Medical Progress and Social Reality: A Reader in Nineteenth-Century Medicine and Literature

Preface

Contents xi xi Preface The aim of this anthology is to explore the literary portrayal of medical practice in the second half of the nineteenth century. The foundations of modern medicine were laid in the series of momentous discoveries and innovations that were initiated in the first third of the century and gained increasing momentum during subsequent decades. The introduction of the stethoscope, of anesthesia and asepsis in surgery, and the growth of an understanding of the way infectious diseases are transmitted are the foremost examples of the major advances made in the course of the century. These advances have been amply documented in the many but often specialized histories of medicine that have proliferated in recent years as part of the expansion of the horizons of social history. However, much is to be gained by also approaching medical history through literary works because they offer a different, essentially personal, perspective. Literature reveals more fully than history the social realities in the dilemmas that physicians and patients alike faced in the wake of new discoveries and technologies. Through its focus on particular characters and situations literature affords vivid insights into the assimilation of, or resistances to, new modes of thought and new methods. So a vivid and nuanced picture emerges from literature of the directions in which the changing practice of medicine affected individual lives in many areas: in hospitals, in surgery, in medical training, in the rising role of laboratories, and in the advent of women doctors. Literature serves literally to flesh out medical history in crucial ways, particularly by revealing how erratic progress was in practice. For while the history of medicine in the nineteenth century is generally presented, and rightly so, as a great march of scientific progress, the actual implementation of innovations proves a far more complicated process. Literary works are especially valuable for disclosing the variegated human responses to the scientific advances of the period. These responses run the whole gamut from enthusiastic embrace of the new to doubts, falterings, skepticism, and downright rejection. The picture of nineteenth-century medical practice that emerges from literature is thus a very mixed one: some practitioners and patients clung to the old ways, some made misguided attempts in partial ignorance to adopt innovations , some moved forward wisely and judiciously on the basis of sound knowledge, and still others were hampered from taking advantage of the benefits of scientific advances by circumstances such as lack of instruments or materials. This diversity of the social reality depicted in literature is a necessary corrective to the overly simple, optimistic assumption of an unchecked progression toward the conquest of disease. It is important to recognize instead the shortfall through both the slow cognitive acceptance of innovations and their tardy—and at times misguided— incorporation into routine practice. I have chosen to focus on the second half of the nineteenth century because it is the time of the most fundamental changes through the transformation of medicine from a largely speculative endeavor into a discipline governed by scientific principles. The later nineteenth century unquestionably paves the way for present-day practice in salient ways (e.g., the ubiquity of the stethoscope as a basic tool), yet it still differs significantly not only in its technological possibilities but also in the issues faced by physicians, especially in the nature of the ethical dilemmas . To look at later-nineteenth-century practice is therefore, at least by inference, to realize the differences between the central problems facing doctors then and now. The majority though not all the texts collected in this volume were written in the latter half of the nineteenth century. However, it is a mistake automatically to equate the date of publication with the timing of the action within the fiction. For instance, George Eliot’s Middlemarch, which appeared in 1872, portrays conditions in 1829–1830; similarly, Thomas Mann’s Buddenbrooks, published in 1901, chronicles the life of a family between 1835 and 1875, and Somerset Maugham’s Of Human Bondage (1915) depicts medical training some twenty years earlier. Sinclair Lewis’s Arrowsmith (1925), which opens in 1897 and extends into the second decade of the twentieth century, is included because it shows the full impact of laboratory discoveries on practice, albeit only at a temporal xii Preface remove. Conversely, Mikhail Bulgakov’s “The Steel Windpipe” (1916) illustrates the lingering therapeutic backwardness in a remote region where...