Persuasions #15, 1993 Pages 170-177
Professional Persuasion: Dr. Anne Elliot
Department of English, McMaster University
In their article, “Medicine and Disease in Jane Austen’s England,” Laurie and Richard Kaplan claim, quite rightly, I think, that Jane Austen, with her obvious knowledge of illnesses and remedies, “would have been a terrific physician” (177). Toby Olshin also writes about Austen’s medical proficiency, and points out “the accuracy of [her] portrayal of medicine” (314). Each of Austen’s novels reflects an interest in the healing arts, but in this paper, I want to look specifically at Austen’s presentation of Anne Elliot as a potential physician, and thus my title: Professional Persuasion: Dr. Anne Elliot.
Of course my title is facetious; in Austen’s day there were no female physicians. Medicine was only beginning to form itself into a profession, and gender restrictions to any form of recognized medical training, whether at the universities, the School of Apothecaries, or surgical apprenticeship, effectively denied access to women. As Anne Elliot reminds us, women in the early nineteenth century “live at home” while men of her class “have always a profession” (Austen, 232). But Austen hints that women’s role in society may be about to change.
In Persuasion, Anne rightly points out that men “have had every advantage of us in telling their own story. Education has been theirs in so much higher a degree; the pen has been in their hands” (234). Although she clearly presents the subordinate position of women in a patriarchal culture, there is a twofold irony in Anne’s statements. Internally, within the novel, Frederick Wentworth has just dropped his pen in the narrative when Anne makes this observation; it is, significantly, no longer in his hand – and externally, it is Jane Austen, a woman writer, who has written the novel. The pen is very much in her hand. If the vocation of novelist is extending to women, why not other professions? Why not medicine?
Just as Austen’s skill with the pen is paramount, it is my contention that Anne’s skill at medicine is potentially just as powerful. For Anne’s character combines a practical pragmatism with a sympathetic solicitude. If we examine what we want to find in a physician today (and I realize I must fall into generalizations, for as individuals we will all vary in our determinants), I believe most of us look for a doctor who combines skill, technical ability and knowledge, with warmth, compassion and respect. We do not want to subject ourselves to a surgeon who is not slick with the scalpel, but I believe most of us also no longer want the physician who graduated top of the class but cannot talk comfortably with us as patients, or who is too caught up in her or his authority either to consider our intelligence or to detect and respond to our emotional needs.
As patients, many of us are interested in sharing power and control with our physicians. We want excellence in our care, but we do not want to be patronized; we want to know what is going on. We want to be consumers of health care, not reified individuals who have health care bestowed upon us. We want to take responsibility, but when we must give our trust, we want to be treated kindly and with regard.
Within such parameters, Anne Elliot would make an excellent physician. She is competent, conscientious, careful and caring. As indicated in her triage skill on the Cobb, her psychiatric proficiency with her hypochondriac sister Mary, and her sympathetic manner with her rheumatic friend, Mrs. Smith, Anne has the ability to function under pressure, to reassure and provide hope, and to sympathize with, and soothe the afflicted. Most importantly, she is able to do this without brandishing undue authority, or patronizing her patients.
The most obvious demonstration of both Anne’s cool-headed composure and her excellent medical skill is in the scene on the Cobb, when Louisa falls and sustains a head injury. The picture has changed from silliness and laughter to sudden and utter tragedy, and if you will remember back to your first reading of Persuasion I am sure you will recall your gasp at that momentous sentence of Austen’s which moves from Louisa’s smile and flirtatious determination to jump once again into Captain Wentworth’s arms, to the completely unexpected mismanaged “half a second [in which] she fell on the pavement on the Lower Cobb, and was taken up lifeless!” There lies Louisa, and her stillness is reflected and magnified by the suspended animation of those around her: “There was no wound, no blood, no visible bruise; but her eyes were closed, she breathed not, her face was like death. – The horror of that moment to all who stood around!” (109).
