Modern medicine has truly come a long way from the rudimentary practice of the ancient era. From the humour theory of the 16th century, which was gradually replaced by the germs theory that indicated the cause of diseases, the purpose of medicine has been to eradicate diseases. The journey has been one towards precision. It is this search for precision that led the medical practitioners across the ages to go beyond the mere exterior and literally cut into the human body in order to learn more about it. Modern surgery may have moved towards laparoscopy and radiology but in the earlier days, surgery was a truly gory affair.
The subjects of surgical experimentation shifted- from animals to human beings, dead and alive, and the history of experimentation is replete with facts about grave robbers and doctors who experimented on living subjects, driving Sara Wasson to the conclusion that medicine was, in itself, “an incorrigibly Gothic project” in her essay titled “Useful Darkness: Intersections between Medical Humanities and Gothic Studies”. While evidence of surgical practices can be found in ancient cultures there was a definite surge in experimentation and development of medical science in the 18th and 19th centuries with ample evidence of bodies being exhumed and experimented upon. And if there was anything that could have understood, captured and reflected the bloody history of the beginnings of modern-day surgery, it is the Gothic imagination with its typically hostile and haunted world.
The Gothic imagination played a role in shaping the changing attitude of different societies to the field of medicine and brought into the fold the question of medical ethics. However, it would be wrong to assume that the idea of ethics in medicine was raised for the first time in the 18th and 19th centuries. Modern medicine prioritizes the subjective experience of the patient, at least on paper, and all doctors have to swear by the Hippocratic Oath. This oath is an adaptation of the original that physicians in ancient Greece used to swear by, in order to uphold some basic standards of ethics. This goes on to show how the question of ethics is almost as old as the medical practice itself, and yet there are examples of extreme breaches even in modern history.
Gothic literature originating in the 18th and 19th centuries presents the argument as to why such ethical codes may be necessary for the field of medicine. This has resulted in the emergence of the field of medical humanities which concerns itself with analyzing the history of medicine as a cultural and social process and aims at dissolving the inherent power relations between physician and patient.
Medical science in the 18th and 19th centuries
In the earlier decades of this period, physicians were perceived to belong to either one of two categories. The first was that of the learned doctors trained in the knowledge of Paracelsus and Vesalius who were regarded as the approved authorities of medicine at the time, and the second was a new class of surgeons who were initially looked down upon. Prior to the discovery and use of anaesthetics, surgery was a limited branch of medicine. Surgeons were equated with barbers as both professions required sharp and fine instruments for their trade. In the 16th century, Ambroise Paré who was an apprentice to a barber served as the surgeon on the battlefield of the kings of France. With very little knowledge, surgery was prescribed for blood-letting that was wrongly used for the treatment of apoplexy and fevers at the time. The occupation of surgeons was limited to removing gallstones and tending to the injured in battlefields.
The 18th century gave precedence to public health and sought to provide medical care to the masses. The London Dispensary was the first clinic of its kind that was set up in 1696, closely followed by other dispensaries throughout the Empire and even in the colonies by 1770s. Guy’s Hospital was the first medical hospital that was set up in London in 1721. Samuel Sharp practised his surgical practices here, as can be noted from his book A Treatise on the Operations of Surgery. This was the first book that focused solely on operative techniques. Simultaneously, Thomas Percival was writing a treatise on ethics in the field of medicine, Medical Ethics or a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons that was published in 1803. The concepts of anaesthesia and antiseptics in the 19th century really gave to the surgeons an opportunity to further their knowledge about the human body, and knowledge of virology and bacteriology helped contemporary figures like Agostino Bassi, Theodor Schwann, Robert Koch, Louis Pasteur and Edward Jenner to come up with vaccinations and cures for epidemics like smallpox, rabies and cholera that were rampant at the time. The contribution of Ignaz Semmelweis significantly reduced the death of women through childbirth as well.
The developing field of medical science bestowed upon the doctors of the time a status of significant power. They were healers of human ailments which gave them power over the ordinary public. The stories of experimentation on cadavers, carcasses and corpses inspired a sense of awe and fear among the general public. The gothic literature written at this time sought to channel these feelings of fear towards the medical profession. This fear may be said to have found expression in these works and the surgeons were given monikers such as ‘sawbones’ which aptly reflected how the public felt.
