INTRODUCTION

Louise Penner and Tabitha Sparks

Not very many decades ago, work on the Victorian cultural context of medicine
ushered in studies of germ theory and Middlemarch, the medicalization of female
hysteria and the influence of Darwinian evolution on the novels of Thomas Hardy.
At the time, such interdisciplinary pairings were revolutionary; they forged access
roads across the two culture divide, made famous by C. P. Snow and routinized by
over a century, of the disciplinary split if not antagonism between scientific and
humanistic study. Such interdisciplinary pairings today, however, are familiar objects
of study, and scholars increasingly argue that power existed on both sides of the
equation and its deployment in each direction can be subtle, complex and dynamic.
Nevertheless, emphasis on the intellectual advancements of medical science
remains the dominant approach.1 Our historiographic tradition reminds us that
as medicine became increasingly scientized and professionalized in the nineteenth century, so too did its normative discourse deviate from ordinary speech
and knowledge fields: if later-Victorian doctors no longer wrote their prescriptions or case studies in Latin, they did by and large adopt a scientific vocabulary
and field of reference that was analogously foreign to much of the lay public.
The process of scientization, then, can appear to be the master plot of Victorian
medicine, with a gap between the specialist practitioners and the non-specialist
public functioning as its operative challenge and metaphor.
But the influence of science is just one strand of the complex medical field in
the Victorian age and, in researching this book, we found it necessary to differentiate our scholarship on popular Victorian medicine from the numerous studies
of the popularization of the Victorian natural sciences. Several important works
have drawn attention to the audiences and not just the knowledge producers of
science, including Aileen Fyfe and Bernard Lightmans Science in the Marketplace
(Chicago, 2007), James A. Secords Victorian Sensation (Chicago, 2001), Roger
Cooters The Cultural Meaning of Popular Science (Cambridge, 1984) and Cooter
and Stephen Pumfreys seminal History of Science article, Separate Spheres and

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Public Places: Reflections on the History of Science Popularization and Science in

Popular Culture.2 As recently as 1985 Richard Whitley documented the unevenness of the nineteenth- and twentieth-century scientific communities themselves,
disproving any perception of the natural sciences as a monolithic field of experts,
who were in agreement about their findings and procedures and who could be
distinctly separated from popular or amateur scientists.3 But that perception of
science as a monolith has not informed scholarship on Victorian medicine and its
unstable, rapidly changing and often divisive organization.4 Thus, while Whitley
conceived of a need to expose the scientific communitys unevenness, scholars of
Victorian medicine have long attested to and assumed its professional, ideological
and epistemological fractures, all of which have important implications for analysis of the popular culture of medicine versus that of science.
For example, scholars have explored the divide between the theoretical
developments of medical science and the actual practices of most doctors. Ann
Digby differentiates between the epistemological revolution in nineteenthcentury medicine and the therapeutic revolution, showing that the former did
not immediately lead to a corresponding change in the doctors power to treat
disease.5 In 1842, The Lancet complained that the information of the medical
profession, generally, on matters of medical science, is very little greater than the
public at large.6 Roy Porters Patients and Practitioners: Lay Perceptions of Medicine in Pre-Industrial England concerns an earlier time period than this book, but
his description of the framework of reciprocity between laypeople and practitioners in periodicals like The Gentlemans Magazine demonstrates that medical
knowledge was not restricted to a top-down pattern of dispersal, which also, if
indirectly, suggests that medical knowledge and discussion were not considered
an elite subject.7 The class and ideological alliances between many doctors and
their middle-class patients, then, were likely stronger than those between Victorian doctors who largely needed to earn a living and scientists, often a class
of gentlemen who had the leisure and income to pursue intellectual interests.8
The historical phenomenon of the reformation of medicine toward professionalization and specialization in the nineteenth century is itself a complex
testament to the medical fields distance from elite society.9 Beginning with the
Apothecaries Act of 1815, the first act of Parliament designed to create oversight
of the medical profession, medicine largely moved from the eighteenth-century
free-market model to a more centralized and government-regulated one.10 The
heterogeneity of the medical field is confirmed by the absence of professional
licensing standards before the 1858 Medical Act and, even after it, quack doctors
found many ways to ply their trades. Martin Weiner describes the nineteenthcentury professional class as one characterized by [its] comparative aloofness
from the struggle for income, but his acknowledgement that aloofness was of
course partly a myth has abundant proof in the medical field.11 Victorian medical
autobiographies, for instance, illustrate the complex class allegiances of the medi-

