In Modernism, Medicine, and William Carlos Williams, T. Hugh Crawford defines the modernist poetics of Williams and attributes their development to Williams' medical education and the state of scientific advancement during the later 19th and early 20th centuries. Crawford identifies four modernist concerns--objectivity, clarity, efficiency, and cleanliness--that recur throughout Williams' poetry (135). (To hear Williams read "The Red Wheelbarrow," click here). Other critics recognize Williams the physician as well as Williams the writer, though no critic is as forthright as Crawford. To Crawford, medicine is the formative parent to Williams' modernist poetics. To understand Williams' modernism, we must look to medicine and science.
There was a dynamic tension between older homeopathic medical practices and the new, more advanced modern medicine in Williams' formative years (Crawford 135). Moreover, this paper will argue, throughout the latter medical fictions of The Knife of the Times (1932), Life Along the Passaic River (1938), and Beer and Cold Cuts (1950), Williams was still struggling to reconcile the old and the new--the antiquated and the modern. Williams' doctor narrators in these stories are perched at the juncture between the two worlds. Modernism is neither wholly accepted nor rejected, but questioned and investigated. This fact suggests that Williams was uncomfortable with certain aspects of medicine and science, and consequently modernism.
The aim of this analysis is not to prove which of Williams' associations--professional or artistic--influenced him most. It is reasonable to assume that both contributed in profound ways. What is certain, however, is that Williams' poetics are distinctly modern. A member of the modern art group "Others" and a frequent visitor to the Arensberg Salon throughout his career, Williams was also close to the surrealists in the 1940s (Slate 654). (see surrealism 1 and surrealism 2). These artistic associations enabled Williams to become an
esthetic revolutionary who never stopped thinking of himself as a dangerous outsider or--at the very least--a subversive agent. He usually wrote to attack academic assumptions about the short story and continually questioned the premises of successful fiction. (Slate 647)
Williams insisted that the short story is an "amoral art form, that . . .it has no responsibility to be anything other than a 'formal' arrangement of words" (Wagner 104).
Through his technique Williams strives for a sharpness of detail; nothing should be "over-crowded" or "overlapping" (Witemeyer 18). He emphasizes action rather than description, a parameter in which verbs become more important than adjectives (Wagner 118). Like the Imagists, Williams believed in the direct treatment of the "thing," which requires concise language. Hence, the language of the short stories is "spare, swift-moving[,] colloquial" and "purged of all stylistic pyrotechnics" (Breslin 138-39). There is also the conspicuous absence of conventional punctuation and speech tags.
Crawford's argument regarding similar characteristics--clarity, cleanliness, efficiency, and objectivity--privileges Williams' professional associations. There is no question about Williams' modernist technique in the short stories. What remains to be seen, however, is how Williams questions modernist ideals in the medical fictions. To investigate this we must accept and concentrate on the professional association, medicine, as a major contributor to Williams' poetics.
Let us place Williams in his medical milieu (see also AMA and NYU). From 1885 to 1910 the medical profession saw sweeping reform, most notably in medical education. During this time medical schools extended the length of their programs from two years to as much as nine years (Ludmerer 72). Important new subjects, such as bacteriology (Ludmerer 76), became part of the curriculum and admissions standards were raised. Practical instruction involving laboratory work and clerkships replaced didactic instruction (Ludmerer 72). This developmental period was a time to embrace new educational principles. Among the first schools, along with Harvard, Michigan, and Johns Hopkins, to fully implement these reforms was the University of Pennsylvania (Ludmerer 73).
Williams graduated from Pennsylvania in 1906, completed internships at the French Hospital and the Nursery and Child's Hospital in New York City in 1909, and concluded his studies in pediatrics at Leipzig, Germany in 1910 (Whitaker xiii). He settled into a rural practice in Rutherford, New Jersey and was between two worlds--the world of a doctor trained by the most advanced (at the time) laboratory techniques, and the world of the rural physician who relied on the "uncertain effects of an 'unscientific' pharmacopeia and on vis medicatrix naturae" (Crawford 5).
