Anxious Times: Medicine and Modernity in Nineteenth-Century Britain

I.

‘There is abundant anecdotal evidence of the “conventional wisdom” that one of the defining features of contemporary social existence is the pervasiveness of anxiety.’ Thus kicks off a co-authored article of the Council for European Studies from 2018.(1) It argues that anxiety is what causes the modern pulse to race, and that, by consequence, to feel society’s pulse is effectively done by studying ‘anxiety culture’. While pointing at a wide range of signs that portend the extent to which our culture is pervaded with anxiety, the authors fail to historicise this sense of being at a particularly disruptive juncture in time. This is perhaps more indicative of the marginal role assigned to historians in European policymaking and less so of possible lacunae in historical scholarship. As a rich historiographical tradition has shown, a sense of novelty, of overwhelming newness, lies at the heart of many conceptions of modernity, in past and present.

People have always had reason to feel unease and anxiety; these have been understood and discussed in pathological terms for centuries. In July 1862, the literary critic Edward Bulwer-Lytton surveyed contemporary British society and — in an analysis not dissimilar to that of the Council for European Studies — observed reasons for concern wherever he turned: ‘In the high-wrought state of civilisation at which we are arrived, few complaints are more common than that of a brain overworked […], nervous exhaustion, with all the maladies consequent on over-stimulus and prolonged fatigue […].’(2) In the eyes of critics like Bulwer-Lytton — who feature prominently throughout Anxious Times: Medicine & Modernity in Nineteenth-Century Britain — Britain’s modernity project had, in some ways, proven too successful by the mid 19th century; as technological advances accelerated, and time itself seemed to speed up, the ‘high-wrought state of civilisation’ put unseemly pressure on its citizens. The machinery of progress had become an autonomous force, and — seemingly — no one was in control. Through a language of anxiety, ‘Victorians confronted and internalized their own sense of modernity’ (p. 221).

For this innovative study, the writings of critics such as Bulwer-Lytton, polemicists, physicians and journalists provide the main windows into anxious mind-sets of 19th-century Britain. It does not require a vivid imagination to relate to the nervous Victorians that populate its pages: the pressures of a fast-changing, modern, life turned people across towns and social classes into strained, overworked, exhausted, precarious, and bored inhabitants of Britain. Indeed, in a comprehensive introduction, the authors emphasise this familiarity across centuries — and, as such, the methodological pitfalls of approaching ‘modernity’. The authors make clear from the outset that they are concerned with debate and discourse, and therefore manage to nimbly avoid those pitfalls by approaching ‘modernity’ from within 19th-century frameworks rather than as a category of analysis. This approach is fruitful, particularly because the book positions itself confidently at the intersection of medical humanities and cultural history.

Victorians were not fundamentally different from us in the 21st century, the introduction points out. Current debates about the pressures of modern life on individuals and groups are not ahistorical, but are variations on older themes: a sense of information overload that was the consequence of a ‘deluge of print culture’ (p. 217) and rapidly evolving means of communication, for example, was accompanied by concerns about the loss of privacy. The bustle of the city led to sensory overload. Technological advances sparked fears of ‘overdevelopment’ and loss of jobs due to automation. Like historians of 19th-century ‘modernity’ before them, the authors point out its ambiguities; what is refreshing in their approach is that they do so by honing in on medical debates and their wider resonance in Victorian society. As such the book offers tentative connections in scope to Jill Kirby’s Feeling the Strain: a Cultural History of stress in twentieth-century Britain (2019), which offers a history of popular mentalities focussing on the strains of contemporary society in the 20th century.