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Introduction

cal occupational ideal: illustrious physicians, like Sir Benjamin Brodie and Sir
James Paget, represent at once an elite disdain for the commercial aspects of their
work and a necessary urgency to earn an income, particularly in the beginnings of
their careers.12 Porter emphasizes the positive results of medical professionalization when he refers to more meritocratic colleges, the emergence of the family
doctor, the parliamentary enforcement of minimum entry requirements the
establishment of the Medical Register and the General Medical Council, and the
British Medical Association, the British Medical Journal, and The Lancet.13
The popular applications or appropriations of science and medicine varied
in terms of their immediate effects. Often, the adaptations of science to culture
have intellectual, class and religious or philosophical implications and, while
this is certainly true for medicine in popular culture, the relevance of health
and often its urgency moves the status of medical culture to the centre of lived
experience. Another way of saying this is that everyone gets sick, hurt or experiences bodily challenges, but not everyone reflects on, or knowingly experiences,
the rise of scientific thinking. Roberta Bivins opens her Alternative Medicine? A
History with a memorable example of a lay application of medicine in the historical account of a patient in 1836 London, who reads an article in The Lancet
about acupunctures alleviation of fluid build-up in the scrotum, and successfully
performs the technique on himself.14 Not only does Bivinss anecdote question
boundaries between expert and lay, orthodox and experimental and east and
west, but it evinces the consequences of medical knowledge on personal life. Far
from challenging his intellect or worldview (though those may have altered too),
this patient affected his immediate well-being.
Beyond the interests of the individual patient, medical authority in Victorian
England was fully embedded in social and political infrastructure. We see this in
the growth of medical offices in parishes, unions, factories and prisons, in the
advent of public vaccinations, health inspectors and coroners, as well as in legal
measures like the Contagious Diseases Acts.15 A dramatic rendering of medicines comparatively urgent and wide-scale application follows the outbreaks of
epidemic disease in the period, after which, as M. W. Flinn writes, immediate,
vigorous, administrative action galvanized otherwise moribund corporations
into temporary frantic activity.16 Such functionalist approaches to medicine
were felt widely in the general public, mostly in positive ways, but sometimes
in ways that smacked of social control, as with the hotly debated Contagious
Diseases Acts legislation (186586). Or, when Dr Henry Allbutt published The
Wifes Handbook in 1886, a cheap manual for women that included information about preventing conception, he was struck off the Medical Register by the
General Medical Council.17 In another example, Nadja Durbach has skilfully
examined the socio-political resistance to vaccination, the first continuous public-history activity undertaken by the British state.18

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The history of Victorian medicines intervention into professional, commercial and bureaucratic bodies, then, can moderate the assumed influence of
scientific or theoretical medicine on the general public. That redirection of medical influence from science to social life, however, can still fall within the bounds
of empirical research, while studies of the popular often grapple with an additional register when they consider how the historical developments of medicine
and the medical field infiltrated those realms of public opinion that were off the
record, equivocal, the stuff of bias, conjecture and opportunism. To delve into
these relatively unmapped and unquantified areas we need to call upon materials that are themselves not restricted to quantitative methods or truth claims,
including advertisements, lay journalism, novels, public speeches and theatre.
The explosion of printed ephemera in the period involved not just the publics
ready access to yellowback and sensation novels (explored here in several essays),
but also to advertising, specialist trade journals and manuals of various sorts.
The very qualities that render these objects of study so dismissible by standard
practices of quantitative research make them rich resources for critics of popular
culture, who value their freedom from the constraints of both conventional historical record and the empirical scholarship that often accompanies it.
Moreover, along with the history of medicine in Victorian culture, this
collection calls upon a critical history of the popular. Raymond Williamss comprehensive set of changing definitions of popular over time offers a nuanced
account of the words connotations, both those that Victorians themselves inherited and those they created. He concludes his account with this useful summary:

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Popular culture was not identified by the people but by others, and it still carries two
older senses: inferior kinds of work (cf. popular literature, popular press as distinguished from quality press), and work deliberately setting out to win favour (popular
journalism as distinguished from democratic journalism, or popular entertainment);
as well as the more modern sense of well-liked by many people, with which of course,
in many cases, the earlier senses overlap. The sense of popular culture as the culture
actually made by people for themselves is different from all these.19

Williamss set of definitions helps us to explain how the various essays in our
collection offer a broader picture of the relationship between Victorian medicine and popular culture than might be generated by essays focused on available
assessment criteria, such as how many people read a text, how a text was reviewed
at the time or how many doctors integrated a new technology into their practice.
Instead, many of the essays in this collection focus on the vital question of the
Victorian writers subject position in relationship to the subject matter he or she
explains. How and in what ways did writers use medical tropes? Freed from the
obligation of biomedical objectivity, what stories did popular writers of fiction
and non-fiction construct in response to medical innovations?
Peter Logan has drawn on Williamss definitions to identify three kinds of
subject positions that appear in Victorian texts. In describing how the Victorians

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Introduction

themselves perceived the complex relationship between the larger crowd and the
individual subject, he writes:
This relationship entails a simultaneous, unreconciled consciousness of both belonging and being distinct Rather than assuming a choice between two subject positions,
defined alternately through alienation [standing aloof from and critiquing popular
beliefs] and belonging, these two simultaneous functions imply the possibility of a
third position, in which one knowingly participates in the crowd while also distancing
oneself from it. This is a skeptical stance, in which one belongs, while retaining reservations about everyone else who belongs and about their acts of belonging to the group.20

Attentiveness to these subject positions (whether oppositional, inclusive or

ambivalent) allows for contemporary readers to recognize the strategies that
writers used to sway popular opinion, but also to make their own views popular. For instance, Julie Kraft in this collection attends to the subject position
of female writers of household management manuals. These writers challenged
the authority of medical experts by offering their own domestically inclined
principles of scientific household management. Their stance both capitalizes
on the new scientific emphasis on household management and takes an oppositional stance toward medical authority as the province of doctors alone. Kevin
Morrisons analysis of advertisements for Dr Lococks pills, by contrast, shows
us the opportunistic seizing of medical authority by laypersons who deliberately
profited off of a prominent physicians name, a once entirely legal fraud the
exposure of which, Morrison explains, changed the way that professional identity and qualifications could be claimed.
Several of our essays focus on popular texts like yellowbacks and sensation
novels, for which popular meant inferior because they were said to appeal to
the common person through manipulation of the senses. The claims these texts
make to expertise in scientific medicine are often implied. And in some cases
they may not even have been the product of a conscious effort to claim expertise. Taking up Gillian Beers provocative suggestion, George Levine argues that
Darwins theory of natural selection shaped Victorian culture as much through
writers who did not read or address the theory as those who did: ideas as influential as natural selection disseminate informally and often inaccurately. The use of
key Darwinian phrases, terms and narrative structures surpasses direct familiarity with Darwin from the very beginning of his fame.21 Assuming or implying
expertise by adopting the tropes of scientific medicine, too, became a popular
strategy for the rising professional and commercial classes.
This collection concentrates on how the effects of changes within the medical field effects which included the rising prestige of most medical professionals
were being depicted and capitalized on by Victorian commentators, many of
whom feared the commercial, social and, not the least, anatomical impact of those
changes. Several of our essayists (Penner, Steere-Williams, Conti) remind us that
challenges to the medical establishment occurred not only along the well-hewed

