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Persuasions #15, 1993 Pages 170-177
Professional Persuasion: Dr. Anne Elliot BARBARA McLEAN Department of English, McMaster University In their article, “Medicine and Disease in Jane Austen’s England,”
Laurie and Richard Kaplan claim, quite rightly, I think, that Jane Austen, with
her obvious knowledge of illnesses and remedies, “would have been a terrific
physician” (177). Toby Olshin also
writes about Austen’s medical proficiency, and points out “the accuracy of
[her] portrayal of medicine” (314).
Each of Austen’s novels reflects an interest in the healing arts, but in
this paper, I want to look specifically at Austen’s presentation of Anne Elliot
as a potential physician, and thus my title: Professional Persuasion: Dr. Anne
Elliot. Of course my title is facetious; in Austen’s
day there were no female physicians.
Medicine was only beginning to form itself into a profession, and gender
restrictions to any form of recognized medical training, whether at the
universities, the School of Apothecaries, or surgical apprenticeship,
effectively denied access to women. As
Anne Elliot reminds us, women in the early nineteenth century “live at home”
while men of her class “have always a profession” (Austen, 232). But Austen hints that women’s role in
society may be about to change. In Persuasion, Anne rightly points out
that men “have had every advantage of us in telling their own story. Education has been theirs in so much higher
a degree; the pen has been in their hands” (234). Although she clearly presents the subordinate position of women
in a patriarchal culture, there is a twofold irony in Anne’s statements. Internally, within the novel, Frederick
Wentworth has just dropped his pen in the narrative when Anne makes this
observation; it is, significantly, no longer in his hand – and externally, it
is Jane Austen, a woman writer, who has written the novel. The pen is very much in her hand. If the vocation of novelist is extending to
women, why not other professions? Why
not medicine? Just as Austen’s skill with the pen is
paramount, it is my contention that Anne’s skill at medicine is potentially
just as powerful. For Anne’s character
combines a practical pragmatism with a sympathetic solicitude. If we examine what we want to find in a
physician today (and I realize I must fall into generalizations, for as
individuals we will all vary in our determinants), I believe most of us look
for a doctor who combines skill, technical ability and knowledge, with warmth,
compassion and respect. We do not want
to subject ourselves to a surgeon who is not slick with the scalpel, but I
believe most of us also no longer want the physician who graduated top of the
class but cannot talk comfortably with us as patients, or who is too caught up
in her or his authority either to consider our intelligence or to detect and
respond to our emotional needs. As patients, many of us are interested in
sharing power and control with our physicians.
We want excellence in our care, but we do not want to be patronized; we
want to know what is going on. We want
to be consumers of health care, not reified individuals who have health care
bestowed upon us. We want to take
responsibility, but when we must give our trust, we want to be treated kindly
and with regard. Within such parameters, Anne Elliot would make
an excellent physician. She is
competent, conscientious, careful and caring.
As indicated in her triage skill on the Cobb, her psychiatric
proficiency with her hypochondriac sister Mary, and her sympathetic manner with
her rheumatic friend, Mrs. Smith, Anne has the ability to function under
pressure, to reassure and provide hope, and to sympathize with, and soothe the
afflicted. Most importantly, she is
able to do this without brandishing undue authority, or patronizing her patients. The most obvious demonstration of both Anne’s
cool-headed composure and her excellent medical skill is in the scene on the
Cobb, when Louisa falls and sustains a head injury. The picture has changed from silliness and laughter to sudden and
utter tragedy, and if you will remember back to your first reading of Persuasion
I am sure you will recall your gasp at that momentous sentence of Austen’s
which moves from Louisa’s smile and flirtatious determination to jump once
again into Captain Wentworth’s arms, to the completely unexpected mismanaged
“half a second [in which] she fell on the pavement on the Lower Cobb, and was
taken up lifeless!” There lies Louisa,
and her stillness is reflected and magnified by the suspended animation of
those around her: “There was no wound, no blood, no visible bruise; but her
eyes were closed, she breathed not, her face was like death. – The horror of
that moment to all who stood around!” (109).
Mr.
