The intersection of medicine and literature has been a particularly fruitful site of investigation for academics in Victorian studies and beyond. With the fall of the so-called two cultures model and the rise of fields like science studies and the medical humanities, academics have begun mining a previously off-limits middle territory. The last two decades have seen a proliferation of such works especially by Victorian literary scholars. Janice Caldwell, John Gordon, Lawrence Rothfield, Jason Tougaw, and Athena Vrettos, for example, have all offered their visions of the medico-literary relationship, as have edited collections such as Lillian R. Furst’s Medical Progress and Social Reality (2000). Rita Charon has used Victorian medicine and literature as a launching pad for the burgeoning field of Narrative Medicine. Now Tabitha Sparks and Meegan Kennedy have entered the discussion, offering fresh, enlightening additions to this rich area of inquiry.
In The Doctor in the Victorian Novel, Tabitha Sparks ambitiously connects the changing figure of the doctor to the Victorian marriage plot. Seeking to differentiate herself from “many recent studies of Victorian science, medicine, and literature that claim…that a novelist’s consciousness was shaped by empirical domains extrinsic to the imaginative consciousness,” she considers “the doctor-character as a representation of and metonym for the decline of the marriage-plot novel” (10-11). Sparks is clear: she interrogates what the figure of the doctor reveals about the changing marriage plot and not “the influences of, for instance, physiology, cellular theory, or evolutionary biology” (11). The Doctor in the Victorian Novel argues that “over the course of the Victorian period, the medical profession’s rise to power (here represented by the doctor) and the associated scientization of medical and lay culture gradually displaces emotional and romantic intuition as the guiding ethos of the novel, and as it is principally rendered through the marriage plot” (161).
Sparks quite thoroughly pursues her argument across the nineteenth century through a variety of texts that range from highly canonical to obscure. Her method is close reading, and, as she moves through various novels, the depth and breadth of her examination go a long way toward convincing her reader of the trajectory she charts. Keeping with the relationship between the doctor and the marriage plot, she explores subsidiary angles such as the power of the text to heal, Victorian marriage debates (considered as “malpractice”), and the relationship between medicine and contemporary legislation over marriage and sexuality.
Examining the Romantic and early Victorian periods, Sparks asks “[h]ow were doctors imagined in fiction before the great Victorian medicalization of culture?” through representations in Harriet Martineau’s Deerbrook (1839) and George Eliot’s Middlemarch (1871-2) (12). Martineau’s Deerbrook, Sparks avers, offers the perfect “pre-scientific age” picture of a physician: a “deft amalgamation of the identities of doctor and husband” (26). Conversely, Eliot’s classic demonstrates that Lydgate’s “scientific perspective…leads him to misjudge his marital fortunes” (26). Sparks sees this movement over the century as emblematic of the arc of her argument. Rising scientism transforms the doctor from a social servant primed for “civil and cooperative union” into a “scientific explorer” whose commitment to empirical inquiry rendered him ill fit for marriage (44). This split exemplifies the two novelistic strains she will explore over the course of The Doctor in the Victorian Novel. After her discussion of Martineau and Eliot, she moves on to writers like Mary Elizabeth Braddon and Elizabeth Gaskell; Sparks finds “conflicted unions between professional doctors and their unfulfilled, romantic wives” which she reads as a “normalized” pairing in the 1860s that telegraphed “marital crisis” (63). Furthermore, Sparks argues (in ways that anticipate Kennedy’s discussions of genre), “the doctor’s scientific/medical perspective inspires a new self-consciousness about the marriage-plot novel’s forms and conventions, and, in doing so, helps to define the limits and goals of realism” in the novels she treats (65-66). Sparks’s story then turns to “far-sighted” femininity as an increasingly antagonistic force to the growing “myopia” of the medical profession. This story reaches a bifurcated climax by the end of the century: doctors’ violence against women and marriage on one hand and the rise of (single) women doctors on the other. The single woman doctor is imagined as the “Bride of Science” whose “commitment to medicine” is “a distinct proxy for the more normative entrance into heterosexual marriage” (137). Both trajectories exemplify plot and representational shifts Sparks sees happening over the course of the century, particularly as the novel as a genre moves toward British modernism.
