Dickens's most charismatic medical personality is Dr Allan Woodcourt in Bleak House. One of his patients was Miss Flite, whom he attended with "much solicitude and compassion." His patient judged him to be the "kindest physician in the college.... All his widowed mother could spare had been spent in qualifying him for his profession. It was not lucrative to a young young practitioner, with very little influence in London ... though he did wonders of gentleness and skill for ... numbers of poor people ... he gained very little by it in money." So he enrolled as a naval surgeon, sailed to the Far East, and in a shipwreck saved many lives. On his return "the whole country rings" with his heroism. Miss Flite felt that her "brave physician ought to have a Title" and his sweetheart, Esther "could have kneeled down ... and blessed him, in my rapture that he should be so truly good and brave."
Ultimately he learnt of the proposed appointment of a "medical attendant for the poor ... at a certain place Yorkshire." This presented an "opening for a man whose hopes and aims may ... lie above the ordinary level ... it should prove to be a way of usefulness and good service ... an appointment to a great amount of work and a small amount of pay; but better things will gather about it." Dr Woodcourt was appointed, married, and settled in the practice in which, Esther wrote, "I never lie down at night, but I know that in the course of that day he has alleviated pain, and soothed some fellow creature in the time of need ... thanks have gone up for his patient ministration.... We are not rich in the bank" but "is this not to be rich?"
Next to Woodcourt, the most prominent doctor in Dickens' novels is Dr Manette, trained in Paris but later in practice in London. [A Tale of Two Cities] Having recovered his memory after years of imprisonment, he "received such patients as his old reputation ... brought him. His scientific knowledge, and his knowledge and skill in conducting ingenious experiments, brought him otherwise into moderate request, and he earned as much as he wanted." When he returned to Paris to secure the release of Darnay "he kept himself ... as a physician, whose business was with all degrees of mankind ... he used his influence so wisely, that he was soon the inspecting physician of three prisons."
Consultants
Some senior doctors achieved consultant status through experience, appointments, and reputation. Prominent among these was the nameless "great Physician" of Litte Dorrit — the "famous physician, who knew everybody, and whom everybody knew ... a profound professor of the healing art ... a composed man, who performed neither on his own trumpet nor on the trumpets of other people.... He went, like the rain, among the just and unjust, doing all the good he could, and neither proclaiming it in synagogues nor at the corners of the streets." This character is almost certainly based on Dickens's friend, Dr John Elliotson, FRCP. Their friendship was originally founded on their mutual interest in mesmerism and phrenology. Use of mesmerism with patients led to Elliotson's disfavour, among his colleagues and his resignation from posts at University College Hospital.
An eminent consultant obstetrician was Dr Parker Peps [Dombey and Son], who supervised the birth of Paul Dombey. He was "one of the Court Physicians, a man of immense if a reputation for assisting at the increase of great families." He and the "family surgeon," Mr Pilkins, indulged in public mutual admiration, and Dr Peps publicly confused the name of Mrs Dombey with various titled ladies, to advertise his high connections.
When Smike was suffering from his chronic and ultimately fatal illness Nicholas Nickleby "carried him to a physician of great repute." The conclusion was r is that "there was no cause for immediate alarm there were no present symptoms which could be deemed conclusive. The constitution had been greatly to tried and injured in childhood." It is likely that the his condition which Dickens portrayed was tuberculosis. [Nicholas Nickleby]
A funny lot
Dickens sometimes poked gentle cynical fun at doctors' consultations. Investigating the Maylie housebreaking, the policemen "held a long council together, my compared with which, for secrecy and solemnity, a consultation of great doctors on the knottiest point in medicine, would be mere child's play."
In the "Madman's manuscript" of Pickwick Papers a lady was "bereft of animation for hours" and later "raved wildly and furiously." Her husband recalls that if a "doctors were called in - great men who rolled up to my door in easy carriages, with fine horses and gaudy
servants. They were at her bedside for weeks. One, the cleverest and most celebrated among them, took me aside, and, bidding me prepare for the worst, told me — the madman! — that my wife was mad."
In his final illness young Paul Dombey "was visited by as many as three grave doctors-they used to assemble downstairs and come up together.... Paul was so observant of them ... that he even knew the difference in the sound of their watches."
From his characterisations it seems that Dickens had respect and admiration for most doctors, as exemplified by Allan Woodcourt and Dr Chillip. But there were features among others that prompted veiled criticism and subtle sarcasm. These were avarice and hypocrisy, manipulation of society for their own ends, and a tendency to prolixity in consultation. Were he writing today, would Dickens think that these were as extinct among doctors?
Correspondence to: 268 Maiinig Road, Glenwood, Durban, Natal, South Africa. British Medical Journal, December 19, 1992
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