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Doctors, Objectively: The Malleable Myth of Modern Medicine in Ulysses

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Around the turn of the nineteenth century, doctors in the British Empire found themselves in a major predicament: the number of physicians was increasing dramatically while simultaneously, unorthodox practitioners were leeching away patients unsatisfied with traditional medicine (Waddington 688). This predicament led the medical community in Great Britain to create medical societies, establish medical schools, publish medical periodicals, and lobby for medical licensing requirements - in other words, to "professionalize" the occupation of medicine by limiting economic competition while standardizing medical knowledge (54). The ultimate goal of this professionalization was to increase medicine's "social cachet" and establish the practice of medicine as a "learned profession" appropriate for "gentlemen" (with a corresponding paycheck) (Plock 15). In order to achieve this goal, physicians began to adopt the rhetoric of science and rationality then popular in intellectual circles (61). This rhetoric served as a tool to increase medicine's stature, both by constructing medical knowledge as specialized and objective and by distinguishing licensed doctors from the legion of herbalists, homeopaths, and quacks peddling alternative remedies (65). The adaptation of scientific rhetoric, did not, however, signal arise in therapeutic efficacy: "scientific" theories such as phrenology and Leopold Bloom's phototherapy (U 15.1737) proliferated in the midst of widespread resistance to innovations such as antiseptics and anesthesia (58-59).

As suggested by the phototherapy reference, Joyce was highly familiar with both the rhetoric of scientific progress employed by institutional medicine and the major gap between this narrative and the actuality of modern medical practice. As a three-time medical school dropout, Joyce would have been exposed to the high hopes and high language of the 19th century medical academy (Plock 5). He also would become familiar with the failure of doctors' "scientific rigor": his empiricist Trieste doctor prescribed several rounds of electrotherapy to treat (unsuccessfully) Joyce's (likely) syphilis infection (Schneider 455). The resultant ambivalent relationship towards medicine - characterized by frustration with doctors' inability to cure his numerous physical ailments and fascination with new medical theories and practices (Plock 23) - manifests itself within the text of Ulysses. The reader of Ulysses encounters an array of proposed prescriptions, disorderly medical students, laymen's clinical thoughts, and quack cures. Ultimately, in its presentation of doctors' behavior, treatments, and public image, Ulysses simultaneously reifies and challenges the new, scientific self-portrait of medicine. In doing so, it captures the elusive state of early twentieth century medicine, highlighting the troubled relationship between scientific rhetoric and clinical reality. The beginning episodes of Ulysses construct and reinforce the picture of modern

medicine as scientific, objective, and respectable that later episodes will challenge. In the book's opening conversation between Stephen and Buck Mulligan, Buck dismisses death as "a beastly thing and nothing else," observing that he sees patients "pop off every day" in the hospital and thus is not moved emotionally by the dying (U 1.205-206). This rhetorical maneuver positions Buck as a modern medical man from two angles. First, in calling death "a beastly thing," Buck reduces the process of dying, traditionally laden with spiritual, philosophical, and personal significance to a physical, animalistic (i.e. "beastly") process. This process in Buck's account can be explained in terms of its constituent parts (in this case, non-functioning "cerebral lobes") and thence dismissed of any broader importance— thus Buck's claim that death "simply doesn't matter" (U 1.207-210). In other words, in this conversation Buck advocates a reductionist scientific materialism, thereby accessing its associations with clarity, rationality, and intellectual thought. Buck situates himself as a person who, through his exclusive medical experience and knowledge, can understand the bodily process at hand (dying) and evaluate its significance. His unimpressed evaluation of said significance here provides the second angle: Buck contrasts his objective, scientific viewpoint with Stephen's implied irrationality and emotionalism. Per Buck, his worldly experience of daily seeing patients "pop off has given him the ability to deal with death unemotionally - unlike Stephen, Buck claims, he doesn't "whinge like some hired mute" over death (U 1.213). Buck thus establishes himself twofold as a figure of knowledge and authority - with both the scientific acumen and objectivity to diagnose problems and formulate appropriate responses. This rhetorical performance achieves its desired function when an uneducated layperson, the milkwoman, admires Buck's position as a "medical student" later in the episode, commenting reverently "look at that now" (U 1.417).

