Children’s literature provides a striking marker for the enormous change brought about in everyday life experience by antibiotics and other medical advances of the twentieth century. A quick glance at classic — and still popular — children’s books written between the mid nineteenth and early twentieth centuries shows many novels in which a character suffers from a chronic illness. In fact, one could quite safely venture that few children’s books of the domestic fiction genre in the period do not feature illness as at least background subject matter. When Heidi is forced to stay in the city she becomes ill, and her friend Clara who lives there suffers from a debilitating illness and cannot walk; both girls are healed by the healthy natural environment of Heidi’s mountain home (Joanna Spyri, Heidi, 1881). Again, in The Secret Garden (F H Burnett, 1911) life in the country proves restorative for sallow, petulant Mary. Her young cousin Colin, however, is a serious invalid who cannot walk, and for most of his life has lain in bed screaming in pain and rage. The garden, and the friendship of other children, restores Colin’s health as well; indeed, there is a strong Romantic strain in early twentieth century fiction for children in which the healing power of Nature is shown to be far more effective than the ministrations of the doctors. Nature’s healing operates independently of the conscious will of the children and most of the adults, though wise peasant characters in both books urge the children to get fresh air and exercise. Many fictional children are less lucky; one of the four sisters in Little Women (L M Alcott, 1868), Beth, is stricken by scarlet fever, becomes an invalid and dies. While childhood illness plays a less dominant role in Anne of Green Gables (L M Montgomery, 1908), Anne’s competent intervention is needed when the baby brother of her friend Diana is dangerously stricken with croup, and she saves the baby’s life. Even in boys’ books, which are traditionally concerned with adventure and action rather than the domestic scene, chronic illness may be a significant part of the background. Huck Finn becomes fascinated with the artistic and poetic mementoes left behind by Emmeline Grangerford, whose short life seemed entirely focused on illness and suffering. In his common-sense reactions to the excesses of the languishing Emmeline, however, Huck shows a clear preference for life and health, and Twain’s treatment of the sickly child is comic rather than Romantic (The Adventures of Huckleberry Finn, 1884).
Two of the most famous and harrowing scenes in Dickens treat the death of children — Little Nell in The Old Curiosity Shop (1841) and Paul Dombey in Dombey and Son (1848) — who have been delicate and sickly through much of the story. Crucial episodes of Bleak House (1853), too, involve the illness of children — from cholera and smallpox, which not only cause their own suffering and death but are transmitted to other characters, and throughout the whole social spectrum. Wealth and social position are no protection, Dickens shows, against illnesses for which there is no known treatment, and the callous indifference of the privileged towards the diseases of the poor is exposed and punished when those diseases pass from the poor to the rich. The common figure of the young invalid in Victorian and early presence twentieth century fiction should not be seen as morbid sentimentality — or not simply as that. A cursory glance at child mortality rates and the statistics of infectious diseases, before antibiotics and the drugs which wiped out such scourges as TB, smallpox and cholera, reveals that fiction, including children’s books, depicting the chronic illness and/or death of children in this time period does reflect prevailing social conditions. Characters like Esther, the narrator of Bleak House, show heroic compassion when they voluntarily subject themselves to disease by nursing the ill at home — a choice made less arbitrary by the limited and often unsavoury options available in public health care.
In children’s fiction in English since the mid twentieth century, however, we simply do not find these sickly child characters. Children in many modern books injure themselves, go to hospitals and die in accidents or war, but they don’t spend months or years in bed suffering from chronic illness. It is remarkable how a major subject area in writing for children so quickly disappeared from view, thanks to the changing conditions of public health and everyday family life. Of course, cancer remains a threat; Canadian author Monica Hughes’ fine young adult novel Hunter in the Dark (1982) shows a teenaged boy bravely coming to terms with the uncertainty of successful treatment of his leukemia, and accepting and appreciating his experience of the world as “a journey through life to death,” whenever that death may come. The illness or death of parents from cancer or other causes is not an unusual element in recent children’s books, for example in Jean Little’s Momma’s Going to Buy You a Mocking Bird (1984) and Joan Givner’s Ellen Fremadon series (2004 and following), or William Mayne’s A Game of Dark (1971), a powerful study of the anger and bitterness engendered in a family by the father’s chronic illness. When a young person is the principal sufferer, however, the problem usually comes from a disability or accident rather than chronic illness. A partial exception to this generalization, in recent years, is AIDS, as in The Heaven Shop (2004) where Canadian novelist Deborah Ellis writes of the effect of AIDS on a group of children in Malawi.