Mr. Curtis, Apothecary at Alton
I want to examine closely just who does what next. First of all, the silence is broken by the hysterical cries of Anne’s sister Mary, who screams “She is dead! she is dead.” Wentworth, Anne’s hero, is completely paralysed. He can do nothing but hold Louisa and look “on her with a face as pallid as her own, in an agony of silence” (109). When finally he does manage to speak, it is not to take control, but to call meekly and desperately for assistance: “Is there no one to help me?” he entreats “in a tone of despair, and as if all his own strength were gone” (110). He is almost as limp as Louisa; he is completely impotent and has no idea what to do.
Charles, also, is numbed by the experience. He is held back when Mary catches hold of him in her panic, but Austen tells us Mary’s grasp is only “contributing with his own horror to make him immoveable” (109). He cannot act. Henrietta, responding to Mary’s conjecture that Louisa is dead, faints away and adds to the array of victims when she nearly breaks her own head but for the quick action of Captain Benwick and Anne, “who caught and supported her between them” (110).
At this point, it might seem plausible that Captain Benwick would take over. This is his home territory, he is a naval officer, and we are used to seeing men in control. But no! It is Anne who takes charge. She begins in the manner of what we now call triage, which is defined in Dorland’s medical dictionary as “The sorting out of casualties of … disaster, to determine priority of need and proper place of treatment” (1610). Anne takes the active role of triage officer, crying out to Captain Benwick to assist Captain Wentworth: “Go to him, go to him … for heaven’s sake go to him … Leave me, and go to him.” Anne clearly recognizes that it is Louisa who needs attention before the hysterical Mary, or the fainted Henrietta, and she gives clear instructions of what must be done: “Rub her hands, rub her temples,” and summons the wherewithal to provide the only drug on hand: “here are the salts,” she says, and then positively commands Benwick to “ – take them, take them” (Austen, 110). Captain Benwick, rather than taking control of the disaster himself, obeys Anne’s orders and responds.
Charles, too, follows Anne’s command and helps Benwick to do “every thing … that Anne had prompted.” Meanwhile, Captain Wentworth, the brave naval officer, can only stagger “against the wall for his support” and exclaim “in the bitterest agony. Oh God! her father and mother!” The smelling salts have not worked and he instantly admits defeat and loses all his sense of logic. While he falls into this emotional stupor, Anne again takes charge: “A surgeon!” (110) she cries out.
Until this point, Anne has used the imperative in her commands. Her orders are followed in the text by exclamation marks. She shows the clear-headed skill, control, ability and knowledge we expect from a doctor. She is firm but calm under extreme pressure while all those around her, even seasoned naval officers, fall apart. It is fascinating to note, however, that as the men come to their senses, Anne moves away from the authoritarian role of commander, and completely changes her mode of speaking. Medical discourse is one of power and control, but Anne, while still manoeuvring the situation, moves from forceful commands to calm suggestions. Once her authority is established, she no longer needs to be demonstrative, and she pulls back.
Captain Wentworth responds to Anne’s call for a surgeon: “the word … seemed to rouse him at once” and he begins to run when Anne, with a decided change in tone (moving from the imperative all the way to the interrogative) suggests: “Captain Benwick, would not it be better for Captain Benwick? He knows where a surgeon is to be found.” This is a perfect example of professional persuasion. Anne does not need to shout out orders. Her composure has gained her the respect she needs to organize the medical situation by gentle persuasion. In an instant, “[e]very one capable of thinking felt the advantage of the idea” and Captain Benwick “was off for town with the utmost rapidity” (110).