Mr. Deasy's proposed medical solution to the hoof-and-mouth problem in the Nestor episode illustrates further the degree to which laypersons in the novel buy into medical claims to exclusive knowledge. Within the 19th century scholarly field of infectious disease, the line between veterinary and human medicine was blurred, as humans and animals share many pathogens (including foot-and-mouth disease) (Lederberg 2000). Deasy's letter thus provides useful insights into the lay view of medicine in Ulysses. In his letter, Deasy claims that "veterinary surgeons" have used "Koch's preparation" to cure a "percentage" of horses with foot-and-mouth disease in Austria; these surgeons now offer a "trial" of their solution for Ireland (U 2.332-335). This language echoes the scientific claims of contemporary practitioners, creating a sense of clinical accuracy and achievement - the precision of the "percentage" cured, the implied clinical "trial" and the reference to Koch, the German bacteriologist who claimed to have discovered a cure for tuberculosis in 1890 (Plock 7), all demonstrate that Mr. Deasy has internalized the triumphant narrative of the new empirical medicine. Indeed, he is so confident in the Austrian surgeons' ability that he proclaims "there can be no two opinions about" bringing them over to help (U 2.322). Thus medicine's expertise, as "objectively" demonstrated through tests and trials, is for Mr. Deasy undisputable. Mr. Deasy's position here thus aligns with Buck's in episode one. In these opening episodes characters (both medical and layperson) construct medicine rhetorically (in speech and writing) as a domain with specialized knowledge of the body and its operations, and as a field whose gentleman practitioners solve current problems through objective, scientifically-determined solutions. The remainder of Ulysses, in turn, complicates and challenges this construction by undermining doctors' social position, the status of scientific cures, and medicine's exclusive modernity.

The most obvious complication is the unprofessional behavior of the medical students, which Ulysses juxtaposes ironically with the above image of doctors as rational and respectable. In particular, this behavior comes to the fore in the Oxen of the Sun episode, which takes place within a hospital, ostensibly the center of medical expertise and progress. Instead of an orderly and effective clinic, however, Ulysses presents the picture of a hospital nurse begging the medical students to "leave their wassailing" to attend to the pregnant Mina Purefoy, to no avail: the medical students are "there to the intent to be drunken," and "never needed none asking" to drink (U 14.167-187). Indeed, the students' "bawdy" singing disturbs the nurses' treatment of Mrs. Purefoy, drawing the ire of "Nurse Quiqley," who "angerly bid them hist ye should shame you" (U 14.313-318). This picture of the young doctors clashes with the image of the clinical professional at several levels. From the start, the students, in ignoring Mina Purefoy, are abandoning a woman in need, thereby failing to uphold gentlemanly conduct in addition to neglecting the doctor's duty to attend to ill patients. Moreover, they neglect Mrs. Purefoy (who is clearly in great distress) for the express end of being "drunken" - a very explicit sacrifice of mental clarity and rational thought for the purpose of physical, hedonistic pleasure. Given how the narrative of medical progress situates medical treatment as the triumph of mind over body (in its position that the human mind, carefully applied, can uncover and solve the body's secrets and problems), that the medicals' bodily needs supersede their higher functions (both moral and intellectual) here is ironic indeed. Worst of all, from the perspective of professionalization, in neglecting their Hippocratic duty to aid Mrs. Purefoy, the doctors allow the nurses - who lack formal education or professional organization at this point - to take over the treatment. In other words they allow some of their functions to be delegated to non-educated labor, a delegation antithetical to the purpose of creating professional requirements in the first place. Thus the medical students of the Oxen of the Sun episode deflate the professional ideal of the respectable doctor, with troubling imprecations against medicine's social prestige. Yet the medical students' uncouth behavior still leaves unchallenged the rhetorical grounding for said prestige: practitioner's claims to scientific, exclusive knowledge.

Ulysses displays numerous instances where various characters, especially Bloom, attempt to apply this exclusive knowledge to solve a problem. In an amusing assault on the rhetoric of scientific certainty, these "prescriptions" are typically either not effective treatments or do not treat the illness at hand, and frequently achieve both these criteria. For example, in the Cyclops episode, Bloom brings up a variety of cures for sick cattle in response to a conversation about hoof-and-mouth disease: "sheepdip" for "scab," "hoose drench" for "coughing calves," and a mysterious "guaranteed remedy" for "timber tongue" (U 12.833-835). These cures are utterly useless; the infected cows do not have parasites or lung infections but hoof-and-mouth disease, and in 1904 there existed no cures for "timber tongue," which the cows also do not have (Gifford 340). This pattern continues most prominently in the Circe episode. In his initial fantasy of worldly success, Bloom prescribes "acid. nit. hydrochlor. dil. 20 minims" for a constituent's "bladder trouble," while later, Bloom, at Virag's behest, considers using "wheatenmeal with lycopodium and syllabax" as a treatment for a prostitute's potential warts (U 15.1649-15.1651, 15.2379). These prescriptions crystallize the ironic treatment of medical knowledge in Ulysses. These "medicines" sound scientific and precise - in the first case, abbreviated and specified to a precise level of dilution, in the second case, composed of what appears to the reader as incomprehensible scientific jargon. Yet in fact these are nonsense remedies: nitric hydrochloric acid is so acidic it is used to dissolve gold (and thus can hardly be ingested for bladder trouble), while wheatenmeal is a cookie ingredient and syllabax is not a word (Raptis and Fackler Jr. 5005, Gifford 494). These examples thus suggest the gap between scientific rhetoric and therapeutic efficacy; their professional sound and appearance does not signify accurate content. The prescriber merely sounding modern is no guarantee of accurate treatment or even diagnosis (the prostitute in question, after all, has a stye, not any warts).