Kirby examines the production and democratisation of stress knowledge, and the ways in which Britons internalised and expressed that knowledge. After World War Two, a strain of public discourse again situated that moment in time as especially ‘anxious’. In 1950 the psychologist Rolly May wrote in The Meaning of Anxiety how the ‘evidence is overwhelming that we live today in an “age of anxiety”’, mirroring the 2018 article of the Council for European Studies, as well as Bulwer-Lytton’s lament.(3) Kirby’s is a cultural history of discourse and, to a large extent, so is Anxious Times. Most of its source material is drawn from (medical and general) periodicals and popular print: expectedly, the Lancet and the The British Medical Journal feature heavily in each chapter, as they often pushed medical issues into wider debate. The authors make clear that they address the perceptions of, and attitudes to, felt anxieties rather than aiming to establish the validity — the ‘realness’ — of those anxieties: no statistical analysis of disease trends here, for example, but rather reflections on the emergence of medical statistics in popular discourse on what made ailments ‘modern’.

That the anxieties under investigation here are not medical per se, but are nonetheless understood in pathological terms, becomes apparent in the way the book is laid out to include the ‘sheer range of ideas’ (p. 15) that encapsulated a cultural sense of crisis, and which were observed to manifest themselves in minds and on bodies. The authors make six incisive, thematic excursions into this culture of disease. It is not surprising that periodicals and press take such a prominent place in Anxious Times. Jennifer Wallis, one of the authors, was a driving force behind a themed issue of Media History that appeared earlier in 2019 and focused on medical journals. The issue’s introduction rightly refers to the seminal text Medical Journals and Medical Knowledge: Historical Essays by W. F. Bynum, Stephen Lock and Roy Porter, which criticised the ‘arbitrary separations of the medium from the message’.(4)

This book itself has grown out of the ERC-funded project ‘Diseases of Modern Life: Nineteenth-Century Perspectives’ at the University of Oxford, which devoted significant research to the role of print. It is a particularly rewarding way into the themes of this study, given the importance contemporaries attributed to print culture in exacerbating anxieties of all kinds: both by providing a sensational(ist) platform and as a source of nervousness in and of itself. Newspapers and journals thus functioned as conduits of ideas and, in some cases, of a shared vocabulary of anxiety. They picked up on particular events and poured them into larger narratives of social overpressure, stress, and degeneration. Anxious Times is particularly convincing when it traces cross-medium (and transnational) trajectories of anxious perceptions and debates. Connectivity, in its many shapes, was an engine of anxiety: from railways to air travel, from telegraph wires to the nervous system itself. News, anecdotes, and rumour ‘went viral’; they spread like viruses.

II.

In many ways, then, Anxious Times is about how people dealt with the production and circulation of — and access to — knowledge and information about health and illness. The first chapter establishes the historical roots of 19th-century concerns with health on the work floor. It offers a sensitive study of the Victorian re-readings and translations of the early 18th-century text Diseases of Workers (first published in English in 1705) by Bernardino Ramazzini, the father of occupational health. Ramazzini was widely read by concerned Europeans throughout the 18th century, and continued to be a point of reference for scientific and popular discussions about occupational health by Victorians. Reaching back to even earlier times in this way, Anxious Times offers a valuable, though largely implicit, argument that undercuts the Victorian notion of a modernity defined by radical newness (itself, of course, a source of anxiety and exhilaration). Jan Golinski shows how melancholy was similarly considered ‘new’ in the 18th century: as a disease of modern life (p. 27). Hinting at the international radius of Ramazzini’s seminal text also helps situate British ‘anxious times’ against the backdrop of more widely-shared, Western fears and hopes. This chapter shows how debates on occupational health centred around deeper, moral and social arguments about workers’ health, linked to growing concerns about unceasing productivity demands, mechanisation, and competitiveness. These were not confined to the ‘usual suspects’ of historiography (factory work, mining, chimney sweeping) but included office work and jobs in the service industry. Nor were they exclusively British anxieties: the public knowledge of such modern pathologies was constituted through transnational interactions. Indeed, this book made me curious for a larger, transnational approach that traces anxieties and ‘diseases of modernity’ across national borders.