Curtis, Apothecary at Alton I want to examine closely just who does what
next. First of all, the silence is
broken by the hysterical cries of Anne’s sister Mary, who screams “She is dead!
she is dead.” Wentworth, Anne’s hero,
is completely paralysed. He can do
nothing but hold Louisa and look “on her with a face as pallid as her own, in
an agony of silence” (109). When
finally he does manage to speak, it is not to take control, but to call meekly
and desperately for assistance: “Is there no one to help me?” he entreats “in a
tone of despair, and as if all his own strength were gone” (110). He is almost as limp as Louisa; he is
completely impotent and has no idea what to do. Charles, also, is numbed by the
experience. He is held back when Mary
catches hold of him in her panic, but Austen tells us Mary’s grasp is only
“contributing with his own horror to make him immoveable” (109). He cannot act. Henrietta, responding to Mary’s conjecture that Louisa is dead,
faints away and adds to the array of victims when she nearly breaks her own
head but for the quick action of Captain Benwick and Anne, “who caught and
supported her between them” (110). At this point, it might seem plausible that
Captain Benwick would take over. This
is his home territory, he is a naval officer, and we are used to seeing men in
control. But no! It is Anne who takes charge. She begins in the manner of what we now call
triage, which is defined in Dorland’s medical dictionary as “The sorting out of
casualties of … disaster, to determine priority of need and proper place of
treatment” (1610). Anne takes the active
role of triage officer, crying out to Captain Benwick to assist Captain
Wentworth: “Go to him, go to him … for heaven’s sake go to him … Leave me, and go to him.” Anne clearly recognizes that it is Louisa
who needs attention before the hysterical Mary, or the fainted Henrietta, and
she gives clear instructions of what must be done: “Rub her hands, rub her
temples,” and summons the wherewithal to provide the only drug on hand: “here
are the salts,” she says, and then positively commands Benwick to “ – take
them, take them” (Austen, 110). Captain
Benwick, rather than taking control of the disaster himself, obeys Anne’s
orders and responds. Charles, too, follows Anne’s command and helps
Benwick to do “every thing … that Anne had prompted.” Meanwhile, Captain Wentworth, the brave naval officer, can only
stagger “against the wall for his support” and exclaim “in the bitterest
agony. Oh God! her father and mother!” The smelling salts have not worked and he
instantly admits defeat and loses all his sense of logic. While he falls into this emotional stupor,
Anne again takes charge: “A surgeon!” (110) she cries out. Until this point, Anne has used the imperative
in her commands. Her orders are
followed in the text by exclamation marks.
She shows the clear-headed skill, control, ability and knowledge we
expect from a doctor. She is firm but
calm under extreme pressure while all those around her, even seasoned naval
officers, fall apart. It is fascinating
to note, however, that as the men come to their senses, Anne moves away from
the authoritarian role of commander, and completely changes her mode of
speaking. Medical discourse is one of
power and control, but Anne, while still manoeuvring the situation, moves from
forceful commands to calm suggestions.
Once her authority is established, she no longer needs to be
demonstrative, and she pulls back. Captain Wentworth responds to Anne’s call for a
surgeon: “the word … seemed to rouse him at once” and he begins to run when
Anne, with a decided change in tone (moving from the imperative all the way to
the interrogative) suggests: “Captain Benwick, would not it be better for
Captain Benwick? He knows where a
surgeon is to be found.” This is a
perfect example of professional persuasion.
Anne does not need to shout out orders.
Her composure has gained her the respect she needs to organize the
medical situation by gentle persuasion.
In an instant, “[e]very one capable of thinking felt the advantage of
the idea” and Captain Benwick “was off for town with the utmost rapidity”
(110). Anne is now in complete control of the
situation. Although the narrator
suggests that Wentworth, Charles and Anne are all “completely rational,” only
Anne has maintained such a condition throughout. Indeed, Charles is convulsed in “sobs of grief” (110), and
implores “Anne, Anne … what is to be done next? What, in heaven’s name, is to be done next?”, and “Captain
Wentworth’s eyes were also turned towards her.” They defer to her judgement and instantly agree when she suggests
they carry Louisa “gently to the inn.”
