Diagnosing narratives: illness, the case history, and Victorian fiction【翻译】

Diagnosing narratives: illness, the case history, and
Victorian fiction
Nicole Desiree Buscemi
University of Iowa
Copyright 2009 Nicole Desiree Buscemi
This dissertation is available at Iowa Research Online: https://ir.uiowa.edu/etd/282
Follow this and additional works at: https://ir.uiowa.edu/etd
Part of the English Language and Literature Commons
Recommended Citation
Buscemi, Nicole Desiree. "Diagnosing narratives: illness, the case history, and Victorian fiction." PhD (Doctor of Philosophy) thesis,
University of Iowa, 2009.
https://ir.uiowa.edu/etd/282. https://doi.org/10.17077/etd.8wdb0a8l
DIAGNOSING NARRATIVES:
ILLNESS, THE CASE HISTORY, AND VICTORIAN FICTION
by
Nicole Desiree Buscemi
An Abstract
Of a thesis submitted in partial fulfillment of the requirements
for the Doctor of Philosophy degree in English in
the Graduate College
of The University of Iowa
July 2009
Thesis Supervisor: Professor Garrett Stewart
1
ABSTRACT
“Diagnosing Narratives: Illness, the Case History, and Victorian Fiction”
explores how the medical case study competes with patients’ experiential accounts of
disease in the development of popular nineteenth-century fictions. During most of the
Victorian period, clinical medicine served as the primary producer of medical
knowledge. At the same time, its objectification of the sufferer—epitomized by the
case narrative, the most prevalent form of nineteenth-century medical writing—led to
an increasingly distanced relationship between doctor and patient. I argue that the
mid-century novel responds by featuring narrator-sufferers who co-opt aspects of the
medical case in order to represent their own subjective experiences and rethink what
constitutes medical knowledge. As the century came to a close, however, sciences of
the laboratory, rather than the clinic, began to gain epistemological sway. In light of
widespread skepticism regarding the possibility of translating discoveries made in the
lab into effective bedside practices, I contend that popular novels and short stories
now returned full circle to the clinical case approach as a valuable alternative to the
laboratory. The result is late-century fiction structurally and thematically driven by
the useful yet sometimes callous techniques of the diagnostician and his case method.
I chart these shifts through an examination of works by Charles Dickens, Wilkie
Collins, Mary Elizabeth Braddon, Robert Louis Stevenson, Bram Stoker, and Arthur
Conan Doyle. My project illustrates the responses of these authors to prevailing
power dynamics in the world of medicine and offers a new reading of the ways in
which the Victorian preoccupation with disease shaped literary narrative.
2
Abstract Approved: _____________________________________________________
Thesis Supervisor
_____________________________________________________
Title and Department
_____________________________________________________
Date
DIAGNOSING NARRATIVES:
ILLNESS, THE CASE HISTORY, AND VICTORIAN FICTION
by
Nicole Desiree Buscemi
A thesis submitted in partial fulfillment
of the requirements for the Doctor of
Philosophy degree in English
in the Graduate College of
The University of Iowa
July 2009
Thesis Supervisor: Professor Garrett Stewart
Graduate College
The University of Iowa
Iowa City, Iowa
CERTIFICATE OF APPROVAL
_______________________
PH.D. THESIS
_______________
This is to certify that the Ph.D. thesis of
Nicole Desiree Buscemi
has been approved by the Examining Committee
for the thesis requirement for the Doctor of Philosophy
degree in English at the July 2009 graduation.
Thesis Committee: __________________________________
Garrett Stewart, Thesis Supervisor
__________________________________
Teresa Mangum
__________________________________
Florence Boos
__________________________________
Mary Lou Emery
__________________________________
Loreen Herwaldt
ii
To the other fruits of my labor, Gianna and Bruno, I dedicate this dissertation.
iii
ACKNOWLEDGMENTS
It takes generosity of several kinds to complete a project of this nature. The
Marcus Bach Fellowship for Graduate Students in the Humanities, which I was awarded
in the fall of 2007 through the spring of 2008, greatly assisted in the completion of this
dissertation, as did the Graduate College Summer Fellowship that I received in the
summer of 2008.
My gratitude also goes to my director, Garrett Stewart, whose regular and
insightful input has always made the writing of this dissertation feel like a journey not
just onward but upward as well. In addition, I must thank my other committee members
in the English department at Iowa: Teresa Mangum, Florence Boos, and Mary Lou
Emery. Whether it be through classes, discussions, or careful readings (and sometimes all
three) each of these faculty members has provided encouragement throughout the
formulation of this project. Thanks go to the newest member of my committee, Dr.
Loreen Herwaldt in the UI Department of Internal Medicine; I deeply appreciate the
“clinical eye” that she has agreed to direct at this project on such short notice. The
conversations regarding nineteenth-century medicine that I have had with medical
historian Susan Lawrence have also been immeasurably helpful.
