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Anna Gasperini builds on existing scholarship by examining how Victorian ‘penny blood’ literature depicted working-class readers’ anxieties concerning medical dissection following the 1832 Anatomy Act. Within the historical context of Britain, a dearth of cadavers spurred the rise of various crimes, including body-snatching, graverobbing, and murder. While the families of the middle- and upper-class dead could finance a funeral and secure a place of safe rest, such as in an ancestral vault or tomb, the poor were often buried in shallow or mass graves. These burial sites were often unearthed, and the bodies were sold to (knowing and unknowing) medical men for anatomical examination. To quell these crimes, government authorities instated the 1832 Anatomy Act, which was “a law that allowed anatomists to source dissection material from the pauper” (xii). More specifically, Gasperini explains, “[w]hen it was passed, the Anatomy Act imposed that the bodies of those who were too poor, or whose families were too poor, to afford a funeral were to be handed over to the anatomy schools for dissection” (xii). The Anatomy Act, disregarding pauper consent and personal wishes, effectively targeted impoverished people who relied on workhouse support and alms, exploiting poor bodies to supply medical schools and advance research. The fear and disgust for the law were widespread: “. . . for them [working-class penny blood readers] dissection, bodysnatching, and forfeiture of one’s body to the anatomists after 48 hours under the Anatomy Act were a terrifying reality” (xiii). This fear oddly presaged Count Dracula’s remark in Tod Browning’s 1931 film: “There are far worse things awaiting man than death.” In other words, the finality of death may be incomprehensible, but posthumous desecration of the body through dissection provokes a deeper sense of horror.

Exacerbating the act’s legal conditions was the fact that “semi-literate” working-class people, although vaguely aware of the law’s significance, could not fully interpret the dense legal argot that described the new regulations—an example of cruel political skullduggery—which obscured what would happen to their bodies following death (12–13). Far from being a benevolent political gesture, the act “. . . was an exercise in rhetoric, against which the pauper—semi-literate, socially powerless, and politically underrepresented—could not possibly win” (15). Popular fears that predated and intensified following the act concretized suspicion and anger directed at physicians, the medical sciences, and mortuary practices.

These apprehensions, Gasperini argues, found vivid expression in the pages of the penny blood, a genre “churned out by underpaid hack-writers” and obsessed with storylines “involving murder, betrayal, gender-shifting, and the occasional supernatural event (not to mention scantily clad damsels in distress)” (4). While the penny blood’s serialized melodramas were derided as tawdry sensationalism by middle- and upper-class readers, the genre reflected working-class preoccupations about the Anatomy Act and how the bodies of the impoverished dead were subject to the posthumous medical gaze (4). The penny blood embraced a “generally more violent and graphic concept of entertainment that was popular among lower class individuals. . . .” (4) and constructed plots that directly tapped into long-entrenched suspicions about medical cruelty and physical dismemberment. While the era’s educated readership disdained the recognizable tropes of the penny blood—murderous graverobbers, devious surgeons, vampires, eldritch cemeteries, and cadavers—the narratives in which they figured elucidated the virulent classism and exploitation perpetuated by the Anatomy Act. 

Gasperini provides close readings of a range of penny blood texts, including Manuscripts from the Diary of a Physician (1840s), Varney the Vampyre; or: the Feast of Blood (1840s), The String of Pearls (1840s, popularly referred to as Sweeny Todd, The Demon-Barber of Fleet Street), and The Mysteries of London (1840s). Not all narratives have explicitly medical themes or characters who are physicians or anatomists, nor do the stories make overt reference to the Anatomy Act. Instead, as Gasperini’s analyses demonstrate, they all confront larger working-class anxieties concerning mortality and what might be regarded as the social afterlife of a human corpse, whether that be posthumous dissection, cannibalism, necrophagy, or some other horrific desecration of the body. Fundamentally, while the stories vary, they share a general preoccupation with the corpse’s “bodily integrity” (16), asking what forces act upon the body (or have the authority to) following death and expressing fear over the individuals and institutions that presume to disturb the repose of the dead. Indeed, for all the penny blood’s grotesquery, there is a tacit insistence on the sanctity of the corpse; however, as Gasperini illustrates, the genre does not flinch from revealing the grim consequences of disturbing this repose in the interests of greed and medical progress.

