Novel care: public health and professional caregiving in the nineteenth-century British domestic novel
Creators: name: Dennis, Kylie
Publisher: name: No Publisher Supplied
Year: 2024

description: In Communities of Care, Talia Schaffer describes the early nineteenth-century care community as an "ad-hoc, flexible, small grou[p] of caregivers" typically composed of one’s relations or neighbors. Both in historical reality and in the pages of domestic fiction, these caring collectives functioned as the primary means of addressing the period’s abundance of illness and disability. However, by the mid-century, Schaffer notes that care communities were no longer "visible as the default way of dealing with sickness," overshadowed by the rise of professional medicine and its attention to an undifferentiated mass public. Late-century fiction, she argues, mourns the loss of these intimate collectives, regularly referring back to and attempting to recreate them. This dissertation contributes to Schaffer’s history of the care by demonstrating how the domestic novel’s nostalgia for the care community is often accompanied and destabilized by the genre’s concerns about the efficacy of such an intimate model of care, especially against the century’s mounting public health crises. From Jane Austen to H. G. Wells, nineteenth-century novelists repeatedly imagine how care might be scaled up to address the needs of a local, national, and even global public. In doing so, their fiction also anticipates pressing questions about who might be held responsible for enacting this new, large-scale and professionalized approach to care and how they might go about performing it. In conversation with theorists of the novel, cultural historians, and care ethicists, this dissertation explores how the development of the British public health system is imagined, reflected, and theorized by the nineteenth-century domestic novel. In the novels at the heart of this project, I identify a surprising narrative pattern: 1) Outside of the main narrative arc, each novel references an ongoing public health crisis, whether real or imagined. This crisis produces a kind of narrative urgency that underlies characters’ speculations about the relative health of the local and national public and the future of public healthcare. 2) Public health initiatives are spearheaded by a central professional man, displacing generations of women who were traditionally associated with care work. In fact, these novels repeatedly represent women caregivers as hypochondriacs, meddling busybodies, and dangerous devotees of quack medicine. 3) Although each novel explores a particular approach to public health, they also confront obstacles that complicate the scaling up of care. Despite the efforts of these professional men, public health measures in these novels often render care inaccessible or unrecognizable. By attending to this narrative pattern across the nineteenth century, I track how novelists began to grapple with both the need for and potential failures of public health initiatives.This dissertation is organized into four chapters. In each chapter, I explore a different public health crisis as well as a central male figure whose profession motivates a particular approach to public health. In Chapter 1, I read Austen’s Sanditon (1817) in order to examine the rise of the public health entrepreneur in the early century. Taking advantage of a period of economic upheaval, Mr. Parker seeks to transform care from a concrete domestic practice to an abstract institutional enterprise that monetizes the public’s fear of illness. In Chapter 2, I investigate the figure of the soldier in Charlotte Yonge’s The Clever Woman of the Family (1865). Alick and Colin Keith, wounded soldiers returning from the Sepoy Rebellion, outline an approach to public health that centers a paradoxically intimate institution – a care home that provides meaningful work for starving local children while also treating the wounds of imperial soldiers. While the entrepreneur seeks to endlessly expand care, Yonge’s soldiers endeavor to limit their efforts to a national scale, creating a strategy for public health that is at once expansive and insular, national but also strictly nationalist. In Chapter 3, I read Harriet Martineau’s Deerbrook (1839) alongside George Eliot’s Middlemarch (1871) to investigate the figure of the provincial doctor. Hope and Lydgate aim to protect the public from the devastating cholera epidemic both by promoting a new standard of rational care and by contributing to professional medical knowledge. However, neither doctor succeeds in making headway against the spread or severity of the disease. Read together, these novels question whether the trained medical man and his new medical epistemologies are any more efficacious than the lost care community. In Chapter 4, I look ahead to Wells’s Tono-Bungay (1908) to consider the state of public healthcare by the end of the century, paying particular attention to the entrepreneurial, soldier, and doctor figures that are reprised in this text. While the early- and mid-century authors across this dissertation maintain some degree of optimism about the future of care, Wells predicts the destruction of any recognizable model of caregiving by the corrupt global pharmaceutical industry.