Healthy Debate: Medical Discourses in the Early Novel by Mary G. S. Gifford Oxford, UK Supervisors: Professor Nicole Pohl and Dr
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Healthy Debate: Medical Discourses in the Early Novel By Mary G. S. Gifford Thesis submitted in partial fulfilment of the requirements of the award of a Doctor of Philosophy by Oxford Brookes University Oxford, UK Supervisors: Professor Nicole Pohl and Dr Katherine Watson June 2018 Acknowledgements I am indebted to Professor Nicole Pohl and Dr Katherine Watson for their sustained guidance, advice, and support throughout this research project. Their different perspectives, coming as they do from different disciplinary backgrounds, has not only made the execution of this research project more stimulating and challenging, but has also made it more enjoyable. I would like to thank Jill Organ, Charmian Hearne, Christiana Payne, Tom Crook, Glen O’Hara and also Tom Betteridge for his encouragement back in 2010. I would like to thank my fellow postgraduate students, some of whom have now completed their studies, for their friendship, encouragement and extracurricular motivational gatherings, especially Mary O’Neill, Lucy Clarke and Sue Ash. Special thanks are due to Joanna Cooksey, Academic Liaison Librarian at Oxford Brookes. Thanks are also due to Bethan Jenkins at the Welcome Unit, the library reception staff at Gipsy Lane and at Wheatley, the staff at the Bodleian Camera and at the Radcliffe Science Library Foyer for their practical help and advice. I dedicate this thesis to ‘family’. I dedicate it firstly to my husband Jonathan, who I love and admire more every day, and who can take on anything from playing jazz saxophone and writing business books, to plumbing and laying floors whilst solving random problems of every kind. I dedicate it to our two children, Harry and Charlotte who are busy starting their careers and of whom we could not be more proud. I dedicate it to my stepchildren, Elen and Edward, who have always kindly enquired with interest about progress, and also to their own growing (and expanding) lovely families. I dedicate it to my brothers John and Bill who have each inspired me in very different ways over (not far off) 60 years. I dedicate it to my father, James, and my mother, Iris, but especially to my mother, who I miss every day since her early death in 1986, and who would have found such joy in how her children and grandchildren have turned out, had she lived. Abstract In the light of different views about how the early novel was distinct as a literary form, this thesis draws on those ideas that emphasise the novel’s capacity to formulate and address issues of major concern to a broad section of eighteenth-century society. Modern experience was shaped by new epistemological and socio-ethical codes, removed from traditional values and assumptions which, as a cultural instrument, the novel was designed to mediate. This thesis focuses on the novel of mid-century when, in Michael McKeon’s view, the novel first became a distinct genre, and displayed a conspicuous adaptability in tackling its explicatory and interpretative role.1 To the reader, the novel opened up a spectrum of (fictional) experiential possibilities. These were delivered through formal realist strategies in a literary form that was askance to established modes of cultural expression such as romance. Furthermore, formal realist strategies reflected empiricist tenets, or the gaining of knowledge through experience rather than by referral to perceived authorities, such as Church or State. One theme which recurs as a prominent area of concern is that of medical theory and practice. This thesis demonstrates how the early novel form explicated and engaged with topical medical discourses by virtue of its emergent literary qualities. These qualities include innovative narrative 1 Michael McKeon, The Origins of the English Novel 1600-1740: 15th Anniversary Edition (Baltimore, MD: Johns Hopkins Press, 2002), pp. 20-21. 1 techniques, the portrayal of multiple perspectives, and characterisation; those attributes that strive to construct verisimilitude. Via this engagement, medical discourses served as a powerful tool to illustrate and participate in wider debates of philosophical, cultural and social significance during the period. Adopting the methodology of the case study, three contrasting representatives of the early novel are analysed with reference to three important medical debates of mid-century. The novels are The Life and Opinions of Tristram Shandy, Gentleman (1759-1767) by Laurence Sterne; The Adventures of Roderick Random (1748) by Tobias Smollett and The Adventures of Ferdinand Count Fathom (1753) also by Smollett. The debates are respectively man-midwifery and conception theories; naval medicine, and the professionalisation of medicine. Furthermore, I argue that together the case studies provide new evidence to substantiate a broader claim. They confirm John Bender’s evaluation of the eighteenth-century novel as an Enlightenment ‘knowledge system’.2 2 John Bender with David E. Wellbury, ‘Rhetoricality: On the Modernist Return of Rhetoric’, in Ends of Enlightenment (Stanford, CA: Stanford University Press, 2012), pp. 203-236 (p. 218). 