Johns Hopkins University Press
  • "The History of Half the Sex":Fashionable Disease, Capitalism, and Gender in the Long Eighteenth Century

This essay examines the way in which disease was framed and narrated as fashionable in the long eighteenth century, and argues that the intensifying focus on women's fashionable disorders in the period grew in tandem with the rise of an unstable capitalism in its manifold forms. Using the satirical articles written by Henry Southern in the London Magazine—"On Fashions" (August 1825), "On Fashions in Physic" (October 1825), and "On Dilettante Physic" (January 1826)—and the literature that led to them, I analyze the role that women were now taking in the newly capitalized world of the early nineteenth century. This world was characterized by a burgeoning medical market, a periodical and print market which could adequately reflect and promote fashionable diseases and the medical market that spawned them, and the nexus of actors in the whole drama of the production, maintenance, and dissolution of fashionable diseases.


capitalism, fashion, disease, gender, London Magazine, Romantic periodicals

Why pursue the history? It is the history of half the sex. And why ask the consequences? Are they not visible? … Thus we are cursed with peevish and nervous wives, useless to all, and a pest to themselves, the curse of their families and the ruin of the children, of the daughters at least, who are trained up in the same knowledge and practice of physic. It is in vain that the conscientious physician interposes, and orders all the salts to be thrown out of the window. The prejudices of the patient and the interests of the trade are against him, and he is himself turned out of the door. … He starves, because of his conscience, and, possibly, is starved into compliance.

Henry Southern's withering critique of fashionable diseases and their effects on women in his article "On Dilettante Physic" is the culmination of a series of four articles dealing with fashion and (then) disease between August 1825 and January 1826: "On Fashions" (August 1825), "More Fashions" (September 1825), "On Fashions in Physic" (October 1825), and "On Dilettante Physic" (January 1826). Southern (1799–1853) is not particularly original, although he is very entertaining, and it is because his views are common that he acts as a mirror for his society's ideas about fashionable disease and its relationship to the larger discourses that frame the phenomenon, particularly gender and capitalism, on which this essay will focus. Here I use Southern's writings on fashion and fashionable disease to answer the question of how women, capitalism, and fashionable disease were perceived [End Page 355] by the literate orders in the early part of the nineteenth century, and the corollary question of what function the image of women played in the framing of fashionable disease or, rather, the evolving narrative of fashionable diseases throughout the long eighteenth century.2 I take Paul Keen's point that the later eighteenth and early nineteenth centuries gave rise to a world of "extraordinary modernity," one that was perceived by its contemporaries as such, and one in which the newly unfixed exchange systems of credit and capital meshed with a more free-floating individual subjectivity, which itself partly constituted the primary symbol of that ever-changing whirl of commodity and consumption: fashion.3 At the time that Southern wrote his essays for the London Magazine, this sense of modernity and its relationship to fashionable disease was acute, and was the culmination of a number of factors, including the rise of periodical literature, that had developed during the preceding century.

We come to Southern in detail in the final two-thirds of this essay, but it is first necessary to analyze elements of the history of capitalism, fashion, and gender before this point, and to demonstrate their connection with fashionable disease. What did fashion have to do with disease? To answer this question we must regard medical markets and their products—diseases and their treatments—as subsets of fashion in this period. In fact, Southern claims semi-facetiously that "the history of fashions in physic would be almost the history of physic itself," and thus it is necessary to edit the potentially "tedious" narrative of the entire history of medicine, and to avoid too much technical detail in the process.4 As various cultural historians have observed, fashion is an ambiguous symbol of—and an actual process constituting—modern capitalism: like capitalism, "Fashion is never satisfied."5 Like capitalism, voracious fashion posed challenges for modern concepts of identity and for the role of women as well as men.

Personal identity is both liberated and destabilized by capitalism in the eighteenth century. Modern commerce differs from the fixed values of agricultural economy by its reliance on the transactions of credit, where value now comes from outside the individual's personal social standing, and is inextricably related to the judgments of others.6 As J. G. A. Pocock has put it: "Once property [and everything else] was seen to have a symbolic value, expressed in coin or credit, the foundations of personality themselves appeared imaginary or at best consensual: the individual could exist, even in his own sight, at the fluctuating value imposed on him by his fellows."7 If everything could be converted into money, no matter what its original nature, what could [End Page 356] be authentic anymore? Was modern identity illusory, like fashion itself? Vicesimus Knox worried about fashion's ability to "transform deformity to beauty and beauty to deformity."8 Fashion's instability was an apt sign of the newly decentered individual, according to Dror Wahrman: "Fashion signified the constant manufacturing and remanufacturing of identity through clothes."9 Commercialization "exposed an increasing number of contemporaries to what was for them an unprecedented phantasmagoria of commodities in a bewildering variety of (relatively) transient forms."10 As we will see, these commodities and forms included those of the medical market.

Eighteenth-century commerce was sociable, polite, but also unsettling in its effects: it provoked anxiety about the possibilities in the exercise of desires (which commerce encouraged) without regulation, without boundaries of rank or religion.11 The discourse on luxury, a close relative of fashion, bore this anxiety out fully. Luxury provoked trade, but also moral confusion or outright condemnation. As Keen has argued, "Fashion constituted a temporalized form of luxury" because it was constantly shifting: "an endlessly exhausted, endlessly self-reproducing scene of excess … [F]ashion conjured up the dangers of luxury in their most commodified form."12 Excess and change were the defining characteristics of fashion, and by 1825 they only seemed to be increasing in intensity. Keen sees a shift in anxieties about credit in the early part of the eighteenth century towards luxury and fashion in the late, and in an increased climate of concern: one which displaced critiques of commerce itself.13 As the discourse of capitalism was naturalized, fashion became the object of much satirical and negative attention. Keen deploys Jon Mee's argument about the need "to distinguish authentic affect from mere enthusiasm" in terms of religious discourse to show that fashion could act as the symbol of the extremes of consumerism, thus drawing attention away from the fundamental instability of consumerism itself: "this double movement translated into a legitimation of particular forms of desire by demonizing those negative forms that could be dismissed as the corrupt symptoms of fashionable excess."14

Literature had a major part to play in the framing and transmission of commerce, fashion, and fashionable disease.15 One reason that Southern's articles could exist in the 1820s was that the "metropolitan sociability" required of modern commerce forced together, in a new way, the literary and fashionable worlds.16 Periodicals partly existed to deal with the "unprecedented sense of the contingency of knowledge" brought about by the Enlightenment, and the "new anxieties about [End Page 357] the social order" that such a sense brought.17 In a striking parallel to our own "information age," in which the internet overloads us with apparent knowledge, Southern complained in 1826 about the deluge of "universal illumination": "Why, we are absolutely suffocated with knowledge; and therefore the age knows every thing, and every body is learned, and antiquity was a jest to us, and we are dying of literary, scientific, and philosophical repletion and stuffing."18 Periodical writers thought of themselves as professional arbiters of this knowledge, even as they contributed to the problem themselves, as David Stewart has observed. Diseases of "repletion and stuffing" were the bane of civilized life, and were in themselves highly fashionable, as other essays in this issue (see Sander L. Gilman, and Jonathan Andrews and James Kennaway) argue.

Fashion was one sign of this contingency since fashion, like knowledge, was in perpetual revolution. Literature, of course, was now a fashion industry in itself, with its own trends chronicled by the periodical.19 Southern makes this point in the London Magazine of September 1825: "It is the fashion too to read Lord Byron and despise Pope, to talk of Shakespeare and the Quarterly Review, to be learned and ological, and clever."20 Mark Parker has argued that the literary magazine is the "preeminent literary form of the 1820s," and part of the reason for this lofty standing was its periodicity, its responsiveness to changing literary and social trends, its ability to write to the minute.21 Literary critics have noted the irony that periodicals both claim to rise above fashion (as a literary object) but are disposable (periodical) and so implicated in fashionability.22 As a flexible, transient, and intrinsically multi-authored form, the periodical was a fashion item in itself, an object for public consumption.

