Diagnosis (). Pl. -oses. [a. L. diagnsis, Gr. , n. of action f. to distinguish, discern, f. - through, thoroughly, asunder + to learn to know, perceive. In F. diagnose in Molière: cf. prec.]
1. Med. Determination of the nature of a diseased condition; identification of a disease by careful investigation of its symptoms and history; also, the opinion (formally stated) resulting from such investigation.
Old Frederick Furnivall was the first of the great dictionary men to go. He died within just a few weeks of the Minnetonka’s sailing from London.
Furnivall had known he was dying since the beginning of that fateful year, 1910. He remained amusing and energetic to the end, sculling his little boat at Hammersmith, flirting with his waitresses at the ABC, sending his daily packages of words and newspaper clippings to the editor of a project with which he had been intimately associated for all of half of a century.
He started one of his final letters to Murray with a typically eccentric disdain for the illness that he knew would shortly fell him. His first expressed interest was in a word—tallow-catch—that Murray had found in Shakespeare, had recently defined, and had sent down to Hammersmith for approval: Furnivall offered his congratulations for a definition that read in part “a very fat man…a tub of tallow,” a word that has similarities today with the reference to a man as “a tub of lard.” Only after this did he speak elliptically of the grim prognosis his doctor had offered—he had intestinal cancer—remarking, “Yes, our Dict. Men go gradually, & I am to disappear in six months…. It’s a great disappointment, as I wanted to see the Dict. finished before I die. But it is not to be. However the completion of the word is certain. So that’s all right.”
He died as predicted, in July; but he did not abandon work until after inspecting, as Murray had suggested that he might, one majestically long entry that was due for inclusion in volume 11. “Would it give you any satisfaction,” Murray had asked him, “to see the gigantic TAKE in final? Before it is too late?”
Murray himself, given his steadily advancing years, suspected that with Furnivall’s passing, his own end could not be too far off. And with offering take to Furnivall it was evident he had only just begun the monumental work on the entirety of the letter T. That single letter was to take him five long years—from 1908 until 1913—to complete. When he finished he was so relieved as to voice an incautiously optimistic forecast: “I have got to the stage where I can estimate the end. In all human probability the Oxford English Dictionary will be finished on my eightieth birthday, four years from now.”
But it was not to be. Neither was the OED to be completed in four years, nor was Sir James ever to become an octogenarian. The grand conjunction for which he hoped—his own golden wedding anniversary, his dictionary’s completion—never happened. Oxford’s Regius Professor of Medicine once joked that the university seemed to be paying him a salary “just to keep that old man alive” so he can complete his work. They did not, it seems, pay enough.
His prostate gave up on him in the spring of 1915, and the burning X rays with which such problems were then treated hurt him severely. He kept up his pace of work, completing trink to turndown in midsummer, and including many difficult words that, as a fellow editor said, “were handled with characteristic sagacity and resource.” He was photographed for the last time in the Scriptorium on July 10—his staff and daughters around and behind him, and in the background shelves of bound books replacing the pigeonholes with their thousands of slips of paper, which had been the familiar backdrop in the dictionary’s earlier days. His academic cap still atop his head, Sir James looks thin and weary; his expression is one of calm resignation, those of the people beside him knowing and tragic.
He died on July 26, 1915, of pleurisy, and was buried as he wished to be, beside a great Oxford friend who had been professor of Chinese.
William Minor, now into his fifth year at the Government Hospital for the Insane in Washington, D.C.—which was known until 1916 only informally by its later permanent name, St. Elizabeth’s—would have heard in due course of the death of the man who had brought him so much solace and intellectual comfort. But on the actual day of Murray’s passing, he merely had yet another of the bad days that he was increasingly now enduring. Some might say that it was a day on which Minor in Washington was unknowingly in sympathy with the sad events that were unfolding in Oxford, more than three thousand miles across the Atlantic Ocean.
“Struck one of his fellow-patients,” read the notes of Minor’s Cherry Ward for that same Monday evening, July 26. “He had happened to stop and look into his room. Shows temper and will try to strike hard, but has little strength to hurt anyone.” (He had started hitting people the month before. He went walking one June afternoon, along with his attendant, and the pair met a policeman. When the officer began to ask questions, Minor started pounding the attendant on the chest—though he later said he was sorry, explaining that he was becoming “a little excitable.”)
