History of Medicine: December 2017

CHRISTMAS, DICKENS, AND MEDICINE

“God bless us, every one”, the final words spoken by Tiny Tim in Charles Dickens’ A Christmas Carol, still echo after over 150 years. It’s a tale of the power of Christmas to soften up a “squeezing, wrenching, grasping, scraping, clutching, covetous old sinner” like Ebeneezer Scrooge.

Tiny Tim, Bob Cratchit’s little son, has aroused medical curiosity. He is depicted as small for his age and carried on his father’s shoulder. He “bore a little crutch and had his limbs supported by an iron frame”, and had a “withered little hand”. He often sits by himself and “thinks the strangest things you ever heard”, though not irrational thoughts.

Tiny Tim on Bob Cratchit's shoulder (Wikipedia)

What was wrong with Tiny Tim? The story does not say but there was fluctuation in his weakness and eventually the boy recovered. Donald W. Lewis, a pediatric neurologist, after ruling out tuberculosis of the spine and rickets by events in the story, made a case for renal tubular acidosis, favoring type I RTA. This disorder, by producing increased body acidification leads to growth retardation, osteomalacia, bone pain and pathologic fractures. A review of British pediatric texts of Dickens' time revealed that general treatments for almost any illness included fresh air and sunshine, a balanced diet, fish liver oils, and tonics for digestion. In Tim’s case treatment for rickets or TB might have been added, and rickets was managed the same way as scrofula. Such patients were believed to have an excess of acid and received alkaline carbonates such as bicarbonate of soda or other carbonates. This combination, especially the alkalinizing effect of bicarbonates, Dr. Lewis believed, could have led to Tiny Tim’s recovery.

Medical problems pop up in much of Dickens’ fiction. (Someone even wrote a book about it.) Just to mention a few, we read about the fat, lethargic boy Joe in the Pickwick Papers, believed to have a “Pickwickian syndrome”. Other stories mention ataxic gait, gout, erysipelas, typhoid, dwarfism, opium use, and additional problems.

Charles Dickens, Photo of George Herbert Watkins
(Wikipedia)

Children populated many of his novels and he took great interest in their welfare. He castigated child labor conditions at a time when children as young as seven worked in mines and other dangerous jobs. In 1850 in London about one half of all deaths were in children and yet there was no children’s hospital. Through the efforts of Dr. Charles West, assisted by Dr. Henry Bence-Jones (of the myeloma protein) and others, the Hospital for Sick Children went up in 1852 on Great Ormond Street, London, in a mansion that previously housed Queen Anne’s physician, Dr. Richard Mead, and his 100,000-volume library. Dickens raised funds for it by public speaking and a reading of A Christmas Carol.

The London of Dickens was pretty filthy. Thick smog all but obliterated sunlight much of the time. The gargantuan clouds of smoke pouring out from soft coal fires joined with Thames Valley mist to darken the streets, irritate the eyes, and create havoc for asthmatics. In poorer areas sanitation was almost absent and the Thames itself was a depository of tons of sewage. It took the “great stink” of 1858 to force members of Parliament, based on the Thames and literally holding handkerchiefs over their noses, to pass a bill authorizing a citywide sewage project. Housing was cramped, food often scarce, and water impure. People, including children, often walked miles to work.

Dickens took an interest in public health. He was an anti-contagionist, attributing diseases of poverty to miasmas arising

Joseph Southwood-Smith (Wellcome Library)

from unsanitary conditions. He befriended sanitarians such as Dr. Joseph Southwood-Smith, the famous public health advocate, fever expert, and co-believer in miasmas, and Edwin Chadwick, the

lawyer who authored the Report on the Sanitary Condition of the Labouring Population in Great Britain. The Report was a bombshell exposé that helped usher in better sanitation. Dickens supported their work with his own writings.

Dickens was also close to Thomas Wakley. Wakley was a

Thomas Wakley (Wikipedia)

combative surgeon, reformer, coroner, Member of Parliament, and editor of Lancet at various times in his career. He used the Lancet as a platform for reforming medicine and public health.

Dickens’ connections to medicine could go on, but that’s enough for now. Good health to all,

HAPPY HOLIDAYS

and A JOYOUS NEW YEAR.

SOURCES:

Hearn, Michael P., ed. The Annotated
Christmas Carol, by Charles Dickens. 2004.

Tomalin, Claire. Charles Dickens: A Life. 2011.

Flanders, Judith. The Victorian City: Everyday Life in Dickens’

London. 2012.

Corton, Christine. London Fog: The Biography. 2015.

Cambridge, Nicholas. “From Mr. Pickwick to Tiny Tim: Charles

Dickens and Medicine”. Lecture at Gresham College. available

at: https://www.gresham.ac.uk/lectures-and-events/from-mr-