Revising the Clinic: Vision and Representation in Victorian Medical Narrative and the Novel by Meegan Kennedy (review)

Meegan Kennedy’s ambitious study makes a significant contribution to the growing body of work on the complex interconnections between medical and fictional vision and narrative. As its title implies, Revising the Clinic rethinks the objective clinical gaze of Michel Foucault’s celebrated account and the work on technologies of medical observation and the representation of the body which has followed it. Kennedy’s key reference point is the medical case history, which made available powerful fictional strategies by “conveying a sense of rigorous scrutiny, careful description and narration, and professional knowledge” (1–2). Its role in shaping novelistic discourse has already been explored in Janis McLarren Caldwell’s Literature and Medicine in Nineteenth-Century Britain (2004) and Jason Tougaw’s Strange Cases: The Medical Case History and the British Novel (2006). Here, though, Kennedy focuses on underlying models of medical perception and knowledge rather than on the case narrative as such—indeed, in swathes of her discussion the case narrative is scarcely visible. Instead, she proposes three stages of the case history’s evolution—the curious, the clinical, and the psychoanalytic—as paradigms of medical observation that lie at the centre of a wider discussion about disciplinary norms. She then considers a range of texts and novelists between 1840 and 1890—specifically Charles Dickens, Elizabeth Gaskell, George Eliot, Sigmund Freud, and H. Rider Haggard—in relation to that discussion of norms.

Kennedy’s historical study of medical and literary concepts of vision and representation relies heavily on Lorraine Daston and Peter Galison’s work on objectivity. While her use of their account is sometimes uncritical, their stress on the uneven process of epistemological transmission—in which modes of vision at specific historical moments incorporate and react to elements of earlier paradigms—proves a subtle and productive framework. Her first chapter studies varied usages of “curiosity” within the medical case history in the eighteenth century—in particular, “curious observation,” based on the disinterested witnessing of physical phenomena, and “curious sight,” in which the patient herself becomes a curiosity, a spectacle, but also the object of sympathetic identification (30). At the centre of her analysis is the fascinating account by William Cheselden of an operation on the cataracts of a blind boy in 1728; Kennedy explores how the oscillation between curious sight and curious observation plays out in the sympathetic insight of his “Account” (which leads him to ask the reader to imagine what it must be like to suddenly have sight) and the “Explication” of the surgery itself (in which he objectifies the subject as a body part). “Both produced knowledge, of different sorts,” she argues (49), and their complex and at times troubled relationship can be traced in medical and literary narrative through the nineteenth century.

The next four chapters, the main body of the volume, explore different configurations of these tensions between 1840 and 1870. Kennedy follows the dominant story of the development of clinical observation with the increasing professionalization of medicine through the early part of the nineteenth century, as greater emphasis is placed on distinterested knowledge underpinned by an idea of unmediated, or “mechanical,” observation (119): an ideal of medical empiricism articulated particularly clearly in the French physician Alfred Stillé’s Elements of General Pathology (1848). Yet while the curious case is viewed with greater suspicion in clinical medicine, the power of its rhetoric remains, and re-emerges in the novel, albeit through the dominance of the clinical model itself. Focusing on Dombey and Son (1846–48), The Old Curiosity Shop (1841), and Ruth (1853), Kennedy argues that, rather than setting mechanical observation in opposition to sympathetic identification and sentimental observation, Dickens and Gaskell take up and adapt the methods of clinical medicine selectively in order to produce sympathetic insight; clinical observation and the sentimental gaze have a symbiotic relationship. In the sickness and deaths of Paul Dombey and Little Nell, Dickens alternates...