Such circumlocutions in language, education, and practice were not merely rhetorical strategies to appease prudish conventions. Regulars were genuinely eager to demonstrate their professional manners and their respect for feminine modesty, particularly since most of their competitors in alternative medicine did not perform physical examinations. Moreover, when studying or teaching obstetrics and gynecology, regulars at mid-century were truly embarrassed. Samuel D. Gross, the esteemed surgeon featured in Thomas Eakins’s The Gross Clinic, described the embarrassment of his obstetrics professor: “it was seldom that he . . . looked squarely at his audience. His cheeks would be mantled with blushes while engaging in demonstrating some pelvic viscous.” Dr. William Potts Dewees was less easily embarrassed. According to Gross, Dewees “did not hesitate to call things by their proper names” and never blushed in the lecture room. And yet, he insisted in his popular midwifery manual that students should learn from mannequins and should perform only “unsighted digital explorations of parturient women.”34
For some, the threat that male physicians posed to women warranted an end to all-male medical care of women, and women physicians were sometimes championed as a solution to the problem of intimate care for the female body. Implicit in such debates was a concern with sexual arousal of the male physician and the vulnerability of the female patient to a lecherous physician and to her own latent desires. The reformer George Gregory, for example, published a pamphlet that concludes with a titillating warning about doctors who seduce their patients. Deploying the salacious language that was common in reform literature, the pamphlet warns of “unprincipled medical men” who have “a most familiar and confidential intercourse” with female patients.35 The patient’s “husband, being confined by business, is absent the livelong day, or for weeks and months” and the physician knows her “whims and weak points.” As Aylmer uses his husbandly access and scientific authority to persuade his wife to submit to his experiment, so Gregory’s imagined physician uses his husband-like medical access to a patient to visit frequently and press his suit. In language reminiscent of Hawthorne’s tale, Gregory notes that the doctor fixes “his prey . . . and resist she cannot . . . she can refuse nothing—all is lost!”36
While Gregory’s imagined scene and the trial in Buffalo may seem to us melodramatic posturing in exaggerated arguments about female delicacy, these texts suggest that anxieties about violence, eroticism, male desire, feminine purity, and medical ambition were not easily sorted out as physical examinations became more common and as medicine was increasingly devoted to knowing the body directly rather than through rationalist a priori systems or indirectly through the patient’s report. Indeed, physicians’ worries that physical examinations threatened domestic decorum were not unfounded. As late as 1876, Tolstoy turned in Anna Karenina to the specter of a full medical exam to figure women’s vulnerability to the shame of physical exposure, and at mid-century, the trope of the doctor who takes advantage of his position had real currency in popular fiction. For example, Eugene Sue’s best-selling novel, The Mysteries of Paris, published in the same year as Hawthorne’s tale, draws a vivid portrait of a fiendish physician trained at La Pitie who preys upon female patients. The American edition made Dr. Griffon’s abuse of women the subject of lurid illustrations, and U.S. physicians were eager to distance themselves quite explicitly from the image of Dr. Griffin.37
Hawthorne’s tale, like Sue’s novel, plays upon these concerns, and as I have suggested, Aylmer’s medical ambition is in part sexual desire gone awry. In “The Birth-mark,” Hawthorne seems genuinely concerned about medicine’s access to the domestic world and about the sexual energy that may fuel male ambition. And his concerns were not, it would seem, unreasonable. Years later, when his oldest daughter was sick while the family was in Rome, the doctor took advantage of his access to the daughter’s bedroom to press unwanted kisses upon Una’s governess, Ada Shephard. In letters to her fiance, Shephard reported that Dr. Franco was a “raging lion” who poured forth a “storm of consuming and raging passion” and “dared to force upon my cheek and lips his hateful, unholy kisses.” Sophia Hawthorne also found Dr. Franco a powerful presence: she described him as “vivid, impulsive, transparent, frank” and refused to “have him blamed” for Una’s continued illness.38
But as much as “The Birth-mark” is about scientific interests confused with and fueled by libidinal passions, it is also a significant revision of the familiar portrait of the mad doctor with access to the female body. Hawthorne invokes the specter of the sexually obsessed medical experimenter, but he warns against a danger perhaps even more worrisome than crude sexual advances. Aylmer’s ambition is not about sexual access to his wife’s body. The medicalized rape that the tale imagines is not, in the end, an act of carnal degradation, but rather an attempt to purify by erasure. Aylmer’s ambition is not to have unrestricted access to Georgiana’s body so that he might satisfy his own carnal desires (the goal Gregory and Sue suggested might motivate some physicians). Rather, his experiment seeks to purify his wife’s body of its signs.
The birthmark on Georgiana’s cheek heightens the visibility of her body. It draws attention to her body and to her embodiedness. Critics have variously teased out the meanings of the mark, reading it as a metonym for blood, birth, women’s creativity, sexuality, imperfection, or mortality. In short, it is an overloaded sign that vibrates with multiple and contradictory meanings.39 But it also serves most simply as a synecdoche for Georgiana’s body. In fact, Hawthorne suggests that in this case not only does the part represent the whole, but that the part cannot be separated from the whole. This intimate and never-to-be-sundered relationship between the body and its signs is what medicine, according to Hawthorne, does not understand.
When Aylmer imagines that Georgiana can be separated from the mark, he presumes that the mark is alienable property. His thinking depends upon both a market notion of individualism and self ownership and the medical corollary in which the patient is presumed to own his or her body. Owning one’s self was a central tenet of the rise of modern liberalism,40 and in medicine, possessive individualism meant the body was a thing that might be studied apart from the patient. As a recent medical philosopher explains, this means that during a physical exam, “the patient responds to the request of the physician to live in his or her body . . . as a body that he or she has, not as the body that they are . . . This thing-body . . . is something merely possessed, an object, a thing with physical, anatomical and physiological property.”41 In the nineteenth century, this new model authorized the physical examinations and midwifery exhibitions that many, as I noted earlier, found troubling. According to the new model, physical examinations were not invasions of the patient’s ontological being, but simply an encounter between science and its object of inquiry—the body. Splitting the body from the patient also legitimized access to the body-as-property in medical education, and medical schools promoted themselves by advertising their somatic wealth. Some proclaimed the plenitude of cadavers at their schools, Southern schools touted their easy access to the bodies of deceased slaves, and part of the appeal of studying in Paris lay in greater access to bodies—alive and dead—in clinics and in pathology laboratories.42
In the 1830s and 1840s, it was still possible to challenge a view that is now deeply ingrained and almost impossible to think beyond. Historians offer various accounts of the development of a Western mind/body duality. The rise of Cartesian philosophy is one major moment. The rise of modern medicine at the end of the eighteenth century is another. With this in mind, then, we should understand the popularity of the fictional evil doctor as, in part, a challenge to modern medicine’s notion of the “thing body.” The evil doctor’s misdeed