Throughout the 165 years since the publication of Charles Dickens's Bleak House, readers and critics have attempted to diagnose the unnamed disease at the center of the novel. While smallpox is the most popular diagnosis, others have argued for typhus and erysipelas. Drawing on close analysis of the novel as well as medical history, this article contends that Dickens invites readers to think of two specific diseases—typhus and smallpox—while refusing to settle on either as the “answer” in order to hold open a narrative space for a theory of social pathology that encompasses the structural and individuated, the localized and the mobile, the macroscopic and microscopic at once. Recognizing that etiology is political, Dickens uses this diagnostic doubleness to produce a holistic indictment of a biopolitical liberal state that itself enacts power dualistically—that is, via strategic oscillation between disciplinary intervention, “making live,” and selective inaction, “letting die.” In doing so, Dickens also affirms the unique value of fiction to provide insight into our social world.

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