Sparks’s feminism is hard to miss. Her book moves methodically from a consideration of doctors as husband-citizens to discussions of physician abuse, sexist medical legislation, and anomalous female physicians. Interestingly, she suggests that the late nineteenth-century scientific empiricism that makes doctors bad husbands and aggressors toward women is also the framework that allows women to rise in the profession, if only by denying their procreative roles. But because this science has also lost touch with some basic element of humanity, it is ultimately bad for the nation. If a successful marriage offers a viable model for future society, this scientist model is ultimately not productive. Worse, privileging science over social good, this late Victorian narrative destroys both women and Victorian society through relentless dissection; myopically enmeshed in the methods of nineteenth century empiricism, these doctors work to pull England apart rather than drawing it together.
All of this is carefully and persuasively argued, though a more theoretically-minded reader might wish for a bit more. In staying so very close to its texts The Doctor in the Victorian Novel convincingly charts the changing role of the doctor in the marriage plot but holds back on connecting her conclusions to broader discussions about the social roles of doctors or the intersection of medicine and culture. For example, Robert Veatch has recently argued in Disrupted Dialogues (2005) that over the course of the nineteenth century, the dialogue between physicians and humanists rapidly deteriorated. Sparks usefully addresses this cordoning off of scientific thinking, but readers of The Doctor in the Victorian Novel might wonder what cultural implications such separation has beyond marital relations. Additionally, one wonders what even classical theoretical texts like Michel Foucault’s The Birth of the Clinic (trans. 1963) might add to her analysis of doctors’ changing worldviews. How is the “myopia” Sparks notices in late-century physicians connected to Foucault’s argument that “seeing” became critical to medicine in the nineteenth century? But it is a strength of this text, like all good scholarship, to prompt such inquiry, and is perhaps the role of other scholars to pick up where Sparks has left off. In a way, Meegan Kennedy has done just this in Revising the Clinic: Vision and Representation in Victorian Medical Narrative and the Novel.
Kennedy explores “how literary and medical notions of seeing and stating changed over time, in relation with each other and with nineteenth-century historical developments and professional structures such as the rise of dissection, practical microscopy, psychoanalysis, literary periodicals, serialized fiction, and the like” (3). If that sounds ambitious, it is. But Kennedy’s careful prose and deft scholarship guide the reader through these complicated cultural structures, impressively demonstrating that “the Victorian novel’s revision of medical observation and clinical discourse, and a literary history of the case history’s flirtation with human insight…cannot be fully told without the other” (9).
Kennedy’s book begins with a illuminating introduction and moves steadily through the evolution of discussions of vision and representation in the case history and the novel from the late eighteenth century through the turn of the twentieth century. Using an impressive array of literary, historical, and theoretical tools Kennedy charts the development of seeing and knowing in nineteenth-century British culture from what she terms the “curious sights” of the eighteenth-century case history through the development of “valorized mechanical observation” in the early nineteenth century (29). Mid-century, she demonstrates that both experimental medicine and literature grew uncomfortable with the dominance of the atomizing “clinical gaze” and often “intensified, revised, and supplemented” it, while late-century doctors turned back to clinical empiricism’s modes of looking, largely sloughing off literary modes, some novels borrowed clinical vision to enhance their cultural influence (29). While late-century doctors turned back to clinical empiricism’s modes of looking, largely sloughing off literary modes, some novels borrowed clinical vision to enhance their cultural influence.
In an unorthodox move, no novels appear in her opening discussion. Her first chapter sets up the differences between eighteenth and nineteenth century case histories. Her second chapter also resists moving directly into the Victorian novel, easing instead into a discussion of medical and literary writing through periodical culture. In analyzing the avenues of dissemination, Kennedy focuses on some forces motivating literary and medical discursive production. This approach provides persuasive material evidence for why the two ought to be considered together. As Kennedy usefully notes, periodicals “created a space where physicians’ and novelists’ texts circulated equally. Physicians and novelists were not just reading the same pages, as literate ‘men of letters,’ but some were actually writing in the same pages, for the same audience” (86).
