Purity and Pollution: Gender, Embodiment, and Victorian Medicine (review)

Alison Bashford would convince her readers that British practitioners’ obsession with gender influenced the internal organization, knowledge, and practice of Victorian medicine. Men dominated the practice of medicine by virtue of their rationality, self-interest, and physical prowess. Since women seemed particularly ill suited for such rigors by virtue of, well, their virtue and a supposed physical and intellectual fragility, Bashford must account for those women who managed to become physicians. She claims that the gendered stereotypes became weapons in the hands of aspiring women physicians, who insisted that medicine would benefit from the inclusion of women who were ideal missionaries in the cause of health promotion based on the importance of moral rectitude and domestic order. Previous historians have cited this accommodation to widely held gender differences as an occasion to credit women for recognizing the wisdom of couching their demands in terms congenial to maintaining the status quo; Bashford cannot support this explanation, for she detects a protofeminist edge to the supplicants’ argument.

She distills from the women’s argument an explicit feminist critique of mainstream masculine medicine. Women physicians championed a simultaneous ministering to the patient’s body and soul, which contrasted sharply with the focus of male physicians on diseased and broken body parts rather than the whole patient. This gendering of medicine empowered women to challenge the male prerogative to determine optimum health care. Bashford admits that the advance of science and its emphasis on a particularistic medicine marginalized feminine medicine, but she proclaims the ill-fated attempt to generate a regard for holistic medicine a notable, early skirmish in the ongoing gendered politics of health. Her interpretation is sufficiently provocative to demand more evidence than she provides, for she devotes comparatively more attention to the critique of medicine voiced by Florence Nightingale than to that of Elizabeth Blackwell. Further research may clarify whether the concept of feminism had a resonance for Victorian-era women medical pioneers equal to that of modern feminist historians.

As a writer reliant upon literary and cultural theories, Bashford states boldly that “medical knowledge is always socially constructed and always culture-bound: it is never simply ‘true’” (p. xvii). Except, of course, when it is simply true. Her discussion of puerperal fever “privileges” Ignaz Semmelweis. Curiously, she conveys regard for his insistence on a single (true?) cause of the disease by omitting any discussion of how his identification of cadaveric matter as the sole pathogen was either socially constructed or culturally bound. Neither does she disclose a familiarity with Semmelweis’s medical context, which included an informed regard for the pathogenicity of decomposing matter partly due to the reports of the often-fatal illnesses contracted by physicians who sustained a wound during the performance of a dissection. Bashford purports to right the historical record by noting that, contrary to received wisdom, Semmelweis’s warning about the danger attendant on physicians’ contaminated hands did not fall on deaf ears in Great Britain. However, she appears unaware that the ensuing discussion may have been motivated by a crucial difference of opinion between the notoriously anticontagionist Semmelweis and those he held in contempt, the contagionist-bent British practitioners.

Bashford’s unfamiliarity with the medical context is further betrayed by the assertion that cultural attitudes informed physicians’ belief that puerperal fever could arise de novo. She believes that their explanation reveals a culturally warped view of women’s bodies, which were conflated with other environments that constantly fouled themselves: hospitals and houses. She is wrong to declare that the classification of self-poisoning was peculiar to puerperal fever, as this was no culturally informed, gendered reading of disease. A closer reading of medical texts would have acquainted her with physicians’ belief that an amputated stump as well as an abraded birth canal invited the absorption of a gender-neutral poison. Indeed, Semmelweis’s genius was the observation that puerperal fever was identical to the fatal illness of his male colleague Kolletschka.

Purity...