Foulds on Byrne, 'Tuberculosis and the Victorian Literary Imagination'

Katherine Byrne
Alexandra Foulds

Katherine Byrne. Tuberculosis and the Victorian Literary Imagination. Studies in Nineteenth-Century Literature and Culture Series. Cambridge: Cambridge University Press, 2011. viii + 223 pp. $90.00 (cloth), ISBN 978-0-521-76667-8; $29.99 (paper), ISBN 978-1-107-67280-2.

Reviewed by Alexandra Foulds (University of Glasgow) Published on H-Disability (April, 2015) Commissioned by Iain C. Hutchison

Tuberculosis and Literature: The Making of a Nineteenth-Century Disease

Katherine Byrne’s Tuberculosis and the Victorian Literary Imagination is one of the latest publications by Cambridge University Press that delves into the medical humanities in order to explore historical attitudes to, and associations with, illness. Following in the footsteps of Susan Sontag’s Illness as Metaphor (1978), critics such as Miriam Bailin, Anna Silver, and Pamela K. Gilbert have added to an increasing amount of academic research analyzing the roles that disease and invalidism in general, and conditions such as anorexia, syphilis, hysteria, cholera, typhoid, and typhus in particular, played in the Victorian cultural imagination. Tuberculosis, as Byrne notes, despite its high death rate in the nineteenth century and the many characters in Victorian literature suffering from the disease, has somewhat bizarrely received relatively little critical attention by comparison, an oversight her work seeks to address. Her main argument is that tuberculosis, or phthisis as it was often referred to, possessed a potential lacking in these other conditions. Uncertainty about its causes and means of transmission, as well as its tendency to cross class boundaries, she posits, made it a more malleable and versatile metaphor, capable of being used both to idolize and pathologize its victims, as well as to contain paradoxical associations. It is this ambivalence, and the differing representations of the disease that resulted, that is her focus.

The small number of publications that have discussed tuberculosis, such as Clark Lawlor’s Consumption and Literature: The Making of a Romantic Disease (2006), have omitted the nineteenth century, or have approached the subject from a more medical, sociological, or political viewpoint. Byrne, in adopting a medical humanities approach is able to explore the symbiotic relationship between medical texts and fictional texts in constructing a Victorian image of the disease. It is this relationship that she analyzes in her first chapter. She illustrates the influence literary fiction and its portrayal of the idealized consumptive had on medical perceptions of consumption in the nineteenth century. She notes a resurgence in medical interest in phthisis from the 1830s onward. This, she argues, was not being linked to a rise in deaths due to the disease. Nor was it being caused by any advancement in medical understanding of the illness, or treatments for it. Rather, it was a response to changing perceptions of the disease caused by its depiction in novels. She suggests that, with an absence of facts about the causes of the disease and with the medical profession debating its methods of transmission long after the discovery of the tubercle bacillus in 1882, physicians relied on literature’s representations of the stereotypical consumptive as beautiful, angelic, and refined in order to diagnose a consumptive “type.”

In subsequent chapters, her focus shifts from medical literature to literary fiction, using close readings of generally two novels, and sometimes more, to discuss beliefs about the disease in both the medical and cultural imagination. These chapters fit together very well, giving Byrne’s work a nice sense of flow. This is largely due to her tendency to introduce themes in one chapter which she then returns to in more detail later. Indeed, her first chapter serves as an introduction to many beliefs about the disease, which she then explores in relation to her later texts. It is also aided by the fact that she pairs several of her chapters, dealing with similar themes in each, as is the case of chapters 2 and 3.

Both of these chapters deal with the potential for illness to be a liberating condition. While in chapter 2 she discusses this liberation in relation to the possibility of escaping capitalism, consumerism, and industrialization, in chapter 3 she is concerned with the escape from gender norms that illness makes allowance for. In chapter 2, she links tuberculosis to materialism and the consumption of luxury goods and the threats to society these were perceived to pose. In Charles Dickens’s Dombey and Son (1846-48), according to Byrne, Paul Dombey’s illness is described both as the punishment for his father’s wealth and an escape from the capitalist future he is destined for should he pursue the family business. The weakness of the chapter lies in her coupling of Dombey and Son with Elizabeth Gaskell’s North and South (1854-55), a novel in which, she posits, Bessy Higgins’s illness is also depicted as the result of consumerism as it is believed to be caused by her work in the cotton industry where she has inhaled fluff. Byrne seems to question this causality, however, and rather than treating the historically and medically specific nature of Bessy’s condition, which forms a central part of Gaskell’s critique of the factory system, she makes no distinction between this and the other depictions of consumption she analyzes. Her argument is largely based on the interesting fact that Bessy, despite her working-class origins, becomes elevated by her condition. Described as increasingly noble, refined, and pious, Bessy conforms to the stereotype commonly linked to tuberculosis. However, it prevents Byrne from using the class differences between Paul and Bessy to their full potential in comparing the varying associations tuberculosis had within different social classes.

