Copyright © 2004 Mark Twain Forum
This review may not be published or redistributed in any medium without permission.
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