He had probably been capable of inflicting little hurt from the moment he was first entered in the hospital log. He may have been mad, but he was painfully slender; his spine was bowed; he shuffled as he walked; he had lost his teeth and had alopecia. Photographs were taken, full-front and in profile, as if he were a common criminal: His beard is long and white, his bald head high and domed, his eyes wild. His madness was defined as simple paranoia, the doctors said; he admitted that he still thought constantly about little girls, and that he had dreams about the appalling acts they had made him perform during his forced nightly excursions.
But he was not regarded as dangerous: His doctors agreed that he should be granted the privilege of walking into the surrounding countryside, if accompanied by an attendant. The stump of his penis attested dramatically to the fact that he should not be allowed access either to a knife or to scissors. But otherwise, he was deemed harmless—he was just a seventy-seven-year-old man, thin, toothless, wrinkled, slightly deaf, yet “very active, considering his age.”
His delusions steadily worsened during the St. Elizabeth’s years. He complained that his eyes were regularly pecked out by birds, that people forced food into his mouth through a metal funnel and then hammered on his fingernails, that scores, of pygmies hid beneath the floorboards of his room and acted as agents for the underworld. He was occasionally irritable but more usually quiet and courteous, and he read and wrote a great deal in his room. He had a somewhat arrogant air, said one doctor: He did not much care for the company of his fellow patients, and he would absolutely not let any one of them come into his private room.
It was at St. Elizabeth’s that his hitherto puzzling illness was given what might be regarded as its first modern, currently recognizable description. On November 8, 1918, his attending psychiatrist, a Doctor Davidian, formally declared that William Minor, federal patient number 18487, was suffering from what was to be called “dementia praecox, of the paranoid form.” No longer was the vague word monomania to be used, nor would simple paranoia do. Minor and his case history had finally been cast off from the dubious moorings of the Victorians’ puzzled but determinedly “moral treatment” of the mad—the phrase had been coined by the Frenchman Philippe Pinel of the Salpêtrière hospital in Paris—and were at last to be welcomed into the world of modern psychiatry.
The new phrase, dementia praecox, was quite precise. By the time Davidian employed it as a diagnosis it had been current for twenty years. It literally meant early-flowering failure of the mental powers, and was used to distinguish a condition in which a person begins to lose touch with reality, as Minor had done, early on his life—in his teens, his twenties, or his thirties. In this sense the illness was markedly different from senile dementia, a term once used to describe the decrepitude that specifically accompanies old age, and of which Alzheimer’s disease is one kind.
The nomenclature was published in Heidelberg in 1899 by the German psychiatrist Emil Kraepelin, who at the time was the supreme classifier of known mental ills. His naming of the condition was designed less to distinguish it from being an old person’s ailment as to mark it as very different from manic-depressive psychosis, an illness that had enough similarities to confuse the earliest of the alienists.
Kraepelin’s view, revolutionary at the time, was that while manic-depressive psychoses had identifiable physical causes (such as a low level of the alkaline metal lithium in the blood and brain), and were thus treatable (as with the use of lithium pills, for example, to make up a depressive’s lack of it), dementia praecox was a so-called endogenous ailment, quite lacking in any identifiable external cause. In that respect it was to be regarded as similar to such enigmatic systemic physical disorders as essential hypertension, in which a patient develops high blood pressure—and its many untidy and inconvenient side effects—for no obvious reason.
Kraepelin went on to define three distinct subtypes of dementia praecox. There was catatonic, in which the motor functions of the body are either excessive or nonexistent; hebephrenic, in which grotesquely inappropriate behavior begins during puberty, hence the word’s origin from the Greek “youth”; and paranoiac, in which the victim suffers from delusions, often of persecution. It was from this kind of dementia, according to Kraepelin’s classification of the time, that Doctor Minor was suffering.
The traditional treatment offered to him and his kind was still simple, basic, and by today’s standards, dismayingly unenlightened. Those suffering from paranoid dementia were deemed pathologically incurable, were removed from society by court order, and were placed—kindly, tenderly, for the most part, thanks to Pinel’s powerful influence—in cells behind high walls, so as to cause no inconvenience to those living in the normal, outside world. Some were incarcerated for only a very few years; some for ten or twenty. In the case of Minor his involuntary exile from society was to last for most of his life. He existed for most of his first thirty-eight years on the outside, until he killed George Merrett. Then, for forty-seven of the forty-eight years that were left to him, he was locked away in state asylums, essentially untreated because he was, in the view of the doctors of the day, essentially untreatable.
