Mrs. Gaskell's delightful 1851 story "Mr. Harrisons Confessions" is an episodic tale best known for being a precursor and preview to its famous cousin Cranford. 1 Indeed, like Cranford it invites readers to chuckle over the unlimited creativity of those wishing to slip no further in their social ranking. The story also has an odor of Knutsford about it in its bucolic setting and because it describes the life of a country doctor, a subject with which Mrs. Gaskell was intimately familiar as a young girl living in Knutsford and observing her uncle, Peter Holland. "Mr. Harrison's Confessions" features the protagonist's introduction, following study at Guys Hospital in London, into general practice in the country town of Duncombe. Much of the tale revolves around the potential for romantic misinterpretation by the middle-aged spinsters and matchmaking parents when this young, inexperienced, unmarried doctor begins to practice medicine. His mentor, Mr. Morgan, attempts to steer him on the right path, but he too, by the end of the story, falls victim of small-town rumour and suspicion of romantic involvement. A comedy of errors ensues when a high-spirited schoolmate of Mr. Harrison's, Jack Marshland, comes to town and sends a provocative valentine in Mr. Harrison's hand.
Though by no means a perfectly crafted story, as eminent Gaskell critics Enid Duthie and J.G. Sharps have noted, 2 "Mr. Harrison's Confessions" is interesting for the social history it reveals. Therefore, rather than considering its artistic merits, I shall examine how the story foregrounds the uncomfortable social position and shifting professional practices of mid-nineteenth century GPs and their attempt, though adherence to specific codes, to elevate status and particularly respectability. As we consider the following brief overview of received views on the general practitioner's status, remember the words of Cranford's Mary Smith on Mr. Hoggins:
As a surgeon we were proud of him; but as a man--or rather, I should say, as a gentleman--we could only shake our heads over his name and himself, and wish that he had read Lord Chesterfield's letters in the days when his manners were susceptible of improvement. 3
Even allowing for the Cranford ladies' exaggerated and outdated sense of social hierarchy, their views of the town's GP are not singular. Most, though by no means all, general practitioners at mid-century without the advantages of a well-connected Unitarian family like Peter Holland's could not hope to escape this type of labeling. Niece to a country GP and cousin to an eminent consultant (Henry Holland), Mrs. Gaskell was certainly aware of these cultural perceptions. Here are some historical explanations for them.
In the day-to-day practice of medicine, the tripartite structure of physician, surgeon, and apothecary was more fluid than the corporations acknowledged in their fight for political separatism and licensing control. In reality, only the medical elite could afford to practice pure physic or surgery and many made up their own prescriptions. The term "general practitioner", according to Irvine Loudon, was the term that replaced the "clumsier title of surgeon-apothecary and man-midwife" to describe the doctor who practiced general medicine. 4 That term was, again according to Loudon, in common currency by the second or third decade of the century, although "some practitioners . . . preferred themore prestigious title of 'surgeon'". 5 General practitioners were usually licentiates of "College and Hall", or the Royal College of Surgeons and the Society of Apothecaries and therefore performed surgeon's duties and midwifery, along with the making and selling of drugs. However, in the intra-professional strife that raged until late in the century, GPs were the middle child of the profession in terms of status and income. Whereas physicians and elite surgeons, or, by the second half of the century consultants, existed at the top of the medical tripos, usually enjoying the secure professional and economic status that comes with a liberal university education, a powerful network of colleagues within the Royal Colleges, and the honor and visibility of lecturing at teaching hospitals, rank-and-file practitioners fought to make a living wage and upgrade their professional status. Loudon estimates GPs' income during the first half of the century to be between =A3150 and =A3200, 6 while Roy Porter concurs by stating, "[f]ew secured a competent living (and all that it entailed, including the ability to marry respectably and start a family) before they were approaching forty". 7 Mrs. Gaskell shows her familiarity with such matters by having Mr. Harrison's practice yield him, rather generously, an annual income of =A3300 (Ch.12, p.392). 8
GPs' status languished in part because of serious overcrowding; Loudon estimates that "in the 1840s the ratio of general practitioners to population was 1:602 in London [and] 1:1,185 in England". 9 I addition, within the English class system their type of work had the taint of manual labor and trade. (Remember that the Cranford ladies find most objectionable the "manual" aspects of Mr. Hoggins' profession: the smell of the stable and of drugs.) Whereas physician-consultants were associated with "advice" and "services", 10 general practitioners were associated with the sale of drugs. 11 Whereas the public perceived physician-consultants as practicing medicine "with their minds", 12 it perceived GPs as performing "skilled manual labor" 13 in their duties as "sawbones" and midwives. Although cartoons and fiction might lampoon aloof and avaricious consultants (witness Dr. Omnicron Pie and Mr. Fillgrave in Trollope's Barset novels) and sentimentalize hardworking GPs, the "cult of the family doctor" most often did not translate into "professional parity . . . in income or status". 14 As medicine became more scientific and effective, those who practiced it gradually acquired more status. GPs received a substantial status boost in the 1880s when the University of London and several provincial universities began graduating general practitioners with both a "university medical degree" and "clinical experience". 15
