renders the distinction between taking “some little thing” and becoming a preventionist explicit in terms of its narrative aims: “Writings intended to warn against the destruction of health,” he argues, “can hardly be confounded with such as pretend to teach people how to restore it. To direct a stranger how to traverse a slippery ground without injury is one thing. To instruct him how to set his leg should he break it, is quite another” (“Essay II” in Hygeia, 35). These instructions differ in terms of both their content and the form that they take—and to the reader addicted to the drama of broken legs, simply learning to traverse is not so immediately appealing. As Ginnie Smith explains in “Prescribing the Rules of Health: Self-Help and Advice in the Late Eighteenth Century,” “Prevention . . . is and was barely newsworthy[,] being a passive or negative operation.”3 No statistics exist for the number of healthy citizens of a given period, so we cannot know if something has been prevented, we can only know when it has not. The great paradox at work in such narratives is that one can only write about prevention by showing what must be prevented—that is, showing what one wants to keep from happening. To grasp the significance of the warning, we must witness the destructiveness—the proverbial broken leg—that results from avoidable behavior.
Beddoes was certainly not alone in his struggle with this problem. In the highly popular Domestic Medicine (1769),4 William Buchan assumes that his readers will be disappointed in the dearth of “pompous prescriptions, and promised great cures” (vii) to be found in his manual, asserting that he “would much rather teach men how to avoid the necessity of using [pills and potions], than how they should be used” (viii). Physicians such as Buchan and Beddoes were acutely aware that the anxiety over disease (both moral and medical) and the satisfaction that comes with recovery made for a powerful narrative, one not easy for doctors promoting prevention to displace. As such, the problem was how to show what a narrative of prevention looks like. Readers of health manuals wanted to learn how to get well more than they wanted to learn how not to get sick.
The problems associated with narrating prevention hold true for the nineteenth-century novel. Indeed, the novel bears much of the responsibility for the seductiveness of the illness-cure trajectory, having trained its readers to expect conflicts that get resolved and longing that gets rewarded. Narrative arises when we get sick; closure happens because we get well.5 Set during a period in which home health care guides were becoming more accessible than they had been in previous decades, Jane Austen’s novels, though no stranger to the cure model of narrative, embrace this tension between stories that warn and stories that restore. Not only does Austen rely on her heroine’s ailing body to govern, at least in part, how we read her story or how we read any story, but also she situates these crisis-cure moments (dangerous fevers and life-threatening falls) within and against narratives of prevention. Cure is, without a doubt, interesting, but as Austen’s novels demonstrate, it is not the only way to tell a story.
Prevention offers a different way of thinking about any single event. It draws the past and the future into contact by asking us to look forward to a time when we will look backward in regret at our current moment, a moment when we were still (however precariously) healthy and could have done something to avoid disaster. Thus, at the same time that prevention turns our attention to the past, it conditions us to think in terms of the future and to imagine the foreknowledge that will help nip disease in the bud and offer a healthy, happy ending. Prevention often consists in taking action, such as getting inoculated, or, as Austen satirizes in the unfinished Sanditon, in doing silly things to perfectly healthy bodies: pulling teeth, taking emetics, applying leeches. But more often, prevention expects us not to do something (don’t drink too much, don’t touch that). However static this directive may seem, prevention’s etymology—“to come before” (præ ‘before’ and venīre ‘to come’)—allows us to see the narrative opportunities, the intense activity, inherent to this way of thinking. The beforeness that defines prevention captures the imagined state of preserved health that turns plot into a constant caution not to “do” but to “not do” as we ought, redirecting narrative and readerly energy toward plots of averting, not anticipating—making us “patient readers.”
Most health guides, like Austen’s novels, focus their attention on middle-class family conduct and the role that parents play in educating their children and other subordinates. Buchan claims that he wanted to write Domestic Medicine in part because his patients needed a “plain directory for regulating their conduct” (xvi). Similarly, in a section in Hygeia entitled “Art of Preserving Health” (“Essay VI,” 90), Beddoes advocates “practical instruction” for parents on “the structure of the human body.” He even proposes public clinical and anatomical lectures for both men and women, the goal of which would be “to make fully sensible the mischief arising from systematic irregularity; from injudicious management after exposure to the inclemencies of weather, and from the other innumerable ordinary errors of individual conduct. [The lectures] must explain the origin and conduct, much more minutely than the treatment of disease” (91). Beddoes sounds like a novelist, highlighting not only “irregularity” and “injudiciousness” but also “ordinary errors” that shape character action or, as he puts it, “individual conduct.” By focusing his readers’ attention on the body and health as it relates to management, rather than to treatment, Beddoes enacts a subtle but important shift from cure to prevention. Certainly, therapeutics depend heavily on the compliant patient, but both physicians assume that patients are almost too willing at times to follow doctor’s orders when it comes to cures. Buchan and Beddoes offer a prescription for health, as they encourage—even require—individuals to observe the vicissitudes of their own and others’ bodies in a way that conforms to their expert opinion. As Beddoes asserts, “There is nothing [mankind is] so slow in learning, as how to direct their foresight, and portion out their cares properly.”6 For Austen, such foresight translates into learning to “do as one ought.” Indeed, a preventionist ethic assumes and even creates the “ought” with which Austen’s novels are, as critics have noted, so concerned and consumed.7
The first line of prevention is always a narrative one, and cautionary tales provide both the content and the formal structure of preventionist thinking. These stories assume a past (someone else’s) of disease, debility, and even death. These stories about what has been and what might be thus feature “characters” who behave imprudently and suffer greatly because of it. In a section on the “consumptive disposition” in “Essay VII,” for example, Beddoes transcribes a story written by one of his patients, Louisa, as a warning to his readers about the dangers of consumption or tuberculosis. She begins quite simply: “Our family was large.” She goes on, as the narrator of a domestic novel might, to describe this family: “There were twelve of us in all, eight sisters and four brothers. I do not reckon three others, [sic] that died in their infancy.” Louisa reaches back into her family history, noting that with the exception of her grandfather’s gout, “no hereditary disorder had appeared on either side.” The family’s problems developed as a result of her father’s “ambitio[n] that his sons should shine” and that his daughters should “have more information than in general falls to the share of women” (10). Initially, his attentiveness appeared progressive, but as his ambition turned into vanity and degenerated into neglect, the children suffered. Instead of merely describing her symptoms or speculating about proximate causes for her consumption, Louisa offers a narrative of what happens to the children of well-meaning but vain and ignorant parents. They “grow up to be the veriest of wretches,” because in such a household, “health [is] never a constant, and seldom an occasional, concern” (12). In Louisa’s tale, domestic management—a basic understanding of what constitutes a proper diet, exercise, climate, and leisure activities—is the source of prevention, for only a well-run household, we surmise, produces healthy, happy children.
For this reason, Buchan and Beddoes both begin their narratives before the problems, stresses, and dangers that come from living in the world infect the healthy body. In the first chapter of his Domestic Medicine, Buchan offers an earlier version of the cautionary tale Beddoes’s Louisa tells. Buchan highlights the importance