Anne is now in complete control of the situation. Although the narrator suggests that Wentworth, Charles and Anne are all “completely rational,” only Anne has maintained such a condition throughout. Indeed, Charles is convulsed in “sobs of grief” (110), and implores “Anne, Anne … what is to be done next? What, in heaven’s name, is to be done next?”, and “Captain Wentworth’s eyes were also turned towards her.” They defer to her judgement and instantly agree when she suggests they carry Louisa “gently to the inn.” Although Captain Wentworth begs Charles to “take care of the others,” and he, now “comparatively collected” (110), manages to gather up Louisa, it is clearly Anne who has already assumed the role of taking care: “Anne, attending with all the strength and zeal, and thought, which instinct supplied, to Henrietta, still tried, at intervals, to suggest comfort to the others, tried to quiet Mary, to animate Charles, to assuage the feelings of Captain Wentworth” (111). It is not surprising that “[b]oth seemed to look to her for directions” (111).
Anne acts the perfect doctor in this situation. She instantly assesses the damage, offers useful advice, proffers a remedy, rationally sends for appropriate help for the central victim, determines the place of treatment, and calms and soothes those less afflicted. She does all this with the exact amount of authority needed, and is happy to move from overt power to mild persuasion when the others eventually regain their composure. Anne is the kind of medic I would like to come across in an emergency.
Anne’s medical abilities are not always portrayed with such high drama. Dealing with her hypochondriac sister Mary on a day by day basis is much less spectacular, but perhaps if doctors had practised medicine with Anne’s methods, much of the hysteria which prevailed in women in the nineteenth century might have been prevented.
On the surface, Mary seems to be one of Austen’s satiric figures. She is “often a little unwell, and always thinking a great deal of her own complaints” (33). She is manipulative and annoying, and frequently implores Anne to come to look after her. We are never shown any real signs of illness, and Mary’s symptoms tend to disappear with Anne’s presence. The subtext for Mary’s complaints, however, is suggested by Anne’s own dissatisfaction with the limited roles allowed to women in society, and Anne is prepared to humour Mary into wellness rather than treat her with contempt.
In this regard, Anne diverges from standard medical treatment. Nineteenth-century medicine tended to disregard the cultural significance of hypochrondria and hysteria in women, and rarely looked for the cause of their complaints. In his medical text, On the Pathology and Treatment of Hysteria, Dr. Robert Brudenell Carter gives a typical nineteenth-century medical response to what Elaine Showalter calls “The female malady” (3). Carter assumes that women are malicious and conniving in their presentation of hysterical pathology. He instructs physicians and medical students that such women are “gladly availing themselves of [their maladies] for the gratification of the morbid craving after sympathy” (76), and accordingly he recommends treatment which can be interpreted as a sort of punishment for their conditions. His opinion, typical of medical men at the time, was that practically the entire female sex was at risk of hysterical breakdown. He claims: “a certain amount of emotion will produce an attack in almost any woman, however healthy …” (92).
Rather than responding with sympathy and understanding to his patients, as Anne does with Mary, Dr. Carter preferred to assert absolute authority throughout the time of treatment. His cure involved moving women away from their homes, incarcerating them in the doctor’s own nursing establishment, and “wearing out the moral endurance of the patient … remove her and leave her alone, do not … give utterance to a single expression, either of sympathy or alarm … no inquiries being made about her health” (108). Carter insists the doctor must “commence by a positive assertion that she has nothing at all the matter with her, and is, in reality, in perfectly good health; her ailments being, one and all, fraudulent imitations of real disease” (111).
All hysterical women, according to Carter, “are wayward, irritable, capricious” (138), and must be treated accordingly: “She must be told to keep silence and to listen … in such a manner as to convey the speaker’s full conviction, that the command will be immediately obeyed” (119). Carter advises that “any or every part of her past conduct, which can conduce to her humiliation and shame, must be brought fully before her … until … the patient exhibits signs of contrition and regret” (112). Carter never relents on the authority and power of medical discourse. He bullies his patients into compliance.
