- Between Doctors and Patients. The Changing Balance of Power
In this truly interdisciplinary book, Lilian Furst applies her extensive knowledge of realist fiction to the study of medical practice in Western Europe and America in the nineteenth and twentieth centuries. Between Doctors and Patients analyzes the changing public perception of the physician during the [End Page 518] modern period and focuses, specifically, on the evolution of the doctor-patient relationship. Furst concludes that a radical shift in power has occurred from the early nineteenth century, when the patient’s wishes and social position exerted considerable influence, to the present, when technology and specialization place power firmly in the doctor’s hands. While she draws her evidence from a variety of medical writings including handbooks of medical ethics or etiquette, hospital statistics, case histories, sociological studies and medical journals, she turns to imaginative literature, from the novel to television scripts, to tell the story of the human relations between the sick and their healers largely ignored by historians of science. The introductory chapter justifies this literary approach to science by pointing out the concurrent beginnings of modern medicine and realist literature in the early to mid-nineteenth century. Many realist novelists—Flaubert and Conan Doyle, for example—came from medical backgrounds and incorporated ordinary, everyday medical situations such as childbirth, death and illness, into their plots. Their novels, with their multiplicity of characters, are especially useful in presenting the viewpoint of the patient. For Furst, “By restoring the missing patient, fiction can act as a corrective to the one-sidedness of medical histories” and provide the basis for “a humanistically oriented sociocultural history of medicine” (p. 14).
Between Doctors and Patients takes as its thesis the notion that the shift of power from patient to doctor is directly related to the increase of scientific knowledge which led, in turn, to a change in the locus of medical practice from the domestic sphere to the hospital and laboratory. Chapter two, “Missionary to the Bedside,” explores Trollope’s Dr. Thorne (1858) and Gaskell’s Wives and Daughters (1866) as novelistic treatments of the early nineteenth-century doctor, who traveled to his patient’s bedside on horseback, conceived of his mission as one of emotional succor as well as physical cure, and who practiced holistic medicine which depended heavily on intuition and interpersonal skills. The adventures of these doctors reflect the ambivalent social position of the physician vis-à-vis the aristocracy, the changing professional status of the surgeon from craftsman to the equivalent of the modern general practitioner, and the doctor’s need to mediate family struggles in order to become the patient’s confidant. Chapter three, “Seeing-and Hearing-Is Believing,” concentrates on George Eliot’s Middlemarch of 1872, whose hero Ludgate exemplifies the “turn from patient specificity to disease specificity in diagnosis and treatment” (p. 59). Trained in London, Edinburgh and Paris—the leading European medical centers of the early nineteenth century—familiar with the microscope and stethoscope, Lydgate diverges from the holistic approach to perform physical examinations and look for symptoms. Although Lydgate’s knowledge endows him with some power, his new ideas eventually antagonize a clientele suspicious of a physician who breaks with established medical tradition.
Chapter four, “A Woman’s Hand,” turns to the United States in the last third of the nineteenth century, when American medicine was rebounding from an [End Page 519] ebb of quackery and confusion. Five novels, two by men and three by women, explore the phenomenon of the newly emerging woman doctor, normally educated at an exclusively female medical college and often highly idealistic. Here gender issues replace class conflicts. The problems of moving from the domestic to the public realm, of choosing marriage over celibacy, of gaining respect in a male-dominated arena arise in all five novels. These “doctress fictions” also reflect more general dilemmas of a profession in transition, especially “the need to relate to patients in a simultaneously redemptive and scientific manner” (p. 124).
Chapters five and six, “Diseases and...