Kids who love books know the world is a perilous place. Any day a tornado may carry away your house; your little brother may be kidnapped by a disembodied alien brain; a rhinoceros may eat your parents. But when it comes to more ordinary dangers, kids who read the classics might be left confused: Is an ordinary fever likely to kill you? How many days home from school does it take before someone sends you to the seaside to recover?
The illnesses of fictional characters may be the first medical education a kid gets. And that education can be a little out of date. In Peter and Wendy, the Darling children are looked after by a nurse named Nana: “She believed to her last day in old-fashioned remedies like rhubarb leaf, and made sounds of contempt over all this new-fangled talk about germs, and so on,” J. M. Barrie writes. Of course Nana is a large dog, not a human, but we’re told she’s quite competent.
If the characters in our favorite books did have access to modern medicine, though, some of their stories would barely be worth reading.
The Velveteen Rabbit
If you’re somehow not familiar with this 1922 book by Margery Williams, think Pinocchio with less misbehavior and more heartbreak. It’s told from the perspective of a stuffed rabbit that’s given to a boy for Christmas. The boy comes to love the rabbit and carries it around until its fur falls off. Then the boy gets scarlet fever.
His face grew very flushed, and he talked in his sleep, and his little body was so hot that it burned the Rabbit when he held him close. Strange people came and went in the nursery, and a light burned all night and through it all the little Velveteen Rabbit lay there, hidden from sight under the bedclothes, and he never stirred, for he was afraid that if they found him some one might take him away, and he knew that the Boy needed him.
Finally the boy recovers. But the faithful rabbit learns that instead of traveling with him to the seaside to recover, it’s going to be burned. (“Why, it’s a mass of scarlet fever germs!” declares the doctor.) The night before its demise, though, a fairy rescues the toy by turning it into a real rabbit and taking it to the woods to hop and play with the other rabbits.
Scarlet fever is still around. It’s an infection by the same Streptococcus bacteria that give us strep throat. But these days it’s uncommon, thanks to antibiotics. A quick course of them will knock the infection right out, and no one has to burn their toys.
You may also remember scarlet fever from Little Women—a complication from the disease seems to be what eventually kills Beth. And in the Little House on the Prairie books, we’re told scarlet fever is what makes Laura’s older sister, Mary, go blind. (But a 2013 study in Pediatrics found that the real-life Mary Ingalls actually went blind from viral meningoencephalitis. Laura likely chose to simplify the story when writing her books.)
A Little Princess
Frances Hodgson Burnett’s 1905 book follows a young girl who’s sent to boarding school while her father goes to India and pursues “diamond mines.” Then the girl learns that her father has perished: “Died of jungle fever and business troubles combined,” a messenger reports. This leaves her in the care of the mean headmistress, who forces her to work as a servant. (Things work out in the end.)
Jungle fever was another name for malaria in India, though it seems to have also been a catch-all term for tropical diseases. In the 19th century when our heroine’s father was hunting diamonds, malaria could be treated with quinine—though it wasn’t until the very end of the century that people realized mosquitoes were the ones spreading it.
Today, people traveling to parts of the world with malaria can take preventive drugs. But malaria is still a major killer of people who don’t have the resources to fight it. The World Health Organization estimated 660,000 deaths in 2010, mostly in young children.
In other plot lines, malaria is also a key player in the story of the CDC. The government agency came out of an office called Malaria Control in War Areas, which was established to fight malaria in the southern United States. The disease no longer exists in the US, so stateside fortune hunters can cross it off their list of concerns.
A Christmas Carol
Although he’s a minor character in Charles Dickens’s 1843 novella, Tiny Tim is crucial to its plot.
The boy is the son of Scrooge’s underpaid employee Bob Cratchit, and he’s not in good health: “Alas for Tiny Tim, he bore a little crutch, and had his limbs supported by an iron frame!” The Ghost of Christmas Yet to Come tells Scrooge that the boy will die because his family can’t afford to care for him on Cratchit’s meager salary. After Scrooge’s change of heart, he gives Bob Cratchit a raise (along with a Christmas turkey). The book closes with Tiny Tim’s cheer: “God bless us, every one!”
What exactly is wrong with Tim? It’s a question that has plagued academics for decades. Russell Chesney, the author of a 2012 study in JAMA Pediatrics, writes that Tim’s proposed diagnoses “include tuberculosis (TB), rickets, malnutrition, cerebral palsy, spinal dysraphism, and renal tubular acidosis.” Chesney adds a new suggestion to that list. In the first half of the 19th century, he writes, “Sixty percent of children in London had rickets, and nearly 50% had signs of TB. Tiny Tim likely had a combination of both diseases.”
London was filthy and overcrowded at the time; soot filled the sky and blocked sunlight. Combined with a poor diet, this could lead to vitamin D deficiency, which causes rickets in children—a disease that softens bones and can bow the legs. Chesney points out that once Dickens stopped being such a jerk to the Cratchits, they could probably afford better food and “possibly cod liver oil” to treat their son’s vitamin deficiency.
TB, a bacterial infection that attacks the lungs, can be treated today with antibiotics. But in 2010 it still killed around 1.5 million people, mostly in developing countries.
The Secret Garden
Frances Hodgson Burnett may have relied more than most authors on diseases as plot drivers. After writing A Little Princess, she published The Secret Garden in 1911. Mary, the main character, would never have ended up at her uncle’s house (the one with the garden) if her whole family hadn’t been wiped out by cholera in India.
Today the WHO describes cholera, a bacterial infection causing diarrhea, as “easily treatable.” Yet the disease still kills upwards of 100,000 people a year, mostly in areas without clean water.
Even if Mary had found another way to her uncle’s hidden garden, the plot would have foundered without her meeting her sickly cousin Colin. He suffers from a vague spinal problem, which Mary discovers when she finds him hidden away in the house:
“I am like this always, ill and having to lie down. My father won’t let people talk me over either. The servants are not allowed to speak about me. If I live I may be a hunchback, but I shan’t live.”
It turns out that Colin’s real problem is his father hates him, since Colin’s mother died in childbirth. A little fresh air fixes Colin right up. We don’t know exactly what killed his mother, but access to modern doctors during her delivery might have kept her safe—and if not, at least the whole family would have benefited from some 21st-century therapy.
Image: an illustration by M. B. Kork from The Secret Garden