Kennedy’s next three chapters focus explicitly on the Victorian novel before Revising the Clinic pans back out to a more overtly interdisciplinary discussion in its final pages. These chapters, however, insistently steer clear of more conventional moves such as analyses of illness narratives. Since Kennedy is interested in modes of seeing and representation, this move is essential for establishing that her conclusions hold true beyond spaces where we might expect medical observation to bleed into literary narration. In her third chapter, Kennedy offers a well-argued analysis of Charles Dickens’s and Elizabeth Gaskell’s differing uses of what she terms the “sentimental eye”; Kennedy demonstrates the authors’ appropriation of physicians’ “sentimental case histories,” though she is careful to note these uses are strategically—and not monolithically—deployed. Chapters four and five treat George Eliot’s evolving relationship to medical ways of seeing and representing. While focusing two of six chapters on Eliot might make the argument feel a bit uneven, Revising the Clinic’s handling of Eliot merits the time spent. Moving from Adam Bede (1859) to Middlemarch (1871-72), the reader is richly rewarded with Kennedy’s keen observations of Eliot’s intellectual development. At the close of one such passage Kennedy observes: “Increasingly skeptical but also increasingly ambitious, George Eliot produces in Middlemarch a clinical realism enlarged by and corrected with sympathy and imagination, combined with them in a depth of focus that ties the close examination of mechanical observation to the broad and deep vista of speculative insight” (167). Revising the Clinic concludes with a reading of Sigmund Freud and Rider Haggard in which Kennedy importantly connects Freud’s desire to “keep intact” the literary facets of his scientific tasks (for example, “romantic closure”) to current efforts in the medical humanities (200-1).
Perhaps the most impressive aspect of Kennedy’s text is her ability to seamlessly weave together medical, literary, historical, and theoretical texts. In full support of Kennedy’s mission to make scholars see the inextricable interconnectedness of these discourses, her readers never feel pulled between the various disciplinary divides. In fact, the seeming ease with which Kennedy integrates these discourses itself strongly supports her thesis. Kennedy also expertly handles a thorny problem familiar to any critic interested in medicine and literature in the nineteenth century: how to reconcile Michel Foucault’s proclamation in Birth of the Clinic that the century celebrated and solidified medical empiricism’s fixed gaze with Jonathan Crary’s claim in Techniques of the Observer (1992) that scientists were ever more aware of vision’s contingency. One could not ask for a better, more carefully wrought, or more satisfying treatment of these competing visions that are, on the surface, so incompatible.
Revising the Clinic is a sweeping, rich, theoretically deft book that accomplishes a great deal and guides its reader every step of the way. In reaching across a very long nineteenth century and over a wide variety of texts, Kennedy covers the territory of at least two books. Despite this ambitious effort, Kennedy’s readers might wonder if her arguments apply equally to other scientific thinkers, other periodicals, or novelists other than Dickens, Gaskell, Eliot, and Haggard.
One wonders what Sparks and Kennedy might say to one another on the topic. Sparks’s pairing of canonical and non-canonical novels inspires readers of Kennedy to ask what less canonical novels might do to Revising the Clinic and how Kennedy might treat the kinds of scientifically aggressive gothic texts Sparks takes on at the end of her book. Kennedy helps readers of Sparks formulate questions of genre and representation. Sparks’s focus on looking is an implicit feature of The Doctor in the Victorian Novel, but one might subsequently wish to ask what more an attention to the knowledge and technologies of looking might add to her thesis about representation.
Finally, the conclusions of the two scholarly works appear at odds. The Doctor in the Victorian Novel declares that by the end of the nineteenth century, scientific ways of seeing had overtaken older romantic modes, but Revising the Clinic uses the interactions of the case history and the novel to argue for a more complicated relationship in which writers like Freud acknowledge their debt to literary modes even as they work to reject them. Read together, these two excellent books testify the continuation of a lively debate at the fertile intersection of science and art, illuminating for any scholar interested in nineteenth-century medicine and literature.
Sari Altschuler is a doctoral candidate in English at City University of New York, The Graduate Center who writes about literature and medicine in the nineteenth century. Her work has appeared in Disability Studies Quarterly and is forthcoming at the Journal of the Early Republic.