I would like to contribute to these received views by submitting that, in part, the practitioners' ambiguous status stemmed from the middle class dis-ease of having them exist somewhere between the domestic and the public spheres. As damning for general practitioners as were their associations with manual labor, trade, and midwifery noted above, I argue was the gender confusion generated by the geography and manner of their work. Unlike the majority of mid-century male professionals (including the newest breed of medical supermen, the consultants) who left their homes each day to work in the "public sphere", the church, courtroom, ship, regiment, teaching hospital, or university, general practitioners spent a good deal of time in close proximity to the domestic sphere, even if in that part of the house designated as "the surgery". Though as Leonore Davidoff and Catherine Hall argue, "public was not really public and private was not really private", the "potency" of the separate spheres ideology persisted. 16 Shared work and living space had been common in trade and in some professions like medicine, banking, and the law, but David= off and Hall show that by mid-century many professionals sought to separate the two by moving their residences a respectable distance from the workplace and in some cases into the suburbs. 17 Indeed, Mary Pooveys study Uneven Developments demonstrates that the middle-class masculine ideal was predicated upon keeping work and home separate. 18
Notwithstanding the miles country GPs often traveled to those patients too ill to attend surgery hours, their destination was perhaps the most unprofessional and gendered of all spaces: the bedroom. Unlike clergymen, however, who made pastoral visits to sick parishioners, GPs could not claim that their work was spiritual and non-physical. Furthermore, because general practitioners were in geographically feminine territory, the sickroom being the traditional domain of women, their manners might be misinterpreted. Their care might be misconstrued as romantic attention and their "professionalism" might not be recognized at all. Their lot was remarkably like women's, existing as they did on a professional border sans university education, sans specialized skill, and sans real political power. Indeed, many of the amusing vignettes of the story--Mr. Morgan's instructions to his protégé on correct manners and appearances, for example--reveal the need to elevate the professional and suppress the feminine.
Added to the complexity of striking just the right manner is the fact that with a reforming medical curriculum, approaches to patients began to differ. In "Mr. Harrison's Confessions" the doctors are from different medical generations. The junior partner is a product of a newer system with greater emphasis on science and technology, while his mentor belongs to an era when the genteel manner of the practitioner was more important than his science. 19 Their partnership is complicated by the differing ideals of medicine described by Philip Elliott in The Sociology of the Professions as the confrontation of "gentlemanly professionalism" with specialized skill. 20 In other words, in the shifting nature of the profession, status began moving slowly to the newer breed of doctor who had been trained in the latest medical methodology and technology, the Mr. Harrison's of the time. 21 Definitely a member of the older school of medicine trying to overcome status handicaps, Mr. Morgan compromises his young partners professionalism by insisting on old fashioned gentility in manner and dress as well as outdated medical theories.
Though not quite the "elegant economies" practiced by the Cranford Amazons to bolster an endangered gentility, Mr. Morgan engages in his own brand of pretense and false advertising to project professional respectability. The scenes described below show Mr. Morgan's awareness of the proximity between his practice and other competitors. For instance, his exaggerated and disingenuous advertisement to the gossipy dames of the town that Mr. Harrison was "a favorite pupil" of the renowned surgeon Sir Astley Cooper and that his father was acquainted with Sir Robert Peel (Ch.2, p.357) reveal a shrewd bid to claim the most elevated professional (and male) connections. Mr. Morgan's boast about Mr. Harrison's internship at Guy's Hospital and the skills the young man has acquired (though he ironically does not trust these skills when he ought), invites the reader to consider the competing claims to medical expertise in the town and their historical origins. There is Mr. White from nearby Chesterton, a GP called in to do operations before Mr. Harrison's arrival because Mr. Morgan found himself to be too "nervous to be a good operator (Ch.14, p.397). Then, there is Mrs. Rose, a doctor's widow and now Mr. Harrison's housekeeper. Though no one takes serious Mrs. Rose's ramblings about a patient's near-fatal contraction of a "mucous membrane" (Ch.17, p.409) or her attempt at a "dognoses" of her husband's final illness (Ch.4, p.366), her second-hand knowledge of the profession suggests something of the sensitivity "regular" practitioners had about so-called "irregulars" and their need to advertise their orthodoxy. Porter and Loudon provide a good overview of the lost revenue and reputation to regular practitioners occasioned by their fraudulent competitors. 22 The reader can understand the urgency of this self-advertisement following Mrs. Rose's declaration, "for twenty years I sympathized with [my doctor husband], and assisted him by every means in my power, even to making up pills when the young man was out" (Ch.4, p.365)!