Crucially for our understanding of women's engagement with fashionable diseases, Shawn Lisa Maurer has demonstrated that "periodical authors inserted themselves into the age's contentious debates about the proper uses of pleasure," commerce, and leisure, and placed themselves as arbiters, even though they themselves were producers of knowledge and part of this very economy. They also insisted on sexual difference, which helped "contain" these tensions.23 Fashion was to be one area of discursive struggle in which gender had an active role to play, and with fashionable disease in particular, as we will see in Southern's essays. Men's roles in commerce, consumption, and fashion could be naturalized and occluded by the conspicuous and overdetermined representation of women and feminized males. [End Page 358]

Women, Capitalism, and Fashion

Feminist commentators, literary-critical and historical, have noted for some time now, albeit not without dispute, the role of women in consumer capitalism.24 Joseph Addison's essay on women and fashion made a very clear case for women as the focus of fashion: "As Nature … has poured out her Charms in the greatest Abundance upon the Female Part of our Species, so they are very assiduous in bestowing upon themselves the finest Garnitures of Art."25 Beth Kowaleski-Wallace has argued that "British culture projected onto the female subject both its fondest wishes for the transforming power of consumerism and its deepest anxieties about the corrupting influence of goods."26 Women were both consumers and consumed, most obviously in the fashion world where they displayed—on their bodies—the products they themselves had purchased: women were commodities. Harriet Guest has also discussed the way in which polite culture, a facet of modern consumerism, was feminized, and in which the image of woman was profoundly ambiguous: a positive force for both beauty and trade, but also negatively embodying longstanding and newly intensified fears about the effeminizing effects of unregulated trade and the free reign of desires to consume objects, and thus pleasures, across the ranks of society.27 For Guest, the second half of the eighteenth century saw women become increasingly conspicuous in all forms of cultural media, at once prized for their superior sensibility and moral virtue and simultaneously stigmatized due to their allegedly excessive desires for consumer goods, goods that they wore on their own skin or used in their social rituals (such as tea and its related paraphernalia).

Emma Clery has shown how the negative aspects of the "feminization debate" of the early eighteenth century ceded to more positive perceptions of women in relation to commerce in the middle of the century (particularly as promoted by Samuel Richardson's novels), and Jennie Batchelor has demonstrated that, by the end of the century, the Richardsonian association of moral sensibility with female clothing was put under pressure by the critique of sensibility as an excuse for fashionable women to manipulate feeling and fashion for their own selfish ends.28 Overall, as I argue here, women and fashion were both overdetermined discourses, both symbolic of perceived wider problems with the cultures of commercial capitalism, problems that intensified as the century progressed.29

We know that women were serving such a function in the early part of the period, as Alexander Pope's fashionably diseased Goddess of Spleen and her servants demonstrate in "The Rape of the Lock" (1714): [End Page 359]

There Affectation, with a sickly mien,Shows in her cheek the roses of eighteen,Practis'd to lisp, and hang the head aside,Faints into airs, and languishes with pride,On the rich quilt sinks with becoming woe,Wrapp'd in a gown, for sickness, and for show.The fair ones feel such maladies as these,When each new night-dress gives a new disease.30

Women consume fashion, and need a fashionable disease—or at least a fake one—to provide a suitable reason for purchasing their nightdresses conspicuously. The sexual element in the womb-like Cave of Spleen is obvious enough in the poem, and the satire is aimed squarely at women like our ambiguous heroine, Belinda, whose fit of the spleen is occasioned, so Pope implies, by her own sexual desires. Belinda is also a consumer of the exotic cosmetic products of this new century, and is exemplary of the kinds of criticism launched at women in their new role as the standard-bearers for capitalism. Pope's poem praises the glory and beauty of fashionable Belinda above ground, but the satire below in the Cave of Spleen, a kind of pre-Freudian social imaginary for the lusts of women, makes it clear that Pope is at best ambivalent in his attitude to women's consumption of beauty products primarily, but also the other goods and services which are the result of expanding empire and trade.31 The parallel scene is that of Belinda at her Toilette, where she both displays and consumes many such commodities, with dubious moral results:

Unnumber'd Treasures ope at once, and hereThe various Off'rings of the World appear;From each she nicely culls with curious Toil,And decks the Goddess with the glitt'ring Spoil.This Casket India's glowing Gems unlocks,And all Arabia breathes from yonder Box.The Tortoise here and Elephant unite,Transform'd to Combs, the speckled and the white.Here Files of Pins extend their shining Rows,Puffs, Powders, Patches, Bibles, Billet-doux.32

The notoriously disrespectful placement of "Bibles" amongst a collection of cosmetics and love-letters shows how far the reign of commodity and fashion has already corrupted religious values for young women [End Page 360] like Belinda. By the time we arrive at the final part of the century and into the next, the satire directed at women and fashionable disease is well-nigh hysterical—or splenetic—in its own right.

Women and capitalism are key themes in the first extended commentary on fashionable disease, James Makittrick Adair's essay "On Fashionable Diseases" (1786), which proclaims the increased importance of fashion at this historical moment: "the empire of fashion has now become universal" (10).33 Fashion plays a crucial part in fashioning social identity, dividing those who are significant from those "whom no-body knows" (11). The connection to the newly burgeoning medical market is very clear to Adair, occluded though it might have been to others: "Fashion has long influenced the great and the opulent in the choice of their physicians, surgeons, apothecaries, and midwives; but it is not so obvious how it has influenced them also in the choice of their diseases" (11). Adair, a Bath society doctor, writes accessibly and satirically about his profession and its history, a mode that Southern was to emulate consciously in his essays on fashion in physic.

Here Adair identifies the newly burgeoning consumerism of the eighteenth century as fostering addictive desires for products beyond those needed for strictly natural subsistence: "As societies advance in civilization, the active mind of man, not contented with the means of satisfying our natural wants, is anxiously employed in creating artificial wants, and the means of their gratification" (9–10). The extravagant luxuries that had previously been confined to the upper orders were, by the end of the eighteenth century, filtering down to the middling sort. Fashion was a vital vehicle for the creation and maintenance of these excessive wants for the products, whether physical or cultural, of advanced civilization. Adair saw fashion and luxury as a consequence of "national improvement" (9). His essay on "Fashionable Diseases" shares the concern of other cultural commentators with the injurious effects of Luxury and Fashion: these economic and social phenomena had extended their empire to the medical sphere. Spleen and Vapours became passé, and surrendered to the "nerves," which then ceded to "bilious" disorders" (13–15).

