisements for 302 products, of which13 were to be taken internally for relief of skindisease. Another 43 were meant for topical appli­cation to the skin, eyes, or orifices, of which 12seemed directed against skin disease, while theremaining 31 nostrums seemed to be the kind ofsalve prescribed by the novel's character, Sir Wil­liam Thornbill, who "studied physic for hisamusement," and thereby relieved at once thegreat distress the Vicar suffered from his burnedarm. Caveat emptor ruled the marketplace then,for who would regulate truth-in-advertising or ex­press concern for subtle toxicity? Thus, Brown?cites a physician of Bath writing in 1790 that"some of the most celebrated cosmeticks consistof preparations oflead, mercury, or bismuth . . ..This poisonous composition is generally dignifiedby the pompous title of pearl powder, and sold asperfectly innocent. It has however proved fatal tosome, and ruined the health of many others. " An­other of the advertised products was Gowland'sLotion, described in a 19th century source as"mercuric chloride in an emulsion of bitter al­monds . . . used as a wash for pimples, etc.but ... far from safe."

At the time of his writing, Goldsmith (and thusthe Vicar) may have been aware of the possibilityof such potential toxicity, or he may, in saying he"knew that instead of mending the complexionthey (washes) spoiled it," have voiced the viewthen still current that cutaneous eruptions repre-

The Vicar of Wakefield 1077

sented bodily efforts to extrude undesirable hu­mors. By that reasoning, topical efforts to quellthe process would, especially if successful, dele­teriously countermand the body's efforts. Thisview, important in understanding the behavior andreasoning of physicians of the time, might haveinfluenced the general population to a highly vari­able degree, depending on their sophistication andacquaintance with the "official" medical theoriz­ing. Even so, the Vicar's disinclination to thewashes may have stemmed more from his puri­tanical sentiments regarding pride and vanity. TheVicar was doubtless a rigid prig, which protectedhim not at all from being a bumbling fool.

We gain a further sense of the thinking of thetimes if we peruse the recipes (receipts) used thento seek medicinal benefits. For example, from TheArt of Cookery Made Plain & Easy, by a Lady,1760, An Approved Method Practised by Mrs.Dukely, The Queen's Tyre Woman, to PreserveHair and Make it Grow Thick:

Take one quart of white wine, put in onehandful of Rosemary flowers, half a pound ofhoney, distill them together; then add a quarterof a pint of oil of sweet almonds, shake it verywell together, put a little of it into a cup, warmit blood-warm, rub it well on yourhead, & combit dry."8

Although we laugh at such unsophisticated no­tions of those who lived in the "Age of Enlight­enment," the laugh could be on us. A criticalreading of the advertising and contents of dozensof products displayed on the shelves of any largepharmacy today will provoke the same sense ofmirth. Pharmacopeia and folk remedies, now asthen, share far more than just alliteration. Or atleast, such package-browsing will put us in touchwith the immaturity, or pseudosophistication, thattoday's society unwittingly displays. And to visitpharmacies in parts of the world less regulated thanours is to experience a still greater culture shockof present with past, as we see homeopathic reme­dies and folk nostrums side by side with the latestspecies of steroids and antibiotics. Oliver Gold­smith and the Vicar he created surely remind usof two pessimistic aphorisms-Sic transit gloriamundi or Ars longa, vita brevis est-take yourchoice.

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REFERENCES1. Shakespeare W: The comedy of errors, in The complete

works of William Shakespeare. New York, 1937, WalterJ. Black, pp. 379-399.

2. Goellnicht D: The poet-physician: Keats and medical sci­ence. Pittsburgh, 1984, University of Pittsburgh Press.

3. Boswell J: The life of Samuel Johnson, LL.D. New York,Random House. (Not dated.)

4. Wheeler C, editor: Essays on Goldsmith by Scott, Ma­cauley and Thackeray and selections from his writings.Oxford, 1918, Oxford University Press.

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5. King R: Oliver Goldsmith. London, 1910, Methuen &Co, Ltd.

6. Goldsmith 0: The Vicar of Wakefield. New York, 1961,The New American Library, Inc.

7. Brown PS: Some treatments of skin disease in eighteenthcentury Bath. Int J Dermatol 21:555-559, 1982.

8. Meighn M: A little booke of conceited secrets & delightesfor ladies, wherein is contained the most incomparablerecipes & choicest curiosities of many good huswives &learned Doctours of Phisicke. London & Boston, 1928,The Medici Society.

ABSTRACTS

Biopsy procedures, primary wide excisionalsurgery and long-term prognosis in primaryclinical Stage I invasive cutaneous malignantmelanoma

Griffiths RW, Briggs JC: Ann R Coll Surg Engl67:75-78, 1985

This study was poorly planned and poorly done, I think.This article rales against incisional biopsy of melanoma with­out seeming to recognize the important indications for suchbiopsies or the many costs of widely excising all brown spotson the skin. In the follow-up statistics, incisional biopsyseems not to worsen the prognosis, overall, which is an im­portant point. Be prepared to comment on this one, if youagree, when the surgeons quote it.

p.e.A.

Morbidity during the preschool years

Fergusson DM, Dimond ME, Shannon FT: AustPediatr J 20:281-287, 1984

The first 5 years of life for these average youngsters in­volved, statistically, eighteen visits to the family doctor.About one third of them were admitted once to a hospital.Diseases of the skin were a principal source of this morbidity,coming second after respiratory illnesses.

P. C.A.

Sunburn and malignant melanoma

Green A, Siskind V, Bain C, et al: Br J Cancer51:393-397, 1985

Interview data about physical causations are never con­vincing. Measurements or counts should always be verifiedper se. This study fails on these criteria. However, the de­velopment of melanoma and severe sunburns were correlatednicely in this paper, thereby fitting everyone's bias.

P. e.A.

Common acquired nevi and the risk of malignantmelanoma

Green A, MacLennan R, Siskind V: lnt J Cancer35:297-300, 1985

From Australia again, where the epidemiology of mela­noma is an industry, comes this report of 183 patients andtheir matched controls. Briefly, the presence of nevi on thearms seemed to be a mild "increased risk factor" for thesubsequent development of melanoma. Details are discussed.

P. C. A.

Major amputation in paraplegic and tetraplegicpatients

Grundy DJ, Silver JR: Int Rehabil Med 6:162-165,1984

The British seem to lead the way in the study and practicalcare of pressure sores of the skin. This is a short review ofour improved knowledge about paraplegia.

P. C. A.

Recall of UVB-induced erythema in breast cancerpatient receiving multiple drug chemotherapy

Ariderson KE, Lindskov R: Photodermato11:129­132, 1984

From this first volume of a new journal comes a case studyof the sudden reappearance of ultraviolet B (UVB) skin injury,repeatedly over a week, "recalled" by cancer chemothera­peutic drugs. Theorists who wish to understand sunburn mustincorporate this now well-described recall phenomena intotheir total explanation of how UV radiation harms the skin.

P. C.A.