Although Captain Wentworth begs Charles to “take care of the others,”
and he, now “comparatively collected” (110), manages to gather up Louisa, it is
clearly Anne who has already assumed the role of taking care: “Anne, attending
with all the strength and zeal, and thought, which instinct supplied, to
Henrietta, still tried, at intervals, to suggest comfort to the others, tried
to quiet Mary, to animate Charles, to assuage the feelings of Captain
Wentworth” (111). It is not surprising
that “[b]oth seemed to look to her for directions” (111). Anne acts the perfect doctor in this
situation. She instantly assesses the
damage, offers useful advice, proffers a remedy, rationally sends for
appropriate help for the central victim, determines the place of treatment, and
calms and soothes those less afflicted.
She does all this with the exact amount of authority needed, and is
happy to move from overt power to mild persuasion when the others eventually
regain their composure. Anne is the
kind of medic I would like to come across in an emergency. Anne’s medical abilities are not always
portrayed with such high drama. Dealing
with her hypochondriac sister Mary on a day by day basis is much less
spectacular, but perhaps if doctors had practised medicine with Anne’s methods,
much of the hysteria which prevailed in women in the nineteenth century might
have been prevented. On the surface, Mary seems to be one of
Austen’s satiric figures. She is “often
a little unwell, and always thinking a great deal of her own complaints”
(33). She is manipulative and annoying,
and frequently implores Anne to come to look after her. We are never shown any real signs of illness,
and Mary’s symptoms tend to disappear with Anne’s presence. The subtext for Mary’s complaints, however,
is suggested by Anne’s own dissatisfaction with the limited roles allowed to
women in society, and Anne is prepared to humour Mary into wellness rather than
treat her with contempt. In this regard, Anne diverges from standard medical
treatment. Nineteenth-century medicine
tended to disregard the cultural significance of hypochrondria and hysteria in
women, and rarely looked for the cause of their complaints. In his medical text, On the Pathology and
Treatment of Hysteria, Dr. Robert Brudenell Carter gives a typical
nineteenth-century medical response to what Elaine Showalter calls “The female
malady” (3). Carter assumes that women
are malicious and conniving in their presentation of hysterical pathology. He instructs physicians and medical students
that such women are “gladly availing themselves of [their maladies] for the
gratification of the morbid craving after sympathy” (76), and accordingly he
recommends treatment which can be interpreted as a sort of punishment for their
conditions. His opinion, typical of
medical men at the time, was that practically the entire female sex was at risk
of hysterical breakdown. He claims: “a
certain amount of emotion will produce an attack in almost any woman, however
healthy …” (92). Rather than responding with sympathy and
understanding to his patients, as Anne does with Mary, Dr. Carter preferred to
assert absolute authority throughout the time of treatment. His cure involved moving women away from
their homes, incarcerating them in the doctor’s own nursing establishment, and
“wearing out the moral endurance of the patient … remove her and leave her
alone, do not … give utterance to a single expression, either of sympathy or
alarm … no inquiries being made about her health” (108). Carter insists the doctor must “commence by
a positive assertion that she has nothing at all the matter with her, and is,
in reality, in perfectly good health; her ailments being, one and all,
fraudulent imitations of real disease” (111). All hysterical women, according to Carter, “are
wayward, irritable, capricious” (138), and must be treated accordingly: “She
must be told to keep silence and to listen … in such a manner as to convey the
speaker’s full conviction, that the command will be immediately obeyed” (119). Carter advises that “any or every part of
her past conduct, which can conduce to her humiliation and shame, must be
brought fully before her … until … the patient exhibits signs of contrition and
regret” (112). Carter never relents on
the authority and power of medical discourse.
