Untold lives blog

A Dickensian story for Christmas week - but perhaps not as you might expect!  We shift the focus from seasonal Pickwickian jollity to Bleak House and smallpox.

Midway through Bleak House, a simple act of charity lands heroine Esther Summerson with a potentially life-threatening disease.  It looks like smallpox, reads like smallpox and, in one particularly memorable sequence, and even smells like smallpox.  But for all this, Dickens never categorically states that it is indeed smallpox which ruins Esther’s complexion and hastens Jo the Crossing Sweeper to his overly sentimental death. 

'Nurse and Patient' by H K Browne from Charles Dickens, Bleak House (London Bradbury & Evans, 1853)

There is something of a trend of medical ambiguity to be found throughout Dickens.  Various academics have argued that A Tale of Two City’s Sydney Carton is a syphilitic and that Miss Havisham is mentally ill.  But in Bleak House especially, descriptions of the ravages of Esther’s disease are enough to arouse the liveliest of suspicions.  At various stages throughout her illness, Esther finds it difficult to speak (a symptom which could be attributed to smallpox pustules lining her throat) and goes temporarily blind.  Furthermore, she is so badly scarred for the remainder of the novel that a previous suitor, Mr Guppy, withdraws an offer of marriage at the sight of her.  However ambiguous Dickens chooses to be, Esther’s mystery disease very much mirrors Victorian medical knowledge on smallpox, from its fluid-filled pustules, corneal ulceration and mouth blistering to its deforming after-effects and severe contagiousness.

Even so, this retrospective diagnosis is not without its problems.  Why, after all, would a middle-class woman such as Esther not have been vaccinated against the disease, since cowpox vaccinations had already been proving successful over half a century earlier?  Certainly, Dickens himself was a vociferous supporter of the practice, having frequently used his publication All The Year Round as a platform from which to advocate mandatory vaccination and demonstrate his extensive knowledge of the subject.  In an memorable 1860 volume, Dickens waxes lyrical for several paragraphs on Edward Jenner’s technique of using cowpox as a non-infectious smallpox vaccine and is particularly enthusiastic on the way smallpox matter is changed by 'passage through the lower organisation of the cow'.

  Free smallpox vaccination from Petit Journal (1905) ©De Agostini/The British Library Board  Images Online

However, as Mary Wilson Carpenter points out in her book Health, Medicine and Society in Victorian England, vaccination was in no way universal towards the tail end of the nineteenth century and neither did it provide infallible protection against smallpox.  She notes that 'middle- and upper-class people were not necessarily more likely to have been vaccinated than poor people', claiming that Esther’s illness is consequently a 'very realistic representation of smallpox as experienced in Victorian England'. 

In 1853, the same year that Bleak House was published, Britain passed the Compulsory Vaccination Act, which made free vaccination obligatory for all infants under four months. The punishment for not complying was ostensibly a fine but, as Dickens himself wrote in All the Year Round, a lack of enforcement quickly led to the law being flouted: 'At first the act was readily obeyed, and deaths from small-pox fell to one hundred and fifty-two in the million. Then, it was found that nobody was charged with the enforcement of the law, or with the recovery of penalties.  Its coercive power was therefore at an end. This oversight has yet to be remedied'.  With this in mind, it becomes very easy to argue that Dickens’ representation of an unvaccinated Esther succumbing particularly gruesomely to a disease resembling smallpox could well have been an emotive dig at the failure of Compulsory Vaccinations to be properly enforced.

Julia Armfield
Former Intern, Printed Historical Sources

Further Reading:
Mary Wilson Carpenter, Health, Medicine and Society in Victorian England (California, 2009)

David Bevan, Literature and Sickness, (Amsterdam: 1993)

Karie Youngdahl, The Stranger in the Mirror in Bleak House