Life in big Victorian cities was very different from life in small towns or villages. It demanded a stronger immunity on part of the city dwellers to all sorts of pollution as their senses were overwhelmed by the batteries of sound, all-pervasive smog, contaminated potable water, advertisements urging them to continue consuming in spite of a big city’s notorious bad weather, which might affect our consumer’s disposition. This essay examines a wasteful disease associated with consuming the city in Dickens’s represented spaces – tuberculosis also called tb for short and its early name – consumption alluding to the fact that the sufferers from this disease were very visibly consumed by it, which led to their physical dissolution. This essay also establishes the relationship between urban consumption and tuberculosis in Dickens’s representations of the city.
Consumption and the Modern City
Undoubtedly, there exists a relationship between consumption in the city at the end of the nineteenth and beginning of the twentieth centuries and consumption, the disease that was a scourge wiping out thousands of lives during the Romantic, Victorian, and Modernist periods. Extreme consumption has all the symptoms of a terminal disease in Dickens’s represented spaces. The interrelation between the consumer and the modern city appears in the city dweller’s consuming the city – consumption of commodities, and him or her being consumed by it in return – consumption as the medical condition found in the city inhabitants succumbing to the forces sapping their energy while trying to generate means of survival in the metropolis, meeting its costs and paying for them with their health. Indeed, the Victorian city's heavily polluted air and contaminated water caused of many pandemics. Some of the diseases causing them could easily be connected to nineteenth-century modern urbanity – cholera, tuberculosism and typhus, which resulted from consuming contaminated water and food products, breathing polluted metropolitan air, and chronic malnourishment of the poorest class of city dwellers. Not by chance people who had tuberculosis at the time were advised to leave the cities in which they lived in as soon as possible. According to Alan Robinson’s Imagining London 1770-1900 (2004),
The concern with public hygiene in Victorian London reflected the very real and recurrent threat of cholera: there were major epidemics in 1832, 1849, 1854 and 1866. Typhus, typhoid, tuberculosis and smallpox were principally diseases of the poor, exacerbated by overcrowding, poor diet and insanitation; cholera was the great leveller that struck all classes alike. It may have caused fewer deaths but it literally brought home the public health problem to the middle classes. 
In numerous reports in the Victorian press, consumption in its most frequent form at the time, pulmonary tuberculosis, was associated with every-day metropolitan life in overcrowded residential areas known as rookeries where many tenants regardless of sex or age occupied the same room so they could pay a lower rent, narrow city streets where peddlers and local residents and transient travelers would rub shoulders, thus increasing the spread of the air-borne tubercular infection.
Urban novelists, such as Dickens, felt strongly about the issue, and aiming at a truthful representation of urban life, featured ample examples of the devastation this disease brought on the afflicted city dwellers. In corroboration of the data presented by a number of Victorian newspapers, Dickens also lays the blame on the poor sanitary conditions of the London slums at the time as well as the general poverty of the city residents whose only choice for a residence were the tenement buildings. Unlike the newspapers, however, which more often than not assumed a neutral tone referring to statistical data of the numbers of the fatalities from the disease, Dickens establishes a direct connection to its cause, which he sees in insufficient urban consumption.
Consumption in the Victorian Newspapers
The following passages appeared in Victorian newspapers, which viewed pulmonary tuberculosis as a daily companion to city life. Unlike Dickens’s representations of the disease, these journalistic accounts are more closely related to statistics than to establishing correlations with the urban condition with occasional comments on causes and effects. There are many, also, that advertise wondrous medications that supposedly can cure the patients of their affliction.
