to my study, it was written by a novelist who, by 1872, had thoroughly absorbed the lessons of health that I identify in each of my chapters. Two moments from George Eliot’s text exemplify how we might become more conscious of what it means to “read for health.” At first, the scenes are so steeped in the language and metaphors of illness and therapeutics that it is difficult (more so than in the other texts I study) to read them “hygienically.” Each episode involves the doctor-hero Tertius Lydgate, but neither features the doctor engaged in typical medical practice or relies on the clinical and scientific verisimilitude that is generally associated with Eliot’s realism.40 In the first, Eliot stages the scene of Nicholas Bulstrode’s climactic expulsion from Middlemarch at a town meeting—significantly—about sanitary reform. The town’s literal and figurative health is at stake, as the scandal surrounding the wealthy banker has the potential to infect all with whom he comes into contact. Mr. Hawley refuses to let Bulstrode comment on the town’s sanitary concerns if Bulstrode is not himself free of taint, of scandal. Bulstrode cannot refute the allegation that he “was for many years engaged in nefarious practices, and that he won his fortune by dishonest procedures,” and his body reveals as much—he becomes too weak to walk unassisted. Lydgate, though he realizes that any association with Bulstrode will harm his reputation, cannot refuse to see Bulstrode as his patient and must help: “What could he do?” (450). The narrator explains that Lydgate’s “movement of resentful hatred was checked by his instinct of the Healer which thinks first of bringing rescue or relief to the sufferer” (449). At this point, the scene satisfies the requirements of the conventional crisis-cure narrative, underscored by the narrator’s reference to Lydgate as “the Healer” (that is, one who cures). Bulstrode’s narrative is in crisis, he becomes sick, and the doctor offers relief.
The action of this scene comes largely from the publicity of Bulstrode’s misdeeds, but this moment also invokes a preventative impulse, inviting the reader to think of the past and future simultaneously. As any good physician knows, the doctor’s job is not only to diagnose and cure but also to teach patients to avoid illness in the first place. In fact, if more of the latter occurred, less of the former would be needed. Bulstrode’s illness and potential cure become a cautionary tale about the dangerous effects of past acts, while Lydgate’s act of sympathy sets in motion his own tragic future. Had it not been for the doctor’s instinct to offer the weak man his arm and lead him from the meeting, Lydgate would have been absorbed, at least temporarily, into the status quo. As a result of his sympathy, we begin to anticipate, along with Lydgate, the potential dangers of his actions—we begin, that is, to think “hygienically” in terms of prevention and preservation, becoming aware of that moment when Lydgate could have avoided future “dis-ease,” and did not. The townsmen are similarly poised between a crisis-cure model, as they seek to exorcize their diseased part, and a hygienic one, enacting a quarantine to prevent further and future damage. Lydgate helps to remove Bulstrode, but “curing” Bulstrode’s hypochondriasis or saving the town does not motivate his actions or drive the narrative. In fact, this type of “therapeutic” language, though not wrong in this case, is inadequate. The town and the narrative require Lydgate’s sympathy, as “bitter” as it might be, more than they require any type of medical cure. And although this model of sympathy ultimately does not prevail, the impulse of health—of preservation and prevention—emerges momentarily as it pushes questions of moral and medical disease aside.
As the above example demonstrates, the shift I am tracing can be fleeting. As soon as it arises, it is subsumed by the prevailing discourse and metaphors of disease. We see this in a parallel moment when Dorothea posits a more intricate relationship between character transformation and health. Enlisting the kindly Reverend Camden Farebrother into a diagnostic assessment of Lydgate’s condition, Dorothea tries to convince him that Lydgate is innocent of killing or purposely mistreating Raffles, the man who has exposed Bulstrode as a fraud. She asks Farebrother to consider Lydgate’s character, to which he responds, “But my dear Mrs Casaubon . . . character is not cut in marble—it is not something solid and unalterable. It is something living and changing, and may become diseased as our bodies do” (454, emphasis added). Appropriating the language of medicine, interweaving therapeutics and hygiene, as Farebrother does, Dorothea responds in kind: “Then [character] may be rescued and healed” (454, emphasis added). Health, in this exchange, appears to be an end point, the result of sequestering Lydgate in a metaphorical sickroom and treating his illness—he will be healed. On the one hand, then, this scene seems to be (more so than the first example) a moment of crisis in need of cure. And to some extent it is, but we can see, too, that health and the actions one takes to preserve it are not simply about cures and ends. “The Healer” must think hygienically as well as therapeutically, and Dorothea’s project, which does not work as she had hoped, registers a desire to do both: to institute a preventive model, something from which her own love plot may have benefited, and to hint at the possibility (“may become,” “may be”) of preservation rather than only of immediate cure. Health is a persistent, if often overlooked, force within narrative, a continuous and dynamic operation and, ultimately, a form of sustained compassion. As in the first episode, Eliot provides readers a model of social action that does not depend on the sickroom scene, so that thinking novelistically means turning to health rather than disease; it means opening our thinking to a wider range of possibilities and temporalities.
Reading for health involves, as medical advisers routinely assert, knowing what health is. Just as in the therapeutic model, wherein one must be sick to get cured, so too in the hygienic model one must recognize good health to maintain it. But as the novelists discussed in the following chapters demonstrate, and as the organization of this book suggests, defining health and maintaining it are interdependent narrative acts. One’s ability to know what health is does not always precede one’s attempts to maintain it. In fact, it is through the maintenance of health, particularly through acts of prevention, that we can know health, that it becomes a legible text that we become proficient in reading. We define our health, in other words, by the ways we interpret and modify our body’s responses to, for example, the environment in which we live, the food we eat, the physical activity we exert, and the mental and physical hardships we endure.41
While the following chapters reflect an evolution of fictional form and medical practice during the nineteenth century, they do not aim to tell a linear or progressive history of either field. In fact, reading linearly and chronologically is, in part, what this book proposes to resist. I have organized the chapters into three parts to highlight the recursivity of health’s narrative. Our attempts to manage health shape our definition of it, and the terms we use to define it govern how we manage it. Part 1 examines domestic health and personal conduct, whereas part 2 focuses on texts and characters that represent an unconventional view of health. Both parts alternate between chapters on prevention and chapters that seek to define health through maintenance. Part 3 departs from this model by turning to the realm of the professional (the physician and the physician’s stand-in), who must become adept at reading for health. Such narrative competence is an essential instrument of medical practice and medical education.
Chapter 1 identifies prevention as the primary marker of the hygienic plot in Jane Austen’s fiction; it competes with and overrides the more traditional therapeutic one. As I argue in this chapter, health, for Austen, has little to do with the pursuit or even the rejection of cure and everything to do with the absence of crisis. Although most novels ask us to invite risk, experience disease, and recover slowly, her fictions (Sense and Sensibility and Mansfield Park, in particular) move relentlessly to preempt disaster. “Recovery,” then, is the work of ceaseless and anxious prevention. It means looking ahead to what might happen and looking back at what has been in order to manage current, healthful behavior. Austen’s novels and the domestic medical guides discussed in this chapter—William Buchan’s Domestic Medicine (1769) and Thomas Beddoes’s Hygeia (1802)—are equally intent on teaching their readers to think and to read as preventionists.