Williams was a witness to the drastic changes occurring around him that brought the world into the modern age. Born in 1881 into the "era of the steamship and horse and buggy," Williams "soon witnessed the birth of the modern city, the transportation revolution, and--because of the general acceptance of germ theory, laboratory medicine, aseptic practices, and publicly sponsored health programs--the emerging dominance of scientific medicine" (Crawford 3). As mentioned above, in his study Crawford argues convincingly that Williams' form of modernism was developed primarily from his medical and scientific studies, even more so than from his associations with Ezra Pound, Wallace Stevens, and Marianne Moore (Crawford 4). Williams, however, came to question modernism and its authority, particularly in Paterson, as modernism became institutionalized (Crawford 4). As will be shown, throughout the short medical fictions Williams struggles with modernist ideals while trying to reconcile the old and new worlds of medicine.
During his most productive years, Williams often thought of devoting all of his time to the cultivation of his art. Ezra Pound once suggested that Williams give up his medical practice in Rutherford in order to move to the center of the literary scene in Europe. For whatever reasons, certainly among them the dismal popular response to his best poetry (Breslin 125), this drastic change never took place (Williams "Afterword" 139). What is certain, however, is that Williams was a victim of the stock market crash directly preceding the Great Depression (Breslin 125). As a young man Williams decided that poetry and the arts were his first love, and that by taking up a medical profession he would earn the means by which to support his literary and artistic pursuits (Williams "Afterword" 133). Due to the unstable economic climate he was forced to forego his planned retirement (at age 50) and to continue his medical practice. As this situation persisted Williams became increasingly impatient with the daily demands of his medical practice (Breslin 125).
Daily demands aside (Williams once called his evening office hours "that hellish drag" [qtd. in Williams "Afterword" 134]) there is no doubt that his medical training served to define aspects of his writing style in a positive and unique manner. Contemporary reviewers recognized William Carlos Williams' unique position as a physician and writer. Upon review of Williams' first collection of short stories, The Knife of the Times, Gertrude Diamant notes how Williams
treats the psychological complexities of his characters with the objectivity of a physician, neither probing into causes nor attempting to enlist our sympathy. For him the psychological state of each of his characters assumes the morphology and nature of a disease; for, although a disease arises from infinitely complicated causes, the physician must give it form and a name, create it into an artistic whole, before he can proceed to handle it. (119)
After the publication of the collected stories in The Farmers' Daughters (1961), Arthur Kay mentions Williams' "clinical view": "As the body is bared, so is the soul stripped to reveal its petty embarrassments as well as its deepest despairs. Williams, to the advantage of both his arts, is the best of listeners, a man whose compassion and acceptance inspire confidences" (330). The 'clinical view' that is characteristic of much of Williams' short fiction is largely due to his training as a physician.
As we move into an analysis of the medical fictions, or the "doctor stories" as they are often called, it is important to keep in mind the tension between the old and new medical worlds. The 20th century medicine of heroic intervention is naturally opposed to the old school of homeopathy and vis medicatrix naturae. 19th century medical paradigms advocate the illusion of placebo, the power of suggestion, and infinite variability. Heroic intervention views science as the "conquest of nature, the unveiling of her secrets, and the isolation of the controlling molecule . . . the discovery of the first cause or origin" (Crawford 135).
In the medical fictions that follow, Williams' doctor characters are caught in a struggle between the two worlds. In most cases it is not an outright rejection of modernism, but an effort to reconcile feelings for the past--the premodern. Oftentimes the struggle is implicit, suggesting Williams himself struggled with the two worlds of medicine that he knew. The medical fictions of The Knife of the Times are important in that they present the initial encounter with modernism that Williams investigates further in the subsequent medical fictions. Moreover, the first doctor story of the collection is perhaps the only one of Williams' short stories in which the doctor narrator demonstrates a wholly positive attitude toward modern medicine.
The people Williams is drawn to in The Knife of the Times are common people, mostly lower-class, immigrant, and underprivileged. The topics--homosexuality, drug addiction, marital indiscretion--are unconventional by the standards of the 1930s. Most are recollections of one aspect of a moment that begin in media res and conclude unresolved, yet with the promise of perseverance over a difficult situation.