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lines of class, gender and religion. Other professions, too, had an interest in resisting a biosocial emphasis on the organization of government and law. For instance,
medical laymen journalists, philosophers and lawyers were largely responsible, in
the later decades of the century, for changing the perception of suicide from a crime
that denoted insanity and a formal inquest by medical experts, to a personal tragedy without criminal and legal repercussions for family members (a change that
also enabled a Christian burial for the deceased).22 In this case, popular denotes
distance from medical expertise, but not from professional and cultural authority.
Developments in early-mid Victorian medicine related inextricably to two
phenomena: the growing professional class of medical workers and the popularity of general knowledge, trade and self-help print venues for lay writers. These
points of intersection resulted in complex negotiations over identities both
national and professional that the scientization of medicine both produced and
reflected. The chapters in Part I: Reform Initiatives each take up some aspect of
these early-mid Victorian identity struggles. Kevin Morrisons account of Thomas
Wakelys battle, in the 1840s, to achieve standards for medical certification in the
wake of a hugely popular, fraudulent, ad campaign featuring a prominent physician, Dr Locock, shows how the ensuing conflict effectively textualized medical
professional identity. Louise Penners chapter explains how, following on Wakleys
reforms, Charles Dickens used his editorship of popular journals in the 1850s and
early 1860s, as well as his own writings, to promote the Victorian British hospital as a source of national pride and a safe space on which to entrust private and
public funds. Also focusing on how popular print essays attempted to shape public perceptions of health, Meegan Kennedys analysis of Harriet Martineaus The
People of Bleaburn, which Dickens acquired for Household Words, argues both
that Martineaus contributions helped to establish the reputation of Household
Words in the 1840s and 1850s as a popular and reliable source for information
about sanitation, and that Martineau particularly asserted the value of cheer as
a vital component of preserving spiritual, moral and physical health. Focusing
on commercial publications, Jacob Steere-Williams explains how scientific medicines concerns about food adulteration in the 1850s informed the writings of
trade publications that, in turn, asserted the issue of milk purity as a key emblem
of British national pride. Finally, Julie Kraft finds evidence of non-medical female
writers offering advice about health in a popular print venue: manuals for household management. Kraft argues that the 1850s domestic manuals challenged the
authority of medical experts, particularly on issues of food adulteration. Together
these essays recall Bernard Lightmans claim that populizers may have been more
important than the professionals in shaping the public image of science, but do so
through the public image of Victorian medicine as well.23
The underside of modern medicine its representations of unchecked
ambition, descriptions of pathology and contribution to fears of degeneration

