MEDICAL MATTERS:Author's books are a rich repository of illness, writes MUIRIS HOUSTON
MY RELATIONSHIP with Charles Dickens got off to a rocky start. It wasn't his fault, of course. While I was in primary school, my well-meaning mother decided I should read some of his books. Unfortunately, she chose A Christmas Caroland gave it to me during a blazing hot summer. I can still remember struggling to read about Scrooge in various winter scenes while lying in the sun in our back garden.
The 200th anniversary of Dickens’s birth occurs this month. A superb storyteller, many of his books appeared first in weekly episodes and generated the sort of interest that TV soaps do now.
We know that he visited hospitals to learn more about the various illnesses and diseases of people he met. He then used these observations in many of his novels.
Probably the most famous medical reference in Dickens's oeuvre occurs in The Pickwick Papers. His portrayal of the character Joe, who was markedly obese and tended to fall asleep involuntarily during the day, led doctors to describe the illness as the Pickwickian syndrome. Such was Dickens's power of description, he accurately portrayed the symptoms of obstructive sleep apnoea, a clinical entity not fully understood until about 140 years after the book was published. We now recognise this combination of being overweight, sleep disturbance and intermittent cessation of breathing as having serious consequences if left undiagnosed and untreated.
In Bleak House, Phil Squod (described as "shoulding his way along walls") demonstrated symptoms consistent with dysfunction of the vestibular nerve; this was almost certainly a description of Meniere's disease. The symptoms of young Paul Dombey in Dombey and Sonresemble those of a child with leukaemia. A 2006 review in the Journal of Clinical Neuroscience noted, " gift for eloquence, imagery and precision attest not only to the importance of careful clinical observation, but also provide an insightful and entertaining perspective on movement disorders for modern students of neuroscience."
Narrative medicine uses literature as a way to help tomorrow’s doctors appreciate the human toll of disease as well as offering some excellent descriptions of illness such as those that occur in Dickens’s work. Dickens’s characters are a particularly good source of psychiatric illness. This may reflect his extensive contact with Victorian psychiatry.
Writing in the journal Medical Humanitiesin 2008, Dr BC Douglas of the Royal Free and University College Medical School in London described the rich source of psychopathology in Dickens's work. When the author died in 1870, his genius for observation and his skill at describing mental illness were acknowledged by an obituary in the British Medical Journal.
Although written long before Alzheimer's disease was described as a clinical entity, there are cases of dementia in the novels. Mrs Smallweed in Bleak Househas been described as a classic example: "Little old men and women there have been, but no child, until Mr Smallweed's grandmother, now living, became weak in her intellect, and fell (for the first time) into a childish state. With 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."
Dickens offers a brilliant account of delirium tremens, (acute alcohol withdrawal) in his description of Jem in The Pickwick Papers: "There were insects too, hideous crawling things with eyes that stared upon him, and filled the very air around: glistening horribly amidst the thick darkness of the place. The walls and ceiling were alive with reptiles – the vault expanded to an enormous size – frightful figures flitted to and fro – and the faces of men he knew, rendered hideous by gibing and mouthing, peered out from among them."
The description is so good I can immediately see, in my mind’s eye, the faces of several people I have treated with the DTs. But clearly the author had his limits – bringing alive snowy scenes while the ambient temperature was in the 80s being one of them.