The Empowered Physician: William Wilberforce Baldwin and

19^th century medical therapeutics

by Linda Simon

Professor of English, Skidmore College

In James’s The Wings of the Dove, when Milly Theale consults Sir Luke, he offers a diagnosis, prognosis, and prescription for therapy after hardly questioning her and without performing a physical examination. Scholars have seen Sir Luke as the very model of the authoritarian physician, empowered because of his specialized training, his social status, his association with the scientific community, and, not least, the hopes and fears of his deferential and vulnerable patients. That power is most evident in the physician’s penetrating gaze, which exposes, judges, and manipulates the patient’s body and mind.

Letters from patients of William Wilberforce Baldwin, however, complicate these conclusions about the sources of a physician’s authority. Baldwin’s patients were hardly submissive or disempowered; they were sophisticated consumers who evaluated medical treatment according to three criteria: first, they expected to know whether the physician himself had experienced the same symptoms or illness that afflicted them; second, they compared the physician’s diagnosis with their own diagnosis, based on previous experience or knowledge gained from other patients; and third, they responded positively to their physician’s empathy, particularly affirmation that their psychological pain was as real as physical pain.

We learn from Baldwin’s patients that besides sharing his views on art, literature, and politics, Baldwin disclosed details of his own suffering from such ailments as Graves Disease, gout, heart disease, pneumonia, influenza, and, significantly especially for the Jameses, the blackest depressions. These revelations served to fuel his patients' confidence in him:

Because they knew that Baldwin suffered as they did, they believed he could better understand their pain and not trivialize or dismiss their symptoms, especially of depression and anxiety. Many of his patients had been diagnosed, or described themselves, as neurasthenic, and they resented the condescension they felt from some physicians who treated neurasthenia with suspicion, as if the sufferers were malingerers or hypochondriacs. Since Baldwin apparently overcame his psychological problems through a determined optimism and passion for his work, he served as an exemplar, as model of what they, perhaps, also could achieve.

Baldwin allowed patients to collaborate in the process of making a diagnosis by suggesting causes of their illness and treatment, to share with him previous diagnoses and their evaluation of them, and to provide an ongoing evaluation of any treatment that he prescribed.

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Baldwin was born in Walton, New York on February 28, 1850, the son of a minister, whose religious beliefs, Baldwin would admit later, left him haunted and tormented by "hideous Calvinistic spectres." He graduated from Normal School when he was 21, and went on to study at the Detroit College of Medicine, earning his medical degree from Long Island College Hospital in 1876. He continued his education at the University of Vienna, where he took courses in the late 1870s and in summers until 1890. His European education was consistent with other American physicians' training; in Vienna and Berlin, for example, special courses were offered for groups of visiting Americans. When Baldwin was thirty-one, he married and set up a practice in Connecticut. Within a few years, though, he moved to Florence with his wife, where, despite his relative youth (he was in his early thirties), his practice thrived.

His patients' letters, taken as a whole, give us a portrait of a warm, charming, even charismatic man: a man who possessed an artistic temperament and, as William James put it, "genuinely social genius. . . and gallant personal pluck." Patients and colleagues noted the difference between Baldwin and other physicians -- even physically. "[C]ompared with the rest of us, he was in fact a rather striking personality," one colleague remembered; "a fine forehead, extraordinarily penetrating and intelligent eyes, a remarkable facility for speaking, very winning manners." But his looks and urbanity only partly explains his appeal.

Like James's Sir Luke, Baldwin traveled in the same social circles as many of his patients; he often received invitations for dinner or tea, and he reciprocated with invitations of his own; his patients sought his advice on matters other than health (such as traveling, hiring a cook, buying real estate, and finding good schools for their children). We find Baldwin meeting his patients during their travels; he accompanied Henry James on several trips; and when William was a patient at Nauheim, Baldwin nearly persuaded him to renounce his physician there, leave the spa, and live at his home while he recovered.