In "Mind and Body," the doctor narrator uses his observational and diagnostic skills to locate the illness of a nervously loquacious woman. This Norwegian patient named Ingrid argues against a psychosomatic cause for her pains: "I know people think I am a nut . . . . They say it is my imagination. What is that? I know when I am sick . . . . It must be something. How can they say it is my imagination? They don't know. They're fools" (Collected 38). The doctor narrator looks her over and finds nothing: "I carefully palpated her abdomen but could find nothing at all . . . . Her heart action was even and regular. Only flushed cheeks, the suggestively maniacal eyes, the quiver of the small muscles of the face, her trembling fingers told of her stress . . . . I could find nothing" (Collected 47). When the patient warns him not to tell her she is just nervous, the doctor quickly provides an "anatomic basis" for her nervousness--"terminal loops between the arteries and the veins" that are "frail" and the cause of all the nervousness (Collected 48). The woman is satisfied with the answer; the doctor tells her what she wants to hear--a scientific explanation.
What is remarkable about this story and the medical fictions that follow is not the particular "predicaments observed" but the "difficult openness of the doctor's attention" (Whitaker 75). The doctor narrator's observational stance--his "difficult openness"-- reveals how he feels about medicine and modernism. He willingly submits to his medical knowledge, even though his diagnosis is coerced. The narrator humors the patient with a technical definition of her condition: "There has never been an anatomic basis discovered for an opinion in cases like yours . . . until recently. Apparently the cause was laid down in the germ plasm when you were created . . . . The anatomic basis for your condition . . . seems to have been detected in a new study called capillaroscopy, a study of the microscopic terminal blood vessels" (Collected 48).
The doctor narrator understands the implications of her previous diagnoses: that she is "crazy" or at least that she is imagining her illness. The previous inability of medical science--the old "science" of psychosomatic misdiagnosis--to help this woman control her nervousness is contrasted by the genial confidence of the doctor narrator. His faith in modern medical science enhances the well-being of his patient. Modern advances in anatomy and capillaroscopy allow him to make such a diagnosis. Ingrid is satisfied, not with just a vague explanation, but with a specific cause of her malady. Williams' narrator in "Mind and Body" has faith in modern medicine. At the very least, he willingly submits to the new knowledge it provides.
The other medical fiction in The Knife of the Times, "Old Doc Rivers," is an exposition of the life of a talented, prominent physician before and after his destruction due to drug abuse. The story is also the first story in which Williams contrasts the old and new medical worlds. Williams continues this design in the later stories, particularly in "A Night in June." The doctor narrator pieces together various accounts of Rivers' life so that there might be a complete picture and a clear understanding. Like Williams, Rivers is a man between two worlds: old and new (Crawford 5). The narrator frames the story with two lasting images: "Horses. These definitely should be taken into consideration in estimating Rivers [sic] position, along with the bad roads, the difficult means of communication of those times . . . . It was something to look at when he came down the street in the rubber-tired sulky with the red wheels" (Collected 77). At the end of the story we learn that Rivers had a "double garage, where he kept two cars always ready for service. Here he continued to practice for several years while his wife bred small dogs--Blue Poms . . . one or more of which Rivers would often take out in the car with him on his calls, holding them on his lap, for in those days he himself never sat at the wheel" (Collected 105). The modern transportation revolution directly affects Doc Rivers. During his career he witnesses the efficiency of auto-mobiles. We can only imagine the drastic change from horse and buggy to automobile and how it would affect our own lives. The two images underscore Rivers' encounter with modern life.
Through various perspectives the narrator gathers the objective facts of Rivers' life. At various times we are presented with what seem to be explicit statements concerning the modern age. Are modern times simply unnatural? One instance would lead us to believe so. To compose himself, Rivers would head off to the woods, a fact that might reveal the narrator's feelings about modern society:
This flight to the woods . . . is a thing we most of us have yearned for at one time or another, particularly those of us who live in the big cities. As Rivers did. For in the jumble we have lost touch with ourselves, have become indeed not authentic persons, but fantastic shapes in some gigantic fever dream. He, at last, had the courage to break with it and go. (Collected 90)
This passage alone is not enough evidence to condemn modern society. Rivers is shown as being at the "vanguard of [the] transformation" between two worlds; he is the "last of the snake oil quacks" ( Crawford 23-24). The narrator grapples with the confrontation between the two worlds. He remembers that Rivers used cars which greatly increased the efficiency of his visits, yet he kept no ledgers, no office hours, not "anything that even smells like American efficiency" (Crawford 24). Rivers was successful, yet never reduced medicine to an economic commodity (Crawford 24). Moreover, Rivers was a great physician, though a debilitated drug addict.