Since the time of Minor and Davidian, the illness has become much more liberally regarded. Its name, for a start, has changed: What was initially the far less daunting word schizophrenia—it came from the Greek for “split mind”—made its first appearance in 1912. (It may change again: To rid the ailment of its patina of unpleasant associations, there are now moves—perhaps not entirely prudent—to have it called Kraepelin’s syndrome.)
Early treatments for the disease, which were just being introduced at the time of Minor’s final decline, involved the use of massive sedatives like chloral hydrate, sodium amytal, and paraldehyde. Today entire shelves of costly antipsychotic drugs are available at least to treat and manage schizophrenia’s more discomfiting symptoms. But so far, and despite the spending of fortunes, there have been precious few advances in staying the mysterious triggers that seemingly set off the illness and its demonic mischiefs.
And there continues to be much debate about what these triggers might be. Can it ever be said that a major psychological illness like schizophrenia, with its severe disruption of the brain’s chemistry, appearance, and function, truly has a cause? In the case of William Minor, could the terrible scenes at the Battle of the Wilderness actually have triggered his florid behavior?
Might his branding of an Irishman have precipitated, led directly, or contributed even indirectly, to the crime he committed eight years later, which led to the exile he was to suffer for the remainder of his life? Was there ever an identifiable happening, had he ever been exposed to the mental equivalent of an invading germ? Or is schizophrenia truly causeless, a part of the very being of some unfortunate individuals? Moreover, what is the illness—is it simply the development of a personality that is several steps beyond mere eccentricity, and that steps into areas society does not find itself able to tolerate or approve?
No one is quite certain. In 1984 a paper was presented describing a man who firmly believed himself to have two heads. He found one of them irritating beyond endurance, and shot at it with a revolver, injuring himself terribly in the process. He was diagnosed as schizophrenic, and the psychiatric community agreed, since it was manifestly certain that the man only had one head, and suffered from and was dominated by an absurd delusion. But then again, the notorious “Mad Lucas” of Victorian Hertfordshire, who lived with his wife’s dead body for three months and then by himself, in wild biblical solitude and squalor for the next quarter century, and was visited by coachloads of day-trippers up from London—he was diagnosed as schizophrenic too. Should he have been? Was he not merely a borderline eccentric, behaving in a fashion beyond the accepted norms? Was he as mad as the deluded owner of the phantom head? Was he as dangerous, and as deserving of confinement? And how does a case like William Minor’s sit within the spectrum of this madness? Was he less mad than the first man, and more so than the second? How does one quantify? How does one treat? How does one judge?
Psychiatrists today remain cautious about all of these questions, and puzzled and argumentative about whether the illness can be triggered—does have a definable cause. Most academic psychiatrists hedge their bets, avoiding dogma, preferring simply to say that they believe in the cumulative effect of a number of factors.
A patient may have a simple genetic predisposition to the illness. Or characteristics of the person’s basic temperament may similarly increase the likelihood that he or she will “react badly” or floridly to an external stress—to the sights of a battlefield, to the shock of a torture, for example. And then again, maybe certain sights and the shocks are too great, or too sudden, for anyone to endure them and remain wholly sane.
There is the recently recognized condition known as posttraumatic stress disorder, which seems to affect inordinately large numbers of people who have been exposed to truly appalling situations. The only difference between their cases today, after the Gulf War, where it was first identified en masse, or after the trauma of a kidnap or a traffic accident, is that most sufferers are relieved of their symptoms after a period of time. But William Chester Minor never was. His agony endured for his entire life. However convenient it may be to say that posttraumatic stress ruined his life—and that of his victim—the continuing symptoms suggest otherwise. There was something wildly wrong with his brain, and what happened in Virginia probably prompted its more ruinous manifestations to emerge.
Perhaps it was an unusual genetic makeup that predisposed him to fall ill—two of his relations had killed themselves, after all, though we are not certain of the circumstances. Maybe his gentle temperament—he was a painter, a flutist, a collector of old books—made him unusually vulnerable to what he saw and felt on those blood-soaked fields in the South. Maybe his subsequent imprisonment in Broadmoor then left him unimproved, when a more compassionate and enlightened regime might have mitigated his darker feelings, might have helped him recover. One in a hundred people today suffer from schizophrenia: Nearly all of them, if treated with compassion and good chemistry, can have some kind of dignified life, of a kind that was denied, for much of his time, to Doctor Minor.
