[page 54:]

There are three important points to be drawn from Poe's use of medical sources. First, all of the medical works which represent Poe's knowledge of medicine — Dunglison's Medical Dictionary, Dr. Rush's Medical Inquiries, Dr. Combe's Lectures on Phrenology, and the rest — are works of the rational school of medicine of the early nineteenth century. The significance of this fact appears incidentally in Edward H. Davidson's analysis of Poe's philosophy and expression as a crisis in the Romantic movement.(1) Second, no matter what medical sources his knowledge was drawn from, Poe used his sources carefully, for the reasonably large amount of medical data he employed is controlled and consistent. Finally, in Poe's use of medicine there is a distinct movement away from the use of medical data as a contextual medium of expression, as it is used in his best short stories, toward the analytic manipulation of medical theories in the later stories dealing directly with pseudo-medical phenomena. [page 55:]

The medical works cited as probable sources for Poe's use of medical detail all share the central characteristic of the rational school of medicine. Case histories and often astute observations are presented in a rational framework independent of the empirical data. The praise of specific findings and the disavowal of the general system in which they are embodied is a usual form of commentary among the doctors of this age. Dr. Rush, completely disavowing animal magnetism, praises Mesmer's discovery of the importance of the mind in disease.(2) Dr. Oliver Wendell Holmes praised the contributions of the phrenologists in his novel, Elsie Venner, in 1861, while disavowing phrenology.(3) A letter mentioned in Nahum Capen's Reminiscences of Dr. Spurzheim and George Combe indicates that Robley Dunglison and John P. Kennedy chose this method of commending Dr. Combe:

Dr. Combe's important “History of a Case of Anemia” has already been cited as a lasting contribution to medicine completely outside of his phrenological interests, adding yet another dimension to the merits and demerits of his medical studies. [page 56:]

Philosophical generalizations about Poe's short story techniques offer a literary parallel to the scientific method of the scientists of the romantic age. Edward H. Davidson, in Poe, a Critical Study, says that for Poe, writing at “the end of the idealist or Romantic expression and mind,” reality is subject to negotiation with the creative imagination.(5) By this, Mr. Davidson means that Poe, like the doctors of the romantic era, imposed systems on individual observations under the pretense of creating systems out of observation:

Mr. Davidson, thus, sees Poe imposing his mind on the material world, yet without complete dependence upon his own “private” imagination.(7) Poe's mixed methodology, when applied to Dr. Rush's Medical Inquiries as an example, explains how Dr. Rush can be both the father of American medicine in his empiricism and the reactionary theorist which R. H. Shryock calls him in The Development of Modern Medicine.(8) The meaning of this combination of theory and fact for Poe's short stories is that Poe was able to introduce concrete medical details into a generalized [page 57:] Gothic setting more or less directly from the rational medicine of the nineteenth century.

In Poe's short stories, particularly those written before 1840, the careful combination of medical theory and detail with a fictional presentation is almost their hallmark, a sharp departure from the generalization of sentimental literature. “Morella” is one story in which Poe's careful medical borrowing has been obliterated through the loss of the pertinent medical belief. Morella, as noted in the previous chapter, gives birth to a child in the act of dying from a disease which Poe's references establish as consumption.(9) To the modern reader, it is safe to say that the death scene of Morella is too tranquil to be credible. According to nineteenth-century medical theory, however, Poe's treatment of the scene is quite reasonable, for uterine tension during pregnancy, as Dr. Rush notes in his “Inquiry into the Cause of Animal Life,” in Medical Inquiries, “often suspends the fatal issue of pulmonary consumption.”(10) Morella dies quietly in giving birth because she is released from a life-giving stimulus: her death is passive. This passivity, of course, is perfectly appropriate, for the volition of the character is primarily concerned with metempsychosis, and extra-medical phenomenon.

The concepts of miasma and nervous fever, largely discarded at the end of the romantic era, are part of Poe's most complete application of rational medicine to the short story in [page 58:] “The Fall of the House of Usher.” The theory of febrile miasma is itself central to the problem of rational medicine, for Dr. Sydenham's invention of this concept in the seventeenth century to explain the great London plague is thought to have been instrumental in retarding the growth of empiricism in the eighteenth century, where the medicine of Poe's era has its origin.(11) In Poe's “The Fall of the House of Usher,” as in “Morella,” the rationalized medical theory, because it is couched in terms which are more impressionistic than clinical, may be blended directly into the action of Poe's short story.