The ones that offer us the statistics are grisly enough in the sheer numbers of deaths revealing pulmonary tuberculosis as a scourge endemic of the modern city:
Mortality in the Metropolis. – The weekly return continues to exhibit a satisfactory state of public health. The deaths, which were about 1,200 towards the end of last month, have fallen in the last week to 1,048 or 121 less than the average. The mortality from epidemics, with the exception of hooping cough, is little more than the average, and has fallen twenty-five per cent within the period of the month. The mortality caused by small-pox and measles is still unusually low; and that from scarlatina is now little more than the average. Diarrhoea has declined; and the deaths from holera are only 10, 9 of which as is shown below, occurred in one workhouse and two hospitals; three in one family. Scarlatina and typhus were each fatal to 40 persons, which is rather less than the average for the latter disease. Inflammation of the lungs and air passages, and pulmonary consumption, do not prevail fatally at the present time: the aggregate deaths in the week from these diseases were only 260, whereas the average is 329. [The Northern Star and National Trades' Journal Leeds, England. 597 (Saturday, March 31, 1849): 1]
As we learn from the passage above, the statistics presented should be understood as optimistic by comparison with a striking average number of metropolitan deaths per week, which prompted the conclusion made by the journalists of those times that this state of public health should be considered satisfactory. Another passage offering statistical mortality rates in London 11 years later does not reveal an improvement in these black numbers:
In great part of the week that ended on the 10th instant the air was exceedingly cold; it continued cold in a less degree till neat the end of last week, and the London returns exhibit a consequent increase in the mortality. The deaths, which had declined to 1,397, rose again to 1,563 in the week that ended last Saturday. In the ten years 1850-59 the average number of deaths in the weeks corresponding with last week corrected for increase of population, is 1,362. The deaths of last week were therefore in excess of the number by 201. By comparing the results of the last two weeks it appears that the deaths by bronchitis rose from 230 to 267; those by pneumonia from 114 to 140 those by asthma from 20 to 27. Phthisis, or pulmonary consumption, which carried off 143 persons in the previous week, was fatal last week to 171. ( Lloyd's Weekly Newspaper , London, England, Sunday, March 25, 1860; Issue 905, p.1)
As the passage eloquently claims, pulmonary consumption alone caused of death of 314 city residents of a metropolis with a population of over 2 million people in the 2 weeks analyzed.
When discussing the causes of the analyzed disease of the modern city, health officials, journalists, and other investigators invariably attributed it to the very bad sanitary conditions in which city dwellers lived:
A little further up the street there is a house consisting of two storys, and entering from a close one of the most wretched, rickety fabrics imaginable, filled with filth, dirt and smoke. The apartments, small miserable holes, are seven in number, and occupied by as many families. A few weeks ago, four of these families were afflicted with fever at the same time – in one four females were lying together, in another one girl, in a third, a mother and two children, in a fourth, a mother and two daughters, and in a fifth house, an old man in an advanced stage of pulmonary consumption. [The Newcastle Courant. Newcastle-upon-Tyne, England. 8814 (Friday, November 10, 1843): 1]
This description is concordant with similar depictions of mass attacks of tuberculosis related to poor urban residential conditions made by Dickens in the passages that I shall analyze below. These depictions are especially numerous in Sketches by Boz (1836) and Nicholas Nickleby (1839) also featuring Dickens’s sympathetic commentaries towards the sufferers. As it is well known, a definitive cure for the disease was not found until the early 1940s when streptomycin, the first antibiotic effective against tuberculosis was discovered.
Consumption and Sensibility
As Dickens places a strong emphasis on consumption in his represented spaces, tuberculosis (consumption) could not just be deemed an aspect of the larger economic phenomenon as it not infrequently blends with it, simply being the other name of consumption in the city. It was very common among the poor city inhabitants and one might argue that Dickensian punishment for excessive consumption befalling consumers such as Mr. Dorrit, Mr. Merdle, Mrs Clennam, Miss Havisham, etc is an attempt at achieving a wondrous equilibrium of victims of consumption (tuberculosis) among the poor and the rich in both senses of the phenomenon – consuming the city as in extreme consumption of commodities, etc and being consumed by it as in falling victim to consumption (tuberculosis). One may also argue that excessive economic consumption in Dickens’s urban representations is penalized by being transmogrified into a mental illness that doctors cannot diagnose and that has a lethal prognosis, thus restoring consumption equality. Unlike wealthy urban consumers, city inhabitants who suffered from consumption-as-disease could be diagnosed but not helped — a major difference from the extreme urban consumers, who are represented as suffering from the disease of commodity or business consumption, but the symptomology of this disease remains hidden to public scrutiny as illustrated in Mr. Merdle’s mysterious medical condition on Little Dorrit. Dickensian justice is exercised in secret.
