want to ask, “Why always disease?” In asking this question, I want to suggest that health is an epistemological problem and that nineteenth-century narratives register, through both their form and their content, the difficulty of knowing what health is, how to preserve it, and whose is best.13 These questions are made explicit in the periodical press, in government pamphlets, and in memoirs, and are implicit as well as explicit in novels.14
One reason for the critical interest in disease, of course, is that disease and illness are medically and narratively more interesting than health. To use Ruskin’s term, illness is “impressive,” whereas health is, as Alexander Shand notes in the second epigraph to this introduction, a “matter of course,” only “passively appreciated.” Health is, in other words, a nonstory. Like Athena Vrettos, who points out in Somatic Fictions (1995) that “[t]o be ill is to produce narrative,”15 John Wiltshire surmises in his work on Jane Austen, “If the healthy body is largely passive, unconscious of itself, then the unhealthy body, as a site of anxious self-concentration, is the source of events, of narrative energies.”16 For the doctor, illness is a problem to solve; it must be diagnosed, treated, and cured. For the patient, illness is an obstacle to overcome or perhaps a punishment for sin. Indeed, illness forces us to take notice of our bodies and behaviors, to experience compassion, to purge, to repent. In contrast, health signifies the absence of all of this; if anything, it functions merely as the end of the action, the prized reward. It provides the requisite closure or the inaugurating condition that incites narrative, but it is certainly not what keeps the story going.
Robert James’s definition of health in his three-volume A Medicinal Dictionary (1743–45)17 attests to the unconsciousness that attends health: the body is in a “sound state,” he explains, when “nothing is wanting” (lxvi). James depicts health as a negation or an absence (“nothing is wanting”) rather than an affirmation or presence (that is, “every need is met”). Borrowing from D. A. Miller, whose work has greatly influenced this book, we might describe health as the nonnarratable state of “quiescence assumed by a novel before the beginning and supposedly recovered by it at the end.”18 But even here, we can see just how pervasive the disease narrative is, for the very form of the traditional novel and the language we use to theorize it rely on a reading of crisis and recovery that imagines health as the end or beginning, as absence of action. After all, since its rise in the eighteenth century, the novel has persistently trained its readers to expect conflict and resolution, mysteries and solutions, a beginning that moves (but not too quickly) toward an end. The endings of eighteenth-century texts, such as Charlotte Lennox’s Female Quixote (1752) and Tobias Smollett’s The Expedition of Humphrey Clinker (1771), for example, spectacularly showcase cure from illness as the desired and achievable goal.
In this book, I consider the effort (and, as the medical advice warns, it takes effort) that goes into reading for health. I identify a model of reading that interprets health as more than a point of entry or of departure—as more than something to be “passively appreciated.” The novels of Jane Austen, Charlotte Brontë, Harriet Martineau, Charles Dickens, and Elizabeth Gaskell—novels that prominently feature invalids and their doctors, contagions and fevers, sicknesses and cures—provide lessons not only in how to be healthy but also in how to read for health. Whereas a study such as Haley’s offers insight into the former, this book seeks to broaden our understanding of the latter by exploring the difficulty of replacing the familiar narrative arc of prelude, crisis, and cure (which I refer to as therapeutic) with one centered on more-static models of maintenance and prevention (what I am calling hygienic). The novelists and medical advisers featured in the following chapters demonstrate that health has a narrative of its own, one that complements even as it complicates the linearity of the disease-cure model. Through cautionary tales and secondary narratives and characters, the writers I study provide strategies for reading others and the environment for hygienic purposes. Reading for health’s narrative challenges our sense of order and temporality, setting and metaphor, point of view and voice. It means reading for what has largely remained unread.
Physicians have long registered their concern about society’s passive appreciation of health. In The Code of Health and Longevity (1807), Sir John Sinclair laments, “People seldom attend to their health till it be too late. They scarcely ever think of it till they are seriously impaired.”19 The year before, Thomas Beddoes supposed in his Manual of Health (1806) that “could you but once lead the public to suspect that health may be SOMEWHAT OF AN ACCOMPLISHMENT, they would then, I think, cultivate it uninterruptedly without grudging, and not dismiss it as shortly as they can, like an importunate creditor.”20 By the end of the century, James Hinton was still warning readers in Thoughts on Health (1871), “The time for unconscious fulfillment of the laws of health has practically past. We must either know or suffer.”21 These criticisms recur in numerous medical and nonmedical texts throughout the eighteenth and nineteenth centuries, a time during which handbooks such as these rose in popularity and accessibility. The prevalence of so many guides, pamphlets, and memoirs that warn readers about their ignorance and their inability to attend properly to health attests to a cultural desire—compulsion, even—to read and write about, and to imagine, health.22 The mass of material during this period also registers an epistemological anxiety about the possibility of ever truly knowing health. Victorian surgeon John Milner Fothergill captures this concern when he exclaims in the introduction to The Maintenance of Health (1874), “Health! What is it? And how is it maintained?”23 Health is both something we can assert emphatically (“Health!”) and something that remains a mystery (“What is it?”).
An entire industry was dedicated (and still is) to answering Fothergill’s questions and to helping readers solve the mystery of health, which was often imagined in vague yet alluring terms. Fothergill claims that health is the “balance betwixt the various parts of the organism” (1), whereas Hinton declares that it involves being in “harmony with the ceaseless activities of nature” (Thoughts, 333). Such a view of health explains why it is easy to ignore and why it seems to fail as a model for narrative. Health is or should be unremarkable: “[N]o man is truly healthy,” Hinton claims, “who is thinking about his health” (332). We might think here of Aristotle’s conception of tragedy; his emphasis on catastrophe and the consequent catharsis (purification) as offering an early articulation of this critical investment in crisis and cure. But even Hinton’s definition of health’s congruence signifies its narrative potential: health “exists in ceaseless adaptation to all the infinite variety of nature—ever the same, yet ever new. . . . Health knows no monotony” (333, emphasis added). Such claims allow us to interpret health as largely a process, a movement, or an act of loss or gain—in short, as narrative.
The desire to foreground health’s narratability—to make it legible—has been central to medical advice since antiquity. As Greek physician and philosopher Galen explains, health is part one of a two-part story: “Since, both in importance and in time, health precedes disease, so we ought to consider first how health may be preserved, and then how one may best cure disease.”24 P. N. Singer notes in the introduction to his translation of Galen: Selected Works that doctors, such as Galen, were part of the Roman elites’ “daily entourage” and that health was, since at least “Hippocratic times[,] . . . something which involve[d] certain types of constant, daily practice for its maintenance.”25 The advice Galen and subsequent medical writers offer distinguishes between health and disease, between the “daily practice” and the temporary treatment. “Whereas the science concerned with the human body is one,” Galen notes, “its foremost and largest subdivisions are two: one of these is called hygiene, the other therapeutics, differing in their respective functions, the former being concerned to maintain, the latter to modify, the condition of the body.”26
Galen’s demarcation between hygiene and therapeutics, as well as the format of his medical advice, persisted with surprisingly little alteration—given the changes in medical knowledge—well into the nineteenth century. The concern that medical writers express about their readers’ inability
