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Reviewed by
Kevin Mac Donnell
Anyone glancing over the shelves of Mark Twain studies published in the last
one hundred years can't help but notice that scholars have approached Twain
by repeatedly pairing him with nearly every subject, theme, region, and personality
that can be imagined: Twain and government, Twain and court trials, Twain and
race, Twain and women, and religion, and power, and time, and tall tales, and
travel, and Cervantes, and Thackeray, and the Bible, and England, and Germany,
and Nevada, and Australasia, and Nook Farm, and Vienna, and the South, and the
West, and con artists, and Teddy Roosevelt, and George W. Cable, and Bret Harte,
and W. D. Howells, and General Grant, and even Twain and Samuel L. Clemens.
A library of Twain studies looks a lot like a library of Shakespeare or Dickens
studies, and it boggles the mind to conceive of any pairing that has not been
published before. At this late date, when the list seems endless, what new pairing
could possibly yield anything worthwhile?
The answer is Dr. Patrick Ober's Mark Twain and Medicine. Given the central
role that the practice of medicine played throughout Twain's personal life and
because so much of that experience is reflected in both his major and minor
writings, it seems remarkable that a comprehensive study of Twain and medicine
has not appeared sooner. Of course, the subject has not been completely ignored.
Among the earliest studies were George Wharton James' article on Twain and fasting
(1919), and Louis J. Bragman's 1925 article on Twain's "medical wisdom."
Dixon Wecter (1952) certainly blazed a trail when his research identified the
specific brand of painkiller Tom Sawyer administered to the family cat. But
despite these and a few other studies, the medical aspects of Twain's biography
and their implications for his writings have always remained in the background,
rarely given consideration as a major portal into Twain's mind, or as a means
to interpret Twain's approach to his life and art. Ober's work will certainly
change this situation, and provoke new insights into some previously accepted
diagnoses.
Throughout his life Twain was fascinated by new technologies, new money-making
schemes, and new social movements, and like some serial trend-spotter he repeatedly
embraced and discarded new inventions or investments or social causes, one after
another. His typical pattern was to embrace his latest infatuation with boundless
enthusiasm, discover its fatal flaws over time, and ultimately reject it in
a spasm of outrage and guilt. Twain's approach to medicine followed this pattern
as well. Ober, in the best bedside manner, takes us through the series of medical
experiences that laid the foundation of Twain's basic views, beginning in his
childhood when he was the unwilling victim of his mother's enthusiasms for folk
cures and patent medicines, and onward through his encounter with his future
wife's wealthy and well-educated family, the Langdons, who placed their faith
in a quack doctor and faith-healing, and finally to the water cures and rest
cures that failed to save his wife and two of his daughters. In twenty chapters,
Ober examines nearly twenty medical therapies embraced at one time or another
by Twain, provides their medical and cultural contexts, explains Twain's experience
with them, and explores how they function as themes in his writings.
Critical to understanding Twain's view of medicine is an understanding of the
difference between disease and illness, and Ober explains that difference in
both the context of Twain's day and our own. Diseases arise in the physical
body, and have biological origins; illnesses arise in the soul, are less often
biological in origin, and are shaped by the patient's own attitudes, beliefs,
and expectations, as well as those of society. Of course, a patient can have
both a disease and an illness at the same time, and some illnesses can be described
as the way a patient experiences a disease. But the treatments for diseases
and illnesses differ. Ober places each specific disease and illness in both
the medical and social context of the times, and demonstrates how Twain keenly
understood the differences between them. Illnesses were more common than disease,
and tended to respond better to the therapies of Twain's day. Unfortunately,
the medical practitioners of Twain's day were seldom prepared to provide a cure
for either.
Yet the shortcomings of the practice of medicine in Twain's day did not prevent
him from constantly seeking relief for his own and his family's afflictions,
but quite the contrary. But assessing the efficacy of various treatments was
no simple matter. The fact that most diseases resolve themselves eventually
without any treatment at all often created the impression, at least temporarily,
that whatever medicine or therapy was being employed was actually working. Likewise,
both diseases and illnesses often respond to placebos, and Ober explores the
powerful role of the placebo affect. Also, it was a common belief in medical
circles that to do nothing in the face of disease was worse than doing something,
but the results of "doing something" were often tragic, especially
when "doing nothing" might have allowed a disease to resolve by itself.
For these reasons it was sometimes difficult for Twain or even doctors to know
whether a particular therapy was really working, as obvious as it might seem
to us now. Medical science and practices were constantly evolving during Twain's
lifetime, and the repeated failures of each new therapy in curing diseases (most
diseases were untreatable in Twain's day) caused him to keep an open mind toward
any new therapy that appeared, not unlike other Americans of his day, and not
unlike people today whose diseases have not responded to modern treatments.
Because illnesses were more common than diseases, and did tend to respond better
to available treatments, Twain was quite tolerant of alternative practitioners.