Except, of course, that Minor had his dictionary work. And there is a cruel irony in this—that if he had been so treated, he might never have felt impelled to work on it as he did. By offering him mood-altering sedatives, as they would have done in Edwardian times, or treating him as today with such antipsy-chotic drugs as quetiapine or risperidone, many of his symptoms of madness might have gone away—but he might well have felt disinclined or unable to perform his work for Doctor Murray.
In a sense doing all those dictionary slips was his medication; in a way they became his therapy. The routine of his quiet and cellbound intellectual stimulus, month upon month, year upon year, appears to have provided him with at least a measure of release from his paranoia. His sad situation only worsened when that stimulus was gone: when the great book ceased to function as his lodestone, when the one fixed point on which his remarkable but tortured brain was able to concentrate became detached, so then he began to spiral downward, and his life began to ebb.
One must feel a sense of strange gratitude, then, that his treatment was never good enough to divert him from his work. The agonies that he must have suffered in those terrible asylum nights have granted us all a benefit, for all time. He was mad, and for that, we have reason to be glad. A truly savage irony, on which it is discomfiting to dwell.
In November 1915, four months after Sir James had died, Doctor Minor wrote to Lady Murray in Oxford, offering her all the books that had been sent from Broadmoor to the Scriptorium, and that had been in Sir James’s possession when he died. He hoped they might eventually go off to the Bodleian Library. “I am glad…to know that you are well, as I must presume from your letter and occupations. You must be taking or giving a great deal of labour for Dict’y materials still…” He uses the English spellings of words: Clearly his years in Broadmoor had left their mark in more ways than the merely custodial.
And his books do indeed rest in the great library to this day: They are registered as having been donated “By Dr. Minor through Lady Murray.”
But by now he was failing steadily. An old colleague from Civil War days wrote from West Chester, Pa., to ask how his friend was—and the hospital superintendent replies that, considering his years, Captain Minor is in good health, and is in a “bright and cheerful ward, where he seems contented with his surroundings.”
But the ward notes tell a different story, presenting as they do a litany of all the symptoms of the steady onset of senility and dementia. With increasing frequency the attendants write of Minor stumbling, injuring himself, getting lost, losing his temper, wandering, growing dizzy, tiring easily—and worst of all, beginning to forget, and knowing that he was forgetting. His mind, though tortured, had always been peculiarly acute: Now, by 1918 and the end of World War I, he seemed to know that his faculties were dimming, that his mind was at last becoming as weakened as his body, and that the sands were running out. For days at a time he would stay in bed, saying he needed “a good rest”: He would barricade the door with chairs, still certain he was being persecuted. It was more than forty-five years since the murder, fully half a century since the first signs of madness had been noticed, back at the Florida army fort. And yet still the symptoms remained the same—persistent, uncured, incurable.
Still came the occasional querulous note, such as this, written in the summer of 1917:
Dr. White—Dear Sir, There was a time when the meat—beef and ham—was very tough and dry. This has in a degree altered for the better since your note even, and I would not complain of that; and rice seemed to be the only vegetable with it.
This is not much to complain of; and yet these trifles are much to us in this life.
Thanking you for what you would wish to do.
I am very truly yours
W. C. Minor
A year later—though his failing memory and eyesight cause him to date the letter 1819 rather than 1918—he shows another strange spurt of benevolence, similar to his contributing to James Murray’s adventure to the Cape. In this latest case he sent twenty-five dollars to the Belgian Relief Fund, and a further twenty-five to Yale University, his alma mater, as a donation to its military service fund. The president of Yale wrote back from Woodbridge Hall: “I have known much of Dr. Minor’s history,” he replied to the superintendent, “and am therefore doubly touched to receive this gift.”
In 1919 his nephew Edward Minor applied to the army to have him released from St. Elizabeth’s and brought to a hospital for the elderly insane in Hartford, Conn., known as The Retreat. The army agreed—“I think if the Retreat fully understands the case we should let him go,” said a Doctor Duval at an October conference to discuss the matter. “He is getting so old now he will probably not do much harm.” The hospital board agreed too, and in November, in a snowstorm, the frail old gentleman left Washington, and the strange world of insane asylums—a world that he had inhabited since 1872—for good and for ever.