While fiction for older children reflects current social conditions and concerns, and thus has changed a lot over the past century or so in its treatment of the subject of health and chronic illness, picture books are generally less tied to such specific social contexts. Interestingly, several of the (relatively few) picture books which depict illness are perennial favourites written decades ago, such as the Bemelmens’ Madeleine (1939), and H A Rey’s Curious George Goes to the Hospital (1966). In both these books, and many of the other picture books about illness, the focus is on reassuring the child reader about a visit to the doctor or a stay in the hospital. They provide as much information as a young child can handle, set in the context of solving a problem and ending pain and discomfort through the ministrations of competent, if unfamiliar and perhaps somewhat scary-looking, adults. Humour is used, of course, as well as a guaranteed happy outcome, and often the characters are animals rather than people, although they are treated as human characters and visit the doctor rather than the vet! While there are picture books dealing with the subject of death — that of an elderly relative or a pet, illness in picture books is usually, and understandably, of the milder variety — getting over a cold, having an appendix out.
In Madeleine the scare of waking in the night with a bad appendix turns into a triumph, as all the other little girls visiting Madeleine in hospital view the presents she’s received, the charms of the hospital bed which goes up and down with a crank, and — particularly — the impressive scar on her tummy, and decide that they need appendectomies too. The patient here has been empowered with a vengeance! William Steig in Doctor De Soto (1982) creates an amusing reversal of roles as the normally intimidating figure of the dentist is in this case a mouse who is afraid of his patient, a fox who ungratefully plans to eat his dentist once the toothache is dealt with. Many of the series books include one about a visit to the doctor and/or hospital: Curious George, the monkey, creates his usual hilarious havoc in the unusually formal setting of a hospital where he is treated after swallowing a piece of his jigsaw puzzle; when Franklin the turtle cracks his shell, his hospital visit provides the occasion for reassuring explanations of the masks worn by the staff, the process of being x-rayed and so forth (Paulette Bougeois and Brenda Clark, Franklin Goes to the Hospital, 2000). While the potentially frightening topic of illness or injury is often distanced in picture books through the use of animal characters or cartoon-like drawing, more realistic illustrations can have great impact. In its appealing depiction of her own family, Vera Rosenberry’s When Vera Was Sick (1998) is one of the most attractive picture books I’ve seen recently; suffering from chicken pox, young Vera is bored, lonely and itchy, until her family offers comfort and support. In virtually all of these picture books, the capable and reassuring authority of parents and medical professionals is the source — the sole source — of help, information and a solution to the health problem experienced by the child figure. The help and information are not, however, given in an authoritarian way, but rather in the spirit of encouraging the child and enabling her to understand better what is happening.
Even in non-fiction picture books the subject of health — particularly in the sense of dealing with illness — seems to be of relatively low priority these days. Looking through the relevant non-fiction areas in the children’s sections of good bookstores in several cities, I typically could find only one or two books on the subject of health (taking good care of your body, healthy lifestyle) for twenty or thirty books on other lifestyle and psychological topics (hairstyles, dealing with bullies, et cetera). Clearly, picture books, like fiction for older children, reflect some of the confidence in medical help and the security we feel in regard to our own health, at least as young people, which are the great gift of modern medicine. Whatever qualms we may, rightly, have about pharmaceutical marketing practices and over-medication, overuse of screening and some of the other concerns raised elsewhere in this issue of Humanist in Canada, this comparison between children’s books of the relatively recent past and contemporary children’s reading is a vivid reminder of how our world and our concerns have changed. The spectre of the bedridden child, suffering patiently or furiously for months on end with little hope of recovery, while certainly not altogether banished from real life, is no longer a pervasive character of children’s fiction. Lest we should begin to feel complacent, however, we need only open one of the recent books about the AIDS crisis in Africa and its effect upon children. The problems are far from solved, but as it has done in the past, good children’s fiction continues to use story and imagined characters to enlarge the understanding and empathy of young readers towards the problems of their own world.
Gwyneth Evans teaches English and Liberal Studies, and reviews children’s books for Quill and Quire.