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Vital Signs offers both a compelling reinterpretation of the nineteenth-century novel and a methodological challenge to literary historians. Rejecting theories that equate realism with representation, Lawrence Rothfield argues that literary history forms a subset of the history of discourses and their attendant practices. He shows in particular how clinical medicine provided Balzac, Flaubert, Eliot, and others with narrative strategies, epistemological assumptions, and models of professional authority, and he traces the linkages between medicine's eventual decline in scientific and social status and realism's displacement by naturalism, detective fiction, and modernism. Rothfield first demonstrates, in discussions of Balzac's The Country Doctor and Flaubert's Madame Bovary, that the nature of the connection between medicine and realism varies with the purpose and period of each author, even where realists unabashedly appropriate the clinical viewpoint. In Eliot's Middlemarch, however, a crisis of medical authority--provoked by emerging alternative scientific conceptions of the body and by medicine's loss of charismatic appeal as it consolidates into a profession--makes the connection between medicine and realism increasingly difficult to maintain. Zola and Conan Doyle respond by subordinating the clinical viewpoint to others in their "pararealistic" fiction, while modernists negate medicine's basic presuppositions about the body, truth, and professional authority. Pathology, Rothfield concludes, constitutes a category of social differentiation equivalent to race, class, or gender; it generates a politics of knowledge irreducible to either "policing power" or Marxist totalizing.
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