My acknowledgments would not be complete without a nod to the intellectual
community and support system that the members of my writing group have supplied.
Jessica Despain, Kate Henderson, and Laura Capp have offered thoughtful and thoughtprovoking
comments and consistently rigorous readings. The assistance of Harvard
research librarian Elizabeth McKeigue has also been indispensable. I credit my parents,
Lynn and Carl Buscemi, with fostering in me the passion for books and learning that
started me on this path. And, finally, to Scott Nowka—caretaker of children, reader of
drafts, discusser of ideas—I owe many more thanks than can be articulated here.
iv
ABSTRACT
“Diagnosing Narratives: Illness, the Case History, and Victorian Fiction” explores
how the medical case study competes with patients’ experiential accounts of disease in
the development of popular nineteenth-century fictions. During most of the Victorian
period, clinical medicine served as the primary producer of medical knowledge. At the
same time, its objectification of the sufferer—epitomized by the case narrative, the most
prevalent form of nineteenth-century medical writing—led to an increasingly distanced
relationship between doctor and patient. I argue that the mid-century novel responds by
featuring narrator-sufferers who co-opt aspects of the medical case in order to represent
their own subjective experiences and rethink what constitutes medical knowledge. As the
century came to a close, however, sciences of the laboratory, rather than the clinic, began
to gain epistemological sway. In light of widespread skepticism regarding the possibility
of translating discoveries made in the lab into effective bedside practices, I contend that
popular novels and short stories now returned full circle to the clinical case approach as a
valuable alternative to the laboratory. The result is late-century fiction structurally and
thematically driven by the useful yet sometimes callous techniques of the diagnostician
and his case method. I chart these shifts through an examination of works by Charles
Dickens, Wilkie Collins, Mary Elizabeth Braddon, Robert Louis Stevenson, Bram Stoker,
and Arthur Conan Doyle. My project illustrates the responses of these authors to
prevailing power dynamics in the world of medicine and offers a new reading of the ways
in which the Victorian preoccupation with disease shaped literary narrative.
v
TABLE OF CONTENTS
INTRODUCTION ...............................................................................................................1
CHAPTER
ONE THE “STRANGE AFFLICTIONS” AT THE HEART OF BLEAK HOUSE:
ESTHER’S ILLNESS VERSUS THE REPRESENTATION OF
DISEASE........................................................................................................19
“the testimony on which human occurrences are usually received”: Dickens
and the Case ...................................................................................................25
Esther’s Outlook on Disease and Her Inroad into Illness...............................30
The Interplay of Content and Structure:
The Relationship between Illness, Disease, and Dual Narration....................41
Realism and Esther’s Interiority of Experience..............................................47
Communicating Illness ...................................................................................53
TWO “BUT FOR HIS ILLNESS”: THE NARRATIVE NECESSITY OF
INDIVIDUAL SUFFERING..........................................................................56
Thickening the Plot: Illness as Large-Scale Narrative Catalyst .....................61
The Case of Ezra Jennings..............................................................................68
Constituting Illness: Miscegenation, Ostracization, and Disease............70
The Impetus to Action: Constructing Community Through Narrative ...77
Jennings’s Revision of Illness Through Personal Case History..............82
The Generative Potential of Illness: The Union of Plot and Character ..........88
“there was the mixture of some foreign race in his English blood”: The
Mingling of Medical Narratives and Literary Genres ....................................92
THREE CASES POISONOUS AND PREVENTATIVE: FROM BRADDON TO
STEVENSON.................................................................................................95
“Philip Sheldon Reads The ‘Lancet’”: The Spread of Medical
Information and the Threat of Reading in Birds of Prey and Charlotte’s
Inheritance....................................................................................................100
Sensational Science ......................................................................................109
“If you knew as much of doctors as I do, you wouldn’t be in any hurry to
trust a friend to the mercy of one”: Lying Doctors and Fictionalized
Afflictions .....................................................................................................113
Thinking Ill of Himself: Hypochondria and the Laboratory in
The Strange Case of Dr. Jekyll and Mr. Hyde..............................................122
Narrative Contagion and Narrative Containment: The Dangerous Story
and the Preventative Case.............................................................................131
The Moral and the Medical: Shifting Narratives..........................................142
vi
FOUR “YOUR CASEBOOK WAS EVER MORE FULL THAN THE REST”:
MEDICAL REPORTING AS ANTIDOTE IN DRACULA AND THE
SHERLOCK HOLMES TALES ..................................................................145
The History of the Case in Holmes and Dracula .........................................149
Keeping Up “Good Habits” and Making “Blunders”: Clinical
Accumulation and Professional Failure .......................................................158
“Why Did I Hesitate to Write the Word?”: The Absent Illness Narrative
in Dracula.....................................................................................................170
Cataloguing Parts: Death and Distance as Explanatory in Sherlock
Holmes..........................................................................................................179
The Case Comes Into Its Own ......................................................................189
WORKS CITED ..............................................................................................................193

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