Is the story, as Crawford calls it, a "hymn to the medical establishment" (23)? Is Rivers the "victim of the culture he was ostensibly saving" (Wagner 111)? Is he the "best of men cut down by the times" (ibid. 111)? The story is too ambiguous to say definitively. What is certain, however, is that the doctor narrator is interested in the clash between the old and the new, and the problem it creates. In "Old Doc Rivers," Williams does not vilify modernism, nor does he embrace it. The "transformation" is too complicated for Williams to make a decision. What we are left with is an examination without conclusion, however implicit, of both sides.
Williams saw Life Along the Passaic River (1938) as a continuation of the stories in The Knife of the Times (1932). His obsession with the poor was the same, yet he saw in the latter collection a maturity in his development as a writer: "I was much freer. I could say what I had to say" (qtd. in Heal 63). Williams says that the poor "couldn't do anything but give wholeheartedly of themselves . . . . By the time the next collection of stories came out I had begun to experiment a little" (qtd. in Heal 50). He experiments by adding a new dimension to the stories. In The Knife of the Times, most of the stories are one-dimensional expositions of one occurrence that Williams thought noteworthy. The stories involve extraordinary persons who leave the narrator with a lasting impression. With the exception of "Old Doc Rivers," neither the main characters nor the narrators contribute to the main action of the story. That is, in recollection the narrators tell the story as they remember it. In the medical fictions of Life Along the Passaic River, Williams allows his characters the freedom to explicitly contribute to the old vs. new medicine debate. The characters in the latter stories are more consciously and verbally reflective on the situations around them. The subsequent encounters with modern medicine reveal more complex questions and points of contention. Modernism, as represented by medicine, rears its head as an elitist practice, an impersonal institutional machine, and a design fraught with paradox.
The first medical fiction of the collection that I will address is "A Night in June." This story continues the same type of investigation of the encounter with modernism that we see in "Old Doc Rivers." The story begins with the doctor narrator looking back on a case: "I was a young man then--full of information and tenderness. . . . It was a difficult forceps delivery and I lost the child . . . though without nurse, anesthetist, or even enough hot water in the place" (Collected 136). From his modern viewpoint the narrator fondly remembers the old ways. He finds comfort in his
satchel, the same, by the way, [his] uncle had given [him] when [he] graduated from Medical School. One gets not to deliver women at home nowadays. The hospital is the place for it. The equipment is far better. Smiling, [he] picked up the relic from where [he] had tossed it two or three years before under a table in [his] small laboratory hoping never to have to use it again. In it [he] found a brand new hypodermic syringe with the manufacturer's name still shiny with black enamel on the barrel. Also a pair of curved scissors [he] had been looking for the last three years . . . (Collected 137). Nothing so satisfying as a kit of any sort prepared and in order even when picked up in an emergency after an interval of years. (Collected 138)
The competing images of old and new are increasingly complicated when the narrator compares his past with the present: "This woman in her present condition would have seemed repulsive to me ten years ago--now, poor soul, I see her to be as clean as a cow that calves. The flesh of my arm lay against the flesh of her knee gratefully. It was I who was being comforted and soothed" (Collected 142). During this ordeal with the Italian woman the narrator dreams of his experience with modern medicine:
Then I fell asleep and, in my half sleep began to argue with myself--or some imaginary power--of science and humanity. Our exaggerated ways will have to pull in their horns, I said. We've learned from one teacher and neglected another. Now that I'm older, I'm finding the older school. The pituitary extract and other simple devices represent science. Science, I dreamed, has crowded the stage more than is necessary. (Collected 141).
The narrator is comfortable with using the pituitrin, however, because of its efficacy.