Anne Elliot, however, treats Mary with compassion, if sometimes an exasperated compassion, and solicitude. Anne is aware that Mary’s problem stems from the inability of all women of her time to participate in stimulating activities. Women, says Anne, are compelled to be “quiet, confined, and our feelings prey upon us” (232). Mary is less capable than some women of coping with this confinement:
being alone, her being unwell and out of spirits was almost a matter of course … While well, and happy, and properly attended to, she had great humour and excellent spirits; but any indisposition sunk her completely; she had no resources for solitude … and was very prone to add to every other distress that of fancying herself neglected and ill-used. (37)
Certainly Austen is satirizing Mary’s sense of self-importance, but she also gives a convincing account of the very real restrictions on women’s lives which often led to depression and illness.
Anne patiently listens to Mary’s complaints, and encourages her to be well. Arriving to find Mary claiming to be “so ill I can hardly speak … I do not think I ever was so ill in my life as I have been all this morning – very unfit to be left alone, I am sure” (37), Anne humours Mary, and cheers her up with the promise: “you will soon be better now … You know I always cure you when I come” (38). Indeed,
[a] little farther perseverance in patience, and forced cheerfulness on Anne’s side, produced nearly a cure on Mary’s. She could soon sit upright on the sofa, and began to hope she might be able to leave it by dinner-time. Then, forgetting to think of it, she was at the other end of the room, beautifying a nosegay; then she ate her cold meat; and then she was well enough to propose a little walk. (39)
One can read this as evidence of Mary’s silliness certainly, but also as an indication of Anne’s healing power of persuasion over her patient. Mary will always be a problem; she is compelled by her culture to an inactive subordinate position in a patriarchal society, and her restless temperament restricts her options for happiness and fulfilment. Out of frustration, she resorts to the role of invalid and demands sympathy, but Anne’s presence and kind treatment make her well. Anne does not adopt an authoritative attitude with Mary which would have been typical of contemporary medicine; on the contrary, she plays a compassionate psychiatrist.
In her dealings with the crippled Mrs. Smith, a former school friend, Anne shows a sympathetic manner which overrides the pressures of class distinction so important to the rest of her family. In spite of the fact that Mrs. Smith is poor and “almost excluded from society” (153), Anne, of course, has no reservations about visiting her. In fact, when she first heard of Mrs. Smith’s misfortune, Anne “lost no time in going” (153) to help her. Anne is more than willing to offer sympathy and comfort to a sick and needy friend in a situation her father describes as representing “[e]very thing that revolts other people, low company, paltry rooms, [and] foul air” (157). Like the best of doctors, her compassion has no class boundaries.
At the time Persuasion was written, medicine in Britain was divided by class distinctions of its own. Physicians came from the upper classes. They were university trained gentlemen, versed more in the classics than in medical technique, and found their patients among the privileged and the rich. According to one medical historian, “the lordly physician could, and often did, receive his degree without [ever even] examining a patient” (Cartwright, 47). The emphasis in their education “combined an almost medieval respect for tradition with an excessive admiration for the manners and attainments of an eighteenth-century gentleman” (Youngson, 15). Jane Austen does not give us a physician-character in Persuasion, but we can imagine there are plenty of them about, particularly in Bath, treating the worried wealthy clientele.
Surgeons and apothecaries, traditionally, were of a lower class than physicians. Until 1745, surgeons were in the same guild with barbers, and both groups trained, not at the university, but by apprenticeship alone. Although apothecaries were originally taught only to prepare and dispense drugs, by the early nineteenth century they were also treating patients. In order to make a living in small communities, apothecaries began to use surgical techniques, and surgeons began to deal in pharmaceuticals; with their broadening capabilities they were the precursors to general practitioners.
In Persuasion, Austen indicates that the specific skills of the surgeon and the apothecary were practically interchangeable. At Lyme a surgeon is summoned for Louisa, but when Anne’s nephew dislocates his collar-bone in a fall, and injures his back, the apothecary is sent for. Both victims have had falls, both have sustained injuries, both are diagnosed and treated appropriately by the attending medic. Austen, particularly by having an apothecary, rather than a surgeon, reduce the dislocation, suggests that medicine is opening up, and that general practice is on the rise.
