Now What? Surviving Serious Illness in the Nineteenth-Century
Hosanna Krienke joined the project in December 2017. She researches convalescence and narrative in nineteenth-century Britain.
Writing in 1991, sociologist Arthur W. Frank declared that Western scientific medicine had created what he called “the remission society,” a growing number of patients whose lives were saved by medical treatment but who could not be considered cured. This remission society includes people who are cancer survivors, manage heart disease, or live with autoimmune disorders. Such conditions, which would have been fatal only a century ago, now can be managed successfully across many years. Yet such longevity also produces a new challenge for medical professionals and patients. While much of twentieth-century medicine single-mindedly pursued the ideal of full cures (for example, the misguided attempt to find a single cure for all cancers), Frank suggested that medicine of the twenty-first century would need to come to terms with a different kind of caregiving in which patients and physicians both learn to cope with open-ended treatment regimens and uncertainty about patients' prognosis.
'A young girl convalescing in an armchair is visited by her dog. Etching by H. Formstecher after H. Bacon.' by Henry Bacon. Credit: Wellcome Collection.
While Frank imagined that the remission society is unique to today, my work reveals that this emerging medical culture has much to learn from nineteenth-century survivors of illness. I examine Victorian ideas of convalescence, a condition of ongoing recovery and extended uncertainty that followed serious illness. Frank posited that people in the remission society remain “neither ill nor completely well.” Similarly, Victorian convalescents were, according to one physician, “in an intermediate state—neither ill, nor yet quite well.” As I discover, Victorian physicians, philanthropists, writers, and domestic caregivers crafted a sustained ideology to deal with the stress of surviving acute illness. Convalescents faced a prolonged process of rehabilitation as they waited to see whether they would gradually improve, malinger, or relapse. The Victorians worked to alleviate the angst of convalescence both through personalized caregiving practices and unique interpretive strategies designed to make meaning within persistent uncertainty.
Weak but not ill, convalescents could no longer benefit from medical treatment. Nevertheless, Victorian writers, philanthropists, and caregivers concocted a whole range of ways to support the recuperating medical patient's physical, mental and social well-being. Convalescent patients needed relaxation, fresh air, and hearty meals. They also needed healthful distractions, such as social visits, travel, and novels. “Even the outside of a new and interesting book,” one caregiving manual insisted, “which must not be read until permission is given, will have its beneficial effect.” While nineteenth-century scientific medicine increasingly focused on disease processes within the body, convalescent ideology focused on improving the patient’s larger environment. Such changes, it was believed, could profoundly affect the course of patients’ recovery, potentially forestalling relapses, helping chronic conditions, and hastening full recovery.
Alongside practical benefits like leisure and nutrition, convalescent patients needed strategies for coping with the extended boredom, sudden relapses, and small gains of prolonged rehabilitation. Writing about his own recovery from a surgical amputation, the poet W.E. Henley bitterly complained, “Altogether convalescence is a trying period both for nurses and patients […] it is an uninteresting, unsympathetic, and uncomfortable probation.” An entire genre of convalescent self-help manuals and religious devotionals sought to offer strategies to counteract the stress and uncertainty of convalescence. Most importantly, these texts advised against any attempt to predict the outcome of one’s convalescent care. One devotional manual counselled, “[R]esist fore-casting, and undue dwelling on results or consequences.” Even positive conjectures could be hazardous “lest the dangerous hopes which convalescence brings with it should meet with disappointment.” Instead of looking to the future for meaning, convalescents and their caregivers were supposed to track and analyse the complex social, physical, and mental factors at work on the patient’s ongoing recovery.
'A girl reads to a convalescent while a nurse brings in the patient's medicine. Watercolour by R.H. Giles.' by R.H. Giles. Credit: Wellcome Collection. CC BY
As a literary scholar, I examine the history of nineteenth-century convalescent care in order to identify how patients and caregivers narrated the experience of uncertainty. Ultimately, I use these historical narrative forms to better understand how readers can engage with the prolonged uncertainty of reading Victorian novels. My central question is this: if Victorian convalescents were meant to interpret their ongoing recovery without predicting potential outcomes, what would it mean for readers of Victorian novels (particularly novels that feature illness) to interpret an unfolding plot without reference to its ending?
If you have read many Victorian novels, you are already familiar with the timescale of convalescence. Readers are often asked to invest hours of reading-time in tracking the prolonged recuperations of say, Esther Summerson in Charles Dickens’s Bleak House or Lucy Snowe in Charlotte Brontë’s Villette. Many critics read such illness episodes as symbolic of the psychological obstacles these characters face. By contrast, my work reveals that Victorians valued the unique opportunities for reflection provided by the slow time of convalescence. Thus I want to apply the interpretive techniques of convalescent care to Victorian novels in order to recover the ethical value and interpretive meaning Victorian readers would have been trained to find within narratives of digression, boredom, and waiting.
But more than offering new readings of nineteenth-century texts, the history of Victorian convalescent culture can help guide current physicians and patients who are part of our modern remission society. Victorian convalescents spoke with great eloquence and insight about the frustrations—and opportunities—of living within prognostic uncertainty. Thus while Victorian convalescent practices have never before been described within scholarship on the history of medicine, I hope to demonstrate how the distinctive interpretive postures of the nineteenth-century convalescence movement are increasingly relevant to our historical moment as more and more people live with the uncertainty of a medical prognosis.
 Arthur W. Frank, At the Will of the Body: Reflections on Illness. Boston: Houghton Mifflin: 1991. 154.
 William Strange, MD, The Restoration of Health: Or, the application of the Laws of Hygiene to the Recovery of Health. London: Longmans, Green, 1865. 224.
 Edmund S. and Ellen J. Delamere, Wholesome Fare; or, The Doctor and the Cook. London: Lockwood & Co, 1868. 736-7. Original emphasis.
 W.E. Henley, “Convalescence.” Saturday Review. October 6, 1877. 418.
 Mary Ethel Granger, Life Renewed: A Manual for Convalescents Arranged for Daily Reading. London: Longmans, 1891. 70.
 George Black, Sick-Nursing: A Handbook for All Who Have to Do with Cases of Disease and Convalescence. London: n.p., 1888. 37.