Baldwin's medical advice, for the most part, was not unusual. Like other physicians at the time, he emphasized strengthening and stimulating measures for symptoms of weakness, relaxation and change of climate for agitation or anxiety. He prescribed tonics; sometimes he prescribed red wine, even going so far as to recommend particular kind. When they were needed, he recommended stimulants, such as strychnine. He sent his heart patients to the popular German spa Bad Nauheim. He suggested massage or an ocean cruise for others. Sometimes, his advice was nothing more than common sense: when William James was suffering from insomnia, Baldwin suggested that he might sleep better with a higher pillow. It worked. But Baldwin's ability to respond to the unstated emotional needs of his patients offered them something more significant, less tangible, and apparently more unusual, than conventional therapy.

In one moving letter, for example, Mark Twain pleaded for Baldwin's complicity in saving his wife: "Tell her that you want to make a more thorough examination by the light of the last few days' regime, and then tell her there is nothing the matter with her heart that need alarm her. . . .Medicine has its office," Twain added, ". . .but without hope back of it, its forces are crippled and only the physician's verdict can create that hope when the facts refuse to create it. You can lift the patient up again where she was before and I want to see you come and conspire with you to drive her fatal imaginings out of her head."

Baldwin knew firsthand the impact of "fatal imaginings." His own success did not prevent recurring depressions, nor a feeling of discontent that made him restless in Florence. In the late 1890s, we find that he was practicing in Harley Street in London; later, he moved to Rome; in 1904, he coveted an appointment to a professorship of hygiene at the Harvard Medical School. Besides depression and assorted transitory ailments, Baldwin also suffered from heart disease. The treatments that he prescribed for his heart patients were those he underwent himself: baths at Nauheim, for example, or an experimental treatment that caught the imaginations of many patients: the Roberts-Hawley lymph serum, derived from the lymph glands, and probably sexual organs, of goats. Baldwin's "arterial" problems apparently became serious in 1898, when he was forty-eight, and continued for the rest of his life. He died of a cerebral hemorrhage, at the age of sixty.

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Baldwin's relationship with Henry, William, and Alice James offers useful evidence for understanding his reputation. William James spoke for his siblings when he remarked that Baldwin had "no more exact science in him than a fox-terrier," but it was not scientific expertise that the Jameses sought from him; they believed that the knowledge he offered them was deeply intuitive, morally certain, and congruent with their own sense of self.

Henry James suffered from digestive, rheumatic, and nervous illnesses; William, who studied but never practiced medicine, sought physicians' help for assorted ailments, including depression, insomnia, and heart disease; and his sister visited physician after physician for the many emotional and physical problems that plagued her throughout her life. The Jameses were not loyal to any one physician, nor did they privilege those trained at medical school over alternative practitioners.

All three Jameses experimented with assorted therapies, including gymnastics, electrical massage, galvanism, rest cure, baths, mind cure, and various dietary regimens, such as Fletcherism, to alleviate their ailments. No fad eluded them. Neither did the gnawing anxiety that all their illnesses were, at base, psychosomatic, and therefore self-inflicted. They desperately did not want to be at fault, however, and when physicians implied their own culpability in their pain, they became deeply depressed. Alice's exclamation of joy at her physician's diagnosis of breast cancer reflects her longing, as she put it, "for some palpable disease, no matter how conventionally dreadful a label it might have. . . " Until she received that diagnosis, she felt condemned "to stagger alone under the monstrous mass of subjective sensations, which that sympathetic being 'the medical man' had no higher inspiration than to assure me I was personally responsible for, washing his hands of me with a graceful complacency under my very nose." Baldwin was among the few physicians who did not make her, or her brothers, feel guilty for their sufferings.

Henry was the first of the family to consult with Baldwin, perhaps on the recommendation of his friend Constance Fenimore Woolson. In 1887, James, in London, sent Baldwin, in Florence, a long letter detailing a pain that he thought was in his kidney, and feared was caused by inflammation. The pain led to "an outrageous neuralgic headache," which in turn made him feverish. Uncomfortable from the fever one night, he threw off his blanket, opened his bedroom window, and caught a chill. The "general cold" that resulted "lodged. . .particularly in the legs (which ached, rheumatically), in the intestine -- which ached also -- & the lower part of the back." A few days after reporting the symptoms, in response to a letter from Baldwin, he rushed two urine samples to the doctor. But strangely enough, by the time he sent the samples, his symptoms had been alleviated: "the day after I had written to you," James told Baldwin, "I began to feel better & the day after that felt quite well -- which has continued." This syndrome of severe inexplicable pain, followed by complications, followed by inexplicable relief was familiar to all of the Jameses, and puzzling to their various physicians. Baldwin's unquestioning sympathy earned Henry's trust. When Baldwin, in 1893, confided feelings of despondency to James, the novelist replied, “who shall heal the great healer when the great healer is depressed himself?” His own patient, perhaps, by reminding Baldwin of his “genius and fame & prosperity & the power to face the elements.”