He liked his new home, a mansion set in acres of woods and gardens on the banks of the Connecticut River. His nephew wrote in the early winter of 1920 of how the change seemed to have done him some good; and yet at the same time how incapable he was of looking after himself. Furthermore, he was fast going blind and for some months had been unable to read. With this one overarching source of joy now denied to him, there must have seemed to him little left to live for. No one was surprised when, after a walk on a blustery early spring day in that same year, he caught a cold that turned into bronchopneumonia, and died peacefully in his sleep. It was Friday, March 26, 1920. He had lived for eighty-five years and nine months. He might have been mad, but like Doctor Johnson’s dictionary elephant, he had been “extremely long lifed.”
There were no obituaries: just two lines in the Deaths columns of the New Haven Register. He was taken down to his old hometown and buried in the Evergreen Cemetery on the afternoon of the following Monday, in the family plot that had been established by his missionary father, Eastman Strong Minor. The gravestone is small and undistinguished, made of reddish sandstone, and bears only his name, William Chester Minor. An angel stands on a plinth nearby, gazing skyward, with the engraved motto, My Faith Looks Up to Thee.
Around the Evergreen Cemetery a high chain-link fence keeps out an angry part of New Haven, well away from the stern elegance of Yale. The simple existence of the fence underlines a sad and ironic reality: Dr. William Minor, who was among the greatest of contributors to the finest dictionary in all the English language, died forgotten in obscurity, and is buried beside a slum.
The Oxford English Dictionary itself took another eight years to finish, the announcement of its completion made on New Year’s Eve, 1927. The New York Times put the fact on the front page the next morning, a Sunday—that with the inclusion of the Old Kentish word zyxt—the second indicative present tense, in local argot, of the verb to see—the work was done, the alphabet was exhausted, and the full text was now wholly in the printers’ hands. The making of the great book, declared the newspaper roundly and generously, was “one of the great romances of English literature.”
The Americans did indeed love the story of its making. H. L. Mencken—no mean lexicographer himself—wrote that he fully expected Oxford to celebrate the culmination of the seventy-year project with “military exercises, boxing matches between the dons, orations in Latin, Greek, English and the Oxford dialect, yelling matches between the different Colleges and a series of medieval drinking bouts.” Considering that the final editor of the book was dividing his time between professorships at both Oxford and Chicago, there was more than good reason for Americans to take a keen interest in a creation that was now, at least partly, of their own making.
The lonely drudgery of lexicography, the terrible undertow of words against which men like Murray and Minor had so ably struggled and stood, now had at last its great reward. Twelve mighty volumes; 414,825 words defined; 1,827,306 illustrative quotations used, to which William Minor alone had contributed scores of thousands.
The total length of type—all hand-set, for the books were done by letterpress, still discernible in the delicately impressed feel of the inked-on paper—is 178 miles, the distance between London and the outskirts of Manchester. Discounting every punctuation mark and every space—which any printer knows occupy just as much time to set as does a single letter—there are no fewer than 227,779,589 letters and numbers.
Other dictionaries in other languages took longer to make; but none was greater, grander, or had more authority than this. The greatest effort since the invention of printing. The longest sensational serial ever written.
One word—and only one word—was ever actually lost: bondmaid, which appears in Johnson’s dictionary, was actually mislaid by Murray and was found, a stray without a home, long after the fascicle Battentlie-Bozzom had been published. It, and tens of thousands of words that had evolved or appeared during the forty-four years spent assembling the fascicles and their parent volumes, appeared in a supplement, which came out in 1933. Four further supplements appeared between 1972 and 1986. In 1989, using the new abilities of the computer, Oxford University Press issued its fully integrated second edition, incorporating all the changes and additions of the supplements in twenty rather more slender volumes. To help boost sales in the late seventies a two-volume set in a much-reduced typeface was issued, a powerful magnifying glass included in every slipcase. Then came a CD-ROM, and not long afterward the great work was further adapted for use on-line. A third edition, with a vast budget, was in the works.
There is some occasional carping that the work reflects an elitist, male, British, Victorian tone. Yet even in the admission that, like so many achievements of the era, it did reflect a set of attitudes not wholly harmonic with those prevalent at the end of the twentieth century, none seem to suggest that any other dictionary has ever come close, or will ever come close, to the achievement that it offers. It was the heroic creation of a legion of interested and enthusiastic men and women of wide general knowledge and interest; and it lives on today, just as lives the language of which it rightly claims to be a portrait.