In the very second encounter Mr. Morgan has with his new partner, he reinforces the need to advertise their professional legitimacy by dressing according to a strict standard of respectability--shades of the Cranford ladies' distinction between bombazine or silk? The painstaking explanations on the part of Mr. Morgan suggest more than Mrs. Gaskell's attempt to create a humorous situation; they suggest her understanding of how new and important were these codes to the profession in the identification and separation of "regular" practitioners from their "irregular" brethren, including women both middle and lower class who often attended the sick. The fastidious Mr. Morgan makes it very plain that the newcomers "cut-away" coat is not acceptable garb either by cut or color:
"We are sticklers for propriety . . . in Duncombe; and much depends on a first impression. Let it be professional, my dear sir. Black is the garb of our profession. . . . Those coats, sir, give a man rather too much of a sporting appearance, not quite befitting the learned professions" (Ch.2, p.355).
The message here from the initiated to his novice is that professionalism is achieved through the uniform of the profession. Moreover, Mr. Morgans exhortations remind us that "the contrast between the straight lines, practical materials and business-like images of mens clothes and the soft, flowing curved lines, the rich colours and textures . . . of womens clothes was becoming a powerful part of gender segregation". 23 Mr. Morgan reasonably implies that Mr. Harrisons colourful coat is unprofessional and dandified because it deviates from the by now simple and utilitarian uniform of the middle-class male. The irony of Mr. Morgan's concern about Mr. Harrison's coat is that while he (Mr. Morgan) dresses in "a black dress-coat" and dark-grey pantaloons", his wears "the brightest and blackest of Hessian boots with dangling silk tassels on each side", or, for country visits, "the most dandy top-boots" (Ch.2, p.354). Mr. Morgan clings to a tradition as effeminately unprofessional as the one he accuses Mr. Harrison of evoking.
Indeed, in trying to eradicate hints of the unprofessional in his partners dress and bedside manner, he rivals the mistress of veneer, Mrs. General (Little Dorrit), in outlining what represents acceptable and what delinquent conduct. Humor is certainly one of Mrs. Gaskell's goals in having Mr. Morgan preach, but she no doubt recognized what historians have since noted: "no one felt th[e] dependency on the social judgment of patients more acutely than the young man just starting out in practice". 24 I submit that this "dependency on social judgment" was something akin to the never-ending scrutiny endured by young women. In his credo on the art of the perfect manner, Mr. Morgan confesses that he has "studied to acquire an attentive, anxious politeness which combines ease and grace with a tender regard and interest" and tellingly corrects Mr. Harrisons bedside manner with the words, "it is, in fact, sir, manners that make the man in our profession" (Ch.2, p.360). That manners were truly an important feature in medical practice has been amply documented by recent historians like Digby who maintains, "[a] polished social demeanor, with the ability to make good general conversation, were important ingredients in that vital professional attitude--a good bedside manner." 25 However, Mr. Morgan insists upon manners to the exclusion of medical creativity. One has a sense that his medical judgment is held hostage by his need to please and impress. 26
In comparing the manners Mr. Morgan insists upon and those of the only other unmarried man of the story, Jack Marshland, one is struck by the distance, along a gender continuum, that Mr. Harrison seems to have traveled since his rollicking student days. It is almost as striking as the feigned transformation that takes place in Pickwick's oyster devouring and brandy swilling Bob Sawyer once he enters private practice. According to Mr. Marshland, student Harrison had gallivanted about town playing practical jokes but now has "got quite into the professional way of mousing about a room, and mewing and purring according as [his] patients were ill or well" (Ch.9, p.387). This judgment is only partly true. The reader has by now noticed that Mr. Harrison's inclinations to pursue "manly" hobbies like hunting have been quashed by the old fashioned Mr. Morgan, and Mr. Harrison's disagreements with his mentor, discussed below, show a man unafraid to fight for his principles. On a superficial level, however, Jack appears to be the only strong masculine presence in the story. But his own dis-ease among the teacups, spindly legged chairs, and polite chat of the Duncombe ladies, his preference for beef and brandy, his loud, ungoverned laughter and sprawling actions are probably as much an act as Mr. Harrison's unwillingly adopted demeanor.
