The following book review was written for the Mark Twain Forum by Kevin Mac
Donnell.

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BOOK REVIEW

MARK TWAIN AND MEDICINE: "ANY MUMMERY WILL CURE." By K. Patrick Ober.
University of Missouri Press, 2003. 362 pp. Cloth. $47.50. ISBN
0-8262-1502-5.

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Reviewed for the Mark Twain Forum by
Kevin Mac Donnell

Copyright © 2004 Mark Twain Forum. This review may not be published or
redistributed in any medium without permission.

Anyone glancing over the shelves of Mark Twain studies published in the
last one hundred years can't help but notice that scholars have approached
Twain by repeatedly pairing him with nearly every subject, theme, region,
and personality that can be imagined: Twain and government, Twain and court
trials, Twain and race, Twain and women, and religion, and power, and time,
and tall tales, and travel, and Cervantes, and Thackeray, and the Bible,
and England, and Germany, and Nevada, and Australasia, and Nook Farm, and
Vienna, and the South, and the West, and con artists, and Teddy Roosevelt,
and George W. Cable, and Bret Harte, and W. D. Howells, and General Grant,
and even Twain and Samuel L. Clemens. A library of Twain studies looks a
lot like a library of Shakespeare or Dickens studies, and it boggles the
mind to conceive of any pairing that has not been published before. At this
late date, when the list seems endless, what new pairing could possibly
yield anything worthwhile?

The answer is Dr. Patrick Ober's _Mark Twain and Medicine_. Given the
central role that the practice of medicine played throughout Twain's
personal life and because so much of that experience is reflected in both
his major and minor writings, it seems remarkable that a comprehensive
study of Twain and medicine has not appeared sooner. Of course, the subject
has not been completely ignored. Among the earliest studies were George
Wharton James' article on Twain and fasting (1919), and Louis J. Bragman's
1925 article on Twain's "medical wisdom." Dixon Wecter (1952) certainly
blazed a trail when his research identified the specific brand of
painkiller Tom Sawyer administered to the family cat. But despite these and
a few other studies, the medical aspects of Twain's biography and their
implications for his writings have always remained in the background,
rarely given consideration as a major portal into Twain's mind, or as a
means to interpret Twain's approach to his life and art. Ober's work will
certainly change this situation, and provoke new insights into some
previously accepted diagnoses.

Throughout his life Twain was fascinated by new technologies, new
money-making schemes, and new social movements, and like some serial
trend-spotter he repeatedly embraced and discarded new inventions or
investments or social causes, one after another. His typical pattern was to
embrace his latest infatuation with boundless enthusiasm, discover its
fatal flaws over time, and ultimately reject it in a spasm of outrage and
guilt. Twain's approach to medicine followed this pattern as well. Ober, in
the best bedside manner, takes us through the series of medical experiences
that laid the foundation of Twain's basic views, beginning in his childhood
when he was the unwilling victim of his mother's enthusiasms for folk cures
and patent medicines, and onward through his encounter with his future
wife's wealthy and well-educated family, the Langdons, who placed their
faith in a quack doctor and faith-healing, and finally to the water cures
and rest cures that failed to save his wife and two of his daughters. In
twenty chapters, Ober examines nearly twenty medical therapies embraced at
one time or another by Twain, provides their medical and cultural contexts,
explains Twain's experience with them, and explores how they function as
themes in his writings.

Critical to understanding Twain's view of medicine is an understanding of
the difference between disease and illness, and Ober explains that
difference in both the context of Twain's day and our own. Diseases arise
in the physical body, and have biological origins; illnesses arise in the
soul, are less often biological in origin, and are shaped by the patient's
own attitudes, beliefs, and expectations, as well as those of society. Of
course, a patient can have both a disease and an illness at the same time,
and some illnesses can be described as the way a patient experiences a
disease. But the treatments for diseases and illnesses differ. Ober places
each specific disease and illness in both the medical and social context of
the times, and demonstrates how Twain keenly understood the differences
between them. Illnesses were more common than disease, and tended to
respond better to the therapies of Twain's day. Unfortunately, the medical
practitioners of Twain's day were seldom prepared to provide a cure for
either.

Yet the shortcomings of the practice of medicine in Twain's day did not
prevent him from constantly seeking relief for his own and his family's
afflictions, but quite the contrary. But assessing the efficacy of various
treatments was no simple matter. The fact that most diseases resolve
themselves eventually without any treatment at all often created the
impression, at least temporarily, that whatever medicine or therapy was
being employed was actually working. Likewise, both diseases and illnesses
often respond to placebos, and Ober explores the powerful role of the
placebo affect. Also, it was a common belief in medical circles that to do
nothing in the face of disease was worse than doing something, but the
results of "doing something" were often tragic, especially when "doing
nothing" might have allowed a disease to resolve by itself. For these
reasons it was sometimes difficult for Twain or even doctors to know
whether a particular therapy was really working, as obvious as it might
seem to us now. Medical science and practices were constantly evolving
during Twain's lifetime, and the repeated failures of each new therapy in
curing diseases (most diseases were untreatable in Twain's day) caused him
to keep an open mind toward any new therapy that appeared, not unlike other
Americans of his day, and not unlike people today whose diseases have not
responded to modern treatments. Because illnesses were more common than
diseases, and did tend to respond better to available treatments, Twain was
quite tolerant of alternative practitioners. Again, Twain's readiness to
explore alternative medicines was not atypical of his time, but Twain's
wise understanding of the relationship between disease and illness was more
sophisticated than most Americans of his day. Ober calls Twain a "medical
eclectic who was usually willing to try any method that seemed to offer
hope, even if it could not offer cure." (p. 18). Twain believed that hope
was the most valuable thing a doctor could offer a patient, and that
healing the spirit was a greater benefaction than healing the body. Such
healing (of illness) took place more often than curing (of disease).