The move towards an official blending of medical skills, however, was not smooth. Each group resented the encroachment of the other on its territory, and fought for precedence in a medical hierarchy. In a bid to professionalize itself, medicine moved towards creating a single licensing authority which would compile a register of qualified practitioners (Cartwright, 56). All branches of medicine were required to raise their educational standards, which was beneficial for patients, but along with standardization came increased power and authority as these men formed a profession. With the gain in power and status, there was an almost inevitable loss in importance of sympathy and compassion. Doctors acquired prestige when they chartered their profession, but they may have lost some of the emphasis on the skills of sympathy and kindness we see so clearly in Anne Elliot.
The power medicine gained with professionalization allowed practitioners such as Robert Brudenell Carter to advocate unbending authority over patients. Anne Elliot’s technique, that of gentle medical persuasion, was jeopardized when medicine rose to a controlling state. The healing qualities Anne Elliot displays work wonders with her patients, but they take time and they elicit little overt recognition. Her talent also makes her vulnerable to those who would take advantage of her good nature: Charles “wishes [she] could persuade Mary not to be always fancying herself ill” and Mary entreats Anne to “persuade him that I really am very ill – a great deal worse than I ever own” (Austen, 44). Nonetheless, Anne’s skill saves the day on the Cobb, and her ability to move quickly from forceful command to gentle persuasion indicates that she has a positive vocation for medicine which seems to be lacking in the official discourse of the profession throughout the nineteenth century.
Cultural proscriptions kept women like Anne Elliot from practising medicine professionally until the latter half of the nineteenth century. By then, with significant scientific advances in treatment and training, some doctors assumed an elevated position in society which unfortunately enabled them to disregard the traits Anne displays so well. Authority in medicine officially took the place of respect and sympathetic understanding. In her depiction of Anne Elliot, I cannot help but wonder if Jane Austen is suggesting that gentle persuasion is an admirable qualtiy for medicine, and is predicting a future for women like Anne in the profession. Until recently, medicine has not been accountable for its manipulation of power and authority, and women like Anne have been discouraged in their efforts to disarm medical discourse. Although there are many doctors who now question their desire or need for authority, I checked the Canadian Medical Directory, and so far, there is still no Dr. Anne Elliot listed. However, by the year 2000, it is predicted that up to 50% of practising physicians in this country will be women (Smedstad, 171). Certainly, as I believe Austen predicts, Dr. Anne Elliot will surface. I hope she lives up to Austen’s description.
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Carter, Robert Brudenell. On the Pathology and Treatment of Hysteria. London: 1853.
Cartwright, Frederick F. A Social History of Medicine. London: Longman, 1977.
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Gilbert, Sandra M. and Susan Gubar. The Madwoman in the Attic: The Woman Writer and the Nineteenth Century Literary Imagination. New Haven: Yale UP, 1979.
Kaplan, Laurie and Richard. “Medicine and Disease in Jane Austen’s England.” Persuasions, 12 (1990): 117-30.
Olshin, Toby A. “Jane Austen: a Romantic, Systematic, or Realistic Approach to Medicine?” Studies in Eighteenth-Century Culture, 10 (1981): 313-26.
Poovey, Mary. The Proper Lady and the Woman Writer: Ideology as Style in the Works of Mary Wollstonecraft, Mary Shelley, and Jane Austen. Chicago: U of Chicago P, 1984.
Showalter, Elaine. The Female Malady: Women, Madness and English Culture, 1830-1980. 1985. New York: Viking Penguin, 1987.
Smedstad, Kari, MB, ChB, FRCPC, and May Cohen, MD, CCFP, FCFP. “Women in medicine: an overview of practice.” The Canadian Journal of Ob/Gyn & Women’s Health Care. June (1991): 171-72.
Youngson, A. J. The Scientific Revolution in Victorian Medicine. London: Croom Helm, 1979.