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Oliver Twist, as everybody knows, is Dickens' novel about an orphaned boy who starts life in a workhouse and after trials on the streets of London in Fagin's “gang”, is eventually adopted by a middle class gentleman who has liberal and gentle ideas of parenthood. Roy Meadow, in the ABC of Child Abuse, defines child abuse as “treatment which is unacceptable in a given culture at a given time”.1 Clearly, what might have been acceptable in Victorian England was not acceptable to Dickens, who expresses his disapproval of much that he described. In terms of standards in Britain in the year 2001, many of the childcare practices described inOliver Twist constitute child abuse.
Throughout the book, Dickens gives observations on childcare and parenting, both by society and by natural and substitute parents. He observes and describes many categories of child abuse, together with risk factors which modern research has identified in abusing parents.
Institutional abuse is the first scene, as Oliver's mother dies in childbirth. She is attended by a drunken “midwife” and an uncaring doctor. The infant is turned over to a baby farm and later the workhouse itself. The children here are neglected, barely fed or clothed. Oliver Twist's ninth birthday found him “a pale thin child, somewhat diminutive in stature, and decidedly small in circumference” (chapter 2).
They were also emotionally abused, being deprived of all human adult love or affection and constantly criticised. Up to his ninth birthday, Oliver was said to have come “from the wretched home where one kind word or look had never lighted the gloom of his infant years” (chapter 2), “a naughty orphan which nobody can't love” (chapter 2).
While locked in a small dark room “after asking for more”, he could hear the other boys being instructed to be “guarded from the sins and vices of Oliver Twist who was led by wickedness of the Devil” (chapter 3).
Physical abuse was also part of children's lives: “the fist had too often been impressed on his body not to be deeply impressed upon his recollection” (chapter 2); “would flog him to death in a playful mood, some day after dinner, or would knock his brains out with an iron bar” (chapter 2).
The sequelae of abuse, including absconding, passivity, “stupidity”, depression, poor self image, and a vulnerability to corruption by anyone who seems to show them some love or attention, are well illustrated in this novel.
Sexual abuse was only vaguely referred to in descriptions of Nancy and Betsy, the prostitutes. It is suggested that they were led into prostitution, possibly via alcohol, by Fagin at an early age. “Nancy, indeed was not exempt from a failing which was very common among Fagin's female pupils, and in which, in their tenderer years, they were rather encouraged than checked” (chapter 24).
Even more remarkable than the descriptions of abuse, was Dickens' identification of all the parental “at risk” factors which have recently been defined by research. These include alcohol abuse, domestic violence, mental health problems, and animal abuse. His incidents of domestic violence revealed two sides, the battered “wife” and the battered husband.
Bill Sykes was not married to Nancy, but was her partner and pimp. Her ambivalence towards him was well illustrated when she tried to defend Oliver against him, but not at the risk of harm to Bill himself. She was fearful of him, but could not break away. He assaulted her, “she pointed hastily to some livid bruises on her neck and arms” (chapter 20), and finally, in a brutal blind rage, killed her, “the murderer, staggering backward to the wall and shutting out the sight with his hand, seized a heavy club and struck her down” (chapter 47).
In contrast, Mr Bumble, the beadle, after weighing the apparent advantages to himself, married Mrs Coney, the superintendent of the female workhouse. After just two months, he realised that she was the greater bully. “The expert lady, clasping him tightly around the throat with one hand, inflicted a shower of blows ...” (chapter 37).
Substance abuse, in the form of alcohol abuse, features throughout the novel, suggesting the problem was widespread. The midwife attending Oliver's birth “was rendered rather misty by an unwanted allowance of beer” (chapter 1) and Mrs Mann, the baby farm superintendent, plied the beadle with gin with “a very little cold water and a lump of sugar” to give him “that temporary blandness which gin-and-water awakens in some bosoms” (chapter 2). The whole district where Fagin lived was pervaded by alcohol. It had “little knots of houses, where drunken men and women were positively wallowing in the filth” (chapter 8), and Fagin himself plied the young boys in his gang with alcohol. Bill Sykes, like many violent men, drank alcohol at almost every appearance. He seldom had just one drink, and on the evening before the Chertsey robbery drank “all the beer at a draft ... and then disposed of a couple of glasses of spirits and water” (chapter 26).
Bill Sykes, while not obviously mentally ill, is of a violent and paranoid personality, who also abuses his dog. The passivity of the dog after abuse, mirrors the behaviour of some abused children. Bill told him to lie down and accompanies “the command with a kick, which sent the animal to the other end of the room. He appeared well used to it, however, for he coiled himself up in a corner very quietly, without uttering a sound” (chapter 13).
Child abuse and neglect were recognised when Kempe wrote his articles about baby battering in the 1960s and 1970s. However, it has obviously been an issue for centuries and Dickens certainly described all the categories of abuse, together with many predisposing features and many sequelae.
I first came to Barnet in 1955, having just completed my National Service. I became registrar to George Newns at Barnet Hospital and was eventually appointed consultant paediatrician locally. Everyone in Barnet “knew” that Oliver Twist was born at the Wellhouse, the poor law institution that opened in 1835. This was a response to the “new” Poor Law Act of which Dickens was so critical.
When in 1970 the medical centre here opened, I was determined to establish an annual lecture with a social and community emphasis, and what better name than the Oliver Twist Lecture. I then re-read Dickens' account and found that Oliver could not have been born at Barnet. Dickens probably had in mind a very similar institution near Lowestoft. When Oliver ran away from the undertaker to whom he was apprenticed, he saw a sign which read “London 100 miles”. He did indeed pass through Barnet and it was here that the Artful Dodger recruited him, alias Jack Dawns. We have had an Oliver Twist lecture ever since with many distinguished lecturers (see table 1-1).
Dr Ken Norton, consultant paediatrician at Barnet General Hospital in 1972, inaugurated an annual lecture at his hospital—the “Oliver Twist Lecture”.