Not surprisingly, given the rapidity and magnitude of the changes, historians have combed medical archives and identified scientific, economic, sociological, and ideological factors in the emergence of medicine as the most lucrative and prestigious profession in the United States. I propose to add to these efforts by looking at how fiction writers, a diverse group with its own sectarian quarrels and its own claims to knowing the body, responded. Fiction offers a rich, detailed record of anxieties raised and assuaged by regulars’ efforts to professionalize and to claim exclusive somatic authority. Fiction reveals some of the terms on which medicine’s professional prestige was eventually accepted and how the doctor was often envisioned as a stabilizing force in a rapidly expanding nation vulnerable to political, economic, and social troubles. It also reveals the ways in which the aesthetic imperative to make the body meaningful led fiction to resist the medicalized body, “a thing with physical, anatomical and physiological properties.”9 None of the writers I discuss denied medicine’s achievements in these years. Their concern was with the political implications of medicine’s ascent into elite privilege and authority and the collateral damage done by medicine as it installed its peculiar understanding of the body.
Writers were alert to medicine’s class aspirations. At mid-century, when regulars were under attack from many quarters for seeking prestige and market privileges, the doctor was often represented as a stiff aristocrat. Rebecca Harding Davis, Charles Frederick Briggs, and Herman Melville, for example, suggested that elite medicine was unresponsive or even cruel to the bodies of the disenfranchised—mill laborers, minstrel performers, and common sailors. For these authors, professionalism was undemocratic. For other writers, especially later in the century, the professional doctor was just what a heterogeneous nation needed. Professional medicine promised to cure the “ills” posed by increased immigration, poverty, and urbanization, and highbrow literature often abetted the professionalization of medicine. In elite magazines of the day, for example, the fictional doctor was often a liberal gentleman who could encounter the diseased and the bizarre and remain untainted. He brought stability to worlds riven by disorder, and, like the elite fiction that represented him, he dispensed wise, temperate counsel. The doctor’s scientific training was also, by the end of the century, not always evidence of elitism but of legitimate expertise, especially in fiction that negotiated gender and race issues. As an image of manly science, the fictional doctor endowed domesticity, highbrow aesthetics, and racial uplift with the prestige and seriousness of science. The image of the black physician, for example, served for some African American writers as a powerful challenge to popular images and scientific theories of innate black inferiority.
Fiction was also wary of medicine’s claim to know the body. Mid-century fiction often worried that although medicine might nurture embodied democracy and corporeal equality by identifying basic somatic facts, generalizable “truths” about the body might also leave individual bodies with no history, no intimacy, no narrative particularly their own. Medicine threatened to empty the body of meaning. Nathaniel Hawthorne’s tales of medical ambition, for example, warned against empiricism, suggesting that when medicine understood a birthmark as a curable lesion or the body’s interior as a domain that it could colonize, it dishonored the body so profoundly that it destroyed the very thing it sought to know. Or, as Melville suggested, when medicine devoted itself to garnering prestige, making money, and rationalizing the body, it lost sight of precisely the democratic virtues it might facilitate—compassion and conversation. Later in the century, for writers such as William Dean Howells and Elizabeth Stuart Phelps, doctoring was associated with physical vigor, intuitive responses to the bodies of others, and firm grounding in empiricism. And yet, even for these writers medical epistemology was limited and incapable of responding to the diverse beauty, sexuality, history, and politics that might be written on the body. The scientific doctor (male or female) needed a mate with a fine aesthetic sensibility, and white physicians who misread black bodies needed racial education. On occasion, however, and especially for Sarah Orne Jewett and Henry James, the truly great doctor represented a sensibility that achieved both the rigor of science and the aesthetic refinement of highbrow culture, making him or her sensitive to all the complex realities and meanings of embodiment.
In short, as both medicine and literature professionalized and laid claim to widespread authority and elite privilege, their trajectories into respectability sometimes paralleled one another, sometimes reinforced each other, and sometimes were in tension. At times, fiction challenged medicine’s somatic knowledge, contested doctors’ ability to name and solve the body’s mysteries, exposed the violence inherent in medicine’s drive to epistemological mastery, and questioned science’s equation of rational disinterest with white, educated masculinity. And yet fiction also found ways to use the figure of the doctor to argue for compassion as well as management, corporeal pleasure as well as normative health, sensitivity to the political history of bodies as well as somatic mastery, and appreciation of the body’s mortal beauty as well as definitive diagnoses of disease.10
The Body in the Nineteenth Century
As scholars from a variety of disciplines have shown, sometime over the course of the eighteenth and nineteenth centuries thinking about the body changed profoundly. Francis Barker describes the change as a shift from “spectacular corporeality,” in which self and body are one, to “tremulous subjectivity,” in which a private, desiring self is separate from the physical body.11 The body became something the self “loosely possessed” and something science could know.12 With the rise of clinical studies in hospital wards and the increasing importance of dissection, the body became a material object that could be known through direct and repeated observations that yielded not just idiosyncratic interpretations of an individual patient and his or her world, but facts about all bodies.13 The body was now a standardized, normalized, positive object that functioned according to scientific laws, and the predictability of the body, especially as known on the dissecting table, remains a defining presumption in medicine today. As one recent medical school graduate observed, it probably never “occurred to me or my fellow medical students that the human body which we dissected and examined was other than a stable experience.”14
One result, as Catherine Gallagher notes, is that in the nineteenth century the body was considered a troubling, provocative problem and valorized as a site for definitive answers.15 As a result, the body was measured, weighed, categorized, and dissected—work deemed serious and important. For example, in the 1840s U.S. ethnographers devoted their careers and sometimes their personal resources to collecting and measuring crania. In 1861, Abraham Lincoln allocated national resources to establishing the U.S. Sanitary Commission and also to an effort to gather information about the Union troops by measuring the “most important physical dimensions and personal characteristics” of as many soldiers as possible.16 By the end of the century, criminologists created taxonomies of somatic features common to a “hereditary genetic criminal class” and began creating databanks of fingerprints with the hope of identifying hereditary features for various types.17 The body became prima facie evidence, and it was hoped that by knowing the body, men and nations might build stable, healthy worlds in which disease was eradicable and social troubles manageable.18
In theory, the modern body is an egalitarian notion—everyone has a body that functions according to the laws of physiology.19 But in the nineteenth century, some bodies were more visible, more measured than others. While some traits “could go unmarked, even grammatically,” as Michael Warner has noted, “other features of bodies could only be acknowledged . . . as the humiliating positivity of the particular. “20 The fetishistic attention, for example, to cataloging the width of noses, the height of foreheads, the length of femurs, the color of skin, or the size of breasts made some bodies more visible than others, some features more humiliating for being a site of difference. In short, as scholars have amply documented, social categories—gender, race, ethnicity, class, and nationality—were made real, written on the body by medicine, biology, and ethnography, “naturalizing discourses of the