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Introduction

invades the popular imagination in the second half of the nineteenth century.
The second section of this collection explores a variety of fictional and theatrical
texts: some of these integrate medical interventions into stories of middle-class
professionals, families and social circles, while others use the genre of the gothic
romance to analogize later-century medical power. Continuing our investigation of identity formation in the medical field, Part II: Medical and Pathological
Identities attests to the great variety of publics that defined Victorian medicine
beyond its experts and officials. In an essay that looks at two novels by Ellen
Wood, Cheryl Blake Price argues that real high-profile cases of poisoning doctors inspired sensation novels by Wood and others. The novels cast the new
scientific medicine, particularly its developments in chemistry, as a sign of the
medical professional assuming a dangerous medical authority over women and
the home. Marc Milton Ducusin, also discussing sensation fiction and gender,
shows how male gender deviance in Wilkie Collinss Armadale previews the
definitions of sexual pathology that Havelock Ellis and others would attempt
to classify in the late century. Like Price, Ducusin reveals a resonant interplay
between sensation characters and medical typologies in culture. Meredith Conti
examines dramaturgys take on fictional representations of addiction by Robert
Louis Stevenson and Arthur Conan Doyle. The stage versions of The Strange
Case of Dr Jekyll and Mr Hyde and the Sherlock Holmes stories, she claims,
dramatized the newly hybridized model of addiction that united biological and
ethical determinants of drug dependency. Ellen Stockstill probes late-century
debates over evolutionary theory, degeneration, vivisection and changing gender roles in her analysis of H. G. Wellss The Island of Doctor Moreau. In another
examination of a sinister doctor, she proposes that Moreaus tortuous attempt
to fashion rational creatures out of animals is a symbolic stand-in for Wellss
hostility towards and medical punishment of the irrational women of
the fin-de-sicle. And last, Tabitha Sparkss chapter theorizes the relationship
between literature and medical history, challenging common assumptions about
the usefulness of literary analysis to understanding historical medical diagnoses.
Sparks argues that preserving the notion that illness is metaphor in Victorian
fiction is vital to appreciating how novels can, among other things, express the
public impact of the condition or disease on a particular place and time a
mediation that fiction is uniquely able to represent.
None of the essays in this collection definitively divides medical developments, controls or perspectives from public commentary in all of its loose and
factious composition. Assuming the metaphorical and representational character
of medical initiatives and developments distinguishes this collection from the
interdisciplinary tradition, that treats the medical (or the scientific) as fundamentally different from the popular through oppositional pairings like doctor
and patient, specialist and lay or science and folklore. For this reason we take

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the and in Victorian medicine and popular culture to be truly aggregative, not
the computation of more than one field. This approach co-opts medicine away
from its conventional partner in research, science, and moves it into the realm of
cultural currency. Of course, medicine did wield important pragmatic and measurable power through very material practices like surgery, drug interventions or
vaccination. But we maintain that the ways that such practices were represented
and debated suit the methods of humanities scholarship more than those of either
bio-science or social science : these more quantitative methods of inquiry can tell
us (for instance), how often and to whom certain medicines were administered,
but literary and other forms of textual study tell us what such measures meant to
Victorian society and how they were integrated into social politics.
The stakes of doing so are high: attempting to offer richly nuanced, historicized
readings of cultural texts requires that we articulate why such readings matter today.
The current crisis in the humanities in which arts and humanities departments are
continually asked to prove their relevance to real life issues has precipitated vigorous debate in the editorial pages of major newspapers around the world. Essays
by Michael Brub, and Atlantic essayist, Jordan Weissman,24 for instance, explain
how the humanities prepare students to contribute to their world, directly confronting the oft-expressed view that humanities are somehow a luxury that a global
economy in crisis simply cannot afford. Interdisciplinarity has been cited as one
way in which those working in the humanities might make their work relevant
to real world research conducted in the fields of natural science, technology, engineering and medicine (STEM). In an era in which even the US president pushes
STEM for college students as though it were, to quote from Dickenss withering
satire of Victorian educations emphasis on Facts over the cultivation of imagination in Hard Times, the one thing needful25 to keep the US economy competitive,
the result has been a harmful deflection of the publics attention away from the
complex history of how the world and US economies have both been affected by
numerous factors that require attention not just to STEM, but to ethics, social
science research and a complex rhetorical analysis of the priorities of those creating the push for STEM in the political and public education arenas.26 By contrast,
we work from the assumption that the humanities, arts and social sciences in the
popular realm have an enormous amount to add to the understanding of how
societies nurture and fail their citizens. We assume that an analysis of narrative,
culture and language, the means by which we articulate that understanding, are
not adjuncts to the study of the real world of the present or the past, but are in fact
foundational to it.27 Thus our collection assumes that popular literary and artistic
accounts of disease, medicine, health care workers and ideas about health, are as
important as those of non-fictional documents (even those that more readily identify themselves as medical texts) to understanding how Victorians came to view
their rapidly changing world, particularly the changes in worldview, resulting from
the rapid scientization and professionalization of medicine during their era.

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