The theme of a perceived deluge of information also runs through chapter two. It innovatively ties together emerging communication technologies with medical practice. Historians of Victorian modernities have frequently examined the mosaic of emotions and sensations that Victorians experienced when faced with disruptive technology, from Charles Dickens’ near-fatal train journey on 9 June 1865 and fears of heart and eye diseases due to railway travel, to understandings of electricity as instilled with unfamiliar, even magical, powers (for this see the ‘Electric Generations’ project, which examines early attitudes toward electricity). New technologies were sometimes written about warily, even as enabling criminal and addictive personalities: with the introduction of electricity in the household, fears of ‘being a slave to the switch’ arose. As well as unsettling physical and mental states, this chapter shows convincingly, anxieties related to enthusiasm; disruption meant opportunity. Not long after the first electric telegraph line connected Euston Square and Camden Town in London, in 1837, doctors began using telegraphy as an emergency line for diagnosis-by-proxy. In the last quarter of the century, hospitals and city doctors embraced the telephone as ‘instrument of healing’ (p. 64) as well as for diagnosing through the horn.

The speed and efficiency of diagnosing by phone led to futuristic visions in which ‘London physicians would offer consultations to their patients in the countryside without leaving their offices’ (p. 72). The reality of the phone brought new medical anxieties, however, also for medical practitioners. Some of these feared increased workload for hospital staff — the tyranny of the telephone — and the oppressive speed with which modernity unfolded: the phone became ‘a tool by which to evaluate’ their professionalism and standing. Technology was intertwined with the public visibility of medical expertise. As John Tomlinson wrote with regards to the role of speed in discourses of modernity: to reject technology meant to appear ‘irrational’ and ‘obtuse’.(5) Perhaps most ‘modern’ about the introduction of communication technologies in medical practice was the active involvement of doctors in debates about their usefulness: doctors weighed in, for example, in discussions about the nationalisation of the telegraph in 1870.

Acceleration and distance raised concerns about physicians’ precision and accuracy; it also reduced fears of infection. As sanitary conditions improved and awareness of working conditions increased, so too did unease grow about the ‘smoke, smog, and fog’ (p. 91) that polluted industrialised environments. Chapter three turns to late 19th-century health tourism in coastal resorts, and ensuing debates about the need for a ‘change of air’ (p. 92), away from the airborne neuroses and ailments of modern life. The idea that modernity bred disease and an unhealthy lifestyle was linked to a sense of locality. ‘Place shaped illness’: the beach and the sea were, at least initially, associated with fresh air and healing. The chapter skilfully traces the evolution of this medicalised perception of ‘freshness’, to the ‘medical commodification of the British seaside’ (p. 121), to the public debates on sewage problems and seaside infection. In the fin de siècle, some medical textbooks incorporated resort guides that included the details of local doctors. By then, anxieties about ‘unhealthy bodies in need of control’ (p. 111) that travelled to coastal town hotspots like Brighton and Margate dominated public discourse. The coast had become a place shaped by illness. These towns became sites of criticism — about drainage and sanitation as well as the social consequences of health tourism — and subsequently of reform and legislation.

Similar developments mark chapter five, which extends Victorian notions of a healthy mind in a healthy body (in a healthy habitat) through the lens of the educational system. Whereas the health tourist was held personally responsible for their troubled state — and was sometimes even blamed for recklessly ‘infecting’ the seaside resort — the child was painted unambiguously as victim. In 1862 the Education Secretary Robert Lowe introduced the Revised Code, and with it the need for ‘accountability for the use of public funds in terms of academic performance’ (p. 150). Ideas of productivity and revenue in the classroom led to worries over occupational health extending to the habitat of the classroom, where they centred on the pressure of increasing educational demands on children and university students — particularly girls, and particularly working-class children. Their bodies and brains still in development, their exposure to increasing amounts of homework and pressure to perform led to reports of children succumbing to bodily and mental afflictions, from clammy hands to ‘examination fever’, and from fatigue to illness and disorder (the term ‘anorexia scholastica’ was coined by the psychiatrist James Crichton-Browne in 1892). Tragic stories were picked up in the press and made for fiery polemic, in which doctors claimed a central space. This chapter is particularly effective in disentangling the dynamic between medical expertise, print culture, and wider social fears about ‘cramming’. It offers a deeper contextualisation for earlier work such as Catherine Robson’s on poetry recitation in the Victorian classroom.