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Izzy is a teenager who has been in foster care for a decade since the age of 7 when her mother was imprisoned and judged insane for having killed her father. She struggles with a desire to cut herself. Her current foster parents, Harry and Peg, seem kindly and engage Izzy in their task to catalogue artifacts from the nearby state asylum that has recently closed. 

Izzy is given the journal of Clara, a patient who, at age 18 in 1929, was pregnant by her Italian lover, Bruno. She was committed to the asylum by her angry father.  Clara gave birth, but her baby girl was taken from her. She observed how the brutality of the hospital damaged those who did not belong there, eventually provoking the mental illness it purported to treat. With the help of a gravedigger, Bruno planned an escape, but their plan was uncovered, and Bruno died.

Izzy’s own story unfolds as she works her way through the journal, subjected to bullying and tormented by her anxieties. Peg kindly arranges to take Izzy to see her dying birth mother in prison, where she learns that the murder of her father was to prevent him from abusing young Izzy.  

Spoiler alert! Izzy learns from an elderly nurse that the asylum director took Clara’s baby for himself and that Clara is still alive. She reunites the mother and child, who is now a grown woman. Izzy joyfully learns that Peg and Harry will formally adopt her.

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Through ten short chapters, family doctor Susan Boron explains the origin of her neologism, “tokothanatology,” the study of common practices that surround both birth and death, events that “bookend” our existence. Daughter of an obstetrician who pioneered family-centered birth and spouse of a man who worked in palliative care, Boron noticed the tremendous similarities in the gestures, rituals, and obligations of dealing with both the beginning and the end of life. The obligations extend to the loved ones in the sphere of patients in care--a practice, she writes, “from pre-cradle to post-grave.” 

One chapter reviews the rituals emerging from many different cultures and religions; another examines portrayals of birthing and dying in image and word; yet another addresses the impact of sudden and unanticipated outcomes. Ethical and legal dilemmas and the contingencies imposed by time and place are discussed frankly.  

Recognizing the advantages of medical technologies, she is nevertheless skeptical of their utility in every case and includes practical advice for dealing with pain, showing that midwifery techniques could enhance palliation. Throughout, she acknowledges that things have changed, are changing, and will change again. Sources are referenced in footnotes. 

In the end, the repeated message is one we’ve heard many times before, offered in a refreshing way: the importance of empathy and of listening to the patient's wishes in birthing and in dying. 

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In Medical Bondage: Race, Gender, and the Origins of American Gynecology, Owens argues that the emergence, practice, and professionalization of American gynecology in the 19th century were inextricably enmeshed with the institution of slavery and discourses of biological racism. “Modern American gynecology,” writes Owens, “could certainly exist without slavery, but slavery’s existence allowed for the rapid development of this branch of medicine, and especially of gynecological surgery” (6). As she shows, gynecology developed as quickly as it did only because white American physicians had access to women’s bodies marked as racially inferior. That gynecology’s maturation accelerated in the American South is no indication that its practitioners had a humane interest in enslaved women’s health (66). On the contrary. Owens argues that slave owners were invested in maintaining the reproductive health of enslaved women in the interest of increasing the size of their population: “Thus the repair of any medical condition that could render an otherwise healthy slave woman incapable of bearing children further strengthened the institution of slavery” (39). Additionally, there were broader implications, as medical research using enslaved women’s bodies produced knowledge about how to treat, in turn, white women: “Black lives mattered medically because they made white lives healthier and better” (107).