In this story, the narrator is torn between images and thoughts of past and present. As with "Old Doc Rivers," the narrator is unable to reconcile the old with the new. The fact that he uses the pituitrin in the end is not enough to make the claim that he is comfortable with modern medicine. The point of the story is the encounter between old and new--the questioning of modern science and its equivocal acceptance. Suggestive of his own position between two worlds, Williams lets the doctor narrator relish the old, and then question and accept hesitantly the new.
"The Girl with a Pimply Face," brings institutional modern medicine and elitist practitioners to the fore. In this story, the doctor narrator tends to an ailing infant and is so taken by the infant's older sister that he forgets the baby's name. The older sister, the pimply-faced girl who has quit school, makes an impression immediately: "Boy, she was tough and no kidding but I fell for her immediately. There was that hard, straight thing about her that in itself gives an impression of excellence" (Collected 117). Moreover, she "wasn't in the least presumptive. Just straight . . . . A tough little nut finding her own way in the world" (Collected 119). The narrator feels deeply sorry for the underprivileged immigrant family: "Hell! God damn it. The sons of bitches. Why do these things have to be? " (Collected 128). Even though the narrator is sickened by the family and their situation, his ability to spot the positive qualities in the young pimply-faced girl outlast the negative. This is emphasized when the narrator discusses the family with a colleague who is familiar with them. The colleague is only interested in getting his fee from the family and has nothing positive to say of the pimply-faced girl: "That thing! You mean that pimply faced little bitch. Say, if I had my way I'd run her out of the town tomorrow morning . . . . Boy, they sure took you in" (Collected 130). The story ends with the narrator revisiting the pimply-faced girl. He notices her face is beginning to clear up and that she has gone back to school.
In "The Girl with a Pimply Face, " the colleague represents the bad side of institutional modern medicine. Just as the narrator of "Old Doc Rivers" defends Rivers against charges of modern greed and underscores his "altruistic motives" (Crawford 24), the narrator of "The Girl with a Pimply Face" has every reason to suspect the altruistic motives of the colleague. The colleague is unwilling or unable to see the good in the girl. The colleague is interested in money and participates in the elitism of modernism. Williams' narrator shows an implicit derision for the modern practitioner as represented by the colleague.
Another story showing a more complex or extended consciousness regarding the encounter with modern medicine is "The Use of Force. " Like "The Girl with a Pimply Face, " "The Use of Force" calls attention to the elitism of the modern practitioner. In this story, perhaps the best known of Williams' short stories, the narrator also reacts to the "epistemological issue" of science. He is faced with a diagnostic dilemma as he meets the parents of a young child: "I could see that they were all very nervous, eyeing me up and down distrustfully. As often, in such cases, they weren't telling me more than they had to, it was up to me to tell them; that's why they were spending three dollars on me" (Collected 131). The narrator's observational sense finds a positive quality in the surly uncooperative child: "After all, I had already fallen in love with the savage brat, " who "rose to magnificent heights of insane fury of effort bred of her terror in me" (Collected 133). The narrator, despite the constant resistance from the child, continues to force his diagnostic measures because "the damned little brat must be protected against her own idiocy . . . . Others must be protected against her. It is a social necessity" (Collected 134).
The doctor narrator finds the parents to be infuriating in their indolence and naiveté. He also takes exception to their stance that he is there to tell them what is wrong without any assistance. This instance raises the modernist "epistemological issue" of science: "Modern science is concerned with bounding experience and unveiling objects in order to produce knowledge" (Crawford 6). The narrator finds a positive quality in the young girl--her strong will --yet he is forced to assume the role of the elite modern physician. He must protect her from her own stupidity, and the ensuing situation is not pleasurable to him. He does not relish either modern role. He never explicitly attacks modern medicine, but his actions and feeling suggest a negative attitude toward modern science.
