Book Reviews 125 Lawrence Rothfield, Vital Signs: Medical Realism in Nineteenth-Century Fiction . Princeton, N.J.: Princeton University Press, 1992. xvii + 235 pp. Clothbound, $27.50. Lawrence Rothfield has done the field of Uterature and medicine an enormous service by writing Vital Signs: Medical Realism in NineteenthCentury Fiction. He examines the rise of the medical profession in the early nineteenth century, both in England and in France, and expertly reviews and cites historical and sociological literatures. He compares the reaUstic novelist in this period to the doctor. Both embark on a process of professionaUzation to achieve autonomy and authority, and both clarify , through practice, the grounds upon which truth is confirmed, reaüty is faithfully represented, and individual lives are made transparent to the recording eye. He examines several works of reaUst fiction in depth to defend his claim that writers in this genre adopted clinical medical discourse, not only as structural grounding, but also as a source of authority for truth telUng. Finally, he conceptualizes literary reaUsm and clinical medicine, not merely as analogues but as two manifestations of the same social, cultural, and epistemological forces. The book is a service both because it succeeds in some of its goals and because its failures are cautionary tales that scholars in the field of Uterature and medicine must heed. The first several chapters are well-conceived studies of the fictions of Flaubert, Balzac, and Eliot. These chapters stand out in the book for their rich interdisciplinary (and even intertextual) exploration of medical practices that were current when these novels were published. Rothfield takes on the important project of evaluating the epistemological means by which cUnicians determined such states as health and disease. By offering a clear summary of several systems of medical knowledge that nineteenth-century French and British physicians employed (preclinical eighteenth-century medicine, Bichat's pathological anatomy, Claude Bernard 's experimental medicine, French pre- and post-Pinel psychiatry), Rothfield makes a strong case for the need to historicize texts in making generic decisions about them. In tightly reasoned and ably written critiques, Rothfield subjects Madame Bovary, Le Médecin de campagne, and Middlemarch to medicoUterary scrutiny. Flaubert is characterized as adopting cUnical relations with his characters, acting toward his characters as doctors would toward their patients, and fixing them with the Bichatian medical gaze of nonjudgmental and accurate recording of all corporeal and environmental details that might contribute to pathology. Rothfield recognizes the aloof, om- 126 BOOK REVIEWS niscient authorial presence often labeled realist as one of clinical medicine 's contributions to fiction. Balzac's realism—his transparency, his quest for the totality of meaning, and his treatment of the character as "type"—is seen to have devolved from French psychiatric models. Rothfield seeks to unify Balzac's literary devices by naming psychiatric theories , nosology, and practices as the generative source of Balzac's techniques . In Lydgate, George Eliot develops the Bichatian physician who represents both knowledge and feminine compassion, who demonstrates humble humanity while he reveals his superiority over less advanced physicians. Ultimately, Lydgate fails in his quest for the unifying principles of pathological anatomy's theories of disease. Eliot seems to realize that Bichat is soon to be overshadowed by cell theorists, embryologists, and evolutionists. Examining intellectual history critical to the literatureand -medicine enterprise, Rothfield presents Eliot as skeptical of a clinical medicine based on Bichat's tissular theories, as able to see above the web of organic relations toward a biological (and, Rothfield would say, novelistic) universe in which species eventually outdo themselves and artificial boundaries between such neighboring entities as organs or genres can be ignored. Rothfield then studies two genres distinct from realism — naturalism and detective fiction—in a rather unsuccessful attempt to define realism more crisply. These chapters —on Zola and Conan Doyle —suffer from Rothfield's tendentiousness in demonstrating the superiority of his socalled archaeological methods over such methods as ideological criticism, biographical criticism, and other new historicist approaches. A penultimate chapter, which applies these methods to The Wings of the Dove, is disappointing. Looking for the meaning of illness and healing events in this novel with only the terms and frameworks of pathological embodiment , the author misreads essential features of...
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