Poe's use of the phrenological bust as a model for the House of Usher — which is, in turn, a symbolic representation of Roderick Usher — has already been noted. Poe's references to decay and the specific notice of the miasma of the tarn are infecting elements taken directly from the medicine of the early nineteenth century, as well. The environment in “The Fall of the House of Usher” is thus an accurate, even exact, description of the conditions which produce the malady called “nervous fever.” Poe's description of the symptoms of Usher, as the story progresses, is based on the description of the symptoms of nervous fever and makes full use of the mixed nature of early nineteenth-century medicine to involve dramatic suggestions with the medical “facts.” The following passage, in which Poe's use of medicine appears most clearly, is taken entirely from “The Fall of the House of Usher.” [page 59:] Phrases appearing on the right side of the page are ones in which the key words and ideas are found in a medical book, The Family Physician, which contains a typical description on the nosology of nervous fever circa 1835:

Plot development		Medical symptoms
And now, some days of bitter grief having elapses, an observable change came over the features of the mental disorder of my friend.
		[1] His ordinary manner had vanished. His ordinary occupations were neglected or forgotten.
He roamed from chamber to chamber with hurried, unequal and objectless steps [referring to phrenological changes of mind in keeping with wonder].
		[2] The pallor of his countenance had assumed, if possible, a more ghastly hue — but the luminousness of his eye had utterly gone out. [3] The once occasional huskiness of his tone was heard no more;
and a tremulous quaver, as if of extreme terror, habitually characterized his utterance.
		[4] There were times, indeed, when I thought his unceasingly agitated mind was laboring
with some oppressive secret, to divulge which he struggled for the necessary courage. At times, again, I was obliged to resolve all into the more inexplicable vagaries of madness,
		[5] for I beheld him gazing upon vacancy for long hours, in [page 60:] an attitude of the profoundest attention,
as if listening to some imaginary sound. It was no wonder that his condition terrified —
that it infected me.(12)

The integration of the symptoms of nervous fever with Roderick Usher's increasing agitation over the prematurely entombed Madeline indicates the dramatic advantage which Poe derived from his medical material. The injection of the predetermined medical symptoms of nervous agitation gives Poe a series of literal details to serve as the concrete embodiments of Ushers agitation. Similarly, Poe's use of the supposed circumstances of nervous fever provides him with almost a complete Gothic environment. The careful integration of all these details, together with Dr. Combe's phrenological description of the nervous temperament and the appropriate phrenological qualities of ideality and wonder, gives “The Fall of the House of Usher” the intensity of effect which marks Poe's best stories.

In Poe's later stores, as has been noticed repeatedly in Chapter Two, the use of medical details so conveniently available from the structure of rational medicine during the early nineteenth century is no longer dramatic, but becomes analytic. Poe does not borrow details from the preexisting medical systems, instead, he begins writing medical stories, as in his three stories dealing with mesmerism, or uses medicine unimaginatively as [page 61:] a pretext for a flatly Gothic story.

Poe's use of phrenology in his early stories is carried out through the actual employment of phrenological data borrowed directly from the science. Ligeia's ideality, wonder, and love of life, for example, are components in the makeup of her nature and the descriptive phrenological facts are a part of the essential reality of the character. In “The Black Cat,” in 1843, Poe departs from the strictly dramatic use of phrenology to introduce a propensity of his own design, which he elaborated more fully in “The Imp of the Perverse.” In “The Black Cat,” he advances his proposition, using the correct phrenological words to define “perverseness,” a quality which is supposed to explain the moral degeneration of the central character in conjunction with the “disease” of alcoholic intemperance:

The open use of phrenology is, of course, a striking departure from the symbolic applications of earlier short stories. In “Ligeia” and “The Fall of the House of Usher” phrenological faculties were described chiefly through physical description or actions, thus helping to create a texture for the story which included but transcended the analytic principle. In “The [page 62:] Black Cat,” in 1843, Poe has abandoned this careful application.