In chapter 3, she discusses Mrs. Humphry Ward’s Eleanor (1900), averring that the female protagonist’s tuberculosis allows her to escape the restrictions of her gender and to transgress social norms. Instead of remaining the silenced angel of the house she is when she falls in love with Manisty, Eleanor subversively pursues him by vocalizing her feelings for him, manipulating Lucy into abandoning him. This behavior, legitimized by her condition, becomes an acceptable form of self-preservation. Ultimately, however, she undergoes a spiritual awakening in which she begins to conform to the idealized stereotypes associated with her illness. However, the autonomy she has gained is never lost. Byrne’s argument here demonstrates the capacity for the female invalid to embody both the feminine ideal of dependence and passivity and its antithesis. The closer a woman was to death, the closer she appeared to be to the ideal, becoming increasingly pure.

It is this contradiction that is the subject of her next two chapters. In chapter 4, she uses the research of Bram Dijkstra in his influential Idols of Perversity (1988) to discuss pre-Raphaelite painting, focusing particularly on the work of Dante Gabriel Rossetti in which he depicted his wife, Elizabeth Siddal. Using the figure of Siddal, Byrne argues that phthisis, unlike other diseases, was considered aesthetically pleasing and socially desirable. Believed to affect the genteel and beautiful, and to augment these qualities, it bestowed certain advantages on its sufferers and thus caused women to try to achieve this fashionable look. She then progresses to a reading of George du Maurier’s Trilby (1894) and Charles Reade’s A Simpleton (1873), novels that she contends engage with this tubercular aesthetic. While the former questions the sway and consequences of such an aesthetic but simultaneously upholds it, the latter depicts it as pathological and destructive to both health and beauty.

Chapter 5 concentrates on the subversiveness and deviancy, particularly sexual deviancy, increasingly associated with the disease after the discovery of the tubercle bacillus. Here, the author establishes a link in the literary, cultural, and medical imagination between consumption and vampirism. She notes that many of the signifiers of tuberculosis were also associated with vampires in the fiction of this period and that physicians, unable to treat the former, sometimes turned to supernatural explanations and remedies, such as prescribing the drinking of blood. She analyzes Bram Stoker’s Dracula (1897) in this light, relating it to John Polidori’s The Vampyre (1819), Sheridan le Fanu’s Carmilla (1871), and a few lesser-known vampire narratives of the nineteenth century. Her reading is persuasive and her examples illustrate her argument very well. However, Byrne does oversimplify the versatility of representations of vampires in this period. It would have been interesting to see her engage with some of the less conventional vampire texts that the nineteenth century produced, as well as to discuss the interaction of consumption with the other diseases, such a rabies, porphyria, anaemia, and cholera, that she acknowledges as possibly connected to the vampire myth yet quickly dismisses.

Byrne’s final chapter uses Ralph Touchett in Henry James’s The Portrait of a Lady (1880-81) to discuss the representation of invalid men in literature. Here, once again, tuberculosis is described as the result of a capitalist economy in which wealth has rendered men unhealthy, ineffectual, and effeminate. She discusses phthisis in relation to medical debates about the benefit of traveling to improve health as well as eugenic discourses that accompanied the disease even after it was known to be bacterial. She notes that in death Ralph, as a male invalid, appropriates many qualities associated with the idealized female invalid. She ends by returning to the theme of liberation, arguing that Ralph’s illness releases him from the responsibilities of marriage and domesticity, a freedom James himself experienced due to his own various ailments.

Byrne concludes with an epilogue in which she touches on changing attitudes to tuberculosis post-1900 as the disease became publicly recognized as infectious and the mystery associated with the disease began to dissipate. Discussing sanatorium novels she nevertheless notes the continuance of several thematic conventions in depictions of its sufferers.

Overall, Byrne makes her case convincingly, and covers a great deal of interesting material, both medical and literary. It is easy enough to read so that it will be accessible to the newcomer to the medical humanities but detailed enough so that more seasoned researchers will find plenty to absorb their attention. While one could argue that there are points in which she could have engaged in more detail with the research that has preceded hers, particularly with regard to her discussion of invalidism which has accumulated a wide variety of analyses over the last thirty years, and that her focus on gender at times results in a less in-depth discussion of class issues than might be desired, as the first book-length study of tuberculosis in this period, its achievements far outweigh its negatives.

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Citation: Alexandra Foulds. Review of Byrne, Katherine, Tuberculosis and the Victorian Literary Imagination. H-Disability, H-Net Reviews. April, 2015. URL:

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