Again, Twain's readiness to explore alternative medicines was not atypical of
his time, but Twain's wise understanding of the relationship between disease
and illness was more sophisticated than most Americans of his day. Ober calls
Twain a "medical eclectic who was usually willing to try any method that
seemed to offer hope, even if it could not offer cure." (p. 18). Twain
believed that hope was the most valuable thing a doctor could offer a patient,
and that healing the spirit was a greater benefaction than healing the body.
Such healing (of illness) took place more often than curing (of disease).
Readers would do well to keep in mind that Twain's attitudes toward medicine
shaped many of his behaviors as well as his writings, and that Twain's beliefs
about medicine were not unlike those of most doctors and patients of his time.
Nineteenth century medical practices can often explain events and behaviors
that have otherwise baffled modern scholars. Ober explores several incidents
in Twain's life that have attracted much scholarly comment over the years: the
autopsy of his father that he witnessed as a boy, Livy's recovery from "neurasthenia"
after a brief visit from a quack doctor, and Twain's exclusion from Livy's sick-room
at the end of her life. Ober puts each of these in the context of the medical
practices of the day, which casts each of those incidents in a new light, and
scholars and readers who have accepted previous scholarly verdicts about these
events would do well to reconsider. For example, Ober explains how the autopsy
of Twain's father was performed for reasons consistent with contemporary medical
practice, and how it was just one incident among many that shaped Twain's attitude
toward death. Livy's early illness was a common malady, and its cause and cure
cannot be fully understood today without understanding the social context of
"neurasthenia" in the late nineteenth century (and how it later seemingly
disappeared from the scene). Finally, Twain was excluded from Livy's sick-room
during most of her last illness simply because that was a standard protocol
in the rest-cure treatment.
Likewise, the previous interpretations of Twain's writings that involve medical
themes may also need revision. Ober does not call for a fresh look at the oft-debated
ending of Adventures of Huckleberry Finn, but he does examine in detail
the three methods of wart-cure mentioned in The Adventures of Tom Sawyer
(incantations and dead cats, split beans and blood, and spunk-water) and after
reading the elaborate rituals that are critical to the success of these placebos,
Tom Sawyer's ritualistic antics at the end of Adventures of Huckleberry Finn
look a lot less romantic (or absurd, or a satire of Reconstruction efforts)
when the cultural context of his wart-cures is understood. Unlike modern readers
and scholars, contemporary readers of Twain's masterpiece were probably not
a bit puzzled by Tom Sawyer's faith in rituals, nor would they question why
such rituals were required to achieve a proper thematic healing (if not an actual
cure) at the end of the novel. Similarly, the medical meaning of the caption
under an illustration in chapter 18 of Tom Sawyer ("counter-irritation")
would have made perfect sense to a contemporary reader, but will mystify later
readers (cf. Ober, p. 52, if you are among the mystified).
By the end of this book, Ober has provided excellent histories of the major
medical therapies that arose, competed, and eventually vanished or evolved during
Twain's lifetime: allopathic medicine, patent medicines, hydropathy, electrotherapy,
osteopathy, and homeopathy. His histories of these schools of medicine will
provide a solid common reference point for Twain scholars for years to come.
Added treats are Ober's accounts of Hannibal's infamous Dr. McDowell who preserved
his daughter's corpse in a local cave, Dr. Newton the quack who nevertheless
imbued a teenage Livy with the necessary faith to recover from her paralysis,
Twain's entanglement with Plasmon, and Twain's rejection of Christian Science.
All of these have been written about before, but rarely in the words of a medical
doctor. Finally, Ober concludes his book with three useful appendices, an expansive
bibliography, and a reliable index. In the bibliography Ober cites the first
editions of Twain's works; citing the MLA text of the Berkeley editions would
have been more convenient and useful. But the bibliography also invites further
reading on the subject by citing many medical sources previously unfamiliar
to most readers of Twain.
After finishing this book, the reader only wishes there had been even more!
For example, Jean Clemens' epilepsy is discussed briefly, but not fully explored,
and because the contemporary misunderstanding of her condition led in large
part to her tragic separation from her father in his last years, a full discussion
would have been welcome. Ober does mention Jean's attempt to kill Kate Leary,
but does so without questioning such a dubious allegation about somebody subject
to grand mal seizures at a time when epileptics were erroneously viewed as violent
and imbalanced individuals. Karen Lystra provides such a discussion in Dangerous
Intimacy, but a review of Jean's experiences by a medical authority, delineating
both her disease and her illness, would be a welcome addition to Twain scholarship.
However, this is less a criticism than it is a wish for more insights from Dr.
Ober. If the good doctor is contemplating a second book, this reviewer might
be so bold to suggest a broader study of the medical experiences and writings
of Twain's contemporaries. Besides his fellow authors, Twain maintained friendships
with many prominent people, including several physicians, and because many of
them (and their immediate families) experienced medical problems that paralleled
Twain's--and of which Twain was often aware--it would expand the horizons of
Twain scholarship to compare Twain's experiences with those of his circle, and
trace how those experiences influenced their writings.
But such wishful thinking is beyond the scope of this review. This reviewer
is only licensed to practice in this Forum, and so must render his diagnosis:
Mark Twain and Medicine is a must read.
Rx: Read it.
Kevin Mac Donnell