Medical theory had always found reasons to dub women the weaker sex, whether or not one accepts the much-critiqued "one-then-two-sex" Laqueurian approach, and the eighteenth-century medical paradigm of the nerves and fibers was no exception to this stereotype.34

Women were the center of attention for Georgian medicine dealing with these disorders, and it is to Adair's credit that he sought to help women with such problems rather than ridiculing them (although he [End Page 361] did attack "lady doctors" and influenced Southern's antifeminist diatribe, as we will see).35 The cynical might observe that female fashionable disease was very profitable, and both Adair and Southern illustrate this point vigorously. Women were more susceptible to nervous disorders than men not only because the ladies were literally finer-nerved (and fibered), but also because their lifestyles trained them to be so: Adair and later medical commentators such as Thomas Beddoes saw "Schools for Girls" and the consequent lifestyles of society ladies as breeding grounds for fashionable diseases, encompassing as they did diet, fashionable clothing, music, novel-reading, tea-drinking, exercise, and sleeping and waking. Beddoes followed in the new tradition of accessible medical writing in the vernacular rather than Latin, a form of literature consciously aimed at a popular audience, even as it defended the burgeoning profession of medicine (and its market) from what it perceived as corrupting influences.36

Adair's knitting together of concerns about the medical market and fashionable disease was not singular, although it was the most cogently expressed in his day. The anonymous author of a brief newspaper article, "Strictures on the Present State of the Practice of Physic," complained of "the encreasing commercial state of Physic," which was preventing modernization of the profession in a variety of ways, and instead leading to "injuries that proceed from mystery, prejudice and fashion in Physic."37

Thomas Trotter's View of the Nervous Temperament (1807) confirmed and elaborated on some of Adair and Beddoes's comments on fashionably diseased women, noting that the middling orders were now contracting the nervous disorders previously confined to society doctor George Cheyne's blue-bloods in the earlier part of the century. In men this was in part due to urbanization, larger cities, the new and bewildering division of labor and the rise in sedentary professions, and in women to the spread of wealth down the social orders and the opportunities for greater civilized refinement and the deleterious lifestyle which accompanied it. The mechanisms for the increased transmission of discourses of fashionable disease were now also mushrooming with the greater availability of print media, which themselves used both written and pictorial narratives.

At this point we arrive in the nineteenth century, where women and fashion became an even more crucial aspect of consumer capital-ism—the "fair sex" were conspicuous consumers who, at the same time, occluded the role of men in consumerism. The overall role of women in relation to capitalism and consumerism has been the [End Page 362] subject of much analysis, as has the agency or otherwise of female writers and their representations, but here I focus on the way in which women were represented (by men) as consumers of fashion and fashionable disease.38 It is worth stating at the outset that men of course were also consumers of fashion in clothing, especially early in the period, and it is only later in the century that the regulation dark suit comes into play.39 Nevertheless, apart from feminized and duly stigmatized men like the dandies (who did not regard themselves as effeminate), the overall role of men in representation was analogous to Mark Micale's analysis of "hysterical men": that is, male hysteria has been rife throughout history, but not acknowledged in representation as much, and as negatively, as that of women.40 Roy Porter has argued that men became the object of satire when suffering from the English Malady because nervous disorders were seen as diseases of effeminacy.41 Feminizing qualities drag the men into fashionable and, to some, risible illness.

Ann Bermingham has discussed the way in which the frequent shifts in female fashion in the Romantic period and later resulted in women being increasingly identified with instability of identity, a lack of fixity that stood in contrast to the relative stability of male fashions.42 Bermingham also analyzes the use of the picturesque to objectify, aestheticize, and marginalize women, particularly in relation to the political arena.43 The general attitude in the early nineteenth century is summarized well by William Hazlitt, writing in the September 1818 edition of the Edinburgh Magazine, who considered fashion to be "an odd jumble of contradictions, of sympathies and antipathies": "It is the perpetual setting up and disowning of a certain standard of taste, elegance, and refinement, which has no other foundation or authority than that it is the prevailing distinction of the moment, which was yesterday ridiculous from its being new, and to-morrow will be odious from its being common. It is one of the most slight and insignificant of all things."44 Hazlitt's condemnation of fashion's insubstantiality and insignificance is at odds with its perceived influence on medicine as outlined by the likes of Adair, Trotter, and Southern. Hazlitt's definition here is narrow; to others, like Southern, fashion is everywhere and has serious effects. Although momentary, fashion seems to dominate all life, and certainly involves both health and wealth in its revolutions. One aspect both definitions have in common is the association of fashion with femininity, be it women or feminized men such as the dandies. Hazlitt's essay "On Effeminacy of Character" (1822) overtly equates the feminization of men with an inability to control one's desires for [End Page 363] the consumption of pleasure (material or otherwise): "Effeminacy of character arises from a prevalence of the sensibility over the will. … They live in the present moment, are the creatures of the present impulse (whatever it may be)."45 The enhanced role of the will creates a distance between Adair's 1786 analysis of fashionable disease as a phenomenon of fashionable feminine sensibility and Southern's attack of the 1820s: now a masculine will was necessary for the efficient functioning of industry and commerce, and the concept of will would only become more significant both medically and socially as the century wore on, the end result being the creation of neurasthenia as fashionable disease.

Women and Fashionable Disease in Southern's London Magazine

The association of women and fashion extended to the health market. Women had become the representational hotspot for the Georgian medicine of the nerves, as Southern's articles of 1825 and 1826 demonstrate. There is some doubt as to whether Southern wrote the first two articles in the series of four—"On Fashions" (August 1825) and "More Fashions" (September 1825): the Index to the London Magazine says that "Hughes attributes this to Henry Southern, but when Southern discusses this subject" in the later article he states that both these earlier articles are by a contributor whom the Index does not identify.46 Southern's attribution of the early articles to a different contributor is probably smoke and mirrors, however: in "On Fashions in Physic" (October 1825), he announces at the start that he has taken up the pen on the subject, but will not adopt the "sneering manner" of the previous (allegedly different) correspondent on "so grave a subject." The fact that he then goes on to sneer frequently at the comical aspects of fashionable disease rather gives the game away, although he does, in all the four articles—the final one being "On Dilettante Physic" (January 1826)—point to the serious aspects of fashion's dominance as well. It is ironic that Southern's editorship of the London Magazine in this period caused its catastrophic decline, partly because of his adherence to Utilitarianism, and partly because of the loss of his star contributors (which in turn was connected with his tendency not to pay them).47 Hence my argument makes no claim about Southern's influence or wide audience (although his article was reproduced in other publications), only that his observations on fashion in physic reflected much popular sentiment about the state [End Page 364] of physic in this period and in the century before. The Dictionary of National Biography says that Southern, "a confirmed Benthamite and a Unitarian, … took a distinctly utilitarian view of contemporary literature, tending to dismiss much of it as irrational, sentimental, and anti-progressive. He especially denigrated fashionable novels and light verse."48 This attitude to contemporary literature apparently extended to contemporary modes of fashion in all areas, especially the medical.

"On Fashions" focuses on clothed fashion, and women as the conspicuous consumers of fashion. The article echoes and expands Adair's ontological point about fashion creating and destroying identity: "To be in the fashion is to exist, it is existence itself: to be out of it, is non-existence; it is oblivion, death, and the grave. It is beauty, morality, everything—not dress alone; its sway is unbounded, its powers unlimited, its sanctions unquestionable."49 If fashion has conquered all in Adair's time, then by 1825 Southern has internalized the formative power of fashionable discourse, and argues that "The fashion of a thing is the form thereof. 'Thou hast fashioned me,' thou hast made me. … Fashion is derived from facio to make: the etymology is abstruse" (585). Fashion is also gendered, dictated by the tailor for men, the milliner and the mantua-maker in women (585, 590). Man is nothing without clothing, nothing without fashion, but woman is the true object of attention and receives the largest amount of Southern's description and analysis: she would be "a nothing; a variable, inapprehensible, inexplicable, unintelligible, bundles of caprices—not even a thing as the Romans considered her … a wind influenced by every wind that blows. But she is solidified by muslin, and silk, and crape, and gauze; and she becomes a tangible substance—a woman of fashion, provided that she is fashioned by Madame Hippolyte or Madame Triaud" (585). The mystery of the female, the stereotypical assignment of meaninglessness and irrationality to women, who are reduced to their physical being in this case, is hardly surprising in Western patriarchal discourse (of whatever stripe), but it is fashion's role in donating an identity to women that is more innovative. Women are collapsed into fashion, physically and psychologically.

