This study sets out to investigate the meaning of the words "orthodoxy" and "quackery" and to show that neither one can be fully defined or understood without the other. Pamboukian's work is apparently aimed at literary academics; although she is trained in pharmacy and deals in some instances with specific diseases and substances, she seldom uses medical or pharmaceutical terms. Her underlying premise is that "orthodoxy" and "quackery" evolved outside the laboratory, showing once again that language is not static and that words coined in one context are not imprisoned there, but may expand and contract in meaning and usage elsewhere.
Given that premise, Pamboukian might usefully have provided a brief lexical history of her two key words, which she often calls "slippery." Instead, she defines "orthodox" ("what I call orthodox" is repeated several times) as "an aura of respectability and trust" (ix); that which is "regular, acceptable, progressive" and part of an "ongoing and dynamic game of definition."(6) But if definition is a "game," what are the rules, who makes them, and how are they to be enforced? The word "orthodox" is originally Greek and entered the English language via Latin, where it first meant "having a correct opinion (especially in religion)" (Comprehensive Etymological Dictionary, 1967). Though Pamboukian discusses the role of religion in medicine and medical discourse in the 19th century, it does not appear in her definition of "orthodox."
According to Pamboukian, "quackery" seems to have served chiefly as an antonym to orthodoxy. "[N]either legislation nor professional groups," she writes, "define quackery"(11). "Quack" comes originally from the Dutch "Quacksalver," a composite of the imitative kawkkan/quacken (prattle, make a noise like a duck) and salf/zalf (ointment). About 1579, when "quack" entered the English language (Chronological English Dictionary , 556), its meaning was limited to a "bold and ignorant pretender to the Art of Physick" (Universal Etymological English Dictionary, 1721). When it began to be used outside the practice of medicine or bogus remedies is unclear. But as seen in the epigraph to the final chapter (147), its application had expanded by 1805. Who hurled the epithet at whom was part of the general power struggle.
Drawing on her training in pharmacy, Pamboukian offers considerable medical-historical information that may be new to literary critics. She often cites the Medical Act of 1858, which was passed to stem "the practice of healing by non-registered doctors" (10). But does "non-registered doctors" include any layperson involved in any way in treating a sick or injured person, or only those who practiced healing as a livelihood? Before the advent of registered, licensed practitioners, every housewife was expected to be able to prepare her own remedies for coughs, sprains, and other minor health problems. One of the most popular health guides was William Buchan's Domestic Medicine, published first in 1769, with at least 142 editions (it is mentioned in Chapter 16 of Little Dorrit). Must we now consider this a handbook for quacks?
Questions about the meaning of "doctors" lead us back to the title of this book, which presents something of a conundrum. What sense of "doctoring" is meant? A brief discussion of the term is given at the start of Chapter Two (49), but its use in the title is not explained. Likewise, though the subtitle seems to promise a continuous account of developments in medicine (and perhaps in the portrayal of doctors) in novels "from Shelley to Doyle," this is not what the book provides. The publication dates of the novels considered here jump from 1816 to mid-century, when most of them were published, then to nearly to the end of the century, and then back about twenty years in the final chapter. Nor, as one might expect from the coupling of "medicine" and "quackery" in the subtitle, does Pamboukian limit "quackery" to medical quackery. She does not use the term to denote cheapjacks selling snake oils or such like to a gullible public, but applies it, based on behavior, to both non-medical characters and medical practitioners -- even those whose creators intended them as anything but quacks.
Despite the Medical Act of 1858, which was intended not only to stop quackery but to raise the prestige of the profession, the social status and worth of medical practitioners remained unclear and debated for decades. "In George Eliot's Middlemarch," Pamboukian writes, "Lady Chettam disparages medical men as 'more on a footing with the servants.' " (12) Actually, having just been informed that Lydgate is "a gentleman," what Lady Chettam says is "I like a medical man more on a footing with the servants; they are often all the cleverer. I assure you I found poor Hicks's judgment unfailing; I never knew him wrong. He was coarse and butcher-like, but he knew my constitution" (Middlemarch, Chapter 10, my emphasis). Hicks had undoubtedly been trained by apprenticeship to a surgeon, since he was financially unable (and not of a class) to attend university. Before the mid-19th century, the title "physician" pertained only to graduates of Oxford or Cambridge. While Scottish universities provided better practical medical education than either Oxford or Cambridge, these latter gave the gentlemen students "an education in morals and manners that made them fit candidates for the Fellowship (F.C.R.P.)." (M. Jeanne Peterson, The Medical Profession  6)
The first "quack" in this study is Victor Frankenstein, whose experiments raise questions about the term "anatomy." Did it denote scientific study, or was it to be understood as a synonym for dissection? If the latter, did it involve body-snatching or even murder? The chapter begins with testimony given in 1828 by Sir Astley Cooper, President of the Royal College of Surgeons, before the Select Committee on (the Teaching of) Anatomy. Pamboukian omits the words "the teaching of" in the Committee title, and she has little to say about dissection and the teaching or study of anatomy in or before 1816, when Mary Shelley wrote the first version of Frankenstein. Implicit in Pamboukian's discussion of the novel is the 16th century law granting the Company of Barbers and Surgeons the right to dissect four bodies of executed criminals per year. Since schools of anatomy needed far more than four cadavers per year, they resorted to the assistance of "resurrection men" -- i.e. body snatchers, which was more repugnant than dissection alone. How frequently murder was involved in the supply chain can't be accurately determined, but Pamboukian's claim that "Victor's desire to quench the creature's new life... might be understood as an allusion to burking" is linguistically impossible. Likewise, the statement that "Shelley does not use the term... burking..." (36) goes without saying, since the term was not coined until after Burke and Hare were caught in 1829. Moreover, Victor's longing to destroy the monster did not arise from the need -- his own or others' -- for materials for the dissection table. Yet Victor is considered the first "quack" in this study because his behavior was not "orthodox."