This leads Owens to argue why enslaved women should be esteemed as the maternal counterparts to the oft-celebrated white ‘fathers’ of American gynecology: “. . . black women, especially those who were enslaved, can arguably be called the ‘mothers’ of this branch of medicine because of the medical roles they played as patients, plantation nurses, and midwives. Their bodies enabled the research that yielded the data for white doctors to write medical articles about gynecological illnesses, pharmacology, treatments, and cures” (25). This is especially true, as she points out, when examining the medical research of the lauded gynecologist, James Marion Sims, who opened and operated a “sick house” for enslaved women suffering from gynecological ailments (36). Sims operated this clinic to devise a surgical solution to a serious and commonplace gynecological issue among enslaved women, vesico-vaginal fistulae. As an enterprising young physician, Sims took advantage of enslaved women’s bodies to conduct his surgical trials. Eventually, he triumphed and cured an enslaved woman, and published the results in a respected medical journal, thus enshrining his reputation (39). The point, Owen emphasizes, is that “[t]hanks in large part to his experimentation on enslaved black women, Sims had established himself as one of the country’s preeminent gynecological surgeons less than a decade after he began his gynecological career” (39). Medical Bondage thus strives, in part, to restore the lives and contributions of these enslaved women to the story of American gynecology’s genesis.

Owens’ study takes a surprising turn, arguing that “. . . the later development of modern American gynecology can no more be disentangled from Irish immigration than it can be separated from its roots in slavery” (90). This shift in racial and geographic focus parallels the similar roles of enslaved black women of the South and poor, immigrant Irish women of the urban North in the development of gynecology. Owens shows how racial alterity was “mapped onto” poor Irish immigrant women living in major urban centers, such as New York City (20). As many Irish immigrant women suffered poverty, inadequate (if any) medical care, sexual assault, and were drawn into prostitution (and the attendant onslaught of venereal diseases), they became ideal medical subjects for gynecologists. Physicians eventually published their Irish patient case studies, which “. . . helped to create the foundation for the racist laws that colored the Irish as not quite white and sometimes placed them alongside black people as biological models for racial inferiority” (90). Just as Southern gynecologists had access to enslaved women’s bodies, their Northern counterparts treated and experimented on racially othered immigrant women. In this way, Owens argues, “[t]he scientific and medical beliefs that doctors held about Irish women were nearly indistinguishable to [sic] those they held about African women” (115). Overall, Medical Bondage articulates a well-researched and sobering retelling of the dominant accounts of American gynecology.

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Brother Diggery, formerly called Jack Fox, tells us that he was given to the monastic order of St Odo at the age of seven in 1341. For another seven years, he is raised in innocence within the strict rules of the community, serving the brother healer, learning herbal remedies, and playing the hurdy gurdy.  

As plague arrives in 1349, he is assigned to help care for the anticipated sick – and immediately falls ill. The brothers seal him inside his cell, where he suffers greatly, narrowly escaping death; however, when he recovers and forces himself out of confinement, he discovers that everyone else has died or fled. After filling a mass grave with the remains of his brothers, he sets out on a picaresque series of adventures, blithely unaware that he and his fleas spread illness wherever they go.  

Like a fourteenth-century Candide, Brother Diggery’s gullibility and curiosity lead him to discover the wonders of good food, sex, and marriage, the cruelty of lies, theft, and wrongful imprisonment, and the corruption of the church (p. 164). He closes his account in 1352, age 18, already twice widowed, but set for life as a lay physician and father of a young boy whom he plans to give to the monastery of St Odo when he reaches age seven.

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Will Raven is a medical student beginning his apprenticeship with Dr James Young Simpson. He has been involved with a prostitute Evie whom he finds murdered. Simpson’s housemaid, Sarah Fisher, takes a dislike to him, not least because of his educational and social privileges. She is barred from such opportunities because of her gender and class, despite her greater intelligence. Sarah studies medicine on her own. Coming from poverty, Raven is nevertheless, pompous, chauvinistic, quick to fight, and desperate to earn money and status. 

