Chapter 4 examines the discourse of good character and cultural refinement that underpins the professional claims of both medical and literary elites at mid-century. The chapter begins by tracing the wealth, family connections, access to power, and cultural connoisseurship that helped early white male medical leaders legitimate their authority. Then the chapter turns to periodical fiction (including works by Oliver Wendell Holmes, Rebecca Harding Davis, and Henry James), tracing an alliance between regular medicine and highbrow literature in the pages of elite magazines of the day. Although regulars often came in for rough treatment in newspapers and sectarian medical journals, prestigious literary magazines rarely published articles critical of regulars, and many printed essays and fiction that defended the medical profession and celebrated the doctor’s character. The Atlantic and similar magazines were deeply enmeshed in “the construction and justification of social hierarchy,”31 and in these magazines the doctor is usually a white, liberal, upper-class gentleman with the virtues the AMA claimed for its members—equanimity, objectivity, disinterest, wise counsel, and ethical leadership. These virtues were also meant to characterize elite fiction itself and thus buttress highbrow literature’s own cultural claims over such popular and populist genres as dime novels and sensational fiction. The good doctor, like the highbrow fiction that tells his story, manages the bodies of others, and he is a figure of stability in stories that admit and seek to contain difference, discord, disruption—forces that democracy may too readily tolerate. The chapter also notes, however, that on occasion the doctor’s class affiliation comes in for close scrutiny and that the doctor is sometimes critiqued for his allegiance to an outdated class order or for his efforts to protect his class status. These stories record a resistance to the cultural claims of the AMA and an inclination to interrogate professionalism. Indeed, elite literature’s willingness to envision for itself a role other than that of conservator of the status quo and handmaiden to the emergence of a class of prestigious doctors was an integral part of its image of itself as disinterested and objective.32
Chapter 5 focuses on the intertwined and shifting gender identities of medicine and literature in the second half of the century as women entered the medical profession, as professionalism supplanted domesticity, and as empiricism eclipsed other ways of knowing. In these years, the doctoress was featured in tracts debating what women could and could not do, in titillating images of women medical students examining or dissecting naked bodies, and in a flurry of short stories and novels by writers such as Elizabeth Stuart Phelps, William Dean Howells, Rebecca Harding Davis, Annie Nathan Meyer, Sarah Orne Jewett, S. Weir Mitchell, and Henry James. The doctoress was a topic “rich in actuality,” as Howells noted, because she threatened deeply held, yet fragile presumptions about masculinity and femininity. More generally, the chapter considers how representations of medicine became a way to negotiate the taint of femininity that worried the nation and particularly threatened the arts, which were increasingly defined as a feminine complement to the manly world of science. For these writers, the good doctor is well-trained, intuitive, objective, and caring, and he or she is a professional who does important work that is both scientific and domestic, work that depends upon expertise and brings the physician into intimate settings. For some of these writers, the doctor’s presence in the home makes the domestic something more than the traditional female world of home and heart. It is where the fabric of the nation is woven, and writing fiction that is good for the nation requires expertise not unlike the doctor’s. But if the doctor’s visits to the world of domesticity and romance endow this world with masculine virtues associated with professionalism, they also reveal medicine’s limitations. Some of these authors note a possible narrowness in medicine’s understanding of the body, and they suggest that health requires not only an absence of disease but also a psychological and aesthetic well-being that is literature’s domain. Others offered the well-trained and well-read male doctor as a reassuring national icon of masculine vigor and cultural refinement.
Chapter 6 considers the relationship between medicine and race at the end of the century, in part by examining the political/racial work that the figure of the physician was pressed to do just when African Americans in medicine were professionalizing and challenging racist medical ideology. In 1895, at the Cotton States and International Exposition in Atlanta, black physicians founded the National Medical Association, an alternative to the AMA, and during these years they founded black-controlled hospitals that offered training for black medical professionals and health care for African Americans. Notably in these same years, between 1891 and 1901, a flurry of stories and novels took up the question of race and medicine: Francis Harper, Katherine Davis Chapman Tillman, Rebecca Harding Davis, Victoria Earle Matthews, Charles Chesnutt, and William Dean Howells all wrote fiction that made a physician living or working on the color line a central issue. Three of these—“Aunt Lindy,” The House Behind the Cedars, and An Imperative Duty—place the white doctor in a racialized world, using him as a trope for medicine’s racism, historical amnesia, and vulnerability to race melodrama. The others—Iola Leroy, Beryl Weston, and The Marrow of Tradition—imagine the black physician as a figure of hope. Not surprisingly, as black physicians gained institutional training and became venerated community leaders, the black doctor in fiction became a ready symbol of racial uplift. His success in medicine challenges racist notions of black inferiority, and he often serves as a figure of a moderate but race-proud leader. All but one of the stories consider the physician as a man as well as a professional, and in several the doctor is judged by his response to the mulatta, a figure that bears the burden of embodying and responding to the nation’s gender and race psychoses. For Harper, the black doctor mediates gender stereotypes, and she makes the black male physician a figure for the promise of institutionalizing tender, maternal care of black bodies. In Harper’s novel, the black doctor stands as an antidote to the caricatures of blacks as primitives that permeated U.S. culture and also as a challenge to the image of black maternal care lavished on white children and the image of black bodies bloodied and destroyed by race violence. For Harper, the black doctor cares for and loves black bodies. For Chesnutt, the black physician figures the possibility of new race relations. Always sensitive to the nation’s anxiety about and fascination with the color line, Chesnutt concludes his novel about the race riots in Wilmington, North Carolina, with a black doctor heading upstairs to perform a tracheotomy on the scion of a white racist. The white body, Chesnutt suggests, needs radical surgery, and the black physician (and writer) must both cut and suture this body.
Finally, the book ends with an epilogue that looks forward into the first years of the twentieth century, when medicine moved decisively from home care into the world of regimented hospital care and from clinical medicine’s emphasis on organic, narrative case histories to pathology’s emphasis on somatic bits and pieces. By looking briefly at short stories by Theodore Dreiser, Jack London, and William Carlos Williams, I trace the disappearance of the beneficent master physician and the emergence of the ruthless, virtuoso