Armstrong, J. Facts, Observations, and Practical Illustrations, Relative to Puerperal Fever, Scarlet Fever, Pulmonary Consumption, and Measles. O. D. Cooke & Sons, 1823. PDF retrieved from the Library of Congress, https://www.loc.gov/item/07014703/
Though medicine was making advancements in the early 1800s, it was not nearly advanced enough to save the large number of citizens who were perishing from tuberculosis. It is likely that Tiny Tim Cratchit in A Christmas Carol was one of the many victims of this illness. This Library of Congress primary source covers many communicable diseases, including tuberculosis (called “pulmonary consumption” in the source) and will help students understand the symptoms suffered by patients at the time. The discussion of Tiny Tim’s illness factors into how Scrooge eventually understands the error of his ways and makes a life change.
This medical book from 1823 was written by Dr. John Armstrong. The topic is infectious disease—specifically, puerperal fever, scarlet fever, pulmonary consumption, and measles. The pathology of each disease is addressed, and diagrams are included.
- Tuberculosis was also known by the name “consumption” before new discoveries were made about its connection to tubercles.
- Tuberculosis is a very old disease, dating back to around 17,000 years ago.
- It is unknown whether humans originally got consumption from animals or vice versa.
- The close quarters, wet weather, and poor air quality of London made it likely that tuberculosis was rampant there during the 1800s.
- Deaths due to tuberculosis were at their height in England during the 1800s.
While there are 430 pages in this book, our focus questions and subsequent connections are based on six specific pages:
- How does Charles Dickens use the character of Tiny Tim in A Christmas Carol to reflect the social and health challenges of nineteenth-century London, particularly in relation to the prevalence of tuberculosis and its impact on poor people?
- How can a clinical understanding of tuberculosis aid in identifying the illness that afflicted Tiny Tim?
Common Core State Standards
RI.9-10.1: Cite strong and thorough textual evidence to support analysis of what the text says explicitly as well as inferences drawn from the text.
- Students can cite textual evidence from the Library of Congress primary source supporting specific symptoms of consumption. In turn, students should be able to pull Tiny Tim’s symptoms from A Christmas Carol and make a comparison between the two.
RL.9-10.2: Determine a theme or central idea of a text and analyze in detail its development; provide an objective summary of the text.
- The primary focus for this artifact is to explore the theme. Students should be able to analyze how Scrooge's selfishness is reflected in his miserly treatment of Bob Cratchit. Additionally, students should recognize that when Scrooge learns of Tiny Tim's illness, it sparks a profound change in his heart.
W.9-10.1: Write arguments to support claims in an analysis of substantive topics or texts, using valid reasoning and relevant and sufficient evidence.
- Students should present a well-supported argument either in favor of or against the diagnosis of tuberculosis for Tiny Tim. Evidence should be drawn from both the provided primary source document from the Library of Congress and A Christmas Carol to substantiate the chosen position.
- Begin by having students look at the symptoms of traditional pulmonary tuberculosis as described on images 203–206 of the Library of Congress primary source. Utilize this time to have students look up words they may be unfamiliar with, such as expectoration and pyrexia. This class assignment could be done in table groups and the results shared with everyone. In turn, have the class come up with a common definition of tuberculosis that includes symptoms.
- As students become familiar with the symptoms of pulmonary tuberculosis according to the Library of Congress primary source, have them make a list of the symptoms as a class to be compiled on the whiteboard.
- Direct students to then gather evidence from A Christmas Carol of the symptoms that Tiny Tim Cratchit experienced. Have students note each symptom and the page number where they find their evidence.
- Using a Venn diagram, have students compare the symptoms of tuberculosis from the Library of Congress primary source and A Christmas Carol. As a culminating activity, have students write a two-paragraph response providing evidence to support their claim that either enough evidence exists to defend a diagnosis of tuberculosis for Tiny Tim or not enough evidence exists to defend this diagnosis and therefore he must suffer from another ailment such as rickets.
- A further activity would be to look at the text in images 247–248 of the Library of Congress primary source, which address the living conditions of patients. Have students analyze how the disease is more likely to fester in closely populated areas such as London, as opposed to in the countryside. Students can then apply this knowledge by considering the possible impact on Tiny Tim.
Challenges could arise based on concerns about the validity of medical practices from the 1820s. These practices, many of which are antiquated, could be seen as a relic of the past. This is a valuable study because it allows students to see how much medicine has progressed and how treatments and disease names have changed over the centuries.
- One alternative to this resource would be this 1920 pamphlet about how much care children needed to take in order to avoid contracting tuberculosis.
- Another interesting aspect of the tuberculosis fight is addressed in this book printed in Philadelphia in 1841. The title, “Consumption Curable,” implies that the ailment that might have plagued poor Tiny Tim is completely curable. Have students review this book to see what evidence they can find of a cure.
- The treatment of “consumption” in the 1800s was much different from what is done with cases of tuberculosis found in the United States today. This Library of Congress source gives a nice description of what was done to treat patients. Pay special attention to images 88, 89, 91, and 190 as these are directly related to consumption treatments.
- This additional Library of Congress resource includes statistics on birth and death rates from the United Kingdom. In particular, it talks about what were termed “zymotic diseases” (those that were highly communicable). Consumption is listed, and it would be helpful for students to see how many people were dying from this illness at that time.
- This archive from the Dickens Society provides additional information on the background not only of A Christmas Carol but also about Dickens and some historical references for the time period.