Turning next to the middle of the 19th century, Pamboukian examines two novels by Charles Dickens, Little Dorrit (1855-57) and Bleak House (1852-53), presented in reverse order of publication. Pamboukian stresses the function of disease in Little Dorrit, which has been generally considered predominantly financial, though much of Dickens's concern was actually about the government of the country (Schlicke, Oxford Companion  338). While Pamboukian says, with some justification, that the drunken, untrained midwife Sairey Gamp in Martin Chuzzlewit (1843-44) is probably the best-known "medical" figure in Dickens's works (53), she deprecates Physician, whose orthodoxy (in Pamboukian's sense) Dickens emphasized by evoking the "Divine Master of all healing" in his description (54). Dickens, I believe, would have been appalled by the claim that "Physician fails both as a physician and as a moral force in society" (61). Though it is true that Physician "cannot diagnose" Merdle, as Pamboukian says (61), he had no access to Merdle's financial books and no way to "diagnose" fraud, though he could see that Merdle was not physically ill. Also, though Pamboukian faults Physician for not preventing Merdle's suicide (61), how could he have done so? No one prevented the suicide of John Sadlier, the financier on whom Merdle was modeled, as Dickens wrote to Forster in March 1856 (quoted in Schlicke, 338). Finally, in asking "How does Physician pay for the grand dinners he gives for the Barnacles?" (62), does Pamboukian mean to imply that a doctor must be poor if he is to be professionally respected? Educated at Cambridge or Oxford, Physician undoubtedly came of relative wealth and social standing; that he "hobnobs with the Barnacles" means that he lives his private life within his class, though he crosses class boundaries as a practitioner.
Involving about twenty medical or socio-medical topics, Bleak House is arguably the most "medical" of Dickens's novels, but Pamboukian's account of it contains some errors. Some are relatively unimportant, like apparently conflating Harry Potter's Professor Flitwick with Dorrit's Jeremiah Flintwinch (60) and calling Boodle, Coodle, and Doodle "Chancery figures" (64) when in fact they were Parliamentarians ("a coterie of aristocrats," Schlicke 50) supposedly running the country. There is also one serious error: Lady Dedlock's sister was not Mrs. Chadband (65) but rather Miss Barbary (a speaking name!), as she calls herself; her housekeeper Rachael married Chadband only after Miss Barbary's death. Another misinterpretation is that "[Esther] requires Woodcourt to heal her visible scars" (70). The scars healed by Woodcourt in this case are the emotional scars caused by Esther's rigid (barbaric, excessively Old Testament-based) upbringing, of which the physical scars are representative. Nor did Esther need Woodcourt to "direct her future charity" (71). Had there been no Woodcourt, Esther would have married Jarndyce and had at her disposal more ample means for dispensing charity.
One important contrast in this novel of contrasts is between "systematized vocation" (Pamboukian's phrase), and professionalism. While the man of vocation--Woodcourt--follows the Christian exhortation to do good unobtrusively, Mrs Jellyby and Mrs Pardiggle do little good (and considerable harm to their own families), while making as much noise about it as possible in their "systematized vocation." Professionalism is set apart from vocation by its self-interest. Tulkinghorn relishes the power his knowledge gives him over Lady Dedlock; Vholes claims untiring attention to his clients' cases, but his family obligations are the real motive; and Bucket indulges in masquerades to obtain information. But however unreliable Bucket's friendly manner may be, Dickens does give him a degree of humanity unapparent in the other two figures. How then should he be classified? If Woodcourt is "orthodox" (in Pamboukian's sense) and the harmful and/or self-serving do-gooders and lawyers are "quacks," what about Bucket? Rather than "quack," perhaps, he should be considered "unorthodox," a word that hardly appears in Pamboukian's text. Despite the slipperiness of the boundaries between its key terms, this analysis of Dickens's characters tends to overlook the spectrum of moral colors that lie between black and white.
