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From awkwardness to impropriety: conceptualising the male doctor\u2019s embarrassing body in Victorian medical literature<\/strong><\/p>\n By Alison Moulds (University of Oxford)<\/strong><\/p>\n This post is based on a paper given at the \u201cEmbarrassing Bodies\u201d conference, organised by Birkbeck, University of London <\/em><\/strong><\/p>\n In 1858, Dr Edward Lane \u2013 owner of the Moor Park hydropathic establishment in Surrey \u2013 was named as co-respondent in one of the first divorce cases to be heard under the Matrimonial Causes Act. Henry Robinson, a civil engineer, alleged that the married Lane had committed adultery with his wife, Isabella, while she was staying at Moor Park as both a friend of the family and a patient. The events may be familiar to some as they form the subject of Kate Summerscale\u2019s Mrs Robinson\u2019s Disgrace<\/em><\/a> (2012). Ultimately, the case rested on whether Isabella\u2019s diary \u2013 which detailed apparently erotic encounters between her and Lane \u2013 was admissible as evidence (as the prosecution claimed) or discredited as the product of a delusional mind (the argument put forward by her defence). When Lane was dismissed as a co-respondent and brought back as a witness, he denied that anything untoward had taken place.<\/p>\n Widely reported in the national press, the case also attracted the attention of medical journals. Their interest was not simply that the man implicated was one of their own; the trial tapped into broader anxieties about the difficulties faced by practitioners in the course of their work. As it unfolded, there emerged key questions about the male doctor\u2019s access to, and intimacy with, his female patients. The British Medical Journal <\/em>branded the case \u201can extraordinary example of the dangers to which medical men above all others are exposed\u201d. Deeming Lane \u201cperfectly innocent\u201d, it suggested the public would probably acquit him, but that the prospects of his establishment were likely to be harmed nonetheless.[1]\u00a0In this editorial, medical men are represented as vulnerable to suspicion and innuendo is seen as having a potentially detrimental effect on their practice.<\/p>\n Interactions between male doctors and their female patients were often represented as sources of anxiety in Victorian medical writing. Professional journals and advice literature advised male practitioners how to guard against difficulties that may arise from examining or treating women. In an 1885 article entitled \u201cThe Relation of Medical Men to their Patients\u201d, the Midland Medical Miscellany<\/em> recommends that \u201c[c]onfidential relations with ladies of a household\u201d are \u201cnot only to be avoided, but to be absolutely declined\u201d and that \u201cexaminations of female patients should always be made in the presence of a third person\u201d.[2]\u00a0Similar sentiments are espoused in Jukes de Styrap\u2019s The Young Practitioner <\/em>(1890), an advice manual for prospective medical men. It suggests readers should be \u201cextremely cautious [\u2026.] in having married women or young females to consult you secretly \u2013 especially, if it be for vaginal, or other private examination\u201d.[3]\u00a0In cases where one needed to anaesthetise a female patient, he recommends having another practitioner present. Then, if the woman experienced \u201challucinations in regard to improper language or action\u201d, the doctor could \u201cavoid scandal\u201d.[4]<\/p>\n There was anxiety that the practitioner might fall prey to local gossip or even accusations of impropriety from family members. In 1887, the Provincial Medical Journal <\/em>(the new incarnation of the Miscellany<\/em>) ran an article entitled \u201cDoctors and Lady Patients\u201d, which explicitly engages with the\u00a0problem of medical men being \u201cmade co-respondents in divorce cases\u201d. While acknowledging such instances are rare, the article suggests they bring not only the individual, but also the wider profession into disrepute: \u201c[s]uspicion is excited, and the confidential relations with our patients are disturbed\u201d. To protect themselves, practitioners are warned against being too \u201cattentive\u201d towards female patients, for \u201cmedical men are closely watched by their clients\u201d.\u00a0[5]<\/p>\n Popular fiction at this time explored the way in which the young practitioner (particularly in the countryside or provinces) may become implicated in local love affairs, real or imagined. In Elizabeth Gaskell\u2019s Mr Harrison\u2019s Confessions <\/em>(1851) the eponymous young doctor learns \u2013 much to his dismay \u2013 that his name has become attached to several women in Duncombe, earning him a reputation as a \u201cgay Lothario\u201d.[6]\u00a0A darker instance of the doctor\u2019s relations with women appears in Thomas Hardy\u2019s The Woodlanders <\/em>(1887). Dr Fitzpiers\u2019s profession is shown to afford him both opportunities for infidelity and a ready alibi. When his fianc\u00e9e spies his lover, Suke Damson, leaving his rooms early one morning, he convinces her she was simply an anonymous patient.