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Home arrow Language & Literature arrow Syphilis in Victorian Literature and Culture: Medicine, Knowledge and the Spectacle of Victorian Invisibility

Medical Sightings and Protective Narratives

Despite major developments in the classification of syphilis, late nineteenth-century practitioners’ vision often remained insensitive to the imitative nature of the disease. The dialectics of visibility and invisibility lay at the core of syphilographers’ practice. In his famous 1879 lecture “Syphilis as an Imitator,” in which he concentrates on the deceitful symptomatology of the disease, Hutchinson compares the “wonderfully great” number of syphilis simulations to Satan’s powers of mimicry (499). Paradoxically, the mercurial character of syphilis affords him insight. Hutchinson considers his own recognition of this feature as highly significant: “I may acknowledge that this general law of imitation or simulation has been of the greatest possible service, and that it has helped me to a clear view of much that was previously obscure” (1879: 541-2). Thus the ability of recognition and apt classification, which make visible the ‘true’ nature of the ailment, become fundamental to medical practice, while the clinician’s gaze develops into an authoritative instrument of knowledge.

That the recognition of syphilis was regarded as a Herculean labour can be seen in medical manuals, which allotted the utmost space to the description of syphilis symptoms while devoting only a fraction of their attention to the treatment and social significance of the ailment. A Manual of Syphilis and the Venereal Diseases (1900), co-authored by James Nevins Hyde, professor of genito-urinary and venereal diseases at Rush Medical College, Chicago, and Frank Hugh Montgomery, associate professor at the same hospital, vividly illustrates this trend. Whereas the treatment of syphilis is discussed on no more than fifty pages, its symptoms cover over two hundred. The first edition of Hutchinson’s Syphilis (1887) takes an altogether different approach. Although the first part, concerned with general statements, devotes equal space to the various stages of syphilis and to its general treatment, the second is comprised of “clinical commentaries and illustrative cases” (Hutchinson 1887: xi). In this section, comments on specific syphilis symptoms are interlaced with a couple ofchapters discussing the possible treatment of the disease and six chapters focussing on the recognition, diagnosis and professional documentation of medical cases. Although based on no apparent principle, the organization of the book shows Hutchinson’s cyclical return to the question of apt diagnosis, which, intensified in the last few chapters, appears to constitute his chief preoccupation in the book.1 Accurate recognition seems to have been indicative of practitioners’ experience and authority. It was, at the same time, constitutive of medical hierarchies as it also remained the crux of medical education. The act of seeing and recognizing the disease was an indelible part of a syphilographer’s practice but it also carried a symbolic meaning that was often used in medical rhetoric.

In fact, in his writings, Hutchinson uses the trope ofsyphilis recognition to underscore the necessity of expanding the study of syphilis and to outline his programmatic creed, with differential diagnosis as its core. His 1879 lecture catalogues a number of ailments, ranging from smallpox and measles to epilepsy and mental disorders, which could be mimicked by syphilis. Syphilis continues this methodical comparison and shows that “[w]e have absolutely no malady which is peculiar to syphilis” (1887: 485). This differential categorization of syphilis allowed Hutchinson to formulate general laws governing the imitative propensities of the disease. He argued that it could only involve those organs that would be affected by the diseases that syphilis imitates (1887: 488-9). This emphasis on the structural characteristics of syphilis broadened the spectrum of syphilogra- phers’ inquiry and called for the “expansion of the clinical picture of the disease” and for an integration of other disciplines into syphilis study (Crissey and Parish 1981: 218-19). Hutchinson’s incessant endeavours to outline the imitative faculties of the disease were part of his attempts at a more systematic science of syphilology, founded on differential diagnosis.