The discussion of Brontë's Villette is supported by reference to articles on quackery in The Lancet, The British Medical Journal, and Fraser's Magazine. While Lucy Snowe's narrative is generally considered unreliable, what makes it so-- Pamboukian suggests-- is the instability of the Victorian norms that Lucy seems to endorse in her praise of Dr. John. "For Lucy," she writes, "John is an ideal . . . However, there is ample evidence that John is not an ideal physician. ... John muddies the very boundaries that Lucy says he defends" (93). He teases Lucy with a letter, flirts with Ginevra and finally courts Polly though she is ostensibly his patient, all unseemly behavior for a practitioner. But calling his pretended treatment of Désirée "trickery" (85) goes a little too far, for trickery implies that the person being "tricked" doesn't know it. Dr. John, the child, and Mme. Beck are all perfectly aware of the game being played, which differentiates this episode from John's teasing of Lucy and from the cases cited from the Lancet and the BMJ (84). The motivation may be less than ideal, but Dr. John is in part dependent on Mme. Beck for his income -- and perhaps for his reputation, which Mme. Beck could have easily ruined had she wished.
Wilkie Colllins' Armadale (1866) raises another question of semantics: what is poison? Pamboukian gives the medical definition, which does not include death as the outcome, and the lay definition, which does. As a verb, "poison" entered English via Old French sometime between 1150 and 1450 (Chronological English Dictionary) in reference to "medicinal draughts" (OED). Pamboukian discusses the Arsenic Act of 1851, the Poisons Act of 1857, and the Pharmacy Act of 1868, which was largely an attempt by the Pharmaceutical Society (founded in 1841) to monopolize dispensing.
For most laymen, the noun "poison" denotes a substance which is -- or at least is intended to be -- lethal. Collins built on cases of domestic poisoning, of which there were several notorious ones in the 19th century and a probably very high number of cases that were either unrecognized or perhaps incorrectly thought accidental. But since "rat poison" could be bought from a greengrocer who might use the same scoop for sugar and weigh both substances on the same scale, a considerable number of deaths from poison may have been genuinely accidental.
In one sense, Pamboukian's account of Armdale evokes Paracelsus, who has been variously quoted as saying that "all drugs are poisons, the benefit depends on the dosage" and "all things are poison..." In another sense, Pamboukian returns to what Rochester says about a drug he has bought from an "Italian charlatan" in Rome: "It is not a thing to be used indiscriminately, but it is good upon occasion" (Jane Eyre, Chapter XX, qtd. 2). Though Rochester is said to "distrust" the medicine, perhaps he was just sensible enough to exercise the caution that is required even today with "orthodox" drugs.
Pamboukian's training in pharmacy is most apparent in this chapter, and she gives considerable historical information, illustrating the problems of definition and of control. She also presents information on specific substances. For example, carbonic acid and limestone were easily available and innocuous as long as they were not combined -- something known to Dr. Downward, but not likely to the general public. Arsenic, on the other hand, was known -- and unregulated until 1851. Pondering why Lydia uses arsenic in brandy, Pamboukian writes that this "queers the term poison" (109) by combining arsenic and alcohol, which were each considered both medicinal and poisonous. Arsenic was meant to be limited by the Arsenic Act, alcohol by the Temperance Movement. The former made arsenic at least somewhat more difficult to obtain; the latter reportedly had the dubious effect of increasing the practice of taking opium (Lancet (1851(I:694).
In her interesting discussion of Arthur Conan Doyle's Stark Munro Letters (1894) and his short story, "The Speckled Band" (1892), Pamboukian points out that at least one form of quackery proved necessary to the practice of medicine (as well as to crime-solving in the case of Holmes). That is, the practitioner benefited from appearance, from publicity (or reputation), and from cultivation of his patients' or clients' confidence -- even when he could not always be as confident himself. But I must question one statement Pamboukian makes about "The Speckled Band": "Roylott does not kill by violence but through medicine." Though it is unclear whether Pamboukian is speaking for herself or for Hodgson, whom she cites (143), Roylott beats his butler to death, throws a butcher off a cliff, and murders Julia by having a snake bite her. Where's the medicine?
The final novel, which Pamboukian cites as anonymous, is Vernon Galbray, or, The Empiric: The History of a Quack Dentist (1875), now attributed to Felix Weiss. Reinvoking the tropes of foreignness and non-Christian vs. English and Anglican, which are especially salient in Pamboukians discussion of Villette, Vernon Galbray clearly contrasts orthodoxy and quackery. Pamboukian points out, however, that the boundaries are not as clear as they might seem, since characters may be involved in orthodox practices and in quackery at the same time -- whether intentionally or not.
Overall, this book is a thought-provoking account of medicine and quackery in English fiction. Though marred by occasional errors in its analysis of particular works, it presents considerable historical information in terms that non-scientific readers can understand. Also, by placing specific novels within the framework of Victorian medical concerns and legislation, it contributes to the ongoing study of how literature reflected and/or influenced society.
Joanne Eysell is a medical translator and author of A Medical Companion to Dickens's Fiction (2005).