[7]Intimacy between medical men and the young women of their acquaintance was not always problematised in fiction, however. The young country doctor repeatedly figures as the romantic hero, though he is rarely shown treating<\/em> the object of his affections during their courtship.<\/p>\n As well as being associated with flirtation or adultery, even more serious allegations of abuse and misconduct could emerge from male attendance on women. In 1887, the British Gynaecological Journal <\/em>featured a lengthy paper by C.H.F. Routh detailing cases of nymphomania in which women make \u201cfalse charges\u201d against their doctors. It presents the problem as systemic, noting \u201cwe are all prone, however innocent, to have such charges invented against us\u201d. It interrogates how practitioners must \u201ccomport themselves\u201d during encounters and, once again, discusses introducing a witness. The report\u2019s chief concern is how men of \u201cunimpeachable honour\u201d can have their reputations ruined \u2013 it does not consider the possibility that the women might be telling the truth.[8]\u00a0In articles such as this, it seems as though the medical press might have closed ranks to protect its own.<\/p>\n Where the evidence against them appeared irrefutable, however, the medical press did attack practitioners\u2019 conduct. In 1858, the Lancet <\/em>reported on \u201cA Painful Scandal\u201d concerning a Walthamstow-based surgeon called Richard Pilching. He had been found making written proposals of \u201cthe most filthy immorality\u201d to a 13-year-old girl. The journal sought to distance him from the profession, arguing he had \u201cmistaken his vocation\u201d, and calling for him to be expelled by the General Medical Council (GMC). It cast him as a depraved predator, suggesting \u201chis disgusting conduct\u201d was \u201ccharacteristic of the lowest and most vicious order of mind”.[9]\u00a0By portraying Pilching as an aberration, the Lancet<\/em> sought to uphold the image of the profession as one which was essentially honourable.[10]\u00a0In my research, the journals\u2019 engagement with improper or abusive conduct seems rare; instead interactions with female patients were more often conceived as potentially<\/em> awkward or problematic.<\/p>\n The notion that male doctors or female patients might be embarrassed by medical encounters was a powerful argument in the hands of the medical-woman movement, which emerged from about the 1860s onwards. Aspiring female doctors and their supporters suggested that female patients would prefer practitioners of their own sex, since their modesty and delicacy would cause them to shrink from male attendance. In her essay \u201cMedicine as a Profession for Women\u201d (1869), Sophia Jex-Blake argues that \u201cthe unwillingness of very many girls on the verge of womanhood, to consult a medical man\u201d causes \u201can enormous amount of preventable suffering\u201d, and suggests some \u201cladies have habitually gone through one confinement after another without proper attendance, because the idea of employing a man was so extremely repugnant to them\u201d.[11]\u00a0She implies that male attendance is objectionable both for young women and their worldlier counterparts.<\/p>\n In response, some among the established profession argued for the essential purity and propriety of the male doctor-female patient relationship. In a debate about the admission of women to the profession held at the GMC in 1875, Andrew Wood \u2013 an Edinburgh-based surgeon \u2013 denied that female patients would prefer female attendance. \u201cI have never found that women shrink from telling their ailments to me,\u201d he insisted. In contrast, other Council members acknowledged the desirability of female practitioners. Dr Allen Thomson (representing the Universities of Glasgow and St Andrews) conceded that it was \u201cincontrovertible that attendance on females by females is upon the whole more decent and appropriate\u201d.[12]<\/p>\n The medical-woman movement capitalised on anxieties about male attendance, though it was careful to avoid impugning medical men\u2019s conduct. Jex-Blake, for example, acknowledges \u201cthe honour and delicacy of feeling habitually shown by the gentlemen of the medical profession\u201d. She emphasises that difficulties which may be of \u201cno importance from [the practitioner\u2019s] scientific standpoint\u201d may be \u201cvery formidable indeed to the far more sensitive and delicately organized feelings of his patient\u201d.[13]\u00a0This demonstrates the way in which aspiring female practitioners deployed arguments around patient preference. However, as we have seen, even medical men adopting a \u201cscientific standpoint\u201d were often anxious about their attendance on women.<\/p>\n When discussing the role of embarrassment in the doctor-patient encounter, one usually thinks of patients demonstrating self-consciousness about their own bodies. While the female patient\u2019s possible discomfiture was often recognised, Victorian medical discourse repeatedly grappled with the idea that the male doctor\u2019s body might be a potential source of embarrassment or awkwardness as well. It was his contact with the woman \u2013 in private interviews or examinations \u2013 that needed to be negotiated. It was his physical presence which could be perceived as intruding upon the female patient\u2019s body, intimate secrets, and private space. In order to protect his reputation, it was his actions that needed to be regulated.