Mr. Morgans whole obsession with finding his young partner just the right establishment intimates, once again, an acute sensitivity to meeting standards of the gentleman professional. He arranges for his protégé to have an establishment of his own because "it looked more respectable, not to say professional than being in lodgings" (Ch.2, p.356). And because a doctor's professionalism and thereby respect is the consulting room, the veteran practitioner "skillfully" places the unofficial badge of the doctor--the skull--in prominent view, conspicuously places proof of formal medical training--medical books--on the most visible shelves, and hides or disguises the Austen, Dickens and Thackeray novels (Ch.4, p.364). His actions do not mean to suggest that middle-class men did not read novels or that there was shame in admitting they did. They do, however, suggest that such reading material was indicative not of the shades of Galen and Hippocrates, but of domestic interests, and, as every Victorian knew, that arena was governed by feminine deities. Mr. Morgan appears to have proceeded Virginia Woolf by almost a century in seeking to kill the angel in the house that he might establish his professional credentials. 27
Helpful as Mr. Morgan may be in the argot of staging a medical career, his limitations as a doctor become apparent during two crises in the story. Here Mrs. Gaskell dramatizes the conflict between the new generation of medicine and the old when Mr. Harrison and Mr. Morgan disagree on treatment options in cases whose visibility puts them under the town's scrutiny. (Those familiar with Wives and Daughters will recognize in Mr. Harrison a prototype of the scientists she would later develop in Roger Hamley and the local GP Mr. Gibson.) When a well liked gardener and father of six badly injures his right wrist, Mr. Harrison listens to his patient's request that the arm be saved and opts for a subtle drug therapy, knowing "the improved treatment in such cases" (Ch.14, p.397). Mr. Morgan, however, wishes to amputate. His unfamiliarity with newer drug treatments combined with his advertisement of showier types of medical skill nearly stifle his partner's wish to practice more subtle forms of medicine, not to mention almost costing Mr. Brouncker his arm. Privileging amputation as a trusty and more dramatic prophylactic against infection, Mr. Morgan, views Mr. Harrison's reluctance to perform the operation as a combination of cowardice and lack of medical training. Along with a sincere fear for the patient's life, the older doctor realizes that refusal to amputate will undermine all his boasting on his new partner's "acquirements as an operator" (Ch.14, p.398). He has even invited the successful lawyer Mr. Bullock to see the operation performed by "a man from Guys" (Ch.14, p.397), indicating both old fashioned medicine and the need to impress those who have similarly old fashioned notions. Mr. Harrison quietly but firmly insists on his own treatment and Mr. Morgan reluctantly acquiesces. The risky treatment works, but, in vindication of Mr. Morgan's fears, not before rumor spreads that the patient (sent to convalesce by the seaside) has died at the hands of an inept doctor.
At the very end of the story, the two doctors once again face a case which illuminates their differences in medical philosophy and training. By this time, Mr. Harrison is head and shoulders in love with the Vicar's daughter, Sophy Hutton, but false accusations of his being a "gay Lothario" (Ch.26, p.424) have banished him from the vicarage. Therefore, during Sophy's life-threatening fever Mr. Morgan attends her while his partner anxiously awaits news. As Mr. Morgan witnesses the swift decline of the young woman, he impotently awaits the outcome. Mr. Harrison, on the other hand, does what was becoming more common in medicine. He seeks consultation from a physician in Chesterton, and is told that the only hope lies in using a drug whose main ingredient is a dangerous "poison" (Ch.26, p.425). Mr. Harrison's willingness to try the remedy, to put his faith in the consultant and the new drug, indicates his confidence in expert diagnosis and science. Once again, however, Mr. Morgan shows how entrenched he is in antiquated treatments. He at first refuses outright to try the drug, resisting his protégé's brave suggestion and even braver insistence on the drug. Predictably, Mr. Morgan only relents at the eleventh hour when there is nothing to lose. Needless to say, the remedy is the right one and the girl recovers, but her recovery is attended by the sober realization, made by Mr. Morgan himself, that he is "an old fool" (Ch.28, p.428).
