Interdisciplinary Perspectives on Aging in Nineteenth-Century Culture

Anne-Julia Zwierlein, Katharina Boehm, Anna Farkas

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136669095
• Edition: 1
• Topic: Social Sciences
• Subtopic: Gerontology
• Index: Social Sciences

This essay collection develops new perspectives on constructions of old age in literary, legal, scientific and periodical cultures of the nineteenth century. Rigorously interdisciplinary, the book places leading researchers of old age in nineteenth-century literature in dialogue with experts from the fields of cultural, legal and social history. It revisits the origins of many modern debates about aging in the nineteenth century – a period that saw the emergence of cultural and scientific frameworks for the understanding of old age that continue to be influential today. The contributors provide fresh readings of canonical texts by Charles Dickens, Elizabeth Gaskell, Anthony Trollope, Thomas Hardy, Henry James and others. The volume builds momentum in the burgeoning field of aging studies. It argues that the study of old age in the nineteenth century has entered a new and distinctly interdisciplinary phase that is characterized by a set of research interests that are currently shared across a range of disciplines and that explore conceptions of old age in the nineteenth century by privileging, respectively, questions of agency, of place, of gender and sexuality, and of narrative and aesthetic form.

Part I

Science, Social Reform, and the Aging Body

1 A Respectful Challenge to the Nineteenth Century’s View of Itself

An Argument for the Early Modern Medicalization of Old Age

Lynn A. Botelho

Western Europe in the nineteenth century was undeniably undergoing significant changes in the worlds of medicine, law, and literature, as well as in its family life and demographic structure.¹ The century was hallmarked by the industrializing process and man’s belief (and, yes, I do mean “Man”) in himself and his ability to control and dominate the world around him, be it in terms of imperial conquest or of the very health of his own person. That is how the nineteenth century saw itself, and indeed that is often how we see the nineteenth century. Yet, I suggest that when it comes to geriatric medicine and the medicalization of old age, we might have taken the nineteenth century’s understanding of itself too much at face value. I want to explore how the topography of old age and health care changes when we broaden our frame of reference to include those centuries prior to the nineteenth and when we allow for more inclusive definitions of the terms “medicine” and “medic,” rather than limiting ourselves to modern meanings generated in the nineteenth century. In short, I want to suggest that the “medicalization” of old age and beginnings of geriatric medicine were products of late-seventeenth- and early-eighteenth-century England, if not earlier, and to explore those developments in terms of an early expression of modern gerontology.²

The Traditional Narrative

What I am suggesting flies in the face of much of what is “known” about medicine and the elderly. The basic argument for situating the start of the medicalization of old age in the nineteenth century can quickly be summed up in five points. 1) To be a “qualified” medical practitioner one had to be university-trained. 2) This person had to be recognized as such by a governing body. 3) Only our modern understanding of biology and medicine is a valid construct and all other, and earlier, ways of thinking are rejected as wrong because they could not work. (This strikes me as rather teleological and not perhaps the best approach to studying the past.) 4) The elderly are singled out as a distinct medical constituency, with their own problems and requiring their own cures or treatments. And, 5) There are dedicated studies, books, and articles about the health and treatment of the old.

The discipline of gerontology builds directly on these arguments. Formally organized and professionalized only in the mid-twentieth century, this specialty seeks to promote “healthy aging” by drawing upon experts across a wide range of disciplines: sociology, medicine, psychology, and theology. In short, gerontology aims to develop the whole aging person. Such an approach relies not only on medical interventions, but considers all aspects of the elderly person’s life, from food and exercise to sex and spirituality.³ Gerontology describes itself as a discipline that draws upon experts from across a wide range of fields, but (and this is a significant “but”) these “experts” are expert according to nineteenth-century terms and definitions. In some ways, today’s gerontology has positioned itself as a very modern and holistic approach to the care of the elderly. What I would like to suggest below is that such a whole-person approach is rather more old than new.

Central to why I believe that we have too readily accepted the nineteenth century’s view of itself is an understanding of the period’s process of “professionalization.” This is the process by which a trade or craft established lines of demarcation between its practitioners, creating a binary between “professionals,” those with a recognized mastery, and “unqualified” amateurs. The rights to self-govern, to regulate admittance, to determine the “qualified” from the “unqualified,” were keys to the process of professionalization and perhaps nowhere have they been more successfully constructed than in the creation of the medical profession.⁴

The professionalization of medicine in England gained particular strength during the early decades of the nineteenth century, when formally trained doctors called for the professionalization of their occupation on two grounds: 1) overcrowding and consequently heavy competition from “unqualified” medical practitioners and 2) the potential harm that these unregulated medical practitioners could do to patients (although it was acknowledged by the doctors themselves that it was the competition that they most feared). The result was the passing of the Medical Act of 1858, its establishment of the General Medical Council of Medical Education and Registration, the council’s controlling membership mostly of doctors, and the council’s ability to self-regulate. Access to the “profession” of medicine was now controlled through the council, which oversaw education and training, and were the gatekeepers to registration as a formal “doctor.” They did not, nor could they yet, make the practice of medicine by those not registered illegal, but the result was a clear boundary between “qualified” and “unqualified” practitioners of medicine.⁵

Geriatric medicine and the medicalization of old age, if we are to follow the traditional historical narrative, were products of this emerging nineteenth-century medical culture. They were also products of a “modern” approach to the organization of knowledge that classified information into discreet groups, and particularly the classification of all living things into genus and species.⁶ The grouping of people into types, in this case the elderly, flowed naturally from this habit of mind.