Now women's bodies are shaped by fashion, and fashion dictates what is beautiful in women:

[F]ashion is beauty, and beauty is fashion. Waists contract and expand, anon she is a wasp, and anon a barrel; now she diminishes the equatorial diameter, and now she enlarges it; zones ascend and descend from the seat of honour to the seat of the heart … [End Page 365] the bosom now "hides, oh! Hides those hills of snow," that the spectator may riot in scapular charms and spinal vales; and again tuckers descend till descent becomes once more precarious, while the balance of compensation restores to concealment that of which the repose should never have been disturbed. Yet, like the moon through all her changing phases, she is always beauty, for she is always fashion.


Changeable women, changeable fashion: the moon is a combinatory metaphor for both here. Whether the shape of a woman be a "wasp" or a "barrel," there is no escaping the fact that women are identified totally with fashion in this kind of satirical discourse. Here, women are figured as the problem partly because they, "a gullible sex," are more susceptible to fashion than men (588, 590). The male moralist's message is that women should make themselves look beautiful for men rather than boasting about how much they have spent on fashion to other women, as "man is the true judge and critic" to be pleased (589). After all, Southern points out, men have to finance these fashion expenditures.

The brief follow-up article, "More Fashions," is less concerned with women, although it does argue that "Indolence; the principle of imitation" causes fashion, a lack of critical thinking in people in a kind of sheep mentality or, in this metaphor, "monkey" behavior.50 In the discussion of fashions of all kinds—a bewildering variety listed here—it is clear that fashion dominates all areas of life, as the first article had made obvious via its anxious comedy. The subject of fashion in physic is first trailed in this essay for a couple of paragraphs, a hint that will be greatly expanded in the next one. The "facile principle of imitation; the monkey principle" motivates fashions like the "sangrado" method of "bleeding and hot water" (93). Women fall under this rubric too: the subject of fashionable childbirth crops up because midwives have been ousted by men, and Southern deploys Mrs. Shandy, from Laurence Sterne's comic novel Tristram Shandy, who "must now lie-in in town" because it is the new fashion (91). This joke is all the more amusing considering that Sterne's enormously vogueish novel was serially published from 1759 onwards. Literary fashionability (and the serial publication of the periodical is implicated here too, although one doubts Southern intended this notion) goes hand-in-glove with the medical.

Most significantly, Southern makes the point that fashion is the mark of Western civilization and its economic systems, an issue of Empire and Nation. Fashion is "the sublime invention by which Europe [End Page 366] is distinguished from the East. China has but one fashion; it has no fashion: therefore, it is the eternal, as it is the Celestial Empire. … When the East has fallen, it has been by changing its dress. Rome fell when she became fashionable and changing. Had she kept the toga, the red harlot would never have sat in the chair of the Cesars."51 Both fashion and empire are feminized here, it should be noted, and there is a danger, even a sexualized danger, to fashion's power, as the reference to the "red harlot" of Cleopatra exemplifies perfectly. Fashion is desirable, useful to the consumerism of the West, but has inherent threats to the sustainability and morality of the system.

The most substantial of Southern's four articles on fashion, "On Fashions in Physic," elaborates the way in which his own time has seen the triumph of fashion in all spheres, including the medical world with all its facets and participants, not least women. The first thing Southern achieves in this essay is to expose comprehensively the workings of the medical market in relation to fashionable diseases, from patient demand to money-making doctors, apothecaries, and quacks. He also takes aim at profitable treatments, which in turn included places of treatment like fashionable spas. As we will see later, in some senses the much-satirized "Lady Bountifuls" fell outside of the more masculine professional system of consumer medicine, which ironically diverted attention from male malpractice and misuse of fashionable diseases.

Southern begins with the diseases themselves and, inevitably, he turns to the group dominating much of the eighteenth century: "all the disorders which have no name … called nervous—when something or other had fallen on the nerves—when the nerves were unstrung, strung, relaxed and so on."52 These illnesses are "that endless tribe of troubles which besets the higher orders of society very conspicuously, the female part of it more conspicuously still" (178). The fact that men were plagued by nervous disorders quite as much as women (as Micale has argued in Hysterical Men) is ignored: this is clearly a disease of effeminacy and luxury, and the middle-class satirist sees no difficulty in condemning the fashionable lifestyles of the upper orders in the manner of Samuel-Auguste Tissot's On the Disorders of People of Fashion (1766).53 Southern rapidly expands this Adair-like description of nervous disorders to the whole nervously fashionable world, which incorporates pretty well all parties: "And when nerves were the fashion, every body [sic] had the nerves and nervous disorders; and took nervous medicines; and physicians wrote books on nervous complaints; and all the people swallowed caster, camphor, asafoetida, galbanum, musk, valerian, opium, aether, juleps, and heaven knows [End Page 367] what more. These were the fashionable remedies: every one was in the fashion, in the remedies as in the diseases."54 A whole system of fashionable disease is encapsulated in this short paragraph: patients appear to acquire the nerves, physicians encourage and legitimate the process by writing medical books on the subject, and patients eagerly consume the treatments manufactured for them by the apothecaries and the eighteenth-century drug industry and medical market (spas amongst them, though Southern does not mention them here). Everyone, as he points out, is "in" the fashion, immersed in a process of fashionable disease from which there is no escape—at least until the next fashion. To nobody's surprise, this is what happens next: "Lo, and behold, the nerves have vanished!" (178). All the old remedies are out of date: "nobody reads Whytt; nobody complains of nerves; nobody cares for nerves" (179). Fashionable diseases are not a static phenomenon, not framed at one moment in time: they are enmeshed with a whole fashion system of medicine, a system which, by its very nature, is a developing narrative consisting of different "characters," different actors, different elements, a spiraling plot in which change is guaranteed and necessary, but does not repeat itself exactly. One cannot understand a fashionable disease without examining its treatments, its sufferers, its healthcare professionals (or possibly un-professionals), its carers, its past history (sometimes going back to classical civilization), its literary and artistic mythology (if it has one), and so on.55

One key element in this construction is the fashionable patient ("the patients themselves have revolved"): "the lady who wants a carriage can no longer gain her end by hysteric fits. Hysterics have ceased to be genteel—they have ceased to be fashionable."56 We see here that fashionable disease can have, in Freud's words, secondary gain: the lady gains her carriage on production of hysteric fits.57 The problem comes when the disease falls out of fashion: no fashion, no gain. The lady is no longer a legitimate patient deserving of sympathy and gifts, large or small. Thus the category of patient goes along with the disease category: legitimacy and fashionability are paradoxically bound up in this instance. Southern's style often involves an attack on fashionable diseases in both genders slipping into an attack on women as the symbols of fashion and fashionable disease.

Social rank, naturally, is also entangled with fashionability: the hysterics are now "sent downwards to Doll, and Cicely, and to the shoemaker's wife."58 Trickle-down is a known effect in contemporary fashion, and was certainly the case in the eighteenth century and later.59 By the time the lower orders have adopted a fashion, however, [End Page 368] the upper orders have moved onto something else, not least precisely because the fashion has been popularized and apparently contaminated by class emulation.60 Even Fanny Kelly's notoriously histrionic acting style was unable to bring hysteria back into fashion. According to Southern, "the mode did not take: it expired in a few screams, and evaporated with the smelling salts."61 The question of female hysteria and authentic disease is one to which we must return, but it suffices to reinforce Southern's representative suspicion that women, like fashion, are false, fickle, and disruptive of class boundaries.