The quack (or "unorthodox" as the quacks would have it) practitioners in Ulysses doubly emphasize this disjuncture between rhetorical appearance and reality by co-opting modern language and practice to sell their products. The "quack doctor for the clap," for instance, impresses Bloom with his adept advertising, putting up posters in "greenhouses" (public restrooms), where presumably the evidence of infection would be clear (U 8.96-97). Later, the reader discovers Bloom has received a "prospectus" for a device called the "Wonderworker," which purports to "remedy rectal complaints" (U 17.1819-1820). This prospectus advertises itself in the same way as professional doctors, by appealing to an explanation of its function (in this case, assisting "nature" and freeing "natural action" — echoing scientific claims to understand the natural functioning of the body) and to evidence of its efficacy (a wide array of testimonials, including one from a "hospital nurse") (U 17.1826-1836). From the fact that Bloom has apparently stored this testimonial away for further use, we can deduce that he must have found the appeals of the pamphlet at least somewhat compelling. The point being here not that these quack cures are identical to the ones being promulgated by doctors, but rather that they demonstrate the ease with which anyone can adopt modern rhetoric (of evidence and explanation) and practice (the latest advertising trends) to achieve similar ends as institutional medicine (witness Bloom's implicit acceptance of the Wonderworker's claims).

Ulysses ' presentation of medicine thus leaves the reader in an ambivalent position: cognizant both of medicine's scientific potential and the yawning gap between this potential and the reality of medical practice in Dublin, 1904. Appropriately enough in a novel of wild stylistic experimentation, Ulysses in particular highlights how the medical practitioners of the late 19th and early 20th century tried to bridge this gap using the newly-developed language of scientific explanation. In doing so, Ulysses manages to capture newly modern Irish (or rather, Western) medicine in all its ambiguity and internal contradictions, deconstructing the narrative of modern medicine much as the novel complicates virtually every institution and dogma it encounters. The function of medicine in Ulysses thus fits into the broader doubt the novel creates about human ability to make sense of the surrounding world using inflexible systems of thought - the dialect of scientific knowledge, Joyce suggests, is no solution to this problem. The failure of rhetoric to capture the true state of things, Ulysses implies, plagues the local physician as much as the neighborhood author.

Citations and Related Sources

Bock, Martin. "James Joyce and Germ Theory: The Skeleton at the Feast." James Joyce Quarterly 45, no. 1 (2007): 23–46
Gifford, Don, and Robert J. Seidman. Ulysses Annotated: Notes for James Joyce’s Ulysses. Berkeley: University of California Press, 2008.
Lederberg, Joshua. "Infectious History." Science 288, no. 5464 (2000): 287–293. http://ftp.columbia.edu/itc/hs/pubhealth/p8475/readings/lederberg.pdf.
Plock, Vike Martina. Joyce, Medicine, and Modernity. Gainesville: University Press of Florida, 2010. http://muse.jhu.edu/books/9780813042961?auth=0.
Raptis, Raphael G., and John P. Fackler Jr. "The Synthesis and Crystal Structure of a Mixed-valence, Digold (I)/gold (III), Pyrazolato Complex Stable in Aqua Regia. The X-ray Photoelectron Study of Homo-and Heterovalent Gold-pyrazolato Trimers." Inorganic Chemistry 29, no. 24 (1990): 5003–5006. http://pubs.acs.org/doi/abs/10.1021/ic00349a034.
Schneider, Erik. "‘ A Grievous Distemper’: Joyce and the Rheumatic Fever Episode of 1907." James Joyce Quarterly 38, no. 3/4 (2001): 453–475. http://www.jstor.org/stable/10.2307/25477818.
Shortt, S. E. "Physicians, Science, and Status: Issues in the Professionalization of Anglo-American Medicine in the Nineteenth Century." Medical History 27, no. 1 (1983): 51–68
Waddington, Ivan. "The Movement Towards the Professionalization of Medicine." BMJ: British Medical Journal 301, no. 6754 (1990): 688. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664090/.

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