Children’s ‘diseases of modernity’ touched a particular nerve in Victorian culture, because they pathologised the oscillations between ‘self-improvement and self-destruction’ (p. 152), between progress and regression, and commodified children themselves as educational revenue. Fears about bodily and mental inflammation also honed in on a modern lifestyle of thrill-seeking and escapism. Stories of intoxicated students exacerbated concern about the havoc caused on young bodies by the education system. Anxieties often revealed underlying moral judgments, that were themselves caught up with ideas of modernity. Chapter four, which examines the fearful fascinations with middle-class women who drank in secret, quotes Thomas Carlisle: ‘[M]odern society has got into a fatal circle. Owing to the high pressure at which life is carried on, there is a constant necessity for fresh fuel and … the habitual use of stimulants.’ But much of 19th-century public discourse in this chapter instead treats women tipplers as ‘drifting into’ secretive alcoholism, ‘for the sole reason of having something to do’ (p. 132). Unlike working-class alcoholism, which incited anxieties of its own and has long been a popular subject for historians, female ‘drawing-room alcoholism’, as The Review called it in 1871 in a long opinion piece, happened at home and in secret, and was all the more insidious for it. It is difficult to ascertain just how much of a problem middle-class drinkers posed; this chapter is particularly insightful as a window into how discussions in print (medical and popular) created the perception of a widespread problem. In this capacity it offers a methodological response to Susan Zieger’s Inventing the Addict (2008), which also weaves together medical and cultural histories. Similar to stories of children’s demise, secret drinkers and other middle-class addicts were reported — often in titillating and tantalising ways — as pathological exponents of modern culture: periodicals reported on ‘cocaine inebriety’, ‘morphinomania’, and ‘dipsomania’. It left this reader curious for a deeper analysis of the power of genre conventions in maintaining and reinforcing anxieties, as well as about readership: suggestively, the chapter hints at working-class fascination with reports on upper- and middle-class ‘bad behaviour’.

Many of the cases that resonated in wider culture played out against the backdrop of medical uncertainty. Knowledge about these ‘diseases of modernity’ developed simultaneously in expert and public discourse; this made of them ‘barometers of cultural anxieties and political attitudes’ (p. 120) — for example about the visibility of women in the public sphere. These anxieties could grow to envelop humanity as a whole. Chapter six explores cultural fantasies of degeneration and adaptation through changing understandings of the nervous system. Its focus on the nerves brings together themes touched upon in previous chapters, and takes them into a broader socio-biological imaginary: ‘if humankind directs all its energies to the brain and nervous system at the expense of the body, the result will be inhuman, and potentially monstrous’ (p. 211). Building on work by Roy Porter and Janet Oppenheim (Oppenheim’s Shattered Nerves [1991] echoes throughout), this chapter explores wider fascination with the near-mystical status of the nervous system and the apparent paradox inherent to heightened nervousness, as ‘modern’ and making its subject less fit to cope with that ‘modernity’. In many of the sources that are used in Anxious Times, modern diseases paved the road to degeneration; ‘teetering on the verge of collapse’ is a recurring phrase throughout all six chapters.