He bullies his patients into compliance. Anne Elliot, however, treats Mary with
compassion, if sometimes an exasperated compassion, and solicitude. Anne is aware that Mary’s problem stems from
the inability of all women of her time to participate in stimulating
activities. Women, says Anne, are
compelled to be “quiet, confined, and our feelings prey upon us” (232). Mary is less capable than some women of
coping with this confinement: being alone, her being unwell and out of spirits was almost a matter of course … While well, and happy, and properly attended to, she had great humour and excellent spirits; but any indisposition sunk her completely; she had no resources for solitude … and was very prone to add to every other distress that of fancying herself neglected and ill-used. (37) Certainly Austen is satirizing Mary’s sense of
self-importance, but she also gives a convincing account of the very real
restrictions on women’s lives which often led to depression and illness. Anne patiently listens to Mary’s complaints,
and encourages her to be well. Arriving
to find Mary claiming to be “so ill I can hardly speak … I do not think I ever was so ill in my life
as I have been all this morning – very unfit to be left alone, I am sure” (37),
Anne humours Mary, and cheers her up with the promise: “you will soon be better
now … You know I always cure you when I
come” (38). Indeed, [a] little farther perseverance in patience, and forced cheerfulness on Anne’s side, produced nearly a cure on Mary’s. She could soon sit upright on the sofa, and began to hope she might be able to leave it by dinner-time. Then, forgetting to think of it, she was at the other end of the room, beautifying a nosegay; then she ate her cold meat; and then she was well enough to propose a little walk. (39) One can read this as evidence of Mary’s silliness certainly, but also as an indication of Anne’s healing power of persuasion over her patient. Mary will always be a problem; she is compelled by her culture to an inactive subordinate position in a patriarchal society, and her restless temperament restricts her options for happiness and fulfilment. Out of frustration, she resorts to the role of invalid and demands sympathy, but Anne’s presence and kind treatment make her well. Anne does not adopt an authoritative attitude with Mary which would have been typical of contemporary medicine; on the contrary, she plays a compassionate psychiatrist. In her dealings with the crippled Mrs. Smith, a
former school friend, Anne shows a sympathetic manner which overrides the
pressures of class distinction so important to the rest of her family. In spite of the fact that Mrs. Smith is poor
and “almost excluded from society” (153), Anne, of course, has no reservations
about visiting her. In fact, when she
first heard of Mrs. Smith’s misfortune, Anne “lost no time in going” (153) to
help her. Anne is more than willing to
offer sympathy and comfort to a sick and needy friend in a situation her father
describes as representing “[e]very thing that revolts other people, low
company, paltry rooms, [and] foul air” (157).
Like the best of doctors, her compassion has no class boundaries. hh At the time Persuasion was written, medicine in Britain was
divided by class distinctions of its own.
Physicians came from the upper classes.
They were university trained gentlemen, versed more in the classics than
in medical technique, and found their patients among the privileged and the
rich. According to one medical
historian, “the lordly physician could, and often did, receive his degree
without [ever even] examining a patient” (Cartwright, 47). The emphasis in their education “combined an
almost medieval respect for tradition with an excessive admiration for the
manners and attainments of an eighteenth-century gentleman” (Youngson,
15). Jane Austen does not give us a
physician-character in Persuasion, but we can imagine there are plenty
of them about, particularly in Bath, treating the worried wealthy clientele. Surgeons and apothecaries, traditionally, were
of a lower class than physicians. Until
1745, surgeons were in the same guild with barbers, and both groups trained,
not at the university, but by apprenticeship alone. Although apothecaries were originally taught only to prepare and
dispense drugs, by the early nineteenth century they were also treating
patients. In order to make a living in
small communities, apothecaries began to use surgical techniques, and surgeons
began to deal in pharmaceuticals; with their broadening capabilities they were
the precursors to general practitioners. In Persuasion, Austen indicates that the
specific skills of the surgeon and the apothecary were practically
interchangeable. At Lyme a surgeon is
summoned for Louisa, but when Anne’s nephew dislocates his collar-bone in a
fall, and injures his back, the apothecary is sent for. Both victims have had falls, both have
sustained injuries, both are diagnosed and treated appropriately by the
attending medic. Austen, particularly
by having an apothecary, rather than a surgeon, reduce the dislocation,
suggests that medicine is opening up, and that general practice is on the rise. The move towards an official blending of
medical skills, however, was not smooth.
