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Authors: Laurence Lerner

Tags: #History, #Modern, #19th Century, #Social Science, #Death & Dying, #test

Angels and Absences: Child Deaths in the Nineteenth Century (15 page)

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Page 37
great historical significance: more interesting is to observe how far medical science itself was or was not able to diagnose.
The second reason for vague and general description could be, simply, the Victorian belief that diagnosis is not important. If death is the release of the soul from the body, if it is to be welcomed as being received into the presence of God, then the body has ceased to matter, and one need waste no attention on what caused it to cease functioning. Here for instance is Mrs. Tait's description of the dead Chatty:
There she lay in the room in which I had given her birth; but that day I felt indeed the spirit was gone, and the little form before us looked so different now the bright spirit which had breathed through it, and given it such exceeding beauty, had flown to a region far more suited for it than this world of sin and sorrow.
Almost every detail tells us that the body, having released Chatty's spirit, no longer matters. Whatever she had died of, the description would have been much the same: all that needs to be said about the empty shell is that it has lost the bright spirit which breathed through it.
To say that something does not matter can, of course, be a defense mechanism: it might matter very much, and hence be a topic we would rather avoid. The great avoidance in nineteenth century linguistic practice, as everyone knows, was sex. Dismissing sex as a mere animal impulse, not worthy of serious attention and shameful to talk about, must have served several purposes: for instance, allowing men to indulge in it without too much fuss being made, allowing women not to talk about it and so, it is presumably hoped, not to have the discomfort of thinking about it. I do not find it easy to decide whether something similar is true of illnesswhether the malfunctioning of the body was regarded as an indelicate topic, and so repressed, enabling us to think of the human being as essentially spiritual.
And then there is a final possibility, the most interesting of all, though the hardest to pin down: a skepticism about diagnosis springing from skepticism about the classification of disease. To explain this, I turn to Florence Nightingale's
Notes on Nursing,
published in 1860.
This admirable book is packed with keen observation and sensible advice, revealing how carefully and sensitively Nightingale had thought about every detail in the sick room. It treats the patient as a frail but responsible person, suggesting, for instance, that his stomach, even if
 
Page 38
expressed as whims and fancies, may be a more reliable guide to diet than chemistry; and it explores what every aspect of nursing practice must look like to the person forand towhom it is done. Most striking, for our purpose, is the emphasis placed on hygiene. The health of a house depends on five essential points: pure air, pure water, effective drainage, cleanliness, and light. This, Nightingale claims, is what every schoolgirl should be taught (rather than "the coxcombries of education" such as the elements of astronomy) and what every nurse should concern herself with. The first rule of nursing is to "keep the air [the patient] breathes as pure as the external air, without chilling him," because foul air is the cause of disease not contagion but foul air:
Is it not a fact, that when scarlet fever, measles or smallpox appear among the children, the very first thought is "where" the child can have "caught" the disease. They never think of looking at home for the source of the mischief. If a neighbour's child is seized with smallpox, the first question which occurs is whether it has been vaccinated. No-one would undervalue vaccination; but it becomes of doubtful benefit to society when it leads people to look abroad for the source of evils which exist at home.
Florence Nightingale is here taking sides in an important medical controversy on the cause of disease, that between the believers in miasma and the believers in contagion. Miasma describes the state of the environment in general terms; contagion refers to something specific. The reason Nightingale resisted it so strongly is that it would introduce an element of pure chance into the battle between order and disorder:
The causes of the enormous child mortality are perfectly well known; they are chiefly want of cleanliness, want of ventilation, want of whitewashing; in one word, defective household hygiene.
22
These are the words of a moral crusader, and Charles Rosenberg has pointed out how central such moral fervour is to Nightingale's conception of nursing.
23
If we put our lives in order, we shall not catch scarlet fever or measles or smallpox. Looking back more than a century later, we can see that she was both right and wrong. Of course foul air and foul water are the causes of disease, because there are airborne and waterborne infections. It is not foulness as such that we must be protected from, but the microorganisms
 
Page 39
that carry these diseases. But for her, to maintain that would be to reify disease:
Is it not living in a continual mistake to look upon diseases, as we do now, as separate entities, which
must
exist, like cats and dogs, instead of looking upon them as conditions, like a dirty and a clean condition, and just as much under our control. I was brought up, both by scientific men and ignorant women, distinctly to believe that smallpox, for instance, was a thing of which there was once a first specimen in the world, which went on propagating itself, in a perpetual chain of descent, just as much as there was a first dog.Since then I have seen with my eyes and smelt with my nose smallpox growing up in first specimens, either in close rooms or in overcrowded wards, where it could not be any possibility have been "caught" but must have begun.
24
Here we hear the commanding voice of experience, authoritative, impressive, and wrong. For a counterstatement from modern times to set against it, I choose not a medical writer but Susan Sontag's vigorous and personal essay,
Illness as Metaphor.
This stirring defense of scientific medicine attacks multicausal theories of disease, along with theories that diseases are caused by mental states, because they moralize what should be seen as pathology and "make people irrationally fearful of effective measures such as chemotherapy, and foster credence in thoroughly useless remedies such as diets and psychotherapy." All moral or mental explanations, which Sontag sees as examples of metaphor, "are always an index of how much is not understood about the physical terrain of a disease,
25
and she has, as one would expect, no respect for the outmoded "miasma" theories that Nightingale still clung to.
The contrast tells us a great deal. It is the contrast between scientific medicine and public health, two institutions that (fortunately) collaborate in practice but between which, as I have tried to show, a deep gulf of principle can open. Perhaps too it is the contrast between the human being seen holistically and morally (what do diagnostic details matter to the spiritual self?) and the human being anatomized by experimental science. And is it going too far to suggest that it is, in part, the contrast between the nineteenth and the twentieth centuries?
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