Two instances of the abuse of such power may be cited in alluding to the figures of Edward Jenner and James Marion Sims. Jenner is credited with the discovery of the cure for smallpox, but he carried out his experiments on an eight-year-old boy, which would be grossly against the ethical standards in modern medicine. An even more disturbing example is the case of J. Marion Sims. Known as the ‘father of modern gynaecology’, his most important contribution was the treatment of the vesicovaginal fistula in women but he perfected his techniques by operating on enslaved black women in America, not bothering to administer any anaesthesia on his subjects. Slaves at the time were subjected to subhuman treatment and Sims had no qualms carrying out heinous experiments on these marginalized female slaves.
Additionally, the 19th century may be regarded to be the beginning of modern classificatory medicine that, as Michel Foucault puts it, removes the “disease from the density of the body” by neglecting the complex and particular environment within which the ill subject lives. According to Foucault, the excessive classification of medicine and modern taxonomy is a ‘reductive discourse’ that failed to fully encompass, “the presence of disease in the body, with its tensions and burnings, the silent world of the entrails, the whole dark underside of the body lined with endless, unseeing dreams.” There was a standardizing of the ‘medical gaze’ in the 19th century that has been critiqued for depersonalization of patients and compressing diverse experience into standardized categories, eluding the social and emotional impacts of illness and medical experience. As an antidote to this, illness narratives were used to encourage the doctor to somewhat engage emotionally through their imagination with the lived experience of the illness. Inspired by the gothic, medical humanities has a pedagogical role to perform as it humanizes medicine, where Frankenstein can be read as a paradigmatic text of medical ambition gone wrong and The Strange Case of Dr Jekyll and Mr Hyde is partly a reflection on the ethics of pharmaceutical experimentation.
Understanding the Gothic
The Gothic imagination goes beyond gargoyles and arches to encompass how the common masses felt about the changes occurring in society. The Gothic literary ‘canon’ is traditionally preoccupied with gore, suffering bodies and vulnerability of victims who feel a sense of confinement. While in the earlier works of Gothic fiction the protagonists seemed to be trapped in remote castles or monasteries, the setting of 19th century Gothic novels shifted to the cities and the many professions emerging there, the field of medicine being the most prominent one. And since then, “Gothic literature and film have long had an interest in the way medical practice controls, classifies and torments the body in the service of healing”, as Sara Wasson eloquently remarks. All gothic representations are negative at their core with horror, fear, terror and despair creating the sense of a menacing past undermined by optimism for the present or future.
Even before the Gothic imagination was entangled with the medical sciences, there was a sense of confinement in the earlier Gothic fiction. As David Punter observes, the Gothic is concerned with “eclipsed lives, lives already among the ruins… where darkness reigns and the future can never escape from the dread of the past.” Like all sciences, the field of medicine also hoped for glory but the Gothic, according to Wasson was “preoccupied with the crumbling of modernity's triumphs, of rationality and science defeated.” The subject of Gothic fiction was much like the victims on whom the practitioners conducted their experiments- the subjects were not in possession of themselves. Gothic representations are not realistic or objective, they represent highly subjective, fraught experiences of crisis.
The Gothic imagination accommodated tales of the urban legend like the vampire tales which, over the years, may have taken its inspiration from Bram Stoker’s Dracula (1897). There have been many adaptations of Mary Shelley’s Frankenstein (1818), often turning comedic in tone in children’s stories as well. The continuous reinvention of Gothic tales still resonates with the people on some level which is why they have continued to be popular. It will be interesting to note that another classic story, The Strange Case of Dr Jekyll and Mr Hyde (1886) written by Robert Louis Stevenson bears resemblance with the character of Bruce Banner in the Marvel Comics now adapted into a film. While Hulk in these stories remains a source of great strength, he does not retain the definitive sinister connotations of his predecessor Mr Hyde. The whole body of Gothic literature may be said to have contributed to this effect on some level, as it will be discussed further in the article.
The monster figure
The epistemology of the word ‘monster’ originates in a Latin word that means ‘to warn’. Almost every classic Gothic tale had a monster in the mix that was truly horrific in character. Lisa Joy Bertrand in her essay “Monsters and Medicine: The Evolution of Warning in Gothic Literature” has referred to the monster figures in Frankenstein, Dr Jekyll and Mr Hyde and Dracula to show the rising power of medical practitioners at the time. The anxiety people felt towards the monster also channelled the public feeling and unease towards medical practitioners. While the subject of these monsters is much more complicated, a basic allegorical reading of the monster figure in these works can give us a sense of how the contemporary world felt about the discipline of medicine.