Early works representing tuberculosis in the city, such as Sketches by Boz (1836) and The Old Curiosity Shop (1841) manifest an ambivalent view that sees tuberculosis both as an indiscriminate killer regardless of sex, age, or financial means and as a scavenging urban agent that has a predilection for the minimal consumers of the city – the very poor, who are consumed by the metropolis and to whom (consumption) acts as an allegory of the indifference of the modern city towards its residents. The city, which has accumulated the synergy of all its residents, consumes them in turn, dispensing with the most vulnerable ones. In other words, the city is seen as a monster fed by and feeding off its inhabitants. Later, more mature works such as Dombey and Son (1848) accentuate the spiritual character of tuberculosis, which is related to a perceived mythologizing of the disease (Sontag, AIDS and Its Metaphors, 1988), and which allegorizes innocence. Finally, in its antithetic representation synonymous with consumption and at the same time its negation, tuberculosis underscores the pathology of capitalism of the modern city as represented by Dickens.
Consumption as an Indifferent Killer
An example of tuberculosis as an indifferent killer appears in the following description from Sketches by Boz, which contains an early proto-modernist sensibility in the depiction of the consumptive curate whose love for religion and the spiritual is at variance with the demands of the metropolis on his body, so that religious asceticism is refuted by corporeal needs through the vehicle of tuberculosis:
One would have supposed that, by this time, the theme of universal admiration was lifted to the very pinnacle of popularity. No such thing. The curate began to cough; four fits of coughing one morning between the Litany and the Epistle, and five in the afternoon service. Here was a discovery—the curate was consumptive. How interestingly melancholy! If the young ladies were energetic before, their sympathy and solicitude now knew no bounds. Such a man as the curate—such a dear—such a perfect love—to be consumptive! It was too much. Anonymous presents of black-currant jam, and lozenges, elastic waistcoats, bosom friends, and warm stockings, poured in upon the curate until he was as completely fitted out with winter clothing, as if he were on the verge of an expedition to the North Pole: verbal bulletins of the state of his health were circulated throughout the parish half-a-dozen times a day; and the curate was in the very zenith of his popularity. [II, 10-11]
Urban consumption and its pathological form of tuberculosis is extended to all members of the metropolis, appearing even in the consumptive donkey as a beast of burden:
Covent-garden market, and the avenues leading to it, are thronged with carts of all sorts, sizes, and descriptions, from the heavy lumbering waggon, with its four stout horses, to the jingling costermonger’s cart, with its consumptive donkey. [I, 59]
When it comes to portraying tuberculosis with the minimal consumers of the metropolis, Dickens’s early modernist irony of a detached observer gives way to passing remarks of Victorian sympathy:
This eloquent address produces anything but the effect desired; the women rail in concert; the man hits about him in all directions, and is in the act of establishing an indisputable claim to gratuitous lodgings for the night, when the entrance of his wife, a wretched, worn-out woman, apparently in the last stage of consumption, whose face bears evident marks of recent ill-usage, and whose strength seems hardly equal to the burden—light enough, God knows!—of the thin, sickly child she carries in her arms, turns his cowardly rage in a safer direction.
‘Come home, dear,’ cries the miserable creature, in an imploring tone; ‘Do come home, there’s a good fellow, and go to bed.’ Go home yourself,’ rejoins the furious ruffian. (XXIII, 194)
The passage above portrays London’s inhabitants in naturalist terms contending for places of habitation, the weakest members consumed by tuberculosis. Dickens’s approach is scientific observing details of the ravages of the disease and the impact left by the husband (marks of recent ill-usage, in the last stage of consumption, natural protector), but at the same time humane, commiserating with the plight of the afflicted with tuberculosis (a wretched worn out woman, >miserable creature). The insensitive husband is called furious ruffian, thus subjective comments are made to the otherwise naturalist representation of contended city space.
Tuberculosis and Spirituality
Dickens’s depictions of tuberculosis range from the sarcastic and ironic (the curate) through the sympathetic (the poor woman from the passage above) to the deeply philosophical and spiritual as the following passage from Nicholas Nickleby (1839) will show:
There is a dread disease which so prepares its victim, as it were, for death; which so refines it of its grosser aspect, and throws around familiar looks unearthly indications of the coming change; a dread disease, in which the struggle between soul and body is so gradual, quiet, and solemn, and the result so sure, that day by day, and grain by grain, the mortal part wastes and withers away, so that the spirit grows light and sanguine with its lightening load, and, feeling immortality at hand, deems it but a new term of mortal life; a disease in which death and life are so strangely blended, that death takes the glow and hue of life, and life the gaunt and grisly form of death; a disease which medicine never cured, wealth never warded off, or poverty could boast exemption from; which sometimes moves in giant strides, and sometimes at a tardy sluggish pace, but, slow or quick, is ever sure and certain. [XLIX, ])
This passage shows that those afflicted by the disease can be seen as being cleansed of consumption in preparation for passing away. The concept expressed here shows a duality resulting from the dreaded onset of the medical condition and the solemn reinstatement of the spirit over the consumptive body. Tuberculosis as an extreme form of consumption (wasting) of the body prepares the spirit for another mortal term until it can be freed into a pure personification of innocence (Hristo Boev). The transformations of the body in its passage to death is seen as indicative of the fact that urban consumption in all its forms can be ultimately interpreted as conductive to death, the more extreme it is, the faster death sets in.