In the next story, "Jean Beicke, " the doctor narrator explicitly questions the role of modern medicine. The narrator, under a mask of callousness, wonders why the establishment must save the neglected children whose futures are dubious:
And sometimes the kids are not only dirty and neglected but sick, ready to die. . . . [The nurses] handle those kids as if they were worth a million dollars . . . when I, for one, wish they'd never get well . . . . I look at some miserable specimens they've dolled up for me . . . and I tell them: Give it an enema, maybe it will get well and grow up into a cheap prostitute or something. The country needs you, brat. (Collected 160)
Although his crude coping method--a brash exterior uncaring--betrays his true feelings, the narrator cares about the underprivileged infants. He finds fault for the children's vile conditions in the parents and society. Since a healthy productive life is against the odds for most of these children in society, the narrator adds: "You really wonder sometimes if medicine isn't all wrong to try to do anything for them at all. You actually want to see them pass out . . . they're awful sometimes" (Collected 160). Not only is modern medicine called into question for keeping her alive when she is doomed to a life of sordidness. Society is also to blame. When his colleague, the "ear man, " suggests that they should have checked her mastoid process, the location of her fatal ailment, sooner, the narrator, realizing that she was doomed socially if not physically, retorts "for what! . . . Vote the straight Communist ticket" (Collected 166). The narrator believes that saving this infant would be more acceptable if only there were equality in society. If they voted the straight Communist ticket, then Jean would have a chance in society. Without socioeconomic equality Jean is doomed both physically and socially.
The story reveals the narrator's ability to take the good with the bad. Like the pimply-faced girl, little Jean Beicke reveals remarkably positive traits considering her condition and surroundings. The narrator is taken by her fight for survival, that in spite of it all she would eat and sleep and persist.
"Jean Beicke" is one of the stories in which the doctor narrator's concern with modern medicine is obvious. The story is evidence of the stress of medical practice--a stress that could ultimately change an optimistic caregiver to a pessimistic determinist. The narrator simply questions the moral and social purpose of modern medicine. It is easy to imagine the narrator asking questions such as: Even though it is a moral imperative to try to save every life, is it really moral to save a life that is destined for such ignominy? It is also easy to imagine Williams himself questioning modern medicine, given the anguish it caused him in his own daily routine. Although the narrator questions modern medicine, there are no references to antiquated medical practices as a solution.
Like the narrator of "Jean Beicke, " the doctor narrator of "A Face of Stone" is facing complete pessimism. The doctor narrator is fed up with the overwork of his "miserable practice" (Collected 170). His disgust is compounded by the insolence of a particular couple who call on him with a young child: "[The husband] was one of these fresh Jewish types you want to kill at sight, the presuming poor whose looks change the minute cash is mentioned . . . . Just dumb oxen. Why the hell do they let them into the country. Half idiots at best" (Collected 167). He has no patience for them: "To hell with you, I thought to myself. Get sore and get the hell out of here" (Collected 168). Yet the young child, "a smart looking little thing and a perfectly happy, fresh mug on him" (Collected 172), changes his outlook. In one instant, the husband's previously most annoying quality--his mysterious blushing--causes a final change in the doctor's outlook: "His face reddened again and suddenly I understood his half shameful love for the woman and at the same time the extent of her reliance on him. I was touched" (Collected 176).
"A Face of Stone, " unlike "Jean Beicke, " has a positive ending. The doctor narrator regains his composure and his optimism toward the people he serves. The narrator is clearly disheartened by his daily routine, his overwork. The implication is that, even though modern medicine is valuable to society and a service to both patient and physician, modern medical practice does not necessarily make the doctor's life easier. The paradox--call it a modern paradox--in which 'better' does not always mean better, is a concern for Williams in his society. Modern efficiency allows the doctor to see more patients in a day. Over time, more and more patients means less attention per case (One need not look far to find this phenomenon reaching the most ridiculous heights in the late 20th century. Sit in the waiting room of any HMO and you will find it common). In any case, Williams is reluctant to embrace the 'positive' qualities of modernity until he has fully investigated them.
Most critics agree that the stories collected in Life Along the Passaic River are among Williams' best and his most widely read. The doctor stories that comprise this group are certainly his most complex statements about modernism and medicine.
James Guimond states that the later stories, most of those in Life Along the Passaic River and Beer and Cold Cuts, were about similar characters, yet those of the later stories possess "less colorful but more constructive" qualities (144). These constructive qualities are manifested in the medical and ethical issues encountered: the machine-like quality of institutional medical care and the modern paradox. Constructive qualities aside, some of the stories from Beer and Cold Cuts are of lesser quality than those from the early collections because Williams became less interested in short fiction after 1938, devoting most of his time to the Stecher novels, his plays, and Paterson (Wagner 117).