Women are also used to legitimate fashionable disease and fashion in general as a given ideological and economic condition, an inescapable feature of modernity in 1825. The fashion "of longing" in pregnancy, for example, also benefits women, "a delicious invention," or would have had it not fallen out of fashion: "the ladies are much to blame that they have lost sight of this notable discovery … they will not now long, even for a pine-apple" (181). Tobias Smollett's Adventures of Peregrine Pickle (1751) is the point of reference here: Smollett's novel places Mrs. Pickle's (fake) longing for a pineapple in pregnancy as a sign of pleasurable female consumerism—literally a fleshly appetite to be fashionably indulged on a whim.62 When things are in fashion, they seem natural, certain, irrefutable facts: "Nobody could possibly doubt the fact and the philosophy both;—when it was the fashion. It is not the fashion now, and every body [sic] doubts it."63 The flip side of the fashionable coin is that the unfashionable becomes inauthentic, unnatural, contestable—at least from the perspective of those in fashion.

Money, of course, is an integral part of fashionable disease: the fashion system is, as we have seen, a part of the consumer process of creating demand. Only some people have access to fashionable treatment, however. Indeed, the status and personality of the person dictates the level of fashionable treatment one can receive: "if he abounds in wealth, folly, fashion, or confidence, it [bleeding treatment] is repeated" (189). One fashionable treatment replaces another as the patient is bled, then "sent to Italy" where the bleeding via lancet is halted, and then the patient gets better and "the climate gains the applause" (189).

Fashionable doctors are a crucial part of the equation, along with the patients, who are not passive actors in the creation of fashionable diseases (as Jonathan Andrews and James Kennaway demonstrate elsewhere in this issue). Southern wisely observes that "A man ought always to be in the fashion, whether he is a doctor or a patient. … For a doctor to run counter to the fashion, would be to cut himself [End Page 369] off from all chance of future salvation—and present fees" (178). A doctor needs to cultivate fame and celebrity, those important sales tools in the manufacture of fashionability, for both himself and the disease: "Each makes each's fame and fortune; that is, the doctor makes the fame for the disease, and the disease makes the fortune for the doctor. Between them they make the money" (183). The question of fame is intertwined with fashion; without fame, there can be no fashion because fashion is a phenomenon that involves groups of people, and fame is the lubricant that enables fashion's ongoing financial success.

As Southern succinctly points out, there are many elements to the systems of the creation, maintenance, and fall of fashionable diseases: "If there are fashionable theories, fashionable diseases, fashionable practices, fashionable doctors, and if all these revolve and change, like our dresses, our opinions, or other fashionable matter; so there are fashionable drugs, fashionable remedies, shifting with the seasons; omnipotent when in the fashion, worthless when out of it. And, as we just hinted, the remedy which thus gains temporary rank, renders fashionable the doctor who introduced it. A fashionable physician needs not introduce a new drug—it is the drug's business to introduce the unknown doctor" (186). In this topsy-turvy world of fashionable physic, it is often objects (drugs here) that have agency, and more power than human beings, even doctors. The creation of fashionable disease and its related phenomena (fashionable doctors, patients, treatments) is a complex one, however, and cuts across discursive domains. Medical knowledge and its legitimacy are heavily implicated in the production of physic and its fashions. Hence the process of creating a fashionable drug sounds uncannily familiar to the modern reader: "write a book, give it a name, call it rhatany root, make it a sovereign cure for all diseases, put a high price upon it, and the business is done" (186). If a book, the physical embodiment and legitimation of medical knowledge and power, recommends a certain treatment and invests it with a more or less spurious medical theory, and then, as the contemporary phrase has it, "monetizes" the product by making it available for consumption at a conspicuously exorbitant price (thus legitimating its efficacy again via the market assumption that if it is expensive it must be good), voilà!—a fashionable drug is created.

Fashionable disease is of the moment in more ways than one in Southern's essay, as the Industrial Revolution and its division of labor made for a more intensively "productive" system of fashion in physic. After all, Adair had not given much emphasis to the notion of medical specialization in his attack on fashion. Southern takes aim [End Page 370] comically: "It thus appears that fashion in physic partakes in that most profound, most valuable, most scientific, most economical quality which Dr. Adam Smith terms the division of labour. He who understands gastro-enteritis cannot possibly understand the ears: he who knows the eyes is ignorant of the teeth. By and bye we shall have a doctor for consumptions, a doctor for bile, a doctor for dropsy, a doctor for water in the head, and a doctor for scrofula" (185). This essay is truly fashionable in its ability to cite contemporary trends in discourses beyond medicine, including a plentiful peppering of political references and jokes. Of course that division of labor already exists and brings fame to its fashionable practitioners: "Dr Stewart is the only man who can cure consumptions, Dr Solomon is, or was if he be dead, the man of men for nervous diseases; nobody can cure the liver but Mr. Abernethy, nobody the bile but Dr Scott—when he was alive; nobody can champoo but Mahomet, or scrub but Dr Grosvenor, or make steel collars but a man who lives at Warwick" (185). Some of these practitioners are inconveniently dead, although this does not seem to prevent them from being fashionable and profitable. The larger point is that, as in wider society, the dizzying multiplication of possible doctors, treatments, and diseases as objects for consumption is indicative of the explosion of modern consumer capitalism, of which medical knowledge itself is a part, and which periodical literature exists to frame.

We return—as Southern frequently does—to the issue of women as the symbolic perpetrators of the sins of fashionable disease, and central players who drive the system's profitability, even as they hide the role of men, not least of the doctors themselves. Women feature largely in Southern's discussion of the power of fashion to be actually useful, where he describes how barbers replaced surgeons and lancets replaced cupping glasses, which "occupied too much time, the blood would not flow, in short, it went out of date" (187). This led to a "new division of labour" where the "cupper" springs up. The cupper needs to make trade by generating diseases which cupping can treat: "if he does not find the disease, he makes it; if he finds a disease he makes it worse" through more cupping. "Cupping could not thrive, unless there was a 'flow of blood to the head,'" Southern informs us: here theory drives treatment, or at least justifies it. The fashionable female is a prime candidate for fashionable diseases, theories, and treatments: [End Page 371]

the pale-faced or green-visaged Miss, whose blood has been flowing a whole winter at Alamack's, the opera, balls, assemblies, till six o'clock every morning, heaven knows in what direction, discovers that it is all accumulated in her head; the cupper restores the equilibrium, she turns green and greener, must be cupped again, becomes nervous, cross, giddy, hysterical, and when she displays her scapulae and her nape next winter, displays them with twelve, eighteen, twenty-four, or thirty-six white ornaments marshalled in the most beautiful quincunx order imaginable. Man becomes disgusted, her lover flies: what matters it?—cupping is the fashion.


The giddying and exhausting whirl of the fashionable woman's lifestyle leads to green-sickness (a form of anemia seen as a woman's malady), much treatment, more illnesses of a nervous variety, and disfigurement by the multiple marks left by the cups on her fashionably exposed skin.64 All this is to the profit of those treating her, of course. The recent celebrity vogue for cupping (by Jennifer Aniston, Gwyneth Paltrow, Katy Perry, et al.) is eerily reminiscent of Southern's comments here, although the celebrity industry in the twenty-first century is more heavily exposed in the media than that of the long eighteenth.

Hence the fashionable treatment becomes, as it were, a fashionable disease all of its own, like the remnants of the smallpox which so scarred a lady's beauty and reputation in the eighteenth century. Lady Mary Wortley Montagu's character in her town eclogue "Saturday, the Small Pox" describes the impact of such marks on the female body in melodramatic fashion. Admiring beaus, opera tickets, fashionable chinoiserie, "empire" over other women—all are lost when beauty is no more, weeps "the wretched Flavia."65 In this context, the life and diseases of women in fashionable society do not seem particularly different from the early eighteenth century to the early nineteenth, but there is a telling difference in the representational intensity of the world of fashionable diseases in Southern's time.

