Scientific methods: American fiction and the professionalization of medicine, 1880--1940.

摘要

During the second half of the nineteenth century, the medical profession in America began to transform itself from a motley group of practitioners---registering remarkably disparate levels of education, expertise, and credibility---into a cohesive and exclusive body, enjoying ever-increasing status and income and solidifying what social historians have termed their "professional sovereignty" within the larger culture. The concomitant appearance of numerous novels and stories preoccupied with the figure and the business of the doctor suggests that these texts from the late nineteenth and early twentieth centuries not only documented but also intervened in the professionalization of medicine. Scientific Methods juxtaposes literary texts with non-literary documents and with material culture in order to determine the nature and the extent of these interventions and to delineate competing narratives within the history of medicine.;By interrogating a range of professional performances represented in American fiction between 1880 and 1940, Scientific Methods establishes a complementary narrative to accounts of medical professionalization constructed by social historians. Although social historians have managed to destabilize the master narratives of scientific progress elaborated by the physician-historians of the nineteenth and twentieth centuries, their investigations into the history of professionalization still center on physicians in conflict with each other and in thrall to science and technology, neglecting public perceptions of the professionalization process. Literary representations of this process, on the other hand, chart the ways in which popular understandings of the figure and the business of the physician arose and circulated, elucidating points of accord and disparity between professional ideologies and lived experience and exposing the dynamics of power between doctors and patients. These fictions of medical professionalization both reflected and produced beliefs; thus they stand as essential tools for understanding the consolidation of authority around doctors. In addition, I utilize a diverse range of archival materials---from hospital records to WPA posters---to complicate my readings of these fictional engagements with the professionalization process and to illuminate the relationship of literature to other cultural domains.;I argue that this textual sequence recasts the pursuit of professionalism and the gradual consolidation of cultural authority around doctors as a constant tension between the discipline of self---as the popularity of nineteenth-century "conduct books" for physicians demonstrates---and the discipline of Others. Lacking pervasive cultural authority at the end of the nineteenth century, doctors concentrated upon cultivating professional identity through professional "pantomimes" that simultaneously demonstrated their mastery of specialized knowledge and of middle-class social norms. Eventually, these professional "pantomimes" migrated from the stage of community practice to the arena of eminently consumable, ubiquitous popular entertainments such as radio programs and public art. This movement coordinates with an increasing amount of cultural authority and a decreasing need for individual self-discipline within the profession, and with doctors---a group overwhelmingly white, middle-class, and male---feeling freer than ever to visit spectacular and invasive violence upon the raced, class, and gendered bodies of Others. These disciplinary measures include the exclusion or removal of nonwhite male and white female practitioners from the medical profession, elaborated in Frank Norris's McTeague; human experimentation by the single-minded "microbe hunters" on southern populations during the interwar period, romanticized in Sinclair Lewis's Arrowsmith ; and eugenic pressure exerted on poor women by the Depression-era discourses of public health, critiqued by Tillie Olsen's Yonnondio and Meridel LeSueur's The Girl. Yet far from reflecting an idealized vision of the medical professional, replete with cultural authority, these narrations of disciplinary events reveal doctors threatened by incursions by nonwhite and female practitioners, defeated by their own experimental protocols, and agitated by the unlimited reproduction of the working class.