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^Disease as Device: The Role of Smallpox in Bleak House Michael S. Gurney A discussion of fictive ills in Bleak House is particularly appropriate. Disease is a central theme throughout the novel, and many illnesses are depicted: smallpox, stroke, gout, epilepsy, senile dementia, paraplegia, psychiatric disease, and an equilibrium disorder that was probably the first description of Meniere's disease. Moreover, the sodety of Bleak House is itself diseased. Dickens adopts the posture of sodal pathologist and dissects his nation, finding decay at every level. He often uses disease as a physical manifestation and consequence of sodety's sickness. One illness in particular—smallpox—appears throughout the novel for diverse purposes. The recognized communicability is used to emphasize the need for graveyard reform. With impressive foresight, the scarred features of the novel's heroine effectively lobby for more widespread vaccination, the policy that would ultimately eradicate the disease over a century later. The spread of the infection is also used as a symbol to emphasize the connections between sodal classes in a callous, dehumanized sodety. Furthermore, the infection provides a crisis in the heroine 's life that Dickens uses in Carlyle's fashion to transform Esther from a naïve girl to a true Bildungsroman diaracter. The ability to use diverse disease manifestations so accurately and effectively implies a degree of medical knowledge surprising in a nineteenth -century novelist. However, there is much circumstantial evidence of Dickens's medical knowledge. His library contained many sdentific and medical books from the 1840s and 1850s. His close friends induded three prominent physidans: John Elliotson, John Connolly, and T. Southwood Smith. He worked hard for the creation and support of hospitals, raising money for the Children's Hospital on Great Ormond Street, and helping to establish the London Foundling Hospital and the Sanitorium of Devonshire Place House, a private hospital for single middle-income Literature and Medicine 9 (1990) 79-92 © 1990 by The Johns Hopkins University Press 80 DISEASE AS DEVICE Londoners.1 Dickens worked with Smith for medical-sodal reform, particularly for slum reform. He also regularly published articles and editorials about public health issues in his two weekly magazines, All the Year Round and Household Words. Even more convincing evidence of Dickens's medical knowledge is in his books themselves. The fictive ills given to his charaders are real diseases, not romantic swoons or lingering obscure fevers. The diseases are from Dickens's actual experience, carefully observed and painstakingly reproduced with definite signs and symptoms that progress in a logical sequence. His descriptions of disease are frequently superior to the medical texts of his day. The illnesses are realistic and challenging enough that Dickensian diagnoses are often the subjed of discussion in current medical journals. Many of Dickens's characters have now become classic examples of medical syndromes. His description in Pickwick Papers oÃ- Fat Joe, whose morbid obesity led to sleep apnea and narcolepsy, was penned years before this condition, now referred to as pickwickian syndrome, became widely recognized in medicine. His account in Great Expectations oÃ- Mrs. Garger^s symptoms after the assault by Orlick is fascinating. Her neurologic defidts correlate exactly with those areas of the brain—the back and side—that would have been injured in the surprise attack. The idea that certain areas of the brain controlled distinct functions was not widely known at the time of Great Expectations in 1861. Broca only that same year localized the area responsible for speech, and it was not until the next two decades that Meynert and Sir David Ferner performed their studies on brain anatomy and localization of sensory function to specific areas of the cortex.2 Dickens's descriptions of other neurologic disorders are classics . Sir Leicester Dedlock's stroke in Bleak House, Mrs. Skewton's recurrent strokes and deterioration in Dombey and Son, the grand mal seizure of Anthony Chuzzlewit, and the psychosis of Dr. Manette in A Tale of Two Cities are all remarkably accurate and insightful descriptions of such illnesses . In Bleak House, Dickens describes a peculiar disorder in Phil Squod, Mr. George's assistant. Phil cannot walk on his own without falling unless he leans one shoulder against the wall for support...