Southern's style reflects this intensification of the discourse on fashion and fashionable diseases between 1786 and 1825: Adair's even-paced and urbane prose gives way to a more frantic and acerbic content and tone in Southern's articles, perhaps also influenced by the Stock Market crash of 1825–26, often referred to as the first modern crash because it was caused by elements internal to the economic system rather than external factors (war, foreign investment) that could be blamed on an individual or group of people; after this crash, political economists realized that Britain was a fully commercial society governed [End Page 372] by economic laws which exceeded the power of individuals to control its effects.66 Fashion was now an obvious factor in the speculative play of the markets, and the crash brought a new anxiety about fashion to the fore, not least in the medical market. The immateriality of fashion would chime with Marx and Engel's famous claim from The Manifesto of the Communist Party (1848) about the logic of capitalist exchange, "all that is solid melts into air." Hence Southern, writing in the very midst of economic disaster, reflects and expresses a greater anxiety about fashion and its medical consequences than Adair's article of nearly forty years earlier.

Women: The Economics of Authenticity and Literary Style

Central to the problem of fashionably diseased women is their illusory, insubstantial nature, manifested in part by attacks on fashionable women as inauthentic or fake (on this subject, see Jessica Monaghan's essay in this issue). This question is important for the framing of fashionable disease in eighteenth-century and Romantic culture. In his discussion of the rotation of fashionable diseases, Southern states that "bile stepped in at a favourable moment: and it was a more tangible, intelligible kind of substance. The existence of nerves was somewhat obscure, rather metaphysical: they might be doubted—they and their effects."67 The liver does not rely on "imagination" and "fanciful" invention: "the liver was a real, sensible organ, as any one might see in a paté de perigueaux, or under the left wing of a roasted chicken" (180). Certain physical qualities lend themselves to an apparent disproof of the accusations of melodrama at least, if not downright mendacity, that accompany fashionable disease in women. Like cosmetics, fashionable diseases hide the truth below. Bile, however, is grittily real (or appears to be so): "It was an indisputable fact and equally certain of it, that, when the ball was over, the rouge wiped off, there was a yellow tinge in the complexion, which could be nothing but bile" (180). Again, the discourse of fashionable disease has slipped imperceptibly into a diatribe against fashionable women and all the accoutrements that constitute their evanescent social world.

These attacks are also attached to the fact that women (allegedly) drive fashionable behavior. Southern's analysis of the fashionable location of treatment is entirely framed in terms of female desire and (fickle) will: the locale of fashionable disease becomes as contingent upon social fashion and the medical market as upon the symptoms and rationale [End Page 373] of the disease itself. The apothecary must ask "the private question: 'To Bath or Cheltenham?'" (180). All the comforts and rhythms of home life are disrupted as the fashionable female patient follows the crowd: "the excellent house in the square becomes deserted for a dirty lodging at Leamington, or Brighton, or Ramsgate, or Cheltenham, or Bognor, or Margate, or Southend, or any where else that is the fashion and at a price greater than the house in the square itself; the children are sent to a preparatory school, or to a cobler's [sic] wife to nurse; the husband must console himself at home with upholsterer's rubbish and naked floors, and a woman to look after the house; and abroad, with his office at the Treasury" (180). The issue now becomes fashionable disease as a menace to the entire domestic economy for which the woman of the house is traditionally responsible. The husband, with his job at the Treasury (hints of the stock market crash here), is similarly "deserted" by his wife and emasculated by the power of fashionable disease. Ironically, the new "dirty" lodgings are bound to be unhealthier than the "excellent" home deserted by the fashionable patient. Similarly, the implication that there will be transmission of disease from the lower orders to the children via wet-nursing is an ironic commentary on the potential for further victims of the melding of disease with fashion. This metaphoric language of dirt and cleanliness, disease and health, purity and danger, maps social spaces onto the families and individuals who inhabit them, but such discourse is caused by female wilfulness in the broadest sense of the word. Ironically, the husband in this example works at the Treasury, but his economic role is obscured by the consumer behavior of his wife, who cannot get enough either of fashionable disease or its fashionable treatment.

Southern reinforces the economic consequences of female desire in relation to fashionable disease as he goes on to paint a post-Smollettian vision of social disorder and financial ruin, again chiming with contemporary turmoil in the markets: "The money that is not spent in lodgings goes in jackasses, and raffles, and apothecaries; habits of incurable idleness, and folly, and dissipation are produced; and at length it terminates in a country-house at Brighton, or elsewhere. The nerves would not have cost half the money, even if the hysteric fits had added another pair of horses to the carriage" (180). Apparently the progress of fashionable diseases goes in tandem with the maladies of feminized civilization, which echoes diatribes against the curse of luxury by eighteenth-century moralists and medics alike. Now even diseases are causing more expensive consumption of fripperies; even diseases promote idleness and dissipation of potentially productive [End Page 374] energies. That said, in this satirical portrayal diseases are really social diseases: people—women—are manipulating the disease rather than the other way round.

In Southern's "On Dilettante Physic," the final article in his fashion series, woman herself becomes a fashionable disease, inflicting her own contagious addiction to fashionable physic on all around her, or at least on those unable to resist. Lady Bountiful (the name of a character in George Farquhar's 1707 play The Beaux' Stratagem) is only one aspect of this feminized economy of disease. One of the main problems here is that women are partaking of the new knowledge economy to redirect medical power and fashion into their own hands. With the innovation of widespread diffusion of knowledge via such periodicals as Southern's own, if everyone knows something about everything, then it follows, so the satirical argument goes, that "every lady too is her own physician, and not only her own physician, but that of other people."68 Physicians like Adair and Beddoes had also railed against "lady doctors," but Southern adds a new vigor to the attack in this article. This assault probably reflects Southern's anxieties about the status of the literary as well as the medical professional, and a more general uneasiness about the fact that women were a crucial part of his audience, as David Stewart has argued about the wider audience for the periodical market at this time.69 Women are aided in this usurpatory enterprise by popular self-help manuals of medicine like "the labours of Dr. Buchan, Dr. Reece, Dr. Underwood on Children … the New London Practice of Physic, and more. …"70 Again, this sounds familiar, a clear parallel with our own age of internet diagnosis, where medical professionals are routinely challenged with information—perhaps correct, perhaps not—gleaned from a rapid internet search.

Southern's focus is on women in this article: they have the time and idle lifestyle to indulge such "dilettante physic." Through this assumed knowledge of medicine a woman can affect the lives and health of "her children or those of her poor neighbours, or her rich ones, if they are fools enough" (88). For Southern, dilettante physic is ruinously dangerous, as the law judges "properly" "that every person has the right over his or her own life, and that, provided it be done by physic, and not by steel or gunpowder, they have an equal right over those of their neighbours" (88). It is worth noting that the way men acquire medical degrees, especially in Scotland, comes in for some scathing criticism: "we understand that there is a university called the University of Edinburgh, where ragged Scotch louts spend [End Page 375] twenty or thirty pounds, and six months, in acquiring what is called medical knowledge … [I]n Glasgow they do pretty much the same" (88). Nevertheless, the default position of the piece, as with the Adair and Beddoes essays, is that women should keep out of medicine and leave proper professionals (men) to do the work. The female method of physic, however, is called "instinct, or intuition, which can never err, as reason does." Much sarcasm follows about the delights of being tended to by the "lovely sex" who "sweeten" the experience of taking drugs, and positively encourage men to "have a pleurisy or a hay-fever once a week" (89). (We remember that hay-fever was identified in Southern's previous article as a fashionable disease of his time.)