The two men, James the older by seven years, became friends. When Baldwin visited London, or passed through on his way to America, he stayed with James, often for several weeks. One summer, James recalled sharing "a very hot Italian railway-carriage, which stopped and dawdled everywhere. . . " with a physician that scholars assume was Baldwin. Apparently Baldwin shared stories about various patients - certainly James found out much about Fenimore Woolson from him - and this time, he told James about an American family he had treated, whose son, “acute and precocious” and “beautifully intelligent” suffered from a serious heart problem. The anecdote, which James considered a “windfall,” became the seed of his tale, "The Pupil," with its young hero, Morgan Moreen. Although the story echoes James's own childhood in Europe, when he was a precocious and often ill boy, taken here and there by a family of "high but unauthenticated pretensions," it is likely that Baldwin would have been consulted in this case, since he was known as a specialist in cardiology with experience in treating children.

He also had a special interest in neurotic women - women frustrated over their care by other physicians -- and he established a clinic where his bedside manner seemed to one rival to be the primary reason for his patients’ recovery. Certainly Alice James, who had no kind words for most medical men, responded unusually positively to Baldwin.

Here is her description of one disappointing visit from another doctor, as she reported it to her brother William:

My doctor came last week & examined me for an

hour with a conscientiousness that my diaphragm

has not hitherto been used to. When he came to the

end he was as inscrutable as they always are & the

little he told me I was too tired to understand. He

is coming next week when as there wont be as much

percussing & stethoscoping to be done I can get more

out of him. . . . I think he takes the gout as a foregone conclusion simply & is deciding what other

complications there are. Meanwhile he has left me

a pill of which he thinks all the world & I am

to have my spine sponged with salt-water. I was

much disappointed by his lack of remedial suggestions,

all great doctors are chiefly interested in the diagnosis & don't care for anything else apparently. They ought to have a lot of lesser men, like tenders,

to do their dirty work for them, curing their patients,

etc.

The doctor's return visit proved no more enlightening, and Alice complained again about his lack of interest in giving her useful advice about "climate, baths or diet. . . .The truth was," she wrote to her aunt, "he was entirely puzzled about me & had not the manliness to say so." Alice attributed his lack of interest in her to his fame as a doctor: the greater the reputation, she was certain, the less interest a physician had in the trivial maladies of each patient.

"It requires the strength of a horse to survive the fatigue of waiting hour after hour for the great man," she wrote to William late in her life, "and then the fierce struggle to recover one's self-respect." But Baldwin's four visits in 1891, after Alice had been diagnosed with cancer, generated a far different response. "He appears to have been almost the only doctor that she has ever liked to see," Henry James wrote to William, adding that Baldwin had a "joyous" effect on their sister. In a letter of gratitude to Baldwin after his visits, Alice depicted herself as "a humble spinster to whom you upon a day of sore necessity brought hope, comfort & help." She signed the letter, "your limp & shadowy but sincerely grateful friend & patient."

William, the last of the Jameses to put himself under Baldwin's care, began consulting him in 1893, when he settled in Florence during his sabbatical from teaching at Harvard. His comment after a visit with Baldwin reveals the significance to a patient of a physician's intimate revelations. "What a magician you are!" William's wife wrote to Baldwin. "You cured my husband of the morbid depression which has been weighing on him for many days, and how greatly! After you had gone he said to me 'How Baldwin has cheered me up by that talk about himself, it seems almost as if [he] knew how I was feeling.'"

Baldwin’s relationship with his patients urges us to question a characterization of Victorians as deferential, accepting a doctor’s therapy blindly, reduced by their physician’s authoritarian gaze, vulnerable and powerless. Baldwin’s patients sought and found a physician who made them partners in their treatment and care.

Notes

I am grateful to Skidmore College for a Faculty Development Grant, which funded research for this essay.