Thursday, 12 May 2011

Joseph Carey Merrick (5 August 1862 – 11 April 1890), sometimes incorrectly referred to as John Merrick, was an English man with severe deformities who was exhibited as a human curiosity named the Elephant Man. He became well known in London society after he went to live at the London Hospital. Merrick was born in Leicester and began to develop abnormally during the first few years of his life. His skin appeared thick and lumpy, he developed an enlargement of his lips, and a bony lump grew on his forehead. One of his arms and both feet became enlarged and at some point during his childhood he fell and damaged his hip, resulting in permanent lameness. When he was 11, his mother died and his father soon remarried. Merrick left school at 12, and had difficulty finding employment. Rejected by his father and stepmother, he left home. In late 1879, aged 17, Merrick entered the Leicester Union workhouse.
In 1884, after four years in the workhouse, Merrick contacted a showman named Sam Torr and proposed that Torr should exhibit him. Torr agreed, and arranged for a group of men to manage Merrick, whom they named the Elephant Man. After touring the East Midlands, Merrick travelled to London to be exhibited in a penny gaff shop on Whitechapel Road which was rented by showman Tom Norman. Norman's shop, directly across the street from the London Hospital, was visited by a surgeon named Frederick Treves, who invited Merrick to be examined and photographed. Soon after Merrick's visits to the hospital, Tom Norman's shop was closed by the police and Merrick's managers sent him to tour in Europe.
In Belgium, Merrick was robbed by his road manager and abandoned in Brussels. He eventually made his way back to London; unable to communicate, he was found by the police to have Frederick Treves' card on him. Treves came and took Merrick back to the London Hospital. Although his condition was incurable, Merrick was allowed to stay at the hospital for the remainder of his life. Treves visited him daily and the pair developed quite a close friendship. Merrick also received visits from the wealthy ladies and gentlemen of London society, including Alexandra, The Princess of Wales.
Merrick died on 11 April 1890, aged 27. The official cause of death was asphyxia, although Treves, who dissected the body, said that Merrick had died of a dislocated neck. He believed that Merrick—who had to sleep sitting up because of the weight of his head—had been attempting to sleep lying down, to "be like other people". The exact cause of Merrick's deformities is unclear. The dominant theory throughout much of the 20th century was that Merrick suffered from neurofibromatosis type I. In 1986, a new theory emerged that he had Proteus syndrome. In 2001 it was proposed that Merrick had suffered from a combination of neurofibromatosis type I and Proteus syndrome. DNA tests conducted on his hair and bones have proven inconclusive. In 1979, Bernard Pomerance's play about Merrick called The Elephant Man débuted and David Lynch's film, also called The Elephant Man, was released the following year.

Early life and family

Joseph Carey Merrick was born 5 August 1862 at 50 Lee Street in Leicester to Joseph Rockley Merrick and his wife Mary Jane (née Potterton). Joseph Rockley Merrick (c. 1835 – 1897) was the son of London-born weaver Barnabas Merrick who moved to Leicester during the 1820s or 1830s, and his third wife Sarah Rockley. Mary Jane Potterton (c. 1834 – 1873) was the daughter of a Yorkshire agricultural labourer and had some form of physical disability. As a young woman she worked as a domestic servant in Leicester before marrying Joseph Rockley Merrick, then a brougham driver, in 1861. The following year, Joseph Carey Merrick was born, apparently healthy, and had no outward symptoms of any disorder for the first few years of his life. Named after his father, he was given the middle name Carey by his mother, a Baptist, after the preacher William Carey. The Merricks had two more children, William Arthur (born 1866) who died of scarlet fever aged four and Marion Eliza (born 1867), who was born with physical disabilities and died in 1891.
A pamphlet entitled "The Autobiography of Joseph Carey Merrick", produced c. 1884 to accompany his exhibition, states that he started to display symptoms at approximately five years of age, with "thick lumpy skin ... like that of an elephant, and almost the same colour". According to a 1930 article in the Illustrated Leicester Chronicle, he began to develop swellings on his lips at the age of 21 months, followed by a bony lump on his forehead and a loosening and roughening of the skin. As he grew, a noticeable difference between the size of his left and right arms appeared and both his feet became significantly enlarged. Merrick's symptoms were explained by the family as having resulted from Mary's being knocked over and frightened by a fairground elephant while she was pregnant with her eldest son. The concept of maternal impression—that the emotional experiences of pregnant women could have lasting physical effect on their unborn children—was still common in 19th-century England. Merrick held this belief as the cause of his affliction for his entire life.
In addition to his deformities, at some point during his childhood, Merrick suffered a fall and damaged his left hip. This injury became infected and left him permanently lame. Although affected by his physical deformities, Merrick attended school and enjoyed a close relationship with his mother. She was a Sunday School teacher, and his father worked as an engine driver at a cotton factory, as well as running a haberdashery business. On 19 May 1873, less than three years after the death of her younger son, Mary Jane Merrick died from bronchopneumonia. Joseph Rockley Merrick moved with his two children to live with Mrs. Emma Wood Antill, a widow with children of her own. They married on 3 December 1874.