For some of the article Southern's tone is appropriate for a more light-hearted satire on matters trivial, a kind of mock-heroic role for the ladies in a Popeian literary frame, but at times, and especially towards the end, he moves into a Swiftian strident antifeminism. Southern ensures that the audience realize the gravity of women's meddling in medicine: "we have seen mothers kill their children, as effectually as if they had administered poison; and this, even in defiance of advice and caution" (93). Women, along with "country curates," have caused "the great mass of failures in vaccination" due to their interference. The diffusion of medical knowledge via self-help manuals and periodicals has destabilized medical hierarchies and even threatens the women themselves: "Every woman, and now most men, have learned to read their prescriptions, and to reason in their own way about them, with numerous evil results. As far as the power of medicine influences the disease through the imagination, it is often rendered useless or pernicious. Thus also they decline that, of which they pretend to judge better than the practitioner, or alter or increase the doses, or, to use a fashionable phrase, cheat the doctor, forgetting that it is themselves they are cheating" (93). The control over one's own prescriptions, an alleged but illusory knowledge, merely removes the possibility of a proper, professional assessment of the disease. Cheating the doctor is a fashionable activity, and patient power results in further fashionable patient illness. Even the placebo effect is removed by this kind of mistakenly malign medicine.

Women bring chaos in terms of manners too: this fashionably female physic cares not for "false refinements and false delicacy"—"to be profoundly intimate with the effects of calomel and salts" and other powerful drugs of the digestive system is merely "good sense," claims Southern in full ironic mode (89). The fashionable spaces of Georgian England are now placed in the service of paradoxically fashionable [End Page 376] medical realism: "Cheltenham has cured us of most of these false feelings. A spade is a spade: let it be called so: that openness and truth may be the characteristics of our enlightened age." The trampling over social decorum is ironized as a bringing of "divine philosophy into our meals and our drawing rooms," a liberation of both genders from "silly restraints." "Bile" reigns at "our dinner tables."

If social interaction and polite boundaries are reversed in the rise of the dilettante female physician, the disruption caused by her actual practice is of even more concern to our male author. At the start, and more or less innocently, the illness of neighbors of all classes provides an excuse for much prying into other people's affairs and much gossip. Rating the abilities of various apothecaries provides a great deal of amusement ("why Jackson is clever, why Johnson is cleverer still"), but the real point of interest is "the female physician," "physicking, with matter more solid than talk, herself, her children, her husband, her friends, her rich neighbours, her poor neighbours, all whom she can persuade or compel to swallow her physic" (89, 90).

In this article, Southern has women bear the brunt of the stigma of fashionable physicking and disease in their own quasi-domestic sphere, thus diverting attention from the masculine capitalized economy of the mainstream medical profession itself. The problem is a representational one: men are clearly involved in these processes, but women are the focus of attention in volume and genre (antifeminist satire) of narrative. The threat that dilettante women seem to pose, coupled with the fundamental problem of the anxiety they induce as symbols of fashion and fashionable disease, drives Southern into an acerbic Swiftian critique of all things female and medical.71

For example, Southern describes the cultural factors that result in the development of the female dilettante physician from birth, dosed on various medicines from the very time "of her creation." The consequences are predictable: "she becomes innately and congenerously physical. Carrying an apothecary's shop in her inside from her birth, her ideas become necessarily medical, as from the natural transference of the physic to the brain. Among the few ideas found there, a large space is occupied by medicine and medical matters."72 Fashionable treatments ensue: "There are worms, a headache, or nerves, or the apothecary says so, or mamma thinks so, or Anderson's pills are in favour, or Dr. Barclay[']s, or she has a cough, and Greenough's lozenges are sovereign, or some reason or other is never wanting" (91).

Our heroine, not unlike those female valetudinarians of Jane Austen's Sanditon or Persuasion (both published in 1817), thus "becomes [End Page 377] bephysicked for ever" and every situation or mood calls for medication: "she is nervous, irritable, or cross—a dose of salts; or her lover remarks that she is languid—a dose of salts, or Cheltenham, or Leamington, or the sea-water baths, or Bath itself, or the apothecary, or perhaps the physician, if she is sick and fashionable enough."73 In a veritable spiral of fashionable treatments leading to further fashionable maladies, which lead to further fashionable treatment, our heroine descends into both ill health and financial disease: "all this time, the bills are heavy, and the young lady is 'indeed very delicate, poor thing!' and becomes a useless, ill-tempered, fretful, selfish, hypochondriacal compound of drugs and fancies, and becomes idle and peevish for life: or, till growing a little older, and now well imbued and well trained, she becomes convinced that life is what the poet has called it, a 'long disease,' becoming herself a disease, a diseased mind in a diseased body, and a pest and a nuisance to herself and all around her."74 In short, our heroine is a fashionable disease: the two are collapsed into one entity. Much as Pope complained of "this long disease, my life," but without the attendant male genius, the female invalid is doomed to frame her whole existence through fashionable disease. Southern's tone is distinctly acid in this passage: fashionable femininity becomes the focal point, and scapegoat, for all that is wrong in medicine and fashionable culture.

The fact that she takes over her "own management" exacerbates the problem: "each day, she is more nervous and more irritable; every day, her complexion is more muddy, her skin becomes greener, and she is blacker under the eyes. Nothing is so sovereign against nervous irritation as calomel, because it proceeds all from the stomach, and the stomach sympathises with the whole system. That much of the jargon she has learnt. More calomel. Or the liver is afflicted, and she is bilious; more calomel, and the blue pill. Nothing like salts for clearing the complexion, and removing the blackness under the eyes: salts. More blackness or more peevishness-more salts." To cut a long story short, the "young lady of twenty-eight" states that "It is very odd, I have taken calomel or salts every day since I was eight years old, … and I am more nervous than ever!" (91).

The intense focus in Southern's fourth article on fashionable women as the "disease" both of medicine and, in a wider sphere, of capitalism itself, concludes in a closing strategy that is inflected by a Swiftian misogyny rendering fashionable disease grotesque, at least to the appreciative male audience of this satire. Part of the female audience too would no doubt align themselves, in the manner of Austen, [End Page 378] against fashionably diseased and fashionably dosing women. Southern takes on the female physician on her own terms:

[W]e would rather try to influence them by assuring them that they ruin, by their calomel and salts, the beauty which they are so anxious to preserve and improve. We would try to influence them in this also, by telling them that they render themselves odious to our sex; peevish, fretful, anxious, gloomy, and irascible. We might also tell them that they become nervous, and that there is nothing which man so abhors as a nervous woman. We might also tell them, that, to practice physic, is a masculine assumption which a man detests; that to practice on themselves, to frequent Cheltenham and to talk of its necessity; that to be acquainted with medical terms, and to talk, or even insinuate, physic, in any of its forms or modes, is nauseating and disgusting; and that love flies, as it did from Celia, at the repulsive notions excited by physic, apothecaries, calomel, and the whole detestable jargon.


Beauty, or the disastrous consequences of its lack, is a key concept here: like Lady Mary Wortley Montagu's character of Flavia in her poem about the loss of beauty through the smallpox, self-dosing can cause more than just a few facial blemishes. If beauty is lost, so is a woman's social capital. Woman's power, according to this argument, rests precisely in not having the power of self-determination in medicine or in economics (so no expensive trips to Cheltenham).

The Swiftian references here are to the "scatological poems," in which ironic heroines, like Celia, are brought down from their allegedly divine status via a microscopic attention to their physical defects, prosthetic as well as actual. Celia "stars" in The Progress of Beauty and The Lady's Dressing Room (1730). Swift's satirical strategy relies on male nausea in response to the female body. Women becomes monstrous, defamiliarized, grotesque:

The Bason takes whatever comesThe Scrapings of her Teeth and Gums,A nasty Compound of all Hues,For here she spits, and here she spues.75

Southern's invocation of Swift's satirical mode is appropriate to the antifeminist thrust of the whole piece, as well as the strategy of basing the final reproach on the idea that men will be repulsed by [End Page 379] the grotesque transgression of roles perpetrated by fashionable lady physicians. By usurping a male role, women become monsters, or fashionable diseases in their own right, fraught with physical and mental symptoms expressing their attack on the hitherto stable gender categories of the social body.


