Book Review: Medical Paratexts from Medieval to Modern: Dissecting the Page, edited by Hannah C. Tweed and Diane G. Scott (London/New York: Palgrave Macmillan, 2018).

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Book: Medical Paratexts from Medieval to Modern: Dissecting the Page, edited by Hannah C. Tweed and Diane G. Scott (London/New York: Palgrave Macmillan, 2018).

Reviewer: Karoliina Ollikainen, University of Glasgow

Medical Paratexts from Medieval to Modern: Dissecting the Page, edited by Hannah C. Tweed and Diane G. Scott, is part of the Palgrave Studies in Literature, Science and Medicine series. As the title suggests, the chapters in the collection cover material from the late medieval period to the 21st century. It should be noted, however, that this collection is an especially rich resource for those interested in early modern medicine, with five chapters in the collection discussing texts from the 16th and/or the 17th century. These five chapters complement each other and together offer interesting new insights into the role of medicine in the early modern period. There is, therefore, a strong case to be made for further medical paratext collections that focus on one single time period.

The book is organised into two sections: ’Part I: Production, Reception, and Use’ and ‘Part II: Authority, Access, and Dissemination’. While there is some overlap between these themes, there are subtle but interesting differences between the focus of the two sections.

Part I one of the collection is made up of four chapters. Although this is not explicitly its goal, Part I ends up mainly discussing medicine from a marketing point of view, thinking of the audience as consumers of the final product. This approach argues that medical paratexts reflect the commercial interests of those who produced them and show how the reader, as the “end-user”, might have interpreted and interacted with the material.

Mullin’s chapter on 17th century surgical handbills and Mainwaring’s analysis of pharmaceutical packaging in the long 19th century both examine different aspects of marketing techniques. Mullin illustrates how graphic handbills could be used to advertise a surgeon’s services to educated as well as illiterate audiences (2018, p. 59) and argues that in this context the pictures could be seen as the main text rather than as paratext, given their important role in 17th century handbills (p. 71). These handbills tend to contain very little text, and written words are there to support and supplement the images, rather than the other way around (ibid.).

Mainwaring, on the other hand, discusses how industrialisation separated the manufacturer and the buyer in the 19th century, as having a face-to-face, personal interaction with the maker of a product was no longer always necessary (2018, p. 77). Mainwaring argues that this created a need for gaining the consumers’ trust in different ways, and standardised physical appearance of the products became an important factor to lend credibility and authenticity to the manufacturer (p. 78). Even the aspects of packaging that had nothing to do with the quality of the products, such as registered trademarks and evidence of paid stamp duty, could add to the buyers’ trust in the product (pp. 79, 85).

The other two chapters in the first part of the collection look at material that are not as clearly connected to advertising. Newman’s study on early modern surgical texts examines how prefaces to these texts frame the fetishisation of female bodies in surgical illustrations. On the one hand, the prefaces are used to apologise for having to include potentially pornographic material in surgical books, such as illustrations of the female reproductive system (Newman 2018, pp. 24-5), and on the other hand, they tell readers that they should stay away from this line of thinking and shame people who entertain inappropriate thoughts about the book’s contents (p. 29). Newman argues that while on the surface these prefaces protect the author’s and the publisher’s propriety and enforce societal values, they can also function as advertisement because they promise that there is scandalous material to be found inside the book (p. 31).

Powell’s study on illustrations of twins in utero in 17th century midwifery texts stands out from the rest of the chapters in part I in that it does not look at how these texts were marketed to potential buyers. Rather, Powell highlights the discrepancies between the text and the pictures in midwifery books when it comes to discussing twins. Whereas the written text claims that twins never touch while inside their mother, the illustrations repeatedly show them hugging or holding each other. Powell argues that these contradictions communicate an uncertainty surrounding twins and, furthermore, bring into question how safe or reliable contemporary medical practices were (Powell 2018, pp. 43-4). Touch was an important diagnostic tool when it came to identifying conjoined twins, and therefore suggesting that even non-conjoined twins could be touching in utero undermined the reliability of the midwife’s diagnosis (p. 46-7). Powell concludes that studying medical illustrations alongside the main text rather than on their own is valuable because otherwise contradictions such as these would be overlooked (p. 55). While it is overall less obvious how this discussion fits in with the rest of the chapters in the first section, Powell’s study is an interesting addition to the collection in its own right.

Whereas part I of the collection explores what medical paratext tells us about who produced the material and how it was received, part II is more interested in who has access to medical material and who is in control of how it is disseminated. The five chapters in part II address these questions from different angles.

Calder’s study on mental health in the late medieval period explores the question of who was perceived to be able to handle complicated information safely. In the late medieval period, there were concerns over lay people having access to existential, contemplative religious texts. The source of concern was that these texts could be potentially harmful to readers’ minds because such serious contemplation could be detrimental to those who did not lead consecrated lives (Calder 2018, p. 95). To lessen the potentially dangerous impact of religious texts on untrained minds, texts on mental health were circulated alongside them (p. 105). Calder’s chapter examines two such texts: William Bonde’s A deuote treatyse for them that ben tymorouse and fearefull in conscience from 1527, and William Flete’s De remediis contra temtaciones from c. 1358/9 (p. 95).

