A Dose of Fiction, by Angela Spivey, Endeavors, fall 1998

A Dose of Fiction
by Angela Spivey

Between Doctors and Patients: The Changing Balance of Power. By Lilian R. Furst. University Press of Virginia, 300 pages, $37.50.

Most people think of Robert Louis Stevenson's Dr. Jekyll and Mr. Hyde as a story about split personality. But it's also about the fear of medical technology, says Lilian Furst, professor of comparative literature.

In Stevenson's novel, it's the laboratory that produces the lurid Mr. Hyde, who jumps down "from among the chemicals." Furst says, "It was a drug, an impure chemical, that led to the creation of this deformed, depraved character. That shows that people in the later nineteenth century were suspicious of the laboratory." Even though lab research produced benefits, such as the rabies vaccine in 1885, the public was still skeptical because laboratories were known more for producing diagnostic methods than cures, Furst says.

In Between Doctors and Patients, Furst uses Dr. Jekyll and other fiction to explore how medicine has progressed from the early 19th century to the present. In some cases, Furst says, fiction can reveal what the history books can't. "I came across a phrase by a current young medical historian who said, `We have no way of knowing what physicians did at the bedside in the nineteenth century.' My argument is that by looking at realist fiction, we do have ways of knowing."

The details of those relationships are important, especially if you're studying the 1800s, when communication was pretty much all doctors and patients had. Until late in the 19th century, doctors knew relatively little about disease. Most thought that infections were caused by miasma—bad vapors that rose off marshes or decaying plants. Doctors usually made house calls and diagnosed patients by relying heavily on intuition and observations of the patient's color, pulse, urine, and home life.

Since doctors had little specialized knowledge, patients felt free to contradict their advice. In Anthony Trollope's Dr. Thorne, an alcoholic aristocrat named Sir Roger dismisses Thorne because the doctor scolds him for drinking himself to death. "Sir Roger hires another doctor who will be more tolerant of his drinking," Furst says. "Patients could be very highhanded. The physician was simply the patient's employee."

It wasn't until the later 19th century, when knowledge of germ theory and use of instruments such as the stethoscope became common, that doctors began to grow more expert—and more powerful. Since then, technology has given doctors increasing ability to treat patients. But, Furst says, we need to remember what the early doctors did know—that patients are people. Considering lifestyle and environment can be important in treating illness, but that's hard to do when you "put somebody into an office and encase them in a paper gown," Furst says.

Furst hopes that her book will add to the discussion already taking place in many medical schools. "Physicians are very aware of these problems. And I think that particularly the younger physicians are trying harder to incorporate the social context of patients into their treatment. However, they're under pressure from the HMOs who hold the purse strings and pressure them to see a certain number of patients per day."

Despite these constraints, Furst says, she hopes that technology will free doctors to return more of their focus to people. "Maybe technology can be harnessed to liberate physicians from some of the routine tasks and give them more time to do the things that only a human being can do. The machine can diagnose, but only the physician can heal."