The narrator of “The Black Cat” also refers to miasma and contagion. But here, again, we are struck by the merely random employment of a medical element which was carefully infused into the environment of “The Fall of the House of Usher.” In “The Black Cat,” the narrator says that in coming to loathe the cat, he fled “from its odious presence, as from the breath of a pestilence.”(14) Poe never develops this reference further, either in the action or in symbolic surroundings, but leaves the isolated comment in the story for its face value; the fear which is implied to the reader is expressed in the story through several explicit comments more nearly directed to the movement of the action than in the medical reference.

Poe's short stories about mesmerism, although carefully contrived, show the same failure to integrate the science into the symbolic environment of the story which appears in “The Black Cat.” In “A Tale of the Ragged Mountains,” the use of “coincidences” to support the mesmeric plot, roughly explicable through magnetic “influence,” is unconvincing. The doctrinal utterances concerning the soul in “Mesmeric Revelation” are interesting in their own light but do not develop a Gothic story of the caliber of Poe's early tales.(15) the conviction that “The Facts in the Case of M. Valdemar” was a true account [page 63:] of a mesmeric experiment, held in England where the tale was reprinted as Mesmerism “In Articulo Mortis,” in 1846,(16) indicates a literality of expression foreign to the short stories which Poe wrote before 1840.

The detail in “A Tale of the Ragged Mountains” indicates that Poe was using mesmerism with little dramatic inspiration. In order to solidify the feeling of magnetic rapport between the two central characters, Dr. Templeton and Augustus Bedloe, he notes that Dr. Templeton gradually gained ascendency over Bedloe's mind while treating him for a disease which has altered his appearance to one of ugliness. The details of Bedloe's appearance are as faithfully recorded as the details of Roderick Usher's nervous fever, but in Bedloe's case, these details have no significance to the story except that the “neuralgic attacks” which cause them are the reason given for Dr. Templeton's appearance in the story.(17) Finally, the mesmeric vision which Dr. Templeton induces accidentally in Bedloe must be explained to the reader by Dr. Templeton.(18) Throughout the story, the burden of explanation falls on Poe, in direct contrast to the technique of involved implications which appear in the earlier uses of phrenology.

Poe's careful use of medical detail in the short stories before 1840 and his increasingly haphazard employment of similar [page 64:] details in the stories appearing after 1840 suggest that he lost interest in medicine as a means of symbolic communication. Perhaps he expended less care on his later tales than he had previously, for the doctrines associated with early nineteenth-century medicine continue to appear, as in “The Black Cat.” Before 1840, however, he must have borrowed adroitly from a number of medical sources, carefully integrating the medical implications of such data with the dramatic movement of his story, creating Gothic masterpieces with an almost factual air of realistic horror, as in “The Fall of the House of Usher.”

FOOTNOTES

[The following footnote appears at the bottom of page 54:]

1.  Edward H. Davidson, Poe, A Critical Study (Cambridge: The Belknap Press, 1957), pp. 1-75.

[The following footnotes appear at the bottom of page 55:]

2.  Rush, op. cit., I, 257.

3.  O. W. Holmes, Elsie Venner (London: Routledge, Warne, and Routledge, 1861), p. 103.

4.  Capen, op. cit., p. 130.

[The following footnotes appear at the bottom of page 56:]

5.  Davidson, op. cit., pp. viii-ix.

6.  Ibid., p. 44.

7.  Ibid., p. 55.

8.  Shryock, op. cit., p. 155.

[The following footnotes appear at the bottom of page 57:]

9.  Complete Poems and Stories, I, 153-154.

10.  Rush, op. cit., I, 16.

[The following footnote appears at the bottom of page 58:]

11.  R. R. Trail, “Sydenham's Impact on English Medicine,” Medical History, IX (1965), 360-363.

[The following footnote appears at the bottom of page 60:]

12.  Complete Poems and Stories, I, 272.

[The following footnote appears at the bottom of page 61:]

13.  Complete Poems and Stories, I, 478.

[The following footnote appears at the bottom of page 62:]

14.  Complete Poems and Stories, I, 480.

15.  According to S. E. Lind, op. cit., p. 1087. Andrew Jackson Davis, “The Poughkeepsie Clairvoyant,” confirmed Poe's idea concerning “ultimates” in an interview with Poe in 1844.

[The following footnote appears at the bottom of page 63:]

16.  Quinn, op. cit., pp. 470, 560.

17.  Complete Poems and Stories, I, 514-515.

18.  Ibid., I, 521.