Life as a curiosity

Merrick concluded that his only escape from the workhouse might be through the world of human novelty exhibitions. He knew of a Leicester music hall comedian and proprietor named Sam Torr. Merrick wrote to Torr, who came and visited him at the workhouse. Torr decided that he could make money exhibiting Merrick, although to retain Merrick's novelty, he would have to be a travelling exhibit.[22] To this end, he organised a group of managers for Merrick: music hall proprietor J. Ellis, travelling showman George Hitchcock, and fair owner Sam Roper. On 3 August 1884 Merrick departed the workhouse to start his new career.

The shop on Whitechapel Road where Merrick was exhibited. Today it sells saris.
The showmen named Merrick the Elephant Man, and advertised him as "Half-a-Man and Half-an-Elephant".
They showed him around the East Midlands, including in Leicester and Nottingham, before moving him on to London for the winter season. George Hitchcock contacted an acquaintance, showman Tom Norman, who ran penny gaff shops in London's East End exhibiting human curiosities. Without a meeting, Norman agreed to take over Merrick's management and in November, Hitchcock travelled with Merrick to London.
When Tom Norman first saw Merrick, he was dismayed by the extent of his deformities, fearing his appearance might be too horrific to be a successful novelty. Nevertheless, he exhibited Merrick in the back of an empty shop on Whitechapel Road. Merrick had an iron bed with a curtain drawn around to afford him some privacy. Norman observed Merrick asleep one morning and learned that he always slept sitting up, with his legs drawn up and his head resting on his knees. His enlarged head was too heavy to allow him to sleep lying down and, as Merrick put it, he would risk "waking with a broken neck". Norman decorated the shop with posters that had been created by Hitchcock, depicting a monstrous half-man, half-elephant. A pamphlet titled "The Autobiography of Joseph Carey Merrick" was created, outlining Merrick's life to date. This biography, whether written by Merrick or not, provided a generally accurate account of his life. It contained an incorrect date of birth but, throughout his life, Merrick was vague about when he was born.
Ladies and gentlemen ... I would like to introduce Mr Joseph Merrick, the Elephant Man. Before doing so I ask you please to prepare yourselves—Brace yourselves up to witness one who is probably the most remarkable human being ever to draw the breath of life.
—Tom Norman
Norman gathered an audience by standing outside the shop and drawing a crowd through his showman patter. He would then lead his onlookers into the shop, explaining that the Elephant Man was "not here to frighten you but to enlighten you." Drawing aside the curtain, he allowed the onlookers—often visibly horrified—to observe Merrick up close, while describing the circumstances leading to his present condition, including his mother's accident with an elephant.
The Elephant Man exhibit was moderately successful, and made money primarily from the sales of the autobiographical pamphlet. Merrick was able to put his share of the profits aside, hoping to earn enough to one day buy a home of his own. The shop on Whitechapel Road was directly across the road from the London Hospital, an excellent location, as medical students and doctors visited the shop, curious to see Merrick. One visitor was a young house surgeon named Reginald Tuckett. Like his colleagues, Tuckett was intrigued by the Elephant Man's deformities and told his senior colleague Frederick Treves.