Readers would do well to keep in mind that Twain's attitudes toward
medicine shaped many of his behaviors as well as his writings, and that
Twain's beliefs about medicine were not unlike those of most doctors and
patients of his time. Nineteenth century medical practices can often
explain events and behaviors that have otherwise baffled modern scholars.
Ober explores several incidents in Twain's life that have attracted much
scholarly comment over the years: the autopsy of his father that he
witnessed as a boy, Livy's recovery from "neurasthenia" after a brief visit
from a quack doctor, and Twain's exclusion from Livy's sick-room at the end
of her life. Ober puts each of these in the context of the medical
practices of the day, which casts each of those incidents in a new light,
and scholars and readers who have accepted previous scholarly verdicts
about these events would do well to reconsider. For example, Ober explains
how the autopsy of Twain's father was performed for reasons consistent with
contemporary medical practice, and how it was just one incident among many
that shaped Twain's attitude toward death. Livy's early illness was a
common malady, and its cause and cure cannot be fully understood today
without understanding the social context of "neurasthenia" in the late
nineteenth century (and how it later seemingly disappeared from the scene).
Finally, Twain was excluded from Livy's sick-room during most of her last
illness simply because that was a standard protocol in the rest-cure
treatment.

Likewise, the previous interpretations of Twain's writings that involve
medical themes may also need revision. Ober does not call for a fresh look
at the oft-debated ending of _Adventures of Huckleberry Finn_, but he does
examine in detail the three methods of wart-cure mentioned in _The
Adventures of Tom Sawyer_ (incantations and dead cats, split beans and
blood, and spunk-water) and after reading the elaborate rituals that are
critical to the success of these placebos, Tom Sawyer's ritualistic antics
at the end of _Adventures of Huckleberry Finn_ look a lot less romantic (or
absurd, or a satire of Reconstruction efforts) when the cultural context of
his wart-cures is understood. Unlike modern readers and scholars,
contemporary readers of Twain's masterpiece were probably not a bit puzzled
by Tom Sawyer's faith in rituals, nor would they question why such rituals
were required to achieve a proper thematic healing (if not an actual cure)
at the end of the novel. Similarly, the medical meaning of the caption
under an illustration in chapter 18 of _Tom Sawyer_ ("counter-irritation")
would have made perfect sense to a contemporary reader, but will mystify
later readers (cf. Ober, p. 52, if you are among the mystified).

By the end of this book, Ober has provided excellent histories of the major
medical therapies that arose, competed, and eventually vanished or evolved
during Twain's lifetime: allopathic medicine, patent medicines, hydropathy,
electrotherapy, osteopathy, and homeopathy. His histories of these schools
of medicine will provide a solid common reference point for Twain scholars
for years to come. Added treats are Ober's accounts of Hannibal's infamous
Dr. McDowell who preserved his daughter's corpse in a local cave, Dr.
Newton the quack who nevertheless imbued a teenage Livy with the necessary
faith to recover from her paralysis, Twain's entanglement with Plasmon, and
Twain's rejection of Christian Science. All of these have been written
about before, but rarely in the words of a medical doctor. Finally, Ober
concludes his book with three useful appendices, an expansive bibliography,
and a reliable index. In the bibliography Ober cites the first editions of
Twain's works; citing the MLA text of the Berkeley editions would have been
more convenient and useful. But the bibliography also invites further
reading on the subject by citing many medical sources previously unfamiliar
to most readers of Twain.

After finishing this book, the reader only wishes there had been even more!
For example, Jean Clemens' epilepsy is discussed briefly, but not fully
explored, and because the contemporary misunderstanding of her condition
led in large part to her tragic separation from her father in his last
years, a full discussion would have been welcome. Ober does mention Jean's
attempt to kill Kate Leary, but does so without questioning such a dubious
allegation about somebody subject to grand mal seizures at a time when
epileptics were erroneously viewed as violent and imbalanced individuals.
Karen Lystra provides such a discussion in _Dangerous Intimacy_, but a
review of Jean's experiences by a medical authority, delineating both her
disease and her illness, would be a welcome addition to Twain scholarship.
However, this is less a criticism than it is a wish for more insights from
Dr. Ober. If the good doctor is contemplating a second book, this reviewer
might be so bold to suggest a broader study of the medical experiences and
writings of Twain's contemporaries. Besides his fellow authors, Twain
maintained friendships with many prominent people, including several
physicians, and because many of them (and their immediate families)
experienced medical problems that paralleled Twain's--and of which Twain
was often aware--it would expand the horizons of Twain scholarship to
compare Twain's experiences with those of his circle, and trace how those
experiences influenced their writings.

But such wishful thinking is beyond the scope of this review. This reviewer
is only licensed to practice in this Forum, and so must render his
diagnosis: _Mark Twain and Medicine_ is a must read.

Rx: Read it.

Kevin Mac Donnell