The Janus-faced Nature of Consumption
I continue my analysis by examining the consumptive space in A Christmas Carol (1843), revealing Dickens’s idea of urban consumption as instrumental in the onset of and subsequent recovery from supposed bone tuberculosis. This pattern appears in opposition of the city dweller Tiny Tim to the cold harshness of Ebenezer Scrooge, who represents, almost allegorically, unremitting, ruthless industrial consumption. Ironically, Scroog is portrayed initially as the very opposite of what the etymology of his name suggests (Ebenezer means "Stone of Help" in 1 Samuel 7:12-14 NRSV):
External heat and cold had little influence on Scrooge. No warmth could warm, no wintry weather chill him. No wind that blew was bitterer than he, no falling snow was more intent upon its purpose, no pelting rain less open to entreaty. Foul weather didn’t know where to have him. The heaviest rain, and snow, and hail, and sleet could boast of the advantage over him in one respect. They often ‘came down’ handsomely and Scrooge never did. 
Tiny Tim, Bob Cratchit’s little son, is ailing as a direct consequence of his father’s miserly wages from Ebenezer Scrooge, wages which permit very limited consumption. Malnourished and propping himself as he walks on crutches, he is visited by his father’s employer during the second ghostly tour of Christmas Present . Stephanie Papas, Live Science senior writer quotes a physician, Dr. Chesney, who attributes Tiny Tim’s condition to a combination of rickets and tuberculosis (1).
It is also to be understood from the text that Ebenezer Scrooge could help Tiny Tim (and thereby save his own soul) by means of establishing more evenly distributed consumption patterns including an increase of the wages of his clerk, Tiny Tim’s father, as well as rendering himself open to more charity in the spirit of Christmas traditions. Ebenezer’s reformation unlocks the true meaning of his name (stone of help), the return to a sensitivity of the human condition seen as a miraculous Christmas re-territorialization of humanity in industrial England, and suggests a recovery for Tiny Tim as his urban consumption increases.
Tuberculosis and Pathological Capitalism
In her analysis of Dombey and Son and tuberculosis Katherine Byrne also argues that with Dickens the social and moral consequences of consumer capitalism are pathological and manifest themselves in tuberculosis as “the disease of consumer society” (49). Dickens’s city dwellers can, therefore, be seen as more spiritually advanced if consuming less, thus being either closer to death and God respectively (e.g. Nell Trent, Paul Dombey, etc) resulting from sickness (tuberculosis) or closer to God, but away from death in the event of self-imposed abstention (corporeal consumption with Amy, Dora , Florence, etc), thus she sees “Paul’s tubercular decline as a triumph over society’s attempts to assimilate him into the capitalist world, and his father’s impatient desire to see him grow up” (53). Paul’s and Nell’s death scenes are among the most critically acclaimed and contested at the same time and they reveal tuberculosis as consuming youth, growth, and future promise, but also as “a spiritual disease traditionally considered an affliction of the pure, the innocent and the young”(Byrne, 54).
In Illness as Metaphor, and AIDS and Its Metaphors (1988) Sontag establishes a connection between tuberculosis as an illness of the lungs and, consequently, as an illness of the spirit. According to her, the respiratory activity of the lungs and the flesh break down to water and phlegm, thus turning into a spirit – the lungs belonging to the upper (superior) body parts, prioritizing the spiritual over the corporeal — unlike cancer, which attacks lower parts, and is consequently unromantic (22). She also argues that it is a disease related to poverty, and if not always related to the standard of living, sometimes connected to poverty of the spirit (e.g. Marguerite from La dame aux camélias (1848) by Dumas fils, or Paul Dombey from Dombey and Son, books released in the same year. Being an illness of the lungs, tuberculosis is commonly associated with dank and dirty cities, hence the physician’s advice from Nicholas Nickleby given to Smike to leave London at once.
