The Dickens of a Diagnosis

ICYMI: A look back at the literature of the 18th and 19th centuries, which begins to include—and sometimes comes up with—original names for illnesses, along with many now-outdated treatments.

By Mary Carpenter

CHARLES Dickens “achieved an almost matchless status as a definer of medical conditions,” Russel Chesney writes in a JAMA (Journal of the American Medical Association) review.

Dickens became known as a “syndrome spotter,” for example, with Pickwickian syndrome —an imbalance of carbon dioxide (too much) and oxygen (too little) in the blood of overweight patients, who are unable to breathe well while sleeping. What’s now called obesity hypoventilation syndrome—sleep apnea and obesity—in The Pickwick Papers caused a “wonderfully fat boy . . . standing upright . . . his eyes closed as if in sleep.”

The constant “writhings” of Uriah Heep in David Copperfield gave rise to Uriah Heep syndrome, most likely dystonia—repetitive movements that result from the involuntary contraction of muscles. As Miss Trotwood exclaims in Heep’s presence, “If you’re an eel, Sir, conduct yourself like one. If you’re a man, control your limbs, Sir! Good God!”

But Tiny Tim is the Dickens character whose medical issues have inspired the most speculation and research—with possible diagnoses of cerebral palsy, spinal dysraphism (congenital abnormal structure of the spine) and renal tubular acidosis (when the failure of kidneys to remove acids from the blood causes impaired growth in children).

Alternatively, Tiny Tim may have suffered from a “crippling” combination of rickets and tuberculosis, according to the JAMA review, as these two conditions were prevalent among London’s children—in about 60% for rickets and 50% for TB.

With rickets, insufficient vitamin D—needed for the body’s absorption of calcium and phosphorous—can cause a softening or weakening of bones in children, leading to delayed growth, bow legs, weakness and pain.  While crowding and poor nutrition were contributing causes, the soot and particles in coal smoke darkened London’s skies and absorbed ultraviolet rays needed for vitamin D synthesis.

Tuberculosis, a lung infection eventually treated with antibiotics, appeared often in Dickens’s novels and in literature through the 20th century, famously in Thomas Mann’s The Magic Mountain. Also caused by a mycobacterial infection like TB, but not contagious, Lady Windemere syndrome got its name from the Oscar Wilde character whose Victorian manners kept her from coughing. Failure to cough was deemed a cause of the condition, characterized by an accumulation of phlegm.

Scurvy—the result of severe, prolonged vitamin C deficiency, which killed three times as many people as those who died fighting in the Civil War—appeared often in novels of the sea, notably Moby Dick. Another common vitamin deficiency, pellagra resulted from low levels of niacin (vitamin B3) and could lead to dementia, diarrhea and dermatitis—with the exacerbation of dermatitis by the sun causing its link to vampire literature, in particular to Count Dracula.

Cures for ancient ills were often worse than the symptoms, notably the mercury ointment used for skin diseases like scabies–which could lead to kidney damage and death.

Though most ancient treatments are now forgotten, leeches and maggots are “the only two living animals approved as medical devices in the U.S.,” writes Kate Golembiewski in Discover Magazine. Both “critters that clean up wounds by eating flesh and blood” can help treat infection.

Medical-grade maggots consume dead tissue to clean infected wounds. And leeches drink blood—an anesthetic is used first to numb the area and then an anticoagulant added to increase blood flow—in areas where pooling blood causes swelling “and the lack of fresh, oxygenated blood causes skin tissues to die.”

Another enduring treatment is the straitjacket, used on England’s King George III (who appeared recently in the musical “Hamilton”). His most likely diagnosis for “madness” was the genetic blood disorder porphyria (pronounced por-FEAR-e-uh), according to the BBC’s HistoryExtra.

In fact, a kind and industrious king who fathered 15 children and founded the Royal Academy, George III suffered from violent convulsions, terrible insomnia, hallucinations and mania, according to HistoryExtra. He once planted “a beef steak in the ground, fully believing it would grow into a beef tree.”

Of two forms of porphyria—both causing urine to turn red or brown, sometimes described as “bluish”—King George likely had an “acute” porphyria, caused by deficient production of heme, which is a component of hemoglobin. Symptoms can include pain, gastrointestinal problems and seizures. With the other “cutaneous” porphyrias, extreme sun sensitivity causes skin blisters and pain.

Besides the straitjacket, King George’s treatments included “arsenic-based powders applied to his skin . . .  a method thought to draw the illness out,” according to HistoryExtra. Also, he was starved, bled and given freezing cold baths as a way of “shocking” the illness from his body. And “purgatives such as rhubarb, castor oil and senna were used to treat his constipation and cause diarrhoea, while emetics were given to make him vomit, purging him of disease.”

Some ancient diseases are still around, with others expected to return, according to NYU physician Marc Seigel, who is concerned about the “‘rise in diseases not seen since the Middle Ages,” including leprosy.

Seigel pinpoints homeless individuals as creating a “perfect cauldron for a contagious disease…Transmitted by nasal droplets and respiratory secretions with close repeated contact.” Los Angeles physician Drew Pinsky worries about “what usually comes on the heels of typhus,” which he has seen in this population: bubonic plague.

—Mary Carpenter looks at how illnesses were named and treated in the literature of the 18th and 19th centuries.