Dickens and Doctors: Vignettes of Victorian Medicine

(Editor's Note: We're almost at the end of the Bicentenary of Charles Dickens. We thought we'd look at another aspect of his writing, noted in 1992 by a 'layman' writing in the British Medical Journal and reprinted by the National Center for Biotechnology Information, National Library of Medicine.)

by J. E. Cosnett

Doctors are prominently represented in Charles Dickens's fiction. In 14 major works there are at least 27 members of the medical profession, some named, others anonymous. The main medical personalities provide vignettes of Victorian medicine, seen through the eyes of a very observant, critical, and socially conscious layman.

Medical students and medical education
Most prominent among medical students are Bob Sawyer and his friend Benjamin Allen, who appear in Pickwick Papers. At the time of writing Dickens was 24 years old; he must have associated. with London medical students and learnt of their curriculum and lifestyle. Sam Weller introduced Sawyer and Allen to Pickwick as "not reg'lar thoroughbred sawbones."

Pickwick attributed their lack of social graces to "eccentricities of genius." Like later generations of students, they relish their esoteric status and ability to shock their lay friends with privy talk such as "Nothing like dissecting to give one an appetite." They discuss a "good accident brought into the casualty ward." They have riotous drinking parties in lodgings for which the bill is in arrears, and their landlady describes them as a "parcel of young cutters and carvers of live peoples' bodies, that disgraces the lodgings."

Another sight of medical studies is given by Richard Carstone in Bleak House. On an impulse, while undecided about a career, Richard undertakes to "become an MRCS." He had spent eight years at a public school and "learned to make Latin verses to perfection," but he "never had much chance of finding out for himself what he was fitted for . . . and was never guided." However, "the more he thought of it, the more he felt that his destiny was clear; the art of healing was the art of all others for him." He was apprenticed to Mr Bayham Badger, "who had a good practice at Chelsea, and attended a large public Institution besides." He received Richard into his house and undertook to "superintend his studies."

Later Richard "felt languid about the profession" and confessed that "he had misunderstood his inclinations." He considered changing to the legal profession, but wavered, finally deciding to leave medicine when he was "obliged to spend twelve pounds, at a blow, for some heart-breaking lecture fees." (At this time, parish surgeons earned as little as £20 a year.)

Postgraduate career choices
Dickens's doctors had four main avenues of career choice after qualification. Those with financial backing might enter general practice, possibly with the prospect' of appointment to an institution. The young 'doctor without means was forced to consider seeking appointment as a parochial surgeon or to join the army or, worse, the navy as a ship's surgeon. Allan Woodcourt, the young medical hero of Bleak House, initially served as a navy surgeon, then became a parochial surgeon after he had wooed and married Esther Summerson. The conditions of service of naval surgeons were deplored by Dickens. In the appointment of parochial surgeons the choice usually fell on "bad or inexperienced doctors since they were cheapest."

A few qualified men gave up medical practice. Harold Skimpole "had been educated for the medical profession .-. . but he had never been able'to prescribe with the requisite accuracy of detail ... and when he was wanted to bleed ... or physic ... he was generally found lying on his back, in bed, reading the newspapers." [Bleak House] In New York, Martin Chuzzlewit was helped by Dr Bevan, whose "profession was physic, though he seldom or never practised."

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Dickens and Doctors: Vignettes of Victorian Medicine

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