The passages I have selected from Dickens’s works by no means exhaust all his depictions of the disease but they representat the emergence of a modern sensibility, one which views tuberculosis alternatively or simultaneously from the point of view of the investigating scientist and the fellow being; with Dickens, one is identical with the other.
Dickens, perhaps more than any other Victorian writer, provides depiction of tuberculosis as an integral part of city consumption – the other end on the measuring scale of urban consumption. The White Plague (tuberculosis) is certainly the sentence of most unfit consumers of the metropolis – malnourished or lacking the skills for an adept urban consumer (Paul Dombey) languishing away. Dickens’s depictions of the disease vary greatly – from vaguely suggesting its presence by referring to some of its symptoms as a wasting disease (Paul Dombey) to directly naming it as a common urban condition – the consumptive curate, or the worn-out woman in the last stage of consumption, exhausted by the disease and family, etc. He extends onsumption as a disease to domestic animals, too, especially animals of burden as they are also consumed by the city by the way their owners consume them.
Tuberculosis as a form of consumption with Dickens remains largely in the tradition of romantic poetry (the body consumed with passion within, the spirit longing to break free) when referring to a main character (city dweller) like Smike or Paul Dombey. In the case of Nell Trent and Paul Dombey, it is also represents their yearning for innocence and their refusal to be corrupted by city consumption. As Sontag claims, tuberculosis was considered a part of physical appearance (reduced energy and increased sensitivity) (54), and these consumptive looks became a mainstream lifestyle throughout the nineteenth century that excluded eating with appetite and sporting a suffering look (31). That way the city dwellers could always look more spiritual (melancholic and artistic), hence more in touch with their religious practices. The trick, then, was to have that look without having the disease, and that in turn required certain table manners with demonstrated abstention from excessive food consumption, which was to set up the image and example of modern table manners and physical looks. The Victorians passed on to the modernist period that followed the ideal of slim feminine figures and pale faces were.
More modernist — less romantic and overtly ironic — representations of the disease can be seen, perhaps surprisingly, in earlier works such as Sketches by Boz (1836), The Old Curiosity Shop (1841), where Dickens remains truer to life having employed a journalist approach to portraying London and does not fail to capture the hidden duality of tuberculosis in its relationship to consumption, thus the haggard pale faces of the anonymous consumptive city dwellers (mainly women) stare back at the reader with their bulging eyes from deep sockets creating an anxious sensation of palpable suffering or, alternatively, a representative of the clergy could be comically portrayed as being afflicted with the disease (the consumptive curator from Sketches by Boz ), giving prevalence to his consumptive needs in the metropolis related to the inevitable mundane daily practices of the city dweller.
- Good Intentions, Unexpected Consequences: Thames Pollution of and The Great Stink of 1858
- Health and Hygiene in the Nineteenth Century
- Sanitation and Disease in Rich and Poor
Dickens, Charles. A Christmas Carol (1843), the Project Gutenberg, #19337, 2006.
Dickens, Charles. Dombey and Son (1848). Jakarta: The Econarch Institute, 2009.
Dickens, Charles. Little Dorrit (1857). Jakarta: The Econarch Institute, 2009.
Dickens, Charles. Nicholas Nickleby (1839), New York: Collegebookshelf.net, 2004.
Dickens, Charles. Sketches by Boz (1836). Jakarta: The Econarch Institute, 2009.
Byrne, Katherine. Tuberculosis and the Victorian Literary Imagination. New York: Cambridge University Press, 2011.
Boev, Hristo. "De-teritorrialization and Re-territorialization in Little Nell’s Death-bed Scene — Deconstructing Little Nell. Victorian Web.
Pappas, Stephanie. Dickensian Diagnosis: Tiny Tim’s Symptoms Decoded." LiveScience. 2012. http://www.livescience.com/18802-dickens-tiny-tim-diagnosis.html. Web.
Robinson Alan. Imagining London, 1770-1900. New York: Palgrave Macmillan, 2004.
Sontag, Susan. Boala ca metaforă sida şi metaforele ei.  Editura Dacia Cluj-Napoca, 1995.
Lloyd's Weekly Newspaper , London, England 905 (Sunday, March 25, 1860): 1.
The Newcastle Courant. Newcastle-upon-Tyne, England. Issue 8814 (Friday, November 10, 1843): 1.
The Northern Star and National Trades' Journal. Leeds, England. 597 (Saturday, March 31, 1849): 1.
Last modified 28 October 2012