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

Scholarly interest in medical case histories as narrative has grown significantly in the past decade, from Susan Wells’s examination of early women physicians’ case histories in Out of the Dead House: Nineteenth-Century Women Physicians and the Writing of Medicine (Madison, University of Wisconsin Press, 2001) to the many notable works by scholars in the medical humanities who specialize in narrative medicine today. In many ways, Meegan Kennedy’s book, Revising the Clinic, parallels Jason Tougaw’s Strange Cases: The Medical Case History and the British Novel (New York, Routledge, 2006), but Kennedy’s theoretical approach, rooted in visual studies, adds a new depth to our understanding of the integral relationship between novels and medical case histories. It seeks to add another model to the medical narrative genre, and in large part it succeeds. By tracing stages of the case history (curious, clinical, and psychoanalytic) and multiple fiction genres (sentimental, romantic, realist) as they weave an interrelated emphasis on modes of vision, Kennedy offers a richly nuanced analysis of this model. Using novels by a diverse group of authors from Jane Austen to Charles Dickens and George Eliot that do not specifically address medical issues, Kennedy demonstrates the ways in which a hybrid discourse in fiction is created by a reliance on visual and representational norms from the medical discipline, just as case histories have incorporated narrative techniques of the novelist.

Kennedy’s introduction, “Vision, Representation, and the Production of Knowledge,” is both the book’s weakness and indicative of its strength. Broken into seven short sections for less than thirty pages, the introduction posits the multilayered implications of her thesis, but by foregrounding so much of her argument in this space that does not allow for a thorough grounding of its claims, this reader found herself often questioning the broad assumptions of such claims. A more cohesive introduction with clearer transitions into the interrelatedness of her assertions would have better elucidated the model she is establishing. That said, the book as a whole offers exciting new possibilities for assessing the cultural, literary, and historical implications of the orientation of both novels and case histories toward issues of vision and representation in the Victorian era. Importantly, each chapter offers well-researched and articulate advances of her thesis and also offers a template for advancing studies in this field beyond the British novel and the Victorian era.

The first chapter traces the changes over the eighteenth century into the early nineteenth century as medical professionals’ fascination with “curious sight” and “curious observations” in their case studies were purportedly curtailed with the rise of the New Science. As Kennedy demonstrates, however, by the early nineteenth century, physicians had not so much eliminated this element as manifested it through a rhetoric of purportedly exposing the deceptions of curiosities—that is, through deflection rather than eradication. The second chapter on clinical realism in case histories and fiction appearing in nineteenth-century periodical literature is particularly inviting for further study. With the broad, transnational interest in periodical literature today, Kennedy’s use of this genre as prelude to the book form of the novel in her study illuminates the effectiveness of literary periodicals such as the Athenaeum, the Cornhill, and Macmillan’s to extend contemporary medical knowledge and medical debates to a sophisticated audience.

Chapters 3 and 4 use specific novels to articulate an important transition in the fiction, from the use and misuse of clinical observations in the sentimental literature of Charles Dickens and Elizabeth Gaskell to the development of sympathetic realism through a revision of medicine’s mechanical observation in the novels of George Eliot. As cultural and medical changes in observations demanded new forms of representation, so, too, did new literary theories of representation work to codify and valorize specific kinds and ways of seeing. This argument culminates in Kennedy’s penultimate chapter, “Speculation and Insight: Experimental Medicine...