Each group resented the encroachment of the other on its territory, and
fought for precedence in a medical hierarchy.
In a bid to professionalize itself, medicine moved towards creating a
single licensing authority which would compile a register of qualified
practitioners (Cartwright, 56). All
branches of medicine were required to raise their educational standards, which
was beneficial for patients, but along with standardization came increased
power and authority as these men formed a profession. With the gain in power and status, there was an almost inevitable
loss in importance of sympathy and compassion.
Doctors acquired prestige when they chartered their profession, but they
may have lost some of the emphasis on the skills of sympathy and kindness we
see so clearly in Anne Elliot. The power medicine gained with
professionalization allowed practitioners such as Robert Brudenell Carter to
advocate unbending authority over patients.
Anne Elliot’s technique, that of gentle medical persuasion, was jeopardized
when medicine rose to a controlling state.
The healing qualities Anne Elliot displays work wonders with her
patients, but they take time and they elicit little overt recognition. Her talent also makes her vulnerable to
those who would take advantage of her good nature: Charles “wishes [she] could
persuade Mary not to be always fancying herself ill” and Mary entreats Anne to
“persuade him that I really am very ill – a great deal worse than I ever own”
(Austen, 44). Nonetheless, Anne’s skill
saves the day on the Cobb, and her ability to move quickly from forceful
command to gentle persuasion indicates that she has a positive vocation for
medicine which seems to be lacking in the official discourse of the profession
throughout the nineteenth century. Cultural proscriptions kept women like Anne
Elliot from practising medicine professionally until the latter half of the
nineteenth century. By then, with
significant scientific advances in treatment and training, some doctors assumed
an elevated position in society which unfortunately enabled them to disregard
the traits Anne displays so well.
Authority in medicine officially took the place of respect and
sympathetic understanding. In her
depiction of Anne Elliot, I cannot help but wonder if Jane Austen is suggesting
that gentle persuasion is an admirable qualtiy for medicine, and is predicting
a future for women like Anne in the profession. Until recently, medicine has not been accountable for its
manipulation of power and authority, and women like Anne have been discouraged
in their efforts to disarm medical discourse.
Although there are many doctors who now question their desire or need
for authority, I checked the Canadian Medical Directory, and so far, there is
still no Dr. Anne Elliot listed.
However, by the year 2000, it is predicted that up to 50% of practising
physicians in this country will be women (Smedstad, 171). Certainly, as I believe Austen predicts, Dr.
Anne Elliot will surface. I hope she
lives up to Austen’s description. WORKS CITED Austen, Jane.
Persuasion. 1818. Ed.
R.W. Chapman. Third Edition. London,
Oxford UP, 1933. Carter, Robert Brudenell. On the Pathology and Treatment of Hysteria.
London: 1853. Cartwright, Frederick F. A Social History of Medicine. London: Longman, 1977. Dorland’s Illustrated Medical Dictionary. 24th
edition. Gilbert, Sandra M. and Susan Gubar. The Madwoman in the Attic: The Woman
Writer and the Nineteenth Century Literary Imagination. New Haven: Yale UP, 1979. Kaplan, Laurie and Richard. “Medicine and Disease in Jane Austen’s England.”
Persuasions, 12 (1990): 117-30. Olshin, Toby A. “Jane Austen: a Romantic, Systematic, or Realistic Approach to Medicine?” Studies in Eighteenth-Century Culture, 10 (1981): 313-26. Poovey, Mary.
The Proper Lady and the Woman Writer: Ideology as Style in the Works
of Mary Wollstonecraft, Mary Shelley, and Jane Austen. Chicago: U of Chicago P, 1984. Showalter, Elaine. The Female Malady: Women, Madness and English Culture,
1830-1980. 1985. New York: Viking Penguin, 1987. Smedstad, Kari, MB, ChB, FRCPC, and May Cohen, MD, CCFP, FCFP. “Women in medicine: an overview of practice.” The Canadian Journal of Ob/Gyn & Women’s Health Care. June (1991): 171-72. Youngson, A. J. The Scientific Revolution in Victorian Medicine. London: Croom Helm, 1979. |