Merrick's cap and hood
Frederick Treves first met Merrick that November at a private viewing, before Norman opened the shop for the day. Treves later recalled in his 1923 Reminiscences that Merrick was "the most disgusting specimen of humanity that I had ever seen ... at no time had I met with such a degraded or perverted version of a human being as this lone figure displayed." The viewing lasted no more than 15 minutes after which Treves returned to work. Later that day, he sent Tuckett back to the shop to ask if Merrick might be willing to come to the hospital for an examination. Norman and Merrick agreed. To enable him to travel the short distance without drawing undue attention, Merrick wore a costume consisting of a huge black cloak and a brown cap with a hood that covered his face, and rode in a cab hired by Treves.
At the hospital, Treves examined Merrick, observing that he was "shy, confused, not a little frightened, and evidently much cowed." At this point, Treves assumed that the Elephant Man was an "imbecile". He measured Merrick's head circumference at 36 inches (91 cm), his right wrist at 12 inches (30 cm) and one of his fingers at 5 inches (13 cm) in circumference. He noted that his skin was covered in papillomata (warty growths), the largest of which exuded an unpleasant smell. The subcutaneous tissue appeared to be weakened and caused a loosening of the skin, which in some areas hung away from the body. There were bone deformities in the right arm, both legs, and, most conspicuously, in the skull. Despite the corrective surgery to his mouth in 1882, Merrick's speech remained barely intelligible. His left arm and hand, although small, were not deformed. His penis and scrotum were normal. Apart from his deformities and the lameness in his hip, Treves concluded that Merrick appeared to be in good general health. Norman later recalled that Merrick went to the hospital for examination "two or three" times and during one of their meetings, Treves gave Merrick his calling card. On one of the visits, Treves had photographs taken and he provided Merrick with a set of copies which were later added to his autobiographical pamphlet. On 2 December, Treves presented Merrick at a meeting of the Pathological Society of London in Bloomsbury. Eventually, Merrick told Norman that he no longer wanted to be examined at the hospital. According to Norman, he said he was "stripped naked, and felt like an animal in a cattle market."
During this time in Victorian England, tastes were changing in regard to freak show exhibitions like the Elephant Man. Shows like Norman's were a cause for public concern, both on the grounds of decency and due to the disruption caused by crowds gathering outside them. Not long after Merrick's last examination with Frederick Treves, the police closed down Norman's shop on Whitechapel Road, and Merrick's Leicester managers withdrew him from Norman's care. In 1885, Merrick went on the road with Sam Roper's travelling fair. He befriended two other performers, "Roper's Midgets"—Bertram Dooley and Harry Bramley—who on occasion defended Merrick from public harassment.

London Hospital

With Merrick admitted into the hospital, Treves now had time to conduct a more thorough examination. He discovered that Merrick's physical condition had deteriorated over the previous two years and that he had become quite crippled by his deformities. Treves also suspected that Merrick now suffered from a heart condition and that he had only a few years left to live. Merrick's general health improved over the next five months under the care of the hospital staff. Although some nurses were initially upset by his appearance, they overcame this and cared for him. The problem of his unpleasant odour was mitigated through frequent bathing and Treves gradually developed an understanding of Merrick's speech. A new set of photographs was taken. The question of Merrick's long-term care had to be addressed. Francis Carr Gomm, the chairman of the hospital committee, had supported Treves in his decision to admit Merrick, but by November, long-term plans needed to be made. The London Hospital was not equipped or staffed to provide care for the incurable, which Merrick clearly was.
Carr Gomm contacted other institutions and hospitals more suited to caring for chronic cases, but none would accept Merrick. Carr Gomm wrote a letter to The Times, printed on 4 December, outlining Merrick's case and asking readers for suggestions. The public response—in letters and donations—was significant, and the situation was even covered by the British Medical Journal. With the financial backing of the many donors, Carr Gomm was able to make a convincing case to the committee for keeping Merrick in the hospital. It was decided that he would be allowed to stay there for the remainder of his life. He was moved from the attic to two rooms in the basement adjacent to a small courtyard. The rooms were adapted and furnished to suit Merrick, with a specially constructed bed and—at Treves' instruction—no mirrors.
Merrick settled into his new life at the London Hospital. Treves visited him daily and spent a couple of hours with him every Sunday. Now that Merrick had found someone who understood his speech, he was delighted to carry on long conversations with the doctor. Treves and Merrick built a friendly relationship, although Merrick never completely confided in him. He told Treves that he was an only child, and Treves had the impression that Merrick's mother, whose picture Merrick always carried with him, had abandoned him as a baby. Merrick was also reluctant to talk about his exhibition days, although he expressed gratitude towards his former managers. It did not take Treves long to realise that, contrary to his initial impressions, Merrick was not intellectually impaired.

