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Pathology Cartoon of the Day -

Novels by Charles Dickens are like Medical Books


7 things Doctors can learn from Novels by Charles Dickens:


1) Pickwick Papers:

Charles Dickens played an important role in the field of sleep medicine. (Kryger M. Charles Dickens: impact on medicine and society. J Clin Sleep Med 2012;8(3):333-338.)

First description of the sleep apnea syndrome was made by Charles Dickens in the Pickwick Papers in 1836

Almost 140 years after Pickwick Papers was published, doctors understood what he was describing.

In 1956, Burwell et al introduced the term Pickwickian syndrome for obese patients with sleep apnea syndrome.  

It was later known as the obesity hypoventilation syndrome.

Obesity-hypoventilation syndrome (Pickwickian syndrome) consists of obesity ; sleep breathing disorder episodes of excessive daytime sleepiness or prolonged nighttime sleep ; chronic hypercapnia during wakefulness in the absence of other known causes of hypercapnia ; alveolar hypoventilation and right ventricular failure in serious cases.

Charles Dickens describes messenger boy Joe, in The Pickwick Papers as the  "wonderfully fat boy"  who is obese, sleepy, difficult to arouse, snores, and has peripheral edema. -   "and on the box sat a fat and red-faced boy, in a state of somnolency,"

Joe probably had cor pulmonale as he was described as red faced and the word dropsy was used to wake him up.

The important clinical findings of  patients with cor pulmonale are polycythemia and peripheral edema.

Dropsy is an old term for peripheral edema.

2) A Christmas Carol:

Charles Dickens had eye of an expert clinician and gave detailed accounts of movement disorders, physical deformities and disabilities.

Tiny Tim is a sick young boy with physical disability and walks with a crutch.  "Alas for Tiny Tim, he bore a little crutch, and had his limbs supported by an iron frame!" Some authors suggesting that he had Pott's disease (tuberculosis affecting the joints of the spine and the hip joints) or renal tubular acidosis.

3) The Life and Adventures of Nicholas Nickleby:

Charles Dickens highlights the world of poverty and disease in children.

Here again he gives clear clinical description of children suffering from malnutrition.

 "How the last faint traces of hope, the remotest glimmering of any good to be derived from his efforts in this den, faded from the mind of Nicholas as he looked in dismay around! Pale and haggard faces, lank and bony figures, children with the countenances of old men, deformities with irons upon their limbs, boys of stunted growth, and others whose long meagre legs would hardly bear their stooping bodies, all crowded on the view together; there were the bleared eye, the hare-lip, the crooked foot, and every ugliness or distortion that told of unnatural aversion conceived by parents for their offspring, or of young lives which, from the earliest dawn of infancy, had been one horrible endurance of cruelty and neglect. There were little faces which should have been handsome, darkened with the scowl of sullen, dogged suffering; there was childhood with the light of its eye quenched, its beauty gone, and its helplessness alone remaining…."

4) Dombey and Son:

Charles Dickens knew the benefits of clean environment and importance of fresh air and seaside for recovery of major illness like tuberculosis. He was also familiar with the symptoms of bronchial asthma.  

(Kryger M. Charles Dickens: impact on medicine and society. J Clin Sleep Med 2012;8(3):333-338.)

In Dombey and Son, Paul Dombey, whose description suggested he had tuberculosis was sent to Brighton, a seaside city. Major Bagstock, a character in this novel  had "a wheeze very like the cough of a horse"  The Major is described as having an attack of bronchoconstriction and cyanosis with: "…wheezing sounds would be heard, and the major's blue would deepen into purple, while his eyes strained and started convulsively…."

5) Oliver Twist:

He was aware of the importance of sanitation and hygiene.

Note his  description of a cattle market in Oliver Twist - "The ground was covered, nearly ankle-deep, with filth and mire; a thick steam, perpetually rising from the reeking bodies of the cattle, and mingling with the fog, which seemed to rest upon the chimney-tops, hung heavily above.”

6) Bleak House:  

Charles Dickens was a strong supporter of vaccination.

In Bleak House, the heroine, an orphan named Esther Summerson, has a life-threatening disease which looked like smallpox, and even smelled like smallpox.  The Stranger in the Mirror in Bleak House - History of Vaccines

7) Little Dorrit:

Charles Dickens explored some of the dark parts of English urban life and raised awareness of poverty, disability, mental illness, psychosocial and environmental problems.

Little Dorrit is the story of the life of Amy Dorrit. He describes  poverty, pollution, gruesome suicides, disabling dyspepsia, hysterical paralysis, and mentions about infectious diseases like plague, epidemics of smallpox and cholera and travel related diseases like malaria and yellow fever.

Charles Dickens played an important role in medicine. He promoted the treatment of children. In his novels Charles Dickens described various diseases, including tuberculosis, chronic bronchitis, asthma, restless leg syndrome, Parkinson's disease, chorea, Tourette's syndrome, cerebellar ataxia, torticollis, supranuclear palsy, stroke, epilepsy, and the complications of alcoholism, Ménière's disorder and acute leukemia.


Further reading:

Charles Dickens: the man, medicine, and movement disorders.

Charles Dickens: impact on medicine and society.

Extreme obesity associated with alveolar hypoventilation--a Pickwickian Syndrome.  

A Christmas Carol: Charles Dickens and the birth of orthopaedics.

Charles Dickens (obituary) British Medical Journal. 1870:636.

Dickens C. Oliver Twist. London: Richard Bentley; 1838.

Dickens C. Speech given at The Royal Academy Dinner. 1870





Dr  Sampurna Roy  MD

Consultant Histopathologist (Kolkata - India)







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