In considering the more serious aspects of "Mr. Harrison's Confessions", I do not mean to overlook the lighthearted comedy of the tale. It contains a good deal of humor, especially in its comedy of errors over Mr. Harrison's supposed actions, misquoted words, and misunderstood intentions. However, like its wittily humorous cousin Cranford, it features the gently desperate measures those on a class and/or professional boundary believe they must take to maintain status, and the ever-present threat to that status of lost income. In both communities Gaskell foregrounds the "elegant economies" employed by those clinging to the past for their future respectability. In our tale they appear primarily in Mr. Morgan's "economy" of "universal sympathy", always "tender and sympathetic" but not of the sort "to excite hopes" (Ch.21, p.417) which he foists upon the unwilling Mr. Harrison. The crisis resulting from the ladies misreading this currency of professional signs as romantic signals brings to the fore two intersecting themes of the tale. =46irst, it underscores that medical practice was indeed susceptible to the vicissitudes of patient whims and dislikes, thereby underscoring doctors' angst to please. Mr. Harrisons patients choose to go elsewhere till he "had no patients" (Ch.26, p.424). In fact, they show the increasing consumerism of the age by visiting our protagonists' rival: "Miss Tomkinson sent for Mr. White, from Chesterton, to see Miss Caroline; and, as he was coming over, all our old patients seemed to take advantage of it, and send for him too (Ch.25, p.424). The second theme revealed by the crisis is that a practice cannot be built merely by pleasing patients with good manners. The science and technology of medicine must take primacy over the superficial trappings of the profession. Improvements in GPs' social status would, indeed did, ultimately stem from scientific improvement and practice. Standardized medical education for all practitioners and stricter licensing regulations to distinguish the "properly trained" from the "irregular" would improve public confidence in medical men and thereby better their status. 28
The townspeople literally see the wonder of medical improvements in a hale, two-armed Mr. Brouncker returned from his convalescent holiday to a suitably amazed Duncombe, and in a nicely recovering Sophy Hutton, both on the way to healthy lives because of Mr. Harrison's scientific knowledge. In saving the lives of two Duncombe citizens--and doing so where lesser doctors would surely have failed--Mr. Harrison has earned the right to the town's respect and gratitude. The practice is rejuvenated and both men are free to follow their romantic inclinations. Mr. Harrison marries the vicar's daughter, testimony to his elevating social status, while Mr. Morgan fittingly marries the housekeeper, Mrs. Rose. As the story ends with Mr. Harrison, now a proud husband and father completing his "confessions" to an old friend, Mrs. Gaskell invites the reader to speculate on his future. Will his obvious scientific inclinations separate him from his competitors and lead to further professional success? Will he, despite scientific interest and aptitude, become a discontented Mr. Gibson (Wives and Daughters) or, worse still, a disillusioned Lydgate? The optimists among us hope Mr. Harrison finds happiness and success like Ruth's Mr. Davis, first surgeon of Eccleston.
". . . the progressive doctor in Victorian novels before Middlemarch is most often depicted as a quasi-religious model of feeling. Dickens can claim of a Physician that 'where he was some thing real was,' but that real is manifested not so much by the ironic disinterestedness of scientific discernment as by charismatic understanding. . . . In contrast, Lydgate's distinguishing characteristic as a physician is not his compassion...but the degree to which Eliot specifies and valorizes his intellectual activity--the sense he conveys that, to put it bluntly, he knows what he is doing" (p.87).
Loudon, pp.230-33; Porter, pp.48-49. Davidoff and Hall, p.414. Peterson, p.91. Digby, p.172. Mr. Morgan's need to please is reminiscent of another GP, this one Mr. Bridgenorth in Mary Barton, called to attend Mrs. Wilson and decide whether or not she is fit to travel to Jem's trial. He at first declares that Mrs. Wilson can travel, but once he realizes Mary is against Mrs. Wilson's making the trip, he replies: "Why did you not tell me sooner? [The trip] might certainly do her harm". In Norton: New York, 1958, Ch.24, p.263. I refer to her widely anthologized speech/essay given to the Women's Service League in 1931, "Professions for Women". In it, Woolf describes at length her need to kill the Victorian "angel in the house" in order to become a professional writer. Loudon, pp.228, 230.