<\/p>\n The medical man\u2019s presence was imagined as awkward but rarely as improper; while alert to the potential difficulties or dangers in treating women, medical commentators suggested that these could be contained or erased.<\/p>\n Such rhetoric was vital in order to sustain an image of the profession as honourable and gentlemanly. During this period, medicine (particularly the emerging field of general practice, which I have foregrounded here) was still divesting itself of its old associations with trade.[14]\u00a0Whether medical discourse suggested female patients should be treated by medical men or women, an\u00a0overriding concern was how practice could be rendered more respectable and genteel, more palatable to patients. Ultimately, attempts to navigate the embarrassment at the heart of the male doctor-female patient encounter reveal much about the professional anxieties of practitioners in this period.<\/p>\n <\/p>\n References<\/strong><\/p>\n [1] \u201cRobinson v. Robinson and Lane\u201d, British Medical Journal, <\/em>10 July 1858, pp. 561-2 (p. 561).<\/p>\n [2] \u201cThe Relation of Medical Men to their Patients\u201d, Midland Medical Miscellany,<\/em> 1 January 1885, p. 23.<\/p>\n [3] Jukes de Styrap, The Young Practitioner <\/em>(London: H.K. Lewis, 1890), p. 110.<\/p>\n [4] De Styrap, p. 127.<\/p>\n [5] \u201cAnnotations: Doctors and Lady Patients\u201d, The Provincial Medical Journal, <\/em>1 January 1887, p. 35.<\/p>\n [6] Elizabeth Gaskell, \u201cMr Harrison\u2019s Confessions\u201d, in The Cranford Chronicles <\/em>(London: Vintage, 2007), pp. 1-86 (p. 77).<\/p>\n [7] Thomas Hardy, The Woodlanders, <\/em>introduced by F.B. Pinion, with notes by David Lodge (London: Macmillan, 1993), p. 161.<\/p>\n [8] C.H.F Routh, \u201cOn the Etiology and Diagnosis, considered specially from a Medico-legal Point of View, of those Cases of Nymphomania which lead Women to make False Charges against their Medical Attendants\u201d, British Gynaecological Journal, <\/em>11 (February 1887), pp. 485-511 (p. 487; 498; 501).<\/p>\n [9] \u201cMedical Annotations: A Painful Scandal\u201d, Lancet, <\/em>5 March 1859, pp. 247-8.<\/p>\n [10] In a subsequent issue, however, the Lancet <\/em>published a letter from the surgeon\u2019s solicitors which asked them to withhold any further commentary on the matter while legal action was pending. \u201cCorrespondence: A Painful Scandal\u201d, Lancet, <\/em>12 March 1859, p. 278.<\/p>\n [11] Sophia Jex-Blake, \u201cMedicine as a Profession for Women\u201d, in Woman\u2019s Work and Woman\u2019s Culture: A Series of Essays, <\/em>ed. by Josephine Butler (London: Macmillan, 1869), pp. 78-120, (p. 106; 101).<\/p>\n [12] \u201cThe General Council of Medical Education and Registration: Session 1875\u201d, Lancet<\/em>, 10 July 1875, pp. 55-63 (p. 57; 61).<\/p>\n [13] Jex-Blake, p. 82.<\/p>\n [14] See, for example, Anne Digby, Making a Medical Living: Doctors and patients in the English market for medicine, 1720-1911 <\/em>(Cambridge: Cambridge University Press, 1994), p. 6.<\/p>\n <\/p>\n Alison Moulds\u00a0<\/strong>is a second-year DPhil English Literature student at St Anne\u2019s College, University of Oxford.\u00a0Working as part of the AHRC-funded project \u201cConstructing Scientific Communities\u201d, she is researching the\u00a0construction of the doctor-patient relationship and the formation of professional identity in nineteenth-century medical writing, including fiction by doctors. She previously undertook her MA Victorian Studies part-time at Birkbeck College, University of London while working full-time in health policy and public affairs. She is Peer Review Editor for the\u00a0Victorian Network\u00a0<\/em>journal.<\/p>\n <\/p>\n Related articles and posts<\/strong><\/p>\n HM Evans. Medicine, the<\/span> body<\/span> and an invitation to wonder.\u00a0Med Humanities<\/abbr> 2016;<\/span><\/span>42:<\/span><\/span>2 <\/span>97<\/span>–<\/span>102<\/span><\/span><\/em><\/span><\/p>\n Devan Stahl. Living into the<\/span> imagined body: how the<\/span> diagnostic image confronts the<\/span> lived body.\u00a0<\/span>Med Humanities<\/abbr> <\/cite>2013;<\/span><\/span>39:<\/span><\/span>1 <\/span>53<\/span>–<\/span>58<\/span> <\/span><\/cite><\/p>\n Alan Radley. Book Review: The Cambridge Companion to the Body in Literature.\u00a0https:\/\/blogs.bmj.com\/medical-humanities\/2015\/07\/15\/the-reading-room-a-review-of-the-cambridge-companion-to-the-body-in-literature\/<\/a><\/p>\n <\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" From awkwardness to impropriety: conceptualising the male doctor\u2019s embarrassing body in Victorian medical literature By Alison Moulds (University of Oxford) This post is based on a paper given at the \u201cEmbarrassing Bodies\u201d conference, organised by Birkbeck, University of London In 1858, Dr Edward Lane \u2013 owner of the Moor Park hydropathic establishment in Surrey […]<\/p>\n