Dickensian Diagnoses

Charles Dickens afflicted his characters with a bizarre variety of diseases. What is surprising, says London Neurologist Sir Russell Brain in last week's British Medi cal Journal, is that Dickens did so with impressive clinical accuracy.* When doctors were just beginning to evaluate physical symptoms and other authors were using vague terms like "brain fever," Dickens "looked on disease with the ob serving eye of the expert clinician ... so that he often gives us accounts that would do credit to the trained physician." Samples:

P:In Dombey and Son the Hon. Mrs. Skewton, mother of the second Mrs. Dombey, suffers from what is now known to be cerebral arteriosclerosis. Dickens accurately follows the relentless progress of the disease. First she suffered from tremor, and "the palsy played among the artificial roses [on her hat] like an almshouse full of superannuated zephyrs." After a stroke "she lay speechless and staring at the ceiling for days; sometimes making inarticulate sounds . . . giving no reply either by sign or by gesture, or in her unwinking eyes." Dickens describes her recovery, the change in her temperament--and the second stroke that left her "crooked and shrunk up" and led to her death. Says Dr. Brain admiringly: "Dickens shows that he knows that loss of speech is associated with paralysis of the right side of the body and that in such cases there may also be agraphia [inability to write]."

P:Two of Dickens' best-documented accounts of disease occur in Bleak House, in which he describes the paraplegia of Grandfather Smallweed, who is "in a helpless condition as to his lower, and nearly so as to his upper limbs," and the senile dementia of his wife, who suffers from "such infantine graces as a total want of observation, memory, understanding and interest, and an eternal disposition to fall asleep over the fire and into it . . ."

P: Dickens shows his psychiatric insight in many instances, but the story of Dr. Manette in A Tale of Two Cities is remarkable, says Dr. Brain, "for the accuracy of his account of a case of multiple personality and loss of memory . . . and because it includes an anticipation of psychotherapy." As a prisoner in the Bastille during the French Revolution, Dr. Manette had been a shoemaker. After release he lost his memory, but regained it when he came to London. He continued to have memory lapses periodically, leaving his practice with each lapse to return to shoemaking. Finally, a friend helped Dr. Manette analyze his behavior. The doctor came to realize that the shoe maker's bench was a symbol of his unhappy past and of what now would be called his neurosis, and he consented to destroy it. But before long he was demanding it again, and this time the relapse was permanent. He became a "helpless, inarticulately murmuring, wandering old man."

Other clinical descriptions in Dickens' novels are varied and comprehensive enough to make a case book: the post-concussional state of Eugene Wrayburn in Our Mutual Friend, the fatal cerebral vascular disease of Mr. Dorrit in Little Dorrit, the chronic hypomania of the stranger who made advances to Mrs. Nickleby over the garden wall in Nicholas Nickleby. In at least one instance Dickens got the jump on the medical profession: the first recorded instance of the association of narcolepsy (uncontrollable desire to sleep) with obesity occurs in the fat boy of Pickwick Papers.

*Some of Dickens' clinical observations may have been based on his own illnesses. He is reported to have suffered from kidney troubles, facial rheumatism, depression, insomnia, pains in the stomach and chest, flatulence, biliousness, nausea, painful foot symptoms and lameness. He died of a stroke at 58.

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