The first medical fiction of Beer and Cold Cuts (1950) I will investigate is "Ancient Gentility. " Like "A Face of Stone, " "Ancient Gentility" portrays a modern paradox. The story begins with the doctor narrator recalling the old days on Guinea Hill and the people he met there. During one house call he encountered an old man: "He was wonderful. A gentle, kindly creature, big as the house itself, almost, with long pure white hair and big white moustache. Every movement he made showed a sort of ancient gentility" (Collected 274). The narrator examines the old woman of the house, who "didn't look at all sick" (Collected 274), and he accepts a pinch of snuff as a sort of payment. The quiet interaction between the old man and the young doctor is touching: It was "one of the most gracious, kindly proceedings [the narrator] had ever taken part in . . . . Finally, with tears in [his] eyes, [he] felt the old man standing there, smiling, an experience the like of which [he] shall never, in all probability, have again in [his] life on this mundane sphere" (Collected 275). The narrator, now later in life, remembers fondly those old days.
"Ancient Gentility" again presents a situation in which the old meets the new in the doctor narrator's mind. From his modern perspective, the narrator longs for the simplicity and meaning-fulness of the past, here represented by the old man's gesture. It is unlikely in the present day of the narrator that a patient could pay for a visit with a pinch of snuff. I do not mean to suggest that premodern medical practices were easier when I refer to this story. Williams is suggesting, however, that simple, meaningful personal contact between a patient and a physician is rare in modern times. The advance of technology enabled physicians to see more and more patients in a day, filling every allowable time-slot with the ease of modern efficiency. The doctor narrator recalls the days when this was not the case.
The modern paradox is also evident in "The Insane, " a story of a young medical student at home with his mother and physician father. During conversation the son comments on the nature of modern psychiatry: "Of the twenty-five children I saw in the clinic this week only two can be said to be really free from psychoneurotic symptoms. Two! Out of twenty-five. And maybe a more careful history would have found something in those two. " The statistic implies a paradox: that with considerable advancement in medical technology there will inevitably be a time when everybody has some form of ailment, whether mental or physical. As technology finds more ailments, the frequency of diagnosis increases. That is not to say that the prevalence of existent disease increases, but that knowledge of previously uncatalogued disease increases. There are more ailments to distribute to the population. Upon hearing the statistic the father replies, "Not a very reassuring comment on modern life, is it? " (Collected 290).
As the story progresses, the son argues against the dehumanizing effect of modern medicine: "But what gets me, said [the] son. Of course we're checked up on all these cases; they're all gone over by a member of the staff. And when we give a history like that [that if a child has a rough family background], they say, Oh those are just the psychiatric findings. That gripes me. Why, it's the child's life. Good boy, said [the] father. You're all right. Stick to it" (Collected 290). The title of the story is sarcastic. Williams is asking how a group of children can be labeled "insane. " Is that possible? The father in the story represents the old medical style. He is pleased to learn that his son has not succumbed to the pitfalls of modernism.
In "The Paid Nurse" modern medicine is a cold institution. The doctor narrator tells the story of a young man mistreated by a large company. The young man, George, was hurt in an industrial accident that the company downplayed for insurance and compensation reasons. The doctor narrator is not surprised; the company nurse is paid to protect the interest of the company, even if it is through unethical medical practices. The narrator is very angry: "What! [he] said, when he's in agony in the middle of the night from the pains of his burns, [George] has no right to get advice and relief? . . . . You send me the compensation papers to sign. You heard me . . . and make it snappy if you know what's good for you" (Collected 268).
The narrator of "The Paid Nurse" is not pleased by the institutionalized modern medical practices of this large company. As mentioned earlier, Williams came to question modernism and its authority as it became institutionalized. The narrator's reaction to the company and its nurse is one instance of Williams' dissatisfaction. Whatever the original intention of the company policy (it is not unreasonable to suspect that they were well-intentioned), the modern medical practice becomes unethical and a point of contention. Williams questions this unchecked modern machine --the large company--revealing a negative aspect of medicine and modernism.