The only surviving letter written by Merrick
Treves observed that Merrick was very sensitive and showed his emotions easily. At times Merrick was bored and lonely, and demonstrated signs of depression. He had spent his entire adult life segregated from women, first in the workhouse and then as an exhibit. The women he met were either disgusted or frightened by his appearance. His opinions about women were derived from his memories of his mother and what he read in books. Treves decided that Merrick would like to be introduced to a woman and it would help him feel normal. The doctor arranged for a friend of his named Mrs. Leila Maturin, "a young and pretty widow", to visit Merrick. She agreed and with fair warning about his appearance, she went to his rooms for an introduction. The meeting was short, as Merrick quickly became overcome with emotion. He later told Treves that Maturin had been the first woman ever to smile at him, the first to shake his hand. She kept in contact with him and a letter written by Merrick to her, thanking her for the gift of a book and a brace of grouse, is the only surviving letter written by Merrick. This first experience of meeting a woman, though brief, instilled in Merrick a new sense of self-confidence. He met other women during his life at the hospital, and appeared taken with them all. Treves believed that Merrick's hope was to go to live at an institution for the blind, where he might meet a woman who could not see his deformities.
Merrick wanted to know about the "real world", and questioned Treves on a number of topics. One day he expressed a desire to see inside what he considered a "real" house and Treves obliged, taking him to visit his Wimpole Street townhouse and meet his wife. He filled his days with reading and constructing models of buildings out of card. He entertained visits from Treves and his house surgeons. He rose each day in the afternoon and would leave his rooms to walk in the small adjacent courtyard, after dark.

Card church built by Merrick
As a result of Carr Gomm's letters to The Times, Merrick's case attracted the notice of London's high society. One person who took a keen interest was actress Madge Kendal. Although she probably never met him in person, she was responsible for raising funds and public sympathy for Merrick. She sent him photographs of herself and employed a basket weaver to go to his rooms and teach him the craft. Although Kendal never visited Merrick, other ladies and gentlemen of high society did, bringing him gifts of photographs and books. He reciprocated with letters and hand made gifts of card models and baskets. Merrick enjoyed these visits and became confident enough to converse with people who passed his windows. A young man, Charles Taylor, the son of the engineer responsible for modifying Merrick's rooms, spent time with him and played the violin. Occasionally, he grew bold enough to leave his small living quarters and would explore the hospital. When he was discovered, he was always hurried back to his quarters by the nurses, who feared that he might frighten the patients.
On 21 May 1887, two new buildings were completed at the hospital and the Prince and Princess of Wales came to open them officially. Princess Alexandra wished to meet the Elephant Man, so after a tour of the hospital, the royal party went to his rooms for an introduction. The princess shook Merrick's hand and sat with him, an experience that left him overjoyed. She gave him a signed photograph of herself, which became a prized possession, and she sent him a Christmas card each year.
On at least one occasion, Merrick was able to fulfil a long-held desire to visit the theatre. Treves, with the help of Madge Kendal, arranged for him to attend the Christmas pantomime at the Theatre Royal, Drury Lane. Treves sat with some nurses, concealed in Baroness Burdett-Coutts's private box. According to Treves, Merrick was "awed" and "enthralled". "The spectacle left him speechless, so that if he were spoken to he took no heed." For weeks following the show Merrick talked about the pantomime, reliving the story as if it had been real.

Last years

On three occasions Merrick left the hospital and London on holiday, spending a few weeks at a time in the countryside. Through elaborate arrangements that allowed Merrick to board a train unseen and have an entire carriage to himself, he travelled to Northamptonshire to stay at Fawsley Hall, the estate of Lady Louisa Knightley. He stayed at the gamekeeper's cottage and spent the days walking in the estate's woods, collecting wild flowers. He befriended a young farm labourer who later recalled Merrick as an interesting and well-educated man. Treves called this "the one supreme holiday of [Merrick's] life", although in fact there were three such trips.
Merrick's condition gradually deteriorated during his four years at the London hospital. He required a great deal of care from the nursing staff and spent much of his time in bed, or sitting in his quarters, with diminishing energy. His facial deformities continued to grow and his head became even more enlarged. He died on 11 April 1890, at the age of 27. At around three o'clock in the afternoon, Treves' house surgeon visited Merrick and found him lying dead across his bed. His body was formally identified by his uncle, Charles Merrick. An inquest was held on 15 April by Wynne Edwin Baxter, who had come to notoriety conducting inquests for the Whitechapel murders of 1888.

