Medical Examinations: Dissecting the Doctor in French Narrative Prose, 1857-1894

Introduction

Introduction
Iatrogenic adj [Gk iatros + Eng -genic]: Induced in a patient by a physician’s activity,mannerortherapy.Usedespeciallyofaninfectionorothercomplication of treatment. American Heritage Dictionary, Third Edition Iatrogenic: Induced by a physician. Used chiefly of imagined ailments induced in a patient by autosuggestion based on a physician’s words or actions during examination. Webster’s Third International Dictionary The seemingly paradoxical notion that the medical practitioner may cause illness rather than cure it has a factual basis. From the wellknown dangers of hospital confinement in the pre-Pasteurian era to contemporary tales of horror concerning the transmission of the aids virus by doctors and dentists, the danger inherent in surrendering oneself to the medical profession has long been recognized, and in our times the many lawyers who make a specialty of medical malpractice lawsuits foment the widespread public mistrust of the physician. In recent years, the concept of iatrogenesis has even been expanded to include social and structural iatrogenesis, as defined by the Catholic cleric and historian Ivan Illich in his Medical Nemesis, an acerbic attack on the medical profession published in 1975. Illich’s study begins with the provocative statement that “the medical establishment has become a major threat to health.”1 Incensed by what he terms the “illusion” of the doctor’s effectiveness, Illich thunders first against clinical iatrogenesis, that is, doctor-inflicted pain or injuries.2 He then turns his attention to 2 introduction social iatrogenesis, the way in which medical practice “sponsors” illness, creating a demand for its services by, for example, helping “defectives” to survive in large numbers through neonatal care and certifying their infirmities so that they may be excused from participating actively in the labor force. Finally, he raises his voice against structural iatrogenesis, the medical profession’s alleged tendency to “destroy the potential of people to deal with their human weakness, vulnerability and uniqueness inapersonalandautonomousway.”3 Illichcontendsthatinamedicalized society,individualsfeelhelpless and are unable tocope withpain, disease, and death as well as their ancestors did. The fact that Illich’s late-twentieth-century attack against the medical profession contains explicit suggestions for reform does not concern us here, except insofar as this aspect of his work distinguishes it from the vast majority of antimedical invectives that history has bequeathed to us. Not surprisingly, perhaps, constructive criticism is especially lacking in those works that don the mantle of fiction in order to camouflage their principal goal, that of heaping scorn on the field of medicine. Antimedical fiction has a long history, going back to Aristophanes and beyond. In France alone, one could cite satires of the doctor from the Middle Ages (such fabliaux as Le Paysan médecin) through the twentieth century (Jules Romains’s Knock), with many striking diatribes along the way (most notably from Rabelais himself a physician and Montaigne in the sixteenth century, Molière in the seventeenth, and Voltaire in the eighteenth). Furthermore, many works that have subjects ostensibly unrelated to medicine feature physicians as episodic characters and work surreptitiously to demean the medical profession. A case in point is Sartre’s story “Le Mur,” with its characterization of the coldly clinical Belgian physician as the Other. Such negative portrayals of the medical practitioner transcend not only chronological but also geographical boundaries. In nineteenthcentury England, distrust of men of science (often represented as physicians) or anxiety about their potential to harm (rather than help) society found expression in such classic works of literature as Mary Shelley’s Frankenstein (1818), George Eliot’s Middlemarch (1871–72), and Robert Louis Stevenson’s The Strange Case of Dr. Jekyll and Mr. Hyde introduction 3 (1886). And while one can certainly find physicians in heroic and selfless roles throughout world literature (Dr. Martin Arrowsmith of Sinclair Lewis’s Arrowsmith [1825], Dr. Thomas Stockmann of Ibsen’s An Enemy of the People [1882], and Dr. Rieux of Camus’s La Peste [1947] come to mind), stereotypes of the inept and unskilled physician on the one hand, or the unscrupulous, opportunistic materialist on the other, dominate the collective imagination and populate the pages of both high and low literature. In twentieth-century America, the physician-turned-novelist Robin Cook has written a highly successful series of medical thrillers (Coma, Fever, Brain, Fatal Cure, etc.) that play on common fears of the medical profession, and the American humorist Dave Barry’s quip “When the medical community finishes with you, you may...