In the last of the medical fictions that I will discuss, "Comedy Entombed: 1930, " the doctor narrator notes the downside of institutional modern medicine. He remembers the story of a complicated premature birth. Amid the simple surroundings of their small dwelling, the narrator sees the positive in the family. He remarks the spirit of the family, their sense of humor, the order of the disorder in the house, the peace of the early morning, and their will to persevere in spite of tragedy. All of these aspects combined give the narrator a sense of inner peace. Of the woman he notes: "And she was not unattractive! I remarked it again. It was odd to see that rather amused expression on her face. Whom did she remind me of? Oh yes, the woggle-headed kid downstairs. Clowns, the two of them" (Collected 325). He finds something remarkable about the woman: "She too had been asleep, opened her eyes and smiled. Marvelous! " (Collected 329).
In a passage that is suggestive of a cubistic influence, the narrator notes that in their house
there was nothing properly recognizable, nothing straight, nothing in what ordinarily might have been called its predictable relationships. Complete disorder. Tables, chairs, worn-out shoes piled in one corner. A range that didn't seem to be lighted. Every angle of the room jammed with something or other ill-assorted and of the rarest sort. I have seldom seen such disorder and brokenness--such a mass of unrelated parts of things lying about. That's it! I concluded to myself. An unrecognizable order! Actually--the new! And so good-natured and calm. So definitely the thing! And so compact. Excellent. And with such patina of use. Everything definitely "painty. " Even the table, that way, pushed off from the center of the room. (Collected 327)
The couple maintain their sense of humor even during a high-risk premature birth. As the narrator prepares for delivery by donning his apron, the woman smiles and says "now the butcher work begins!" (Collected 328). The narrator basks in the peace of the whole experience: "These are the great neglected hours of the day, the only time when the world is relatively perfect and at peace. But terror guards them. Once I am up, however, and out it's rather a delight, no matter what the weather, to be abroad in the thoughtful dawn" (Collected 331). Finally, after the still-born baby is delivered the father wants to know the sex because he always wanted a girl:
I want to know if it's a girl.
I looked. Yes, it would have been a girl.
There, she said, you see! Now you've got your girl. I hope you're satisfied.
I haven't got any girl, he answered her quietly.
(Collected 332) Williams notes the instance that is the story because it is unlikely that a doctor could experience this in the impersonal maternity ward of a modern hospital. Perhaps the finest story of the last collection, "Comedy Entombed: 1930" is the last short medical fiction in which Williams reveals his feelings toward medicine and science. He is not rejecting modern medicine outright. The story suggests a longing for the past, the simpler times when appreciating simple things was not difficult.
Throughout the medical fictions of The Knife of the Times, Life Along the Passaic River, and Beer and Cold Cuts, Williams examines 20th century medicine of heroic intervention as it replaces older homeopathic medicine in the daily lives of his doctor narrators. Some of these characters have faith in modern medicine, while others neither fully embrace nor reject it. Instead the narrators are witnesses to the transformation from the old to new; they encounter and reflect on modernism in its various forms as it changes the medical profession.
The encounter with modern medicine--the investigation of the tension between the old and new worlds--raises questions about modernism. Among the issues regarding modernism in the stories are the "epistemological issue" of modern science, the moral and social duties of medicine, the "modern paradox" (better is not always better), and the ultimate futility of medicine. The tension between old and new also reveals the negative side of institutionalized modern medicine--the drive for money, the commodification of health, the elitism of the "utopian impulse" to modernism, the impersonal machine-like quality of the modern company or hospital in which meaningful contact is rare.
Medicine defines aspects of Williams' writing style from his poetics of cleanliness, clarity, efficiency, and objectivity, to his 'clinical view' and observational stance. Indeed, much of his modernism is due to his medical profession. Like Doc Rivers, Williams lived at the "vanguard of the transformation" between the premodern and modern worlds. In the medical fictions, Williams explores the tension between the two. These short fictions suggest that Williams was not satisfied with modern medicine and modernism. He was more comfortable exploring the implications of the modern world and its effect on his literary and medical professions. For William Carlos Williams, questioning the movement of which he was an integral part does not show a lack of faith in its ideals. It shows, however, a critical and regulatory stance--a keen eye for observation and variable control that was so much a part of his daily life.
ADDITIONAL CRITICAL WORKS ON WILLIAMS AND MEDICINE