2 Contents Introduction Situating the Research Aims: The Medical and the Literary Landscape in the Eighteenth Century 6 Contexts: An Overview 14 Eighteenth-Century Society, Medicine and the Body 15 A Sudden Break with the Past? Different Perspectives on the Emergence of Clinical Medicine in the Eighteenth Century 21 Eighteenth-Century Medical Narration and the Social Construction of Medical Concepts 32 The Early Novel, ‘A New Species of Writing’ 43 Theories Linking the Early Novel and its Origins to Contemporary Medical Paradigms/Epistemes 50 Zooming In: A Brief Exposition of the Disciplinary Position of this Thesis 57 The Anatomy of the Thesis: Originality, Methodology and Chapter Organisation 65 Chapter One – Man-midwifery, Childbirth, and Conception in Laurence Sterne’s The Life and Opinions of Tristram Shandy, Gentleman (1759-67) Introduction 72 Tristram Shandy and the Wide-Reaching Scope of Epistemological Change in the Eighteenth Century 78 Close and Even Closer? The Early Novel and Society, and Tristram Shandy and Society 83 Tristram Shandy and its Impact: From Bestseller to Proliferant Cultural Resource 94 Off to a Bad Start: The Perils and Pitfalls of Conception and Childbirth 99 3 Questions of Space: Childbirth and the Domestic Setting 106 The Homunculus versus the Foetus: The Preformation Debate and Predetermination 110 Midwifery Manoeuvres: The Female versus Male Midwife Dynamic in Tristram Shandy 116 Man-Midwifery: A Theme Signalling ‘Modernity’ 121 A Closer Look at Dr Slop: A ‘Representative’ of the Profession of Man-midwifery? 132 Conclusion 140 Chapter Two – Naval Medicine in Tobias Smollett’s The Adventures of Roderick Random (1748) Introduction 148 Smollett and the New Literary Form 154 The Body, The Embodied Reader and Verisimilitude in Roderick Random 162 Eighteenth-Century Sea Power: ‘Only the Navy […] can bring any lasting Peace or Happiness to this Nation’ 169 Naval Medicine versus Established Theory and Practice 178 Naval Medicine, Professionalisation and Career Advancement 188 Smollett and Roderick: What of the Similarities? 194 Conclusion 200 Chapter Three – The Professionalisation of Medicine in Tobias Smollett’s The Adventures of Ferdinand Count Fathom (1753) Introduction 206 The Professionalisation of Medicine in Context 217 Trick or Treat? The Quack as an Ambiguous Agent of Change 227 4 What is a Novel and What is a Doctor? FCF as an Intersection Between Two Discourses 235 An Approach via Smollett’s Concept of the Novel 237 An Approach via the Expression of Smollett’s Professional Status in FCF 253 Conclusion 260 Conclusion 266 Bibliography 279 Appendix: Selective Chronology 304 5 Introduction “Who are you? — whence are you? […] For my own part, my education cost me fifteen hundred pounds.” “Never was money laid out to less purpose,” said Ferdinand; “for it does not appear that you have learned so much as the basis of medical requirements, namely that decorum and urbanity which ought to distinguish the deportment of every physician.”1 Situating the Research Aims: The Medical and the Literary Landscape in the Eighteenth Century The early novel’s close alignment with the prevailing anxieties, preoccupations and appetites of a broad spectrum of contemporary Georgian society was one of its most defining characteristics.2 It also underpinned its commercial and critical success. Tracing its origins relative to earlier genres from 1600 to 1740, Michael McKeon has argued that it secured its ‘modern, “institutional” stability and coherence at this time because of its unrivalled power both to formulate, and to explain, a set of problems that are central to early modern experience’. Modern experience was shaped by new epistemological and socio-ethical codes, far removed from traditional values and assumptions which, as a cultural instrument, the novel was designed to mediate.3 This thesis focuses on the novel of mid- century when, in McKeon’s view, the novel first became a distinct genre, and 1 Tobias Smollett, The Adventures of Ferdinand Count Fathom, ed. by Jerry C. Beasley (Athens: University of Georgia, 1988), p. 249, hereafter cited as FCF. This edition is based on the first edition and is heavily annotated. All subsequent references appear in parentheses in the text and relate to this edition, unless they are footnoted to offer further context or to avoid ambiguity. 2 The term ‘early novel’ is equivalent to the ‘mid-century novel’ in the context of this study because it was at an early stage of its development at this point. 3 Michael McKeon, The Origins of the English Novel 1600-1740: 15th Anniversary Edition (Baltimore, MD: Johns Hopkins Press, 2002), pp. 20-21 and xx-xxii: To McKeon these categories are ‘an aspect of the long term process of the modern division of knowledge’, in contrast with traditional cultures in which conceptions of truth exist within an all-embracing idea of religious or cosmic truth (as in Christian theology). 6 displayed a conspicuous adaptability in tackling its explicatory and interpretative role.