Narrating the Unexceptional: The Art of Medical Inquiry in Victorian England and the Present

The fear of a widespread anthrax outbreak, which so consumed media, popular, and pharmaceutical attention in the last months of 2001, seems to have departed from the national spotlight nearly as quickly as it appeared. A fleeting and relatively contained episode in public health history rather than the large-scale medical danger it threatened at times to become, the outbreak of anthrax cases prompted a reaction that will likely be remembered as a symptom of a national sense of fragility and vulnerability in the aftermath of September 11, 2001, what The Nation called "a scare rather than a medical nightmare." ¹

Yet the threat offered to the health of the general population does not alone account for the magnitude of that "scare." A lingering fear of terrorism contributed to its development, as did the sudden and seemingly untreatable decline suffered by victims of inhalation anthrax. But the media focus often became most intense when someone who "[fit] no one's profile of an anthrax victim," someone who was not working in "post offices, government agencies and newsrooms" succumbed to the disease and when journalistic and medical inquiry into the seemingly uneventful lives of a number of the victims yielded no reassuring secrets to explain their exposure. ² Indeed, what provoked journalistic discussion and speculation was not only the investigators' inability to locate the means of transmission amid the victims' ordinary circumstances but, even more, the way in which those unremarkable circumstances seemed at odds with the victims' remarkably sudden declines in health. As teams of epidemiologists and health officials turned up only the most ordinary details of the victims' lives, the contents of dressing tables and vacuum cleaners, the public "scare" grew correspondingly.

Underlying these accounts was an implicit acceptance of the disjunction between the catastrophic effects of disease on one hand and these unremarkable lives on the other, between the sphere of medical expertise and the seemingly ordinary narratives emerging from these investigations—in sum, between what was and was not considered worthy of medical attention. Rather than requiring explanation, this apparent incongruity instead provided the assumption from which most articles began. However, in the following pages, I will suggest that these cases of anthrax troubled both the popular and medical imagination precisely because they probed the disjunction between the severity of disease and the ordinariness of its causes, and they unsettled conventional understandings of what "counted" as medical evidence. Further, that disjunction resonates beyond recent thinking about disease. For the assumed distinctions between the ordinary, unexceptional life and the medically interesting case were intimately, if at times uncomfortably, linked to the development of public health and medical discourse over the past two hundred years.

The question of medical inquiry's appropriate focus corresponds to a broader and long-debated question about professional methodology and epistemology: whether medicine should be understood as having its foundations in the details of the individual case or in the abstractions of theory. At stake is the status of the anecdote or the single narrative as opposed to the claims of an abstract understanding as they might be supported by theory, terminology, and long-term professional expertise. As Dr. F. G. Crookshank framed this ongoing tension early in the twentieth century, the profession maintained an uncertain position between the "Art of Medicine," with its "accumulated facts" and observations, and the "Science of Medicine" as constituted by a "formulated Theory." ³ Was medicine properly regarded as a "practice" interested in the details of the individual case, or should it be understood as more closely allied with sciences whose foundational principles were theoretical, such as chemistry and physics? More recently, Kathryn Montgomery Hunter has located the origins of that debate in the late eighteenth and early nineteenth century, when the ascendance of the "scientific, specifically pathophysiological, explanation of disease" had the effect of marginalizing the "anecdote," the narrative account of an individual...