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Byrne’s study fills a surprising gap in the scholarship on culture and disease in the Victorian period. Consumption is so prevalent in the literature, it seems that there should be a vast body of work on the disease in British literature, but there has been no up-to-date, book-length study on nineteenth-century literature after the Romantic period—until now. Byrne at last gives representations of this illness the sustained attention they deserve in a well-written and thoughtful account extending from Charles Dickens to Henry James.

Byrne shows the relationship between medical writings and artistic works to be complex and mutually informing. Medical writers, she demonstrates, were concerned with advancing the latest medical knowledge about the disease, but also with reinforcing their own authority as scientists and sometimes as individual vendors of medical services. Their writings used, created, and reinforced certain cultural beliefs about those vulnerable to the disease: those possessing a particular kind of physiognomy (usually ethereal), engaging in certain kinds of behaviors (usually intemperate), or perceived to have precocious mental, moral, or spiritual qualities. As we see in the chapters devoted to literary and artistic works, however, these qualities varied considerably depending on the class and gender attributes of the patient involved.

Byrne is particularly insightful about the gendered attributes of consumption. Medical writers suggested that women brought on consumption by their own vain or intemperate behaviors, such as tight lacing or insisting on going out décolleté at night. Whereas the elite manifestation of the disease emerged from within the individual body, revealing the luxurious over-indulgence and decadence associated with the aristocracy, as a disease of poverty it was thought to be more aligned with infectiousness. And yet, at the same time, the consumptive middle-class woman was idealized both aesthetically and morally. Byrne engages the scholarship on anorexia and invalidism, to show not only how these categories and behaviors controlled women, but also the kinds of control that could be exerted in turn by the consumptive. Reading through Mary Ward’s Eleanor (1900), she shows the excessive passion associated with the tubercular middle-class woman, as well as the ways in which her disease both licensed her behavior and cleansed it of the taint of impropriety. In her study of the aesthetics associated with the tubercular female, Byrne examines the Pre-Raphaelite Brotherhood’s and especially Dante Gabriel Rossetti’s promotion of that aesthetic in the person of Elizabeth Siddal. She reads the artists’ representations of their real-life invalid model against George du Maurier’s literary treatment of Trilby’s decline. Transitioning toward the less-studied topic of consumptive masculinity, Byrne’s reading of Dracula as a vector of tubercular contagion is persuasive and new. Finally, in a discussion of James’s Portrait of a Lady (1880-81), Byrne focuses on Ralph’s effeminization by his advanced pulmonary disease: her reading of the fin-de-siècle consumptive man as both vampirically enabled and socially neutered by his relationship with capitalism is provocative and insightful. A satisfying epilogue takes the reader into the twentieth century, and Byrne, at last free from the self-imposed limit to English language publications that she declares in the Introduction, offers a quick reading of Thomas Mann’s Magic Mountain (1924) in the broader context of the sanatorium novel subgenre that resonates intriguingly with her earlier analysis of masculinity.

The weaknesses in the book—and all books have them—are not significant, in the main. One might wish Byrne would branch out a bit earlier into the literatures and medical writings of Germany or France, but understandably, she chooses some arbitrary limits to keep a vast archive manageable. The argument is generally persuasive and even the weakest of the chapters, focusing on Dombey and Son (1846-48) and North and South (1854-55), advances an interesting and mostly strong reading. Here, Byrne traces the rise of tubercular consumption as a metaphor for that other kind of consumption associated with a capitalist economy. The reading of Dickens is persuasive and insightful, and those interested in childhood studies will find the reading of little Paul as the stereoptypical Victorian child-sufferer fruitful. The reading of Elizabeth Gaskell persuasively traces the tropes and themes associated with consumption in the representation of Bessy Higden, and the classed specificities associated therewith. Byrne counterposes the treatment of the victimized industrial worker to Dickens’s delineation of the child sacrificed to the same economic system. The argument of part of the chapter is significantly undermined, however, by Byrne’s failure to address the medically specific nature of Bessie’s illness. Though Byrne does note that “Bessy (and presumably Gaskell) believe that her disease is caused by the inhalation of dust and fibre,” rather than infection (63), she seems also to believe that they considered it consumption, and Margaret does explain it that way to her housekeeper. But in fact, Gaskell was very much aware of the depredations of byssinosis or “brown lung,” which was well-studied as an industrial disease at the time (and remains a major health problem in many countries today). She is as specific and deliberate in her description of it as she is about other problems of the industrial working class that she wished to publicize. Brown lung was widely discussed in Manchester, and its etiology would eliminate many of the moral and medical assumptions associated with the diagnosis of infectious tuberculosis. This failing does not invalidate Byrne’s argument about the use of consumptive tropes that Gaskell brings into play to describe it—the disease was even sometimes termed cotton- or spinners’ phthisis, and a popular understanding of the disease might well be framed within more widely understood notions of consumption—but this fact needs to be fully and explicitly recognized and contextualized. The lack of that context might mislead the uninformed reader as to the nature of Bessy’s disease, which was important to Gaskell as someone who took an interest in the industrial diseases of the region.

On the editorial side, the reader finds some off-putting aspects. The book is not best served by a couple of the chapter titles that imply attention to a single author or work; in fact, each chapter casts a pleasingly broad net, addressing at least two works at length and sometimes more. A reader in a hurry might thus miss much of interest by relying on a scan of chapter titles. Most frustrating to the scholarly reader is that the book is severely under-indexed. The two pages, total, of entries selected according to no apparent standard is inadequate even to account for proper names in the text.

These minor caveats do not outweigh the pleasures and general accuracy of the book, its ingenious readings and accessible yet rich discussion of the meanings of the white plague as deployed in the literature and art of the Victorian era. Moreover, Byrne’s book fills an important and overlooked area and meets the responsibility of such a task well; as such, it will be of wide interest to those interested in the cultural history of disease, gender and the Victorian novel and modern novel, and I expect that it will be frequently sourced.