He often said to me that he wished he could lie down to sleep 'like other people' ... he must, with some determination, have made the experiment ... Thus it came about that his death was due to the desire that had dominated his life—the pathetic but hopeless desire to be 'like other people'.
—Frederick Treves
Merrick's death was ruled accidental and the cause of death entered on his death certificate was asphyxia, caused by the weight of his head as he lay down. Treves, who performed an autopsy on the body, said that the cause of death was a dislocated neck. Knowing that Merrick had always slept sitting upright, out of necessity, Treves came to the conclusion that he must have "made the experiment", attempting to sleep lying down, trying to sleep like other people.
Treves dissected Merrick's body and took plaster casts of his head and limbs. He took skin samples, which were later lost during the Second World War, and mounted his skeleton, which remains in the pathology collection at the Royal London Hospital. Although the skeleton has never been on public display, there is a small museum focused on his life, housing some of his personal effects.

Medical condition

The skeleton of Joseph Merrick
Ever since Joseph Merrick's days as a novelty exhibit on Whitechapel Road, his condition has been a source of curiosity for medical professionals. His appearance at the meeting of the Pathological Society of London in 1884 drew interest from the doctors present, but none of the answers nor the attention that Treves had hoped for. The case received only a brief mention in the British Medical Journal and the Lancet declined to mention it at all. Four months later, in 1885, Treves brought the case before the meeting for a second time. By then, Tom Norman's shop on Whitechapel Road had been closed, and the Elephant Man had moved on. Without Merrick, Treves made do with the photographs he had taken during his examinations. One of the doctors present at the meeting was Henry Radcliffe Crocker, a dermatologist who was an authority on skin diseases. After hearing Treves' description of Merrick, and viewing the photographs, Crocker proposed that Merrick's condition might be a combination of dermatolysis, pachydermatocele and an unnamed bone deformity, all caused by changes in the nervous system. Crocker wrote about Merrick's case in his 1888 book Diseases of the Skin: their Description, Pathology, Diagnosis and Treatment.
In 1909, dermatologist Frederick Parkes Weber wrote an article about von Recklinghausen disease (now known as neurofibromatosis type I) in the British Journal of Dermatology. He gave Merrick as an example of the disease, which German pathologist Friedrich Daniel von Recklinghausen had described in 1882. Symptoms of this genetic disorder include tumours of the nervous tissue and bones, and small warty growths on the skin. One characteristic of neurofibromatosis is the presence of light brown pigmentation on the skin called café au lait spots. These were never observed on Merrick's body. Neurofibromatosis type I was the accepted diagnosis through most of the 20th century, although other suggestions included Maffucci syndrome and polyostotic fibrous dysplasia (Albright's disease).
In a 1986 article in the British Medical Journal, Michael Cohen and J. A. R. Tibbles put forward the theory that Merrick had suffered from Proteus syndrome, a congenital disorder identified by Cohen in 1979. They cited Merrick's lack of reported café au lait spots and the absence of any histological proof that he had suffered from neurofibromatosis type I. Unlike neurofibromatosis, Proteus syndrome affects tissue other than nerves, and it is a sporadic disorder rather than a genetically transmitted disease. Cohen and Tibbles said that Merrick showed the following signs of Proteus syndrome: "macrocephaly; hyperostosis of the skull; hypertrophy of long bones; and thickened skin and subcutaneous tissues, particularly of the hands and feet, including plantar hyperplasia, lipomas, and other unspecified subcutaneous masses."
In a letter to Biologist in June 2001, British scientist Paul Spiring speculated that Merrick might have suffered from a combination of neurofibromatosis type I and Proteus syndrome. This hypothesis was reported by Robert Matthews, a correspondent for The Sunday Telegraph. The possibility that Merrick had both conditions formed the basis for a 2003 documentary film entitled The Curse of The Elephant Man that was produced for the Discovery Health Channel by Natural History New Zealand. During 2002, genealogical research for the film led to a BBC appeal to trace Merrick's maternal family line. In response to the appeal, a Leicester resident named Pat Selby was discovered to be the granddaughter of Merrick's uncle George Potterton. A research team took DNA samples from Selby in an unsuccessful attempt to diagnose Merrick's condition. During 2003, the filmmakers commissioned further diagnostic tests using DNA that was extracted from Merrick's hair and bone. However, the results of these tests proved inconclusive and therefore the precise cause of Merrick's medical condition remains unknown.

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