Beginning in the very late eighteenth century in North America, and then with more frequency in England and Germany, a number of learned medical books were published whose focus was strictly on the elderly.⁷ For example, Benjamin Rush’s Medical Inquiries and Observations was first published in Philadelphia in 1793, and George Edward Day’s A Practical Treatise on the Domestic Management and Most Important Diseases of Old Age was printed in 1849 in London. In 1867, Jean-Martin Charcot’s famous Clinical Lectures on the Diseases of Old Age was published in French, and two English editions appeared in 1881. It was shortly thereafter, in 1909, that the term “geriatrics” was first introduced into the medical discourse.⁸

Furthermore, to be counted as legitimate, knowledge of the aging body had to be acquired through a university education and from the publications of research physicians. Such knowledge was to be produced by clinical studies and scientific observation. Lay medical knowledge was discounted as quackery, and eventually lay claims to medical authority were outlawed.⁹ Geriatric medical knowledge, to put it most bluntly, could only be geriatric medicine if a university-trained “geriatric” physician practiced it. Geriatrics was the epitome of an emerging nineteenth-century profession. It was a hermeneutically sealed, self-referential system— and one whose sense of identity and development we might have taken too much at its own word.

Old Age and Learned Medicine

Daniel Schäfer’s commanding Old Age and Disease in Early Modern Medicine (English edition 2011), offers the most comprehensive and nuanced investigation of the medical treatment of old age between 1500 and 1800.¹⁰ He ultimately concludes that a medicalization of old age did not happen in the early modern period, even though it looked very much like it did.

Schäfer analyzed over 1,700 monographs on old age from across all of Europe. He identified three phases of production. The first, between 1400 and 1600, was focused on the collection and organization of knowledge and was firmly based in a strict understanding of the Aristotelian-Galenic tradition. The second phase, from roughly 1620 to 1700, was dominated by what he called “proto-geriatric university writing” (174). This period witnessed a split in the approach to aging. One set of authors continued to rely upon the writings of the ancients. Another group developed a further understanding of the specific diseases and treatments of old-age illnesses. Books of the third and final phase, between 1700 and 1900, was written outside of the universities, but by trained medical men. Whereas their approach to treating the elderly remained “eclectic,” a mix of old and new, these books actually presented a more complete view of geriatric medicine than those written from within the academy (173–75).¹¹ It was also during the early years of the eighteenth century that old age itself, as well as its external signifiers, became a disease in its own right. At this point, Schäfer acknowledges that things “look” like the medicalization of old age and “proto-geriatrics,” but ultimately concludes that it was not the case (179–83).

Schäfer rejects the medicalization thesis on seven grounds. (I hasten to add that this shortened account does not do justice to his full argument.) 1) There was no professionalization of old-age medicine. 2) Specialist texts were “merely literary” and not generated from within a university setting (179). 3) No famous university professor wrote on it. 4) Medical writings were too strongly influenced by nonmedical traditions, such as theology and philosophy. 5) Nineteenth-century medical authorities therefore denied that such information was “knowledge.” 6) “No call was made for any specific research or clinical practice in the realm of geriatrics” (181). 7) The early modern understanding of old age was negative and pessimistic. Schäfer therefore agrees that Peter Stern’s position that “geriatrics was born in the nineteenth century” is “fully correct” (183). Further, Schäfer suggests that it was not until after 1750, with the Enlightenment and a changing medical culture, that elderly individuals were thought to require help, and that society, individuals, and a fledgling welfare state were now required to give it. It is here, with the construction of a helpless old age, that Schäfer considers old age to be medicalized (179–83).

Broadening Our Frame of Reference

But what happens if we build upon Daniel Schäfer’s understanding of learned medicine; what happens to this construct if we broaden the terms of our discussion? What if we allow ourselves to move outside the tightly bound parameters of the nineteenth century’s understanding of professionalization? What if we look outside the university environment and away from learned medicine? And, finally, what if we take seriously older (and non-“scientific”) ways of thinking and approaches to knowledge?

If we turn to England and employ a wider scope of enquiry and a broader set of definitions, three trends emerge during the late-seventeenth and early-eighteenth centuries: 1) the “medicalization” of old age; 2) an emergence of geriatric medicine; and 3) an approach to treating the whole elderly person that resembles what we now call “gerontology.”

England’s place in sixteenth- and seventeenth-century medical culture was distinctive. It was a world where medicine was widely practiced by an astonishingly wide range of people, espousing equally comprehensive sets of theories. Old herb women skilled in the arts of materia medica, or the therapeutic use of herbs, competed with university-trained physicians who quarreled amongst themselves over the relative merits of Paracelsian medicine, Helmontian medicine, or the tenacious Galenic approach. In between, there practiced surgeons, barber-surgeons, apothecaries, and sturdy English housewives.¹² However, for the majority of English women and men living outside of London, it was one’s wife, mother, or local gentry housewife who, often with manuscript recipe book in hand, who diagnosed the ailment, dispensed the medicines, and pursued the cure.¹³

An examination of thirty-eight manuscript household recipe books, spanning the early-sixteenth to early-eighteenth centuries, sheds light on t...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• List of Figures
• Introduction
• Part I Science, Social Reform, and the Aging Body
• part II Intergenerational Exchanges
• Part III Transformations and Appropriations of Victorian Old Age
• Epilogue
• Contributors
• Index