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Would the shape of Georgiana's mark as a fish, heart, or oval change its significance?

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Aylmer's comment to Georgiana helps to illuminate the importance of the birthmark's shape. While speaking to her one day, he calls it "'the visible mark of earthly imperfection.'" Further, before their marriage, the narrator says that he was like other "masculine observers" who only wished that the birthmark were gone so "that the world might possess one living specimen of ideal loveliness without the semblance of a flaw." Clues like these help us to interpret Georgiana's birthmark as a symbol of human imperfection, as Aylmer essentially states. Only the divine can be perfect. Humans are flawed, as being imperfect is a part of our very natures.

Therefore, when Aylmer "successfully" removes the birthmark, Georgiana dies; she cannot survive the achievement of perfection because humans, by nature, cannot be perfect. The fact that the birthmark is shaped like a human hand print connects it to this figurative meaning. No other species has hands quite like ours, and our finger prints are always tied to our identity. It makes sense that Hawthorne would use a hand print to refer to humanity.

If the birthmark were shaped like a fish, heart, or irregular oval, for example, it would likely be more difficult for us to connect it to its symbolic meaning. We would look for other associations of these items. We might connect a fish to Jesus Christ, or a heart to the concept of love. We might even fail to connect a birthmark shaped like an irregular oval to anything figurative; we could assume it is simply a regular old birthmark, not symbolic of anything.

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Georgiana's birthmark in Hawthorne's short story "The Birthmark" is shaped like a small hand.  Those who view the birthmark are of two minds; some think it is a shame that this birthmark mars an otherwise absolutely perfect face while others think it looks like a little fairy hand. (Interestingly, most men think the birthmark enhances Georgiana's beauty, while jealous women say it is unattractive.)  Those who find the birthmark charming imagine that a fairy touched Georgiana at birth, giving her not only her transcendant beauty but her loving disposition as well.  Georgiana herself liked the birthmark before her marriage to Aylmer.

Unfortunately, Aylmer is part of the former group and wants to do anything to rid Georgiana of her birthmark so that she will be perfect. He dreams that he tries to surgically remove the birthmark, only to have it enlarge until it is part of her heart (possibly foreshadowing the story's end).  Eventually, with the help of his assistant Aminadab, Aylmer concocts a potion that removes the birthmark, but it takes Georgiana's life, too.  The message here is that perfection is not consistent with human life.  Achieving perfection, in this case, means sacrificing the Georgiana's life.

Some critics, such as Susan Howe, find deeper symbolism in the crimson hand, likening its symbolism to the whale of Moby Dick and the crimson A in The Scarlet Letter.  Howe states (in the e-notes essay cited below):

This "singular mark" wears "a tint of deeper crimson," bears "not a little similarity to the human hand," and signifies endlessly (p. 765). In the course of only a few pages, the hand is referred to as "the Bloody Hand," "the Crimson Hand," and "the odious Hand" and is likened to a "fairy sign-manual" (pp. 765, 766, 767). The hand, in other words, is a text not unlike the scarlet letter or the white whale, about which Ahab says, "he tasks me; he heaps me" (p. 164). Like Moby-Dick, the birthmark, both the physical mark and the story itself, begs to be read.

Howe goes on to liken the crimson birthmark to female sexuality, noting that Aylmer's distaste for the birthmark doesn't begin to grow until after the couple has married and has consumated their marriage.  Thus, the color of the birthmark is symbolic as well as its shape.

Given the attention given this symbol in literary criticism, it is probably fair to say that a fish or heart birthmark just wouldn't be the same.

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