Neurological speech deficits as plot devices in novels

Stroke is a leading cause of death worldwide and a common cause of disability in adults in developed countries.1 Most strokes are not fatal and, in contrast to coronary artery disease and cancer, the major burden of stroke is chronic disability rather than death.2 It is unsurprising, therefore, that characters with stroke appear frequently in literature, although sometimes the diagnosis is wrong. In George Eliot's Silas Marner, for example, the title character is thought to suffer ‘strokes’ whereas the diagnosis is probably narcolepsy. There are a number of common themes in literary descriptions of people with stroke; first, the stroke is often brought on by high emotion or shock, but before the days of adequate treatment of hypertension, cerebral haemorrhage is likely to have been more common. Second, they frequently result in complete or partial loss of speech, which prevents the protagonist from imparting vital information or exposing villains. Third, they are often treated with bleeding if there is a doctor handy. Notable examples of this treatment are Billy Bones in Robert Louis Stevenson's Treasure Island, Squire Dornell in Thomas Hardy's short story The First Countess of Wessex and Prince Bolkonsky in Tolstoy's War and Peace. In the first two cases the treatment is apparently effective (although Bones dies a little while later of a second massive stroke when he receives the pirates ‘black spot’), although in reality the hypotension induced by bleeding would be dangerous and likely to extend the stroke if it was a cerebral infarct. Stroke related speech deficits can be used by authors to influence a novel's plot. We discuss several prominent examples using well-known novels where this occurs.