This post was first published in the Journal of Victorian Culture Online here.  I am grateful to the editors for permission to re-publish it on this blog.

I should begin this post with a confession: I am a hypochondriac. When faced with even the most innocuous medical anomaly, my mind goes to the worst-case scenario. Discovering Internet medical advice sites is perhaps one of the worst things that could have happened to me, because inevitably, if I follow the figurative or literal symptom flow-charts on any of these sites, I find that all symptoms eventually flow back to something terminal and horrific.

Like many hypochondriacs, however, I am relatively self-absorbed when it comes to illnesses. For instance, illnesses in novels from the nineteenth century have never really made much of an impact on me. I attribute this, in part, to the historical separation—while TB can and does affect people today around the globe[1], it is no longer as prevalent or as hopeless in the West as in the era of the Victorian novel (consider Wuthering Heights alone). Illnesses in nineteenth-century novels are also frequently deployed as plot devices and as a result feel distanced further from my repository of Things to Worry About. In an article aimed at diagnosing the mysterious illnesses afflicting nineteenth-century literary heroines, for instance, author Vivienne Parry cites Dr. Neil Vickers, scholar of literature and medicine. Vickers believes that Marianne’s illness in Sense and Sensibility, for instance, is a literary trope—“simply a plot device”—rather than a specific, diagnosable illness.[2]

It is certainly tempting for the literary critic to read depictions of illness as artificial: literary tropes or metaphors that show us something broader about the character, plot, or theme of a given novel. As I have written elsewhere,[3] the fact that Paul Dombey wastes away from what is likely TB,[4] or consumption as it was commonly called, dovetails poetically with the fact that he is figuratively consumed, as Dombey’s son, by the company Dombey and Son from the moment of his birth. When we look disease in a novel such as Bleak House, we similarly find metaphoric possibilities.

Disease, writes Michael S. Gurney, “is a central theme” in Bleak House, and he identifies smallpox specifically as a disease that performs numerous literal and figurative functions (79). Smallpox, according to Gurney, serves as a call for graveyard reform, a lobby for widespread vaccination, a symbol for the connections between the social classes, and a device enabling Esther’s Bildungsroman development. In this list of functions, literal blends with figurative. Cheryl Kinney and Theresa Kenney similarly suggest that Dickens wields smallpox figuratively to “illustrate the social, economic and political nuances of the private and public spheres in which his characters lived” (267). Esther’s resulting scars, furthermore, participate in a tradition “hinting at the hero’s history and character from the earliest literature of the west to the most recent” (270).

I believe we lose the significance of these nineteenth-century diseases precisely by moving too quickly to metaphor. Smallpox, for instance, has been effectively eradicated.[5] As Kinney and Kennedy write, “Readers in Dickens’s time had a decided advantage over us because of their intimate comprehension of his ideas…Few readers today have ever seen a case of smallpox…the cases that Dickens and his readers would have seen would have been much more severe as the native viral strain lost virulence after 1900” (267). For modern readers, the jump to metaphor happens perhaps much more rapidly, as smallpox is not an active disease. Our reading of disease in a novel such as Bleak House is distanced from the physicality of the disease. In that distancing we miss something.

My reading here will attempt to reinsert that physicality. It will of course fail, because by writing about disease I am already separated from it. But my hope is to suggest some of the horrors of the disease so that we might go on to understand Dickens’s metaphors more fully.

Esther and Charley find Jo in a poor cottage, a place that “was closer than before, and had an unhealthy, and a very peculiar smell” (489). Jo himself shivers and stares at Esther and Charley with “burning eyes” (490). He says “‘I’m a being froze…and then burnt up, and then froze, and then burnt up, ever so many times in a hour. And my head’s all sleepy, and all a going mad-like—and I’m so dry—and my bones isn’t half so much bones as pain’” (490). Charley becomes ill, and Esther nurses her in a self-imposed quarantine. Charley’s illness disfigures her, and Esther thinks it “sorrowful to think that Charley’s pretty looks would change and be disfigured, even if she recovered” (500). Charley’s looks, however, improve as she mends—but soon Esther is taken ill, becomes momentarily blind, and “lay ill through several weeks, and the usual tenor of my life became like an old remembrance” (555). When Esther mends, her face remains disfigured.

