Hektoen International

A Journal of Medical Humanities

Children treating children: Anne Shirley as clinician

Kathryne Dycus
Madrid, Spain


First edition cover of Anne of Green Gables

First edition cover of Anne of Green Gables by Lucy Maud Montgomery, published 1908. Cover art by George Fort Gibbs (1870—1942). Public Domain.

Childhood classics provide a range of illness narratives, reminding readers of dangers now preventable and even treatable, but also of the universal imperatives of understanding and accommodating the morbidity and mortality that can accompany childhood.

Sickness in children’s literature, as in medicine, presents dramatically colorful dimensions of plot twist, character development, human connection, tragedy, and triumph. Stories of sickness include stories of tending and healing, remarking on the love and care that comes from parents, from clinicians, and from other children.

Anne Shirley, the heroine of the 1908 book Anne of Green Gables by Lucy Maud Montgomery, is at one point in the novel confronted with a medical challenge. Traipsing across a wintry landscape on rural Prince Edward Island, Diana Barry, Anne’s best friend, seeks Anne’s help in caring for her three-year-old sister Minnie May, who “lay on the sofa feverish and restless, while her hoarse breathing could be heard all over the house.” Minnie May’s symptoms signal to Anne that she suffers from croup.

As presented in the book, the illness tends to come on in the middle of the night, and very suddenly, not because of a build-up of mucus in the lungs, but because of an inflammation of the larynx. It constricts the airway and makes breathing difficult, which is terrifying. And because Minnie May panics, it causes her throat to tighten, further escalating her breathing problems.

Anne Shirley, at the age of eleven, has extensive experience treating croup and knows exactly what the treatment entails. Acting without hesitation or deliberation, Anne first boils huge amounts of hot water, knowing that the hot water creates steam, which then cools when it hits the night air; cool moist air reduces inflammation and allows the child to breathe again. Then, Anne administers ipecac:

“Minnie May has croup all right; she’s pretty bad, but I’ve seen them worse. First we must have lots of hot water. I declare, Diana, there isn’t more than a cupful in the kettle! There, I’ve filled it up, and, Mary Joe, you may put some wood in the stove. I don’t want to hurt your feelings but it seems to me you might have thought of this before if you’d any imagination. Now, I’ll undress Minnie May and put her to bed and you try to find some soft flannel cloths, Diana. I’m going to give her a dose of ipecac first of all.”

When the doctor finally arrives at three o’clock in the morning, Anne presents the case to him with the clarity of a clinician:

“She got worse and worse. . . . I actually thought she was going to choke to death. I gave her every drop of ipecac in that bottle, and when the last dose went down I said to myself. . . . ‘This is the last lingering hope and I fear, ’tis a vain one.’ But in about three minutes she coughed up the phlegm and began to get better right away. You must just imagine my relief, doctor, because I can’t express it in words. You know there are some things that cannot be expressed in words.”

It is hard to know from the description whether Minnie May had what we would think of as normal croup—viral laryngotracheobronchitis—or whether she may in fact have had diphtheria. With diphtheria, children cannot breathe because of a grey membrane of dead cells that covers the airway and can totally block it. The Native Americans used spiky seedpods to try to remove it, but vomiting works, too; it clears up the airway. No one in the story, however, seems worried about contagion, so perhaps diphtheria is less likely. Either way, ipecac (etymologically derived from Ipecacuanha) was often used as an expectorant in cases of croup and bronchitis. Originally discovered in seventeenth-century Brazil and later transported to Paris, it has now been abandoned as a treatment for respiratory illness because of the potential for toxicity. Nowadays, doctors may prescribe a steroid (glucocorticoid) as a way to reduce inflammation in cases of severe or persistent croup.

Depiction of Anne Shirley
My life is a perfect graveyard of buried hopes.” Depiction of Anne Shirley. June 28, 2020. Maria Jas. Private Collection, Poland. Used with artist permission.

When Anne of Green Gables was published, at the turn of the twentieth century, the medical profession had long argued against female doctors based on issues such as their greater emotional response to scenes of pain and suffering and their sympathetic, and thus inherently weak, sensibilities. The American surgeon Edmund Andrews claimed in 1861 that “the primary requisite for a good surgeon, is to be a man—a man of courage.”

Anne Shirley’s initial reaction to Diana’s sobering news is not to behave hysterically, as characteristic of Diana, but to remain calm, confident, even cheerful:

“Don’t cry, Di,” said Anne cheerily. “I know exactly what to do for croup. You forget that Mrs. Hammond had twins three times. When you look after three pairs of twins you naturally get a lot of experience. They all had croup regularly. Just wait till I get the ipecac bottle—you mayn’t have any at your house. Come on now.”

Anne, a true wordsmith, offers words of healing, encouragement, and reassurance. Not only does her behavior challenge Andrews’ sentiment in terms of gender, but her courage appears even more striking for her young age. Furthermore, her sympathetic response for the patient is not a liability, as the male medical establishment suggested at the time, but a valuable asset. It puts everyone more at ease. Anne Shirley speaks and acts with authority when the adults around her are either unavailable or clueless.

Classic children’s literature offers entry into the lives of children at every stage—to how both characters and readers accommodated the very real knowledge of illness and death. It was a time when most families were personally impacted by serious childhood infections and with often tragic outcomes. It is notable how frequently, in children’s literature, we see children taking care of other children, sometimes heroically, like Anne saving Minnie May, and sometimes by providing daily care and distraction that helps a sick child recover, as we see in books like The Secret Garden or Little Women.

The female child, in Montgomery’s enduring classic, possesses the potential to make real contributions to her community that equal or even surpass those of the adults around her. Dr. Spencer, who arrives too late to offer any practical assistance, acknowledges that Anne has done what he could not do. He tells the Barrys (Minnie May’s parents) that Anne is “as smart as they make ’em. I tell you she saved that baby’s life, for it would have been too late by the time I got there. She seems to have a skill and presence of mind perfectly wonderful in a child of her age. I never saw anything like the eyes of her when she was explaining the case to me.”

“Skill and presence of mind” are not qualities often attributed to women, let alone little girls. Pioneering women physicians such as Elizabeth Blackwell and Harriot Hunt used the domestic ideology to validate their place in the medical world. They appropriated the male expectation that women were inherently more moral, sympathetic, and sensitive than men, to argue that these unique qualities made women ideally suited to certain branches of medicine. Many of their female patients agreed.

We could look to Anne Shirley’s “bedside manner” as one of strength, confidence, competence, and optimism. She is able to enter into the mind of the sufferer and know what is going on there. Then she is capable of translating this information to both the family (in this case, the sister Diana) and clinician (Dr. Spencer). Lucy Maud Montgomery endows her young heroine with moral courage, even presenting her as a hero, yet she is flawed like the rest of us. By doing so, she rejects the assumption that female qualities had no place in traditionally male spheres. Anne Shirley was one to “trespass” into whatever sphere she liked, and ever since her arrival in 1908, she has inspired girls everywhere to do the same.


Further reading:

  1. Vrettos, Athena. Somatic Fictions: Imagining Illness in Victorian Culture. Palo Alto, California, Stanford University Press, 1995.
  2. Montgomery, L.M. Anne of Green Gables. Ed. By Cecily Devereux. Peterborough, Ontario, Broadview Press, 2004.



KATHRYNE DYCUS studied British Romanticism at the University of Glasgow. She writes for the anthropology journal Mammoth Trumpet and is currently affiliated with the department of bilingual assessment and development at the University of Comillas, Madrid, Spain.


Summer 2020 |  Sections  |  Literary Essays

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