For him, medical observation was the major source of knowledge about syphilis (Hutchinson 1887: ix). Yet it was a type of observation that arose from a holistic medical inquiry, where the determination of symptoms was accompanied by an examination of the patient’s medical history (1887: viii). While he cautions his colleagues to listen carefully to patients’ histories, Hutchinson also prompts them to be attentive to the possible distortions due to social norms:

Our patients often have reasons for not telling us the exact truth, and, still more often, they are not themselves cognisant of it. [... ] Very often we are precluded, by circumstances, from asking the questions which we should like to put. (1887: vii)

Syphilis recognition is seen here a complex social act based on clinical experience and anchored in doctor-patient encounters. Such encounters are highly conventionalized and greatly dependent on socially prescribed performances of respective identity formations. Hutchinson’s assumptions as to the character of the seeing/being-seen dyad - the patients do not always reveal the whole truth and the circumstances sometimes do not permit a free exchange - show an acute consciousness of his own position in society and of the highly standardized, and therefore instable, type of knowledge obtainable in the course of medical examination.

The trope of syphilis recognition connects Hutchinson’s writings to the urgent question of medical education at a time when the traditional clinical approach to medicine was being undermined by the advancement of laboratory practice. Although laboratory science was in no way as prominent in Great Britain as it was, for instance, in Germany, it had an impact on medical education (Bonner 1995: 251-2). As the new President of the Royal Society, T. H. Huxley gave an address in 1883 in which he called for a further specialization of the medical profession, proposing to centralize the teaching of laboratory medicine and to substitute examinations in general knowledge with physical science. In response to the lecture, the BMJ report “Professor Huxley” painted a grim vision of medical professionalization in which experts’ specialization lead to an excessive preoccupation with “electrical phenomena of muscles,” “the colouring matter of the urine” or “the chemistry of the brain”: matters it assessed as incongruent with the actual needs of medical students at the time (1883: 734). Huxley’s insistence on narrow expertise was counteracted by an oppositional coterie of generalists, especially amongst the Fellows of the Royal College of Physicians, who regarded medicine as an art or a lifestyle rather than a set of specialized skills. Often in possession of a broad, classical education and practicing in elite circles, they privileged individual development through experience over technical expertise. This notwithstanding, they assigned to science a certain, if altogether not very significant, role in the practice of medicine (Lawrence 1985: 503-7).

These two opposing attitudes were not without practical repercussions. Thomas Neville Bonner regards the decade of the 1870s as crucial to the educational reform, with the efforts of such bodies as the General Medical Council or the College of Surgeons to introduce the new ideal of laboratory science into the curriculum decisively influencing medical learning. It was a time when a number of schools with a prime interest in science and technology were founded in cities like Manchester, Newcastle and Liverpool while laboratory studies were introduced almost everywhere. Even hospital schools around the country conformed to new requirements (Bonner 1995: 260-3). Yet the restructuring of medical education in Great Britain was uneven. Whereas improvement was made in the medical curriculum (clinical studies were strengthened and facilities for clinical teaching improved), progress was hindered by the existing structure of licensure and by the “reverence for tradition inherent in the British national character” (Walker 1956: 774).

Although Hutchinson acknowledged the claims of experimental science, he exhibited a penchant for clinical medicine. As he appeals for a combination of clinical and experimental threads of medicine in the preface to the second edition of Syphilis, he nonetheless remains sceptical about the applicability of the new disciplines (such as microbiology) to medical study and concludes that the tentative character of knowledge they promise is the reason for his continuing reliance on clinical medicine in the new edition of the book (1909: ix).2 At the same time, as already mentioned in Chapter 2, he underscores the importance of the clinical, all-round education that combines hospital observation with museum and library study as well as with laboratory science. In his address, “The Uses of Knowledge” (1885), Hutchinson emphasizes broad medical teaching as a prerequisite to a proper practice of medicine. He considers such diverse disciplines and topics as “the peculiarities of soil and atmosphere,” “the history of man” and “plant-life” as critical to the development of a medical man. His character is as important as his medical skill when Hutchinson calls future practitioners to “seek to become [... ] compendiums of empirical knowledge, and embodiments of common sense” (1885: 634).3

The importance of seeing and diagnosis to the study of clinical medicine, as encapsulated in the trope of syphilis recognition, thus influenced the mode of teaching and the dissemination of knowledge about the disease. It was also central to Hutchinson’s postulates concerning the future of medical education, which he saw in the pursuit of objective teaching. The principles of objective teaching were realized in the Polyclinic, whose space offered innumerable exercises in (syphilis) recognition and tied them to professionalization debates.

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