Dickens’s description of Jo’s, Charley’s, and Esther’s illness, the timeline of their contagion, and Esther’s lingering disfigurement lead scholars to conclude that all three suffer from smallpox. While the smallpox vaccine had been discovered in 1796, an anti-vaccine movement in the early nineteenth century meant that the disease was still prevalent throughout the 1830s and 1840s. Technically called variola, smallpox is a member of the poxvirus family. As Russian microbiologist Ken Alibek writes, smallpox was recorded in China as early as 1122 B.C. Symptoms are accompanied by a sweet-sick odor and include “high fever, vomiting, headache, and a strange stiffness…Within less than a week, small spots will begin to develop, forming a rash around the face. As the rash spreads over the following week these spots will develop into painful blisters. In the normal course of the illness, the blisters form scabs that linger for several weeks until they dry and fall off, leaving scars. More severe forms of black or red pox can lead to death within three to four days” (109-110).

Writer Richard Preston describes a variola outbreak in Germany in 1970. A young German traveled to Pakistan, became ill, and returned home. Once there, he took himself to the hospital, where he was placed in an isolation ward for possible typhoid fever. Despite his isolation, he managed to infect nineteen other people in the small German town. Four of those people died—a predictable number considering variola typically kills 20-40% of those it infects. According to Preston’s description of the man’s case, a red rash developed, which then spread into blotches across his face and arms, “and within hours the blotches broke out into seas of tiny pimples. They were sharp feeling, not itchy, and by nightfall they covered his face, arms, hands, and feet. Pimples were rising out of the soles of his feet and on the palms of his hands, and they were coming up in his scalp and in his mouth, too.” These pimples “were beginning to hurt dreadfully, and they were enlarging into boils” (34). The doctors did not yet know what was wrong with him, and “his body had become a mass of knob-like blisters. They were everywhere…but they were clustered most thickly on his face and extremities…When he coughed or tried to move, it felt as if his skin were pulling off his body, that it would split or rupture” (35). After a time, “The pustules began to touch one another, and finally they merged into confluent sheets that covered his body, like a cobblestone street. The skin was torn away from its underlayers across much of his body, and the pustules on his face combined into a bubbled mass filled with fluid, until the skin of his face essentially detached from its underlayers and became a bag surrounding the tissues of his head” (35).

This man had classic ordinary smallpox. A young nursing student at the hospital never saw this man—and worked on a different floor of the hospital—yet caught the disease from him nonetheless and came down with a more severe form: hemorrhagic smallpox, which is nearly 100% fatal. Her version involved large spots filled with blood beneath the skin. Her immune system went into shock and could not produce pus. The blood “begins to clot inside small vessels that leak blood at the same time…the membranes inside her mouth disintegrated” before she died, horribly aware of and feeling everything that was happening to her up until her death (51).

These descriptions are grotesque, but my point is that when we read about Jo’s symptoms, or Charley’s disfigurement, or Esther’s experience going through smallpox, we are held aloof from the misery and horror of the disease. Nineteenth-century readers lived during smallpox epidemics and would not have needed more explicit descriptions, but for readers today, many born since the smallpox eradication of the 1970s, much is lost in historical translation.

Susan Sontag writes that “Any disease that is treated as a mystery and acutely enough feared will be felt to be morally, if not literally, contagious.”[6] The translation of disease into metaphor demoralizes those who suffer from the disease. I would argue that such metaphors also run the risk of domesticating the disease through mystification, rendering it less horrifying because less literal—and less likely to trouble a hypochondriac such as myself. Of course, in writing for a middle-class Victorian readership Dickens isn’t going to explicitly describe the symptoms suffered by his heroine. But our own reading would be enriched by understanding more specifically the horrors of smallpox. This in turn would communicate Dickens’s metaphoric messages all the more effectively.

[1] http://abcnews.go.com/blogs/headlines/2013/12/tb-flight-2846-passengers-get-tuberculosis-warning/

[2] http://news.bbc.co.uk/2/hi/health/7060533.stm

[3] http://www.nla.gov.au/openpublish/index.php/AJVS/article/view/2457

[4] For a description of Paul’s disease as consumption, see Tamara S. Wagner’s Longing: Narratives of Nostalgia in the British Novel, 1740-1890, g. 144.

[5] The disease has been eradicated, but test tubes filled with the virus are still maintained by the U.S., Russia, and possibly other countries.

[6] http://www.susansontag.com/SusanSontag/books/illnessAsMetaphorExcerpt.shtml