To answer our initial questions about how women, capitalism, and fashionable disease were framed in the early part of the nineteenth century, and what function the image of women played in the depiction of fashionable disease, we can say that women's relationship to fashion, its consumption, and its concomitant ability to destabilize identity and morality, placed them in a difficult position vis-à-vis disease and the medical market. Fashionable disease was, and is, partly a product of the medical market, which itself is a subset of capitalism in general. Women's profoundly ambiguous situation as both consumers and consumed, fashionable and fashioned, meant that they were the main targets of satire (itself an index of social anxiety) throughout the long eighteenth century, and that this focus on women and fashion intensified as time went on. Contemporary medical theories (and older classical ones) about the frailty of the female nervous system, especially in the second part of the eighteenth century, further compounded the place of women as a metaphor for, if not the embodiment of, fashion and fashionable disease.

By the moment of Southern's essays in the mid-1820s, the presence of a medical market increasingly divided in its labor, the operation of a periodical press capable of sustaining an outpouring of knowledge on an unprecedented scale, and a literary market itself subject to the scrutiny of the periodicals, all combined with other factors (including the first modern stock-market crash) to subject fashionable diseases to a new level of scrutiny. This intensification of narrative anxiety (and possibly pleasure) was expressed in the very style of writers such as Southern. Literary genre became a vital part of framing fashionable disease. Although the role of men in all aspects of fashionable disease was represented to a certain extent, it was women who drew fire in satirical discourses and women who were their primary symbol. [End Page 380]

Clark Lawlor

Clark Lawlor is Professor of Eighteenth-Century Literature at Northumbria University. His publications include Consumption and Literature: The Making of the Romantic Disease (2006) and From Melancholia to Prozac: A History of Depression (2012). Between 2006 and 2009 he was Co-Director of the Leverhulme Trust project "Before Depression, 1660–1800: The Representation and Culture of the English Malady," and is Principal Investigator of "Fashionable Diseases: Medicine, Literature and Culture, ca. 1660–1832" (2013–2016), a major project funded by the Leverhulme Trust.


I am deeply grateful to David Stewart for drawing "On Fashion in Physic" to my attention early in the project, and for his advice on the Romantic periodical. Megan Coyer has been more than generous in her very helpful and expert comments on the medical periodical and literature in this period. My thanks also to Pete Newbon, Leigh Wetherall-Dickson, Allan Ingram, and Ashleigh Blackwood.

2. Unlike other essays in this volume, my concern is with the broad cultural perception of fashionable disease rather than the patient experience, although we do gain some insight into the misery and possible gain for patients caused by fashionable diseases of many sorts.

7. Quoted in Wahrman, 208.

9. Wahrman, 205, and on fashion 202–7.

10. Ibid., 206.

11. Ibid., 208.

15. Philip Connell has shown that educational and literary discourse was thought necessary to the advancement of commerce and industry by the political economists: see his Romanticism, Economics, and the Question of Culture.

16. See Romantic Sociability, edited by Gillian Russell and Clara Tuite; and Keen, 14. David Stewart discusses the metropolitan "Cockney style" of the varied reading audience of periodicals post-Waterloo in his Romantic Magazines.

24. For a recent intervention which takes into account the complexities of age in the equation of women, fashion, and consumerism see Amanda Vickery, "Mutton Dressed as Lamb? Fashioning Age in Georgian England." Although I am deploying a series of largely literary-critical writers to make my argument here, many of them are clearly influenced by a number of fashion theorists who are themselves inspired by Roland Barthes' foundational study The Fashion System. Barthes' study was first published in French in 1967, and is dated in its source materials and methodology, but it makes the crucial point that fashion is deeply implicated in both capitalism and discourse. Subsequent theorists have turned his theory to feminist purposes, including the almost equally influential Elizabeth Wilson's Adorned in Dreams: Fashion and Modernity. For a more recent overall evaluation (also involving a revaluation by Wilson), see Christopher Breward and Caroline Evan, eds., Fashion and Modernity.

29. Clery, Feminization Debate. James Noggle helpfully discusses the complexity of fashion discourse in the eighteenth century in Temporality of Taste, showing how different social groups constructed fashion in different ways, whether positively or negatively. Tim Campbell has also recently demonstrated the influence of fashion on historical thinking in this period; see his Historical Style.

32. Pope, canto 1, lines 129–38.

33. Further references to this essay, contained within Adair's Medical Cautions, will appear parenthetically in the text.

34. Wagner discusses the political effects (on actual women) of the two-sex model in the Romantic period in Pathological Bodies.

36. For an anthology of, and commentary on, this tradition of accessible medical writing, see Lawlor and Suzuki, eds., Sciences of Body and Mind.

38. For sophisticated, if perhaps optimistic, approaches to Romanticism and gender, see Garofalo, Women, Love, and Commodity Culture; and Wolfson, Borderlines.

39. See Kuchta.

40. See Micale.

42. Bermingham, 91. See also Gillian Russell's discussion of fashionable women and fashionable society in her Women, Sociability and Theatre.

47. See Prance and Riga, xix–xxv. A later review article in the Spectator (1841) mentioned Southern's "On Fashion in Physic" as "the title of an article published many years since in a defunct periodical of more repute than circulation, the London Magazine. The paper contained a rapid narrative of the different medicines and modes of treatment that had been in vogue here, from the time when people, not confined by some acute disorder, began to attend to their health: the object being to ridicule physic, and to insinuate that the prevalence of a fashionable remedy, giving way in its turn to some fresh mode in medicine, was a strong proof of the propriety of the ridicule" (Anon., "Lee on Mineral Springs," 15).

51. Ibid., 95. For British knowledge of China and ensuing literary representations, see Kitson's Forging Romantic China. Wagner analyzes representation of George IV's consumption of Chinoiserie (including food and architecture) in the light of political satire: see Pathological Bodies, chap. 6.

55. See my critique of "framing" disease in Lawlor, Consumption and Literature, 6.

57. See Strachey, 382–85. For a literary discussion of secondary gain in the context of Jane Austen, see Gross, 189. [End Page 382]

59. Tobias Smollett's character Matthew Bramble in the novel Humphry Clinker (1771) attacks the indistinction in rank that the dissemination of fashion and the loss of sumptuary regulations promoted. Who now could tell a footman from a Lord in Bath or London?

60. The emulation theory of "conspicuous consumption" propounded most famously by Thorstein Veblen in his Theory of the Leisure Class (1899) has been modified by Colin Campbell, who argues that this theory "fail[s] to grasp the full complexity of either the symbolic meanings possessed by consumer products and services, or the communal and associational dimension of the act of consumption. … It would be more realistic to note that consumers are typically striving to make their consumption conform to the pattern exhibited by one group and deviate from that manifested by another" (Campbell, Romantic Ethic, 50–51).

62. See Beauman, 100, and 77 for the effect of pineapples in the "hot Bed of fashion" (Ralph, Case of Authors, 41; cited by Beauman).

64. See King, Disease of Virgins, and Tissot on the disorder of the eighteenth-century fashionable lifestyle.

66. For a concise introduction to the 1825–26 crash, see Dick, "On the Financial Crisis."

71. Recent scholarship on the periodical has drawn attention to its status as a literary object, and to the need to analyze its stylistic qualities: see Klancher, Making of English Reading Audiences; Cronin, Romantic Victorians; Parker, Literary Magazines; Stewart, Romantic Magazines.

73. Ibid., 91. For a rapid review of Austen's satire of her hypochondriacal female characters see Gross.


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