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Elephant Man
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Elephant Man

            

Elephant Man
Description: Joseph Carey Merrick, the 'Elephant man' in 1889. Wellcome Institute Library, London


The life of Leicester-born Joseph Carey Merrick (1862-90), ‘the Elephant Man’, has become surrounded by myth, entering popular culture as a symbol of gross deformity and noble spirit. Attention has focused not on his body, but on the man beneath the skin, with his story becoming one of physical and personal metamorphosis. Merrick's life, portrayed in print, on stage, and on film, has been made into a moral tale.

At birth Merrick showed no obvious signs of his later deformities, which began to emerge only after eighteen months. Disfiguring industrial diseases at that time produced a wide range of deformities, and this perhaps made Merrick's adolescent condition more acceptable. Certainly he was not so deformed as to prevent him from attending school until he was twelve. After that he worked for two years rolling cigars. However, the gradual deterioration of his right arm forced him to seek employment peddling goods from his father's haberdashery shop. Here his progressive abnormality worked against him, and Merrick entered Leicester workhouse ‘demonstrating his deformities’ to escape unemployment and his harsh stepmother. It was Merrick who decided to exhibit himself as a ‘freak’, turning his disorder to his advantage. The decision brought him to London and to the attention of the surgeon (later Sir) Frederick Treves, at the London Hospital; of the medical community; and of fashionable society.

Treves discovered Merrick in 1884 at a private view opposite the London Hospital. Appalled by the ‘most disgusting specimen of humanity’, Treves arranged to examine Merrick and presented his case to the London Pathological Society. Continuity was maintained: where Merrick had been exhibited to the public, now he was presented to the medical community by an ambitious Treves. The British Medical Journal felt Merrick was ‘a man who presented an extraordinary appearance, owing to a series of deformities’. His body was difficult to define (see figure). In his Reminiscences, Treves described Merrick as below average height with a limp caused by a childhood hip disease. He recorded an ‘enormous and misshapen head’ where a huge bony mass ‘like a loaf projected from the brow’ and ‘fungus-looking skin’ comparable to ‘brown cauliflower’. From the chest and buttocks ‘hung a bag of the same repulsive flesh’. Merrick's mouth was so deformed, with a jaw protruding ‘like a pink stump’, that he was unable to speak clearly. A trunklike growth had been removed while he was in the workhouse. The right arm was large, with the hand shaped liked a paddle and a thumb like a ‘radish’. Only his left arm and genitals were unaffected. In his early descriptions of Merrick, Treves was inclined to refer to him as ‘repellant’, ‘loathsome’, and ‘horrible’. From his appearance, Treves assumed Merrick was an imbecile, but he later discovered that he was intelligent and sensitive. Treves did not at that time rescue Merrick, who, with his self-exhibition hounded by the police, was bought by an Austrian who took him to Brussels. But he was too repugnant for continental tastes. Robbed of his savings, Merrick was abandoned to return to London, where he was admitted to the London Hospital in 1886 through Treves' intervention. A charitable appeal was made to pay for Merrick's care, and a room, known by some as the ‘Elephant House’, was provided in a quiet part of the hospital.

At the London, Merrick became a celebrity, an object of curiosity, visited by fashionable society women and royalty. Treves encouraged these visits to help normalize Merrick and arranged a trip to the theatre and a country holiday. In one sense, Merrick's time at the London can be seen as reflecting Victorian concerns to domesticize the savage. With cure out of the question, efforts were made to make Merrick comfortable. Daily baths removed the foul smell that had previously surrounded him.

In 1890 Merrick was found dead ‘lying across the bed’, with no signs of a struggle. His head had grown so large that he had to sleep in a ‘crouching position’ and at the time it was suggested that during an afternoon nap his head had fallen forwards onto his windpipe, suffocating him. Others, including Treves, argued that Merrick's head fell backwards, dislocating his neck when he attempted to sleep lying down: Merrick's urge to conform makes this probable.

Merrick was first described as a case of ‘congenital deformity’. In 1884 some speculations were made that he suffered from ‘dermatolysis’, a pendulous condition of the skin, combined with ‘pachydermatocele’, or tumours arising from an overgrowth of the skin, but no definite diagnosis was reached. It was not until 1909 that Parkes Weber retrospectively ‘diagnosed’ neurofibromatosis, a genetic disorder where a failure of cellular control results in tumours of fibrous and nervous tissue. The disorder had been identified by von Recklinghausen in 1882, but in 1884 this was overlooked. Usually, however, neurofibromatosis produces relatively few visible signs. The diagnosis made Merrick extraordinary in degree but not in kind. Weber's view became widely accepted until 1986, when Tibbles and Cohen offered a different diagnosis. They suggested that Merrick exhibited signs of the ‘Proteus syndrome’, a term derived from Greek mythology and first used in 1983 to identify a disorder with varying and shifting manifestations. Tibbles and Cohen supported their diagnosis by explaining that there was no family history of neurofibromatosis, and argued that when Merrick was examined in 1885 there were no ‘café au lait spots’ — the patches of unusual skin pigmentation that are the clearest indication of neurofibromatosis, present in 99% of cases. For them it was evident that Merrick's condition was more grotesque than that associated with neurofibromatosis, while he had many features of Proteus syndrome; these include thickened skin and subcutaneous tissue; hypertrophy of long bones; and overgrowth of the skull. To press their diagnosis, a second case was described who was Merrick's double. The rediagnosis led to a remythologizing of Merrick, although those suffering from neurofibromatosis continued to be confronted with the stigma of the Elephant Man's disease.

Merrick was the Victorian ideal of a deserving cause: a man bowed down by a condition no fault of his own, willing to work and repay those kind to him with handmade gifts. He also challenged basic nineteenth-century assumptions about humanity and the divisions between man and animal. In the twentieth century his deformity came to symbolize something different, showing that it is mind that matters more than appearance.
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Date: 06.11.2009 17:24
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