This last chapter ventures into literary scholarship with an extensive analysis of H. G. Wells’ satirical short story ‘Man of the year million’ (1893), in which the future of humanity is shown to be squid-like, at once superior and inferior to their 19th-century ancestors. Wells’ humans are highly intelligent, but physically degenerated, creatures huddling closer to Earth’s core as the planet dies. Allen MacDuffie has shown how the idea of finite resources underscored industrial and technological pride: the country’s dependency on ‘a continual burning’ of energy triggered some writers into visions of the future in which global ecosystems and even the whole solar system collapsed.(6) The authors of Anxious Times argue convincingly that concerns about finite resources extended from the mental energy of children, to air quality, to the ecosystem. Projecting fears onto ever-larger scales could be tied in with imperial advancement, as Deborah R. Coen has shown for the Habsburg Empire in Climate in motion: science, empire, and the problem of scale (2018).

III.

The ‘onslaught of modernity’, as it was experienced by some vocal Victorians, was felt as such because it seemed out of one’s control. Ailing bodies were on the move, on foot, in trains, carried around in ambulances; spaces became increasingly ‘socially promiscuous’, diseases became cultural.(7) That is not a new insight, and indeed the anxieties of Victorians have been a rich mine from which to draw history for some time. Anxious Times opens up several important new pathways for this historiography, and it does so in a deceptively simple manner. Although the six thematic chapters offer seemingly separate case studies, taken together they give an innovative approach to modernity studies. When, in 1869, the physician George Miller Beard diagnosed neurasthenia based on five elements, these were symbolic of the 19th century: steam power, the press, telegraphy, sciences, and the ‘mental activity of women’ (p. 186). The ails and worries of modern Britons fed into a British myth of modernity, which was Protestant and Anglo-Saxon: in Beard’s view, they excluded Catholics, southerners, Indians and people of colour. To be diagnosed as ill, therefore, was to be modern. Anxiety was modernity’s currency. It paid for morphine and quinine, for cocaine and opium, but also for tonics and treatments. Its pervasions — real and imagined — fostered medical, tourism, advertising, and pharmaceutical marketplaces as well as spurring on legislation, reform, and standardised data collection.

Anxious Times delivers a rich tableau, brimming with pathological unease and nervousness. At its heart, this is a study of a society grappling with information-overload and, relatedly, with a sense of radical change that incited to discourse (to paraphrase Foucault). Doctors asserted an active role in public debate, whether to write opinion pieces against competitiveness and corporal punishment in schools, or to suggest banning drinks for women at parties to combat secretive tippling. It is an important book, and the authors manage to break new ground in a sustained manner. Their approach — which reconstructs the spiralling dynamic of a modernity that awakens fears which in turn trigger further modernisation — is refreshing. The conceptual scope of the book leaves one with the feeling that much more work is needed to expand on themes where medicine and modernity intersect — for example in the turn to spirituality at the end of the century. It is a welcome reminder for cultural historians and historians of medicine alike that there is still much to be gained from more systematic collaboration. The results, this book shows, can be exhilarating.(1)

Notes

1. Michael I. Shapira, Ulrich Holnkes and John P. Allegrante, ‘Anxiety culture: the new global state of human affairs?’, Europe Now Journal, July 2018 <https://www.europenowjournal.org/2018/07/01/anxiety-culture-the-new-global-state-of-human-affairs/> [accessed 14 August 2019].Back to (1)
2. Blackwood’s Edinburgh Magazine, July 1862, p. 40.Back to (2)
3. Rolly May, The Meaning of Anxiety (New York, NY, 1977 [1950]), p. ix.Back to (3)
4. W. F. Bynum, Stephen Lock and Roy Porter, ‘Introduction’, Medical Journals and Medical Knowledge: Historical Essays (London, 1992), p. 4.Back to (4)
5. John Tomlinson, The Culture of Speed: the Coming of Immediacy (London, 2007).Back to (5)
6. Allen MacDuffie, Victorian Literature, Energy, and the Ecological Imagination (Cambridge, 2014), p. 66.Back to (6)
7. Matthew Newsom Kerr, ‘“Perambulating fever nests of our London streets”: cabs, omnibuses, ambulances, and other “pest-vehicles” in the Victorian metropolis’, The Journal of British Studies, 49 (April 2010), 283–310, 309.Back to (7)