Similarly, Jajdelska’s chapter on paratext in Thomas Law’s Physick of the Poor (1657) discusses the tensions between who could exercise authority over whom and who should be allowed to have access to medical knowledge in the 17th century. Jajdelska argues that early modern printed texts reflect the social contexts of speech (2018, p. 113). In early modern society spoken interactions were governed by who had permission to address whom: a person of a lower social status could not initiate a conversation with their superior (ibid.). According to Jajdelska, this social hierarchy is reflected in how medical experts construct their voice in print (pp. 113-4). Prefaces of medical texts take pains to apologise to higher ranking readers for addressing them unprompted, even though at the same time the physicians’ expertise makes them a person of authority when it comes to medical matters (pp. 114-5). As shown by Jajdelska’s analysis, Law’s preface to the Physick of the Poor demonstrates how physician writers attempted to navigate this difficult position (p. 117).

Tweed’s study on diaries written by Canadian nurses during the First World War and Thorpe’s exploration of the complicated history of graphology both examine the question of who is in control of medical narratives. Tweed’s chapter focuses especially on the diary of Alice Lighthall, which includes details of the course of the war and the medical procedures Lighthall performed (2018, p. 125). Lighthall’s entries are written in a five-year diary with a predetermined layout, and the way Lighthall follows and ignores the diary’s format adds an intriguing paratextual element to how a person keeping a diary structures their life experiences (p. 128). Unlike the personal accounts of soldiers, nurses’ diaries of the war have mostly gone unpublished, which limits the public’s access to their stories and has kept the narrative of military history focused on male experiences (p. 135-6). This, Tweed argues, leaves a gap in our understanding of self-reflective writing during the First World War (pp. 128, 136).

While Thorpe’s chapter focuses on a completely different subject matter, that of the status of graphology, it raises similar points about who has authority over how something is perceived. Graphology, or the study of handwriting to gain insight into an individual’s personality or psychological state, is largely regarded to be a pseudoscience and something completely separate from proper scientific methods of enquiry, such as forensic handwriting analysis or palaeography (Thorpe 2018, p.140). However, according to Thorpe, the similarities between the techniques of handwriting analysis blur the actual lines between science and pseudoscience (p. 141). Thorpe argues, therefore, that the label of pseudoscience is likely to dissuade researches from entertaining the idea that any information associated with graphology could be potentially useful, which in turn can lead researchers to underuse handwriting analysis techniques when it comes to gathering paratextual information (pp. 148-9).

The final chapter of the book, in which MacLean discusses early printed books and the digitisation of paratextal features, adds a further metatextual dimension to the whole collection. MacLean’s discussion centres on the importance of marginalia and how in the process of digitising collections valuable paratextual information can be easily lost (2018, pp. 157-8, 169). The quality of modern scholarship on historical paratextual features rests on access to collections. Digitising and cataloguing these collections adequately is costly, and currently these endeavours are underfunded (pp. 167-8). As a potential solution to this, MacLean suggests that researchers interested in marginalia should collaborate with special collections librarians to secure funding to provide the detailed catalogues these research projects need (p. 169. MacLean notes that researchers are often eligible for funding sources that libraries do not have access to, and therefore collaboration can be mutually beneficial (ibid.).

The editors of Medical Paratexts from Medieval to Modern state that the goal of the book is to introduce the concept of ‘medical paratext’ as ‘a useful addition to medical humanities, book history, and literary studies research’ (Tweed and Scott 2018, p.7). The take away from all the chapters in the collection is that ‘medical paratext’ is not ultimately about paratextual features that are unique to the context of medicine (although this can be the case, such as in Mainwaring’s chapter on pharmaceutical packaging). The kind of paratexts studied in the collection, such as illustrations and prefaces, are mostly universal and by no means exclusive to medicine. However, what unifies the concept of medical paratext is that these paratextual features are being examined from the point of view of medical humanities. In other words, medical paratext is paratext that can tell us something about medicine’s role in society, whether it is mental illness in the late medieval period or graphology in the 21st century.

Medical paratexts offer a unique space for examining the societal tensions that surround medicine, such as tensions between experts and non-experts, science and pseudoscience, or medicine and religion. As illustrated by this collection, even when the time periods, subject matters, and materials are myriad and diverse, there is something universal about the way in which medical paratext reflects the material’s place in society, be it a pamphlet, diary entry, or the label of a laxative. What paratext tells us about how medical texts have been produced, disseminated, and received is an exciting avenue for the field of medical humanities to explore.

Works cited
Tweed, H. C. and Scott, D. G., eds. (2018). Medical Paratexts from Medieval to Modern: Dissecting the Page. London/New York: Palgrave Macmillan.

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