Like Evie, other young girls are being brutally murdered in the Old Town of Edinburgh, and Raven and Sarah are separately motivated to find the killer. Their master, Simpson, is conducting experiments with anesthesia and suspicions are cast upon him. Although Raven and Sarah are part of his household, they find his behavior mysterious. Eventually they collaborate to solve both mysteries.

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Andrew Mangham’s The Science of Starving in Victorian Literature, Medicine, and Political Economy examines how Victorian writers drew upon the era’s medicine and physiology to represent the physical realities of starvation. Wondering readers, at first glance, might ask if starvation can be described in any terms other than a physical experience; however, Mangham argues that prevailing nineteenth-century political economy theorized population growth and food scarcity in ways that radically obscured the corporeal suffering wrought by starvation. Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty. Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation.

For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31). While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works, Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it. Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but humanized renderings of the poor.

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All the [medical] world’s a stage! In elegant prose, with Felliniesque flights into whimsical metaphor, physician-historian-playwright Charles Hayter describes his encounters with cancer, as a doctor and as a son, and how the experience changed him as a person. 

Just as he finishes his residency training as a cancer specialist, his stoic physician father develops cancer. The story of that family illness is interwoven with vivid case histories of patients, recounted personally rather than clinically. These patients display many of the characteristic reactions and behaviors of his own father. 

Several other themes are prominent: the losing battle against death – or rather Death--who is a character lurking in the corners of the consultation rooms; the tensions of a son trying to please his difficult parents with advice and understanding that they seem not to want; the bravery of a gay man coming out to his wife and children to find a new place in the world.  

These struggles are placed on a background of the nebulous status of radiation therapy, a maligned and misunderstood specialty.

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In 1902, an unusual structure was erected on South Dakota’s windswept prairies. It was not a silo, farmhouse, or barn—buildings that would be perfectly commonplace in that corner of the state. This conspicuously odd edifice, a “two-story building, with its jasper granite foundations,” was called the Canton Asylum for Insane Indians, a first-of-its-kind and federally managed institution based outside of Canton, South Dakota (Joinson 24). The asylum, which operated from 1902 to 1934, was designed to incarcerate and treat Indigenous peoples deemed ‘mad’ by powerful political authorities, such as reservation superintendents and the Bureau of Indian Affairs. According to the historian and disability studies scholar, Susan Burch, the facility “ultimately held four hundred men, women, and children from seventeen states and nearly fifty tribal nations.”

In Vanished in Hiawatha: The Story of the Canton Asylum for Insane Indians, Carla Joinson provides an incisive institutional history of the Canton Asylum, examining the political motivations for its establishment, its different periods of (mis)management, and, ultimately, its demise in the early 1930s due to inspection findings and Indigenous affairs advocacy spurred by John Collier. In writing the book, Joinson seeks to answer her chief research question: “why an institution like this asylum could exist for so many years, and what made it tick as a viable part of the Interior Department” (2). Her research explores the mechanics of institutional longevity, specifically how, despite government inspection reports that revealed appalling evidence of neglect and abuse, the facility remained in operation for over three decades. Joinson’s book also corroborates the staggering fact that many of the asylum’s patients were not, in fact, ‘insane,’ but sent to the institution only so that the federal government could detain and surveil people who may have experienced difficulties with reservation authorities back home. Other Indigenous peoples, such as those with epilepsy and ‘feeblemindedness,’ were also deemed ‘mad’ and in need of medical detention. Many instances of abuse are chronicled: unhygienic conditions, patient restraint, fraudulent diagnoses and misdiagnoses, suicide, and failure to quarantine tubercular patients. Joinson also unearths decades-long dysfunction among the facility’s administration: staff backbiting and high turnover rates, lack of medical treatment, poor medical training and recordkeeping, and refusal to employ translators to communicate with Indigenous patients and understand their different cultures. Vanished in Hiawatha documents that Canton’s patients suffered years of neglect, and those who would have potentially benefitted from psychiatric treatment never received it because the facility was little more than a rural prison for unwanted, troublesome, and chronically ill Indigenous peoples.

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