In Mary Shelley’s Frankenstein, the creature created by Victor Frankenstein gradually turns into the monster he is feared to be because his creator refuses to take responsibility for his actions and experiments. While Mary Shelley may be said to focus on the responsibility of the doctor, Stevenson’s monster highlights the evil manifestations within a human being where the monster figure is actually fused with the human. It is the effect of a potion on a human being that creates Mr Hyde who is a decidedly evil version of his creator Dr Jekyll. The potion as a representative of science is bringing out the worst instincts of his human creator. The characters in these novels, therefore, justify the readers’ fear of medicine and its practitioners in 19th century England. However, in Stoker's Dracula, we are shown a story where the medical surgeons are successful in destroying a monster that is effectively preying on other human beings. In Dracula (published at the very end of the century in 1897) Dr John Seward and Dr Abraham Van Helsing are physicians who are portrayed in a positive light as they help decommission the monster. This suggests that the public sentiment was gradually warming up to the idea that medicine was actually a field that was essentially beneficial to mankind.
The awareness that the Gothic imagination brings to medicine has given rise to the field of medical humanities that seeks to deal with the issue of ethics. Medicine has come a long way, and so has the ethical standards that go along with it. Jenner’s experiment on the 8 years old boy may have helped him secure a cure for smallpox, but it was unacceptable according to today’s codes of ethics in medicine. One hopes that the existence of ethical codes would make Sims' experiments impossible in today’s day and age. And yet, the people in the margins always seem to bear the brunt of experimentation. In spite of having strict ethical codes in place today, numerous examples may be cited where these codes were not respected. Until the 1960’s all pharmaceutical experiments were carried out on prisoners. Inmates of the San Quentin correctional home under Dr Leo L. Stanley received transplanted testicles from recently executed prisoners, rams, goats and boars in the 1920s. Similar stories from many other prisons may be cited to show how prisoners, as a part of the marginalized demographics in society, are treated as easy targets. In fact, the violation of ethics is often encouraged in times of war- Japanese Unit 731 led by Lieutenant General Shiro Ishii was given full immunity in exchange of biological, medical and chemical weapons testing on over 10,000 prisoners of war during World War II.
As experimentation is carried out on those who are unable to protect themselves, the dynamics of power remain unchanged and inherent. These instances are examples where people were victimized by knowledge of medical sciences. With a field such as medicine that scientifically relies on experimentation, the ethical way would perhaps be aimed at finding willing subjects as opposed to victims to conduct necessary experiments. The Gothic imagination shows that on basic humanitarian grounds, medicine must navigate the complicated question of ethics.
The Gothic imagination does not aim to question the value of medical science and it’s immense contribution to society. Medicine consists of a field of knowledge that is aimed primarily at helping and healing people and most medical institutions adhere to the responsibility and ethics that go with the discipline. But at the very basis of it, medicine is the knowledge that, like all other disciplines, may be grossly misused.
The Gothic imagination does not seek to misrepresent the domain of medical science, but it represents the exceptions where the misuse of medical science may have gory and heinous consequences that are against human life and values. The Gothic perspective may be regarded as highly subjective, but this only adds credibility to its powerful narrative. For society at large, the Gothic imagination seeks to focus on the inherent dangers in institutional discourses, and medicine is no exception. On a one-on-one level, it sets out to provide some kind of an agency to the patient by generating empathy in the physician for the patient, developing on the interpersonal relationship between doctors and those who are to be doctored.
HISTORY OF MEDICINE. [online] Available at: http://historyworld.net/wrldhis/PlainTextHistoriesResponsive.asp?ParagraphID=kvb
Bertrand, Lisa Joy, “Monsters and Medicine: The Evolution of Warning in Gothic Literature” (2017). Culminating Projects in English, p 113.
Hahn, Daniel. John Hunter and the horrors of 18th-century surgery. History Extra. (2005). [online] Available at: https://www.historyextra.com/period/georgian/john-hunter-and-the-horrors-of-18th-century-surgery/
Krans, B. Pain, Suffering, and the History of Human Experimentation. [online] Healthline. Available at: https://www.healthline.com/health-news/strange-the-sordid-history-of-human-experimentation-101213#9
Punter, David, Gothic Pathologies: The Text, the Body and the Law. (1998), Basingstoke: Palgrave Macmillan, p 9.
Wasson, Sara, “Useful Darkness: Intersections between Medical Humanities and Gothic Studies” (May 2015). Introduction to Gothic Studies 17.1.
Image source: ‘Tales of Terror’ from The Chapel Hill Rare Book Blog
Image link: https://goo.gl/images/vv3bkj
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