'The Doctor': Profession rather than Person

By Bethany Frost

            During the Victorian Era, science and medicine saw a revolution: improvement was made with new steel tools and anesthetics; and new procedures prevented patients from getting infections. This change was also presented in Victorian Literature, through doctor-characters, such as Lydgate in Middlemarch by George Eliot, and Mr Gibson in Wives and Daughters by Elizabeth Gaskell. Yet within these novels and through this revolution revealed the demands of a doctor, their lack of domesticity and lost identity as a human being: 'It was the same professional mindset that accommodated the empirical advances of surgery later in the century, and informed the portraits of fictional surgeons whose progressive scientism all but destroy their humanity and compassion' (Sparks 4). 

MiddleMarch

'Victorian Literature’s most famous doctor, the surgeon Tertius Lydgate in George Eliot’s Middlemarch (1872), exemplifies the ill fit between the marriage plot and the doctor-character.' (Sparks 3). Under a male pseudonym, George Eliot produced one of her most famous works: Middlemarch. Instead of a love story, Eliot chose to challenge the ideas of marriage and battle it with profession, revealing the disadvantages of both. This is most displayed through her two major characters: Lydgate and Rosamund. 

(1) Eliot's book cover

What is evident in the novel is Lydgate’s responsibilities as a surgeon and a husband; yet combining both has it's difficulties. For example, Lydgate's lacks the ability to show sympathy or understand other men because of his scientific mindset: "He had no power of imagining the part which the want of money plays in determining the actions of men." (209). What is later evident is when his love for Rosamund collides with his career, specifically his finance after she overspends. This, therefore, damages Lydgate's career, and ability to financially continue his research. It is argued in Tabitha Sparks' The Doctor in the Victorian Novel: Family Practices that 'the collision of the medical/professional and emotional spheres in their marriage typifies the friction between doctor-characters and domestic, romantic plots in the Victorian novel across the period.' (3)

Lydgate's responsibilities as a doctor is demanding, especially during this era where science and medicine is constantly evolving. However, his ability to have a domestic life, having Rosamund as a wife and form a emotional relationship, causes friction with his career and his mindset. Therefore discourages the chance of domesticity and leads to Lydgate and Rosamund's unhappy relationship.

The Old Operating Theatre

When researching Victorian Surgeons, the Old Operating Theatre Museum in London was a favourable location. When entering St. Thomas Street, the outside of the Theatre seems unusual, as it was a tall tower beside a church. 'The wards of the south wing of St. Thomas’ Hospital were built around St. Thomas’ Church' (Flude). This meant that the Herb Garret in the roof of the church was converted in an Operating Theatre in 1882. On the website of the Museum, History of St Thomas' Hospital, Kevin Flude explains how it 'provided a separation from the ward. It gave separate entrance for students, and afford a measure of sound proofing. It was also approximately at the same level as the women’s surgical ward which aided the transport of patients to the theatre.' (Flude). 

(2) Outside the Operating Theatre in 1825 (3) Outside the Operating Theatre in 2008

Since it is in the roof of the church, you must climb a tall wooden spiral staircase leading to the first room: the Herb Garret. The room contains medieval remedies and ingredients used for coughs and colds, but further through the room there are displays of surgical equipment for midwives, including forceps, hooks, clamps and calipers. Below show forceps used to remove the child and underneath displays the 'Cervical Dilator' (the metal instrument with eight prongs).

(4) Equipment for Midwives

At the back of this room, there is a corridor that leads to the Operating Theatre. Within the corridor there are more displays containing surgery cases, knives of different sizes and saws. It was very unnerving seeing these, knowing that the equipment had been previously used to perform surgery on real Victorian people. One of the surgical cases was owned

(5) Surgical Case by Edward Mason Wrench (1833-1912) who trained at St Thomas' Hospital. In the case consisted of: 1. Two Ebony handled saws 2. Trephines  3. Tourniquet  4. Forceps 5. Bullet Extractor 6. Amputation Knives 7. Bone Nippers

In the next display case, there are early inventions of antiseptic liquids and anesthetic masks. J.T.H. Connor explains in his essay The Victorian Revolution in Surgery that 'By the 1880s, antiseptic surgery had transformed into aseptic surgery as knowledge about pathogenic bacteria accumulated. Surgeons now concentrated their efforts on excluding disease-causing bacteria from incisions and amputation sites by ensuring that their own hands had been thoroughly cleaned and their street clothes were covered by clean white gowns.' (54) Victorian surgery was transforming, the Museum displayed this transition from old methods to new.

(6) antiseptic liquids and anesthetic masks

To enter the Operating Theatre, you have a climb a small set of stairs onto the balcony area looking down at the center, where a small wooden operating table stands in the center. 'The Theatre was purpose built to maximize the light from above, with a large skylight. Although not heated or ventilated, it provided an ideal, albeit small, area for demonstrating surgical skills.' (Flude). On the wall there is a plaque saying: ‘Miseratione Non Mercede’ which was explained underneath to mean 'For compassion not for gain'. Beside it is a coat hanger for the surgeon’s coat and a basin for hygiene use. 

(7) The Operating Theatre

Wives and Daughters

After seeing this museum, there is a sense of professionalism with a Surgeon's work; seeing the transformation of surgery and medicine. When looking for another Victorian Literature book that displays a doctor-character, Elizabeth Gaskell’s Wives and Daughters seemed most useful. Although the protagonist is Molly Gibson, Mr Gibson, her father and the town Doctor, displays the same recurring themes of constrained domesticity and demanding professionalism. 'Mr. Gibson's work as a surgeon limits his emotional perception. This is not because of the scientific orientation of surgery...but rather because of his field's demand for dogged, ambitious and practical-minded professionals.' (Spark 4) Through Mr. Gibson’s experiences we see the struggle of being a doctor during the Victorian era, but the novel also highlights how his profession becomes his identity. Mr. Gibson lacks a sense of class position, this is shown in the novel when he is often invited to dine with a upper class family: "The grandeur of being an invited guest to dinner at the Towers from time to time, gave him but little pleasure for many years, but it was a form to be gone through in the way of his profession, without any idea of social gratification." (70)

 

(8) Gaskell's book cover

What can also be shown is the expectation of doctors, for example Mr. Hall was the previous doctor of the town and took Mr. Gibson as a partner. In the description of Mr. Hall, it explains: “But, blind and deaf, and rheumatic as he might be, he was still Mr. Hall, the doctor who could heal all their ailments – unless they died meanwhile – and he had no right to speak of growing old, and taking a partner.” (60). This shows a dependence the town had on their doctor, and that a doctor having any domesticity was seen as wrong. Doctors therefore had a responsibility for their patients, to the extent they had no freedom to have a life of their own. However, for Mr. Gibson, it is more complex. 

To start with, Mr. Gibson is rarely referred to with his name, but rather ‘the doctor’, thereby losing his identity as anything else other than a healer. His battle between emotion and profession is displayed with his daughter, Molly: “Mr. Gibson’s position seemed settled for life, both socially and professionally. He was a widower, and likely to remain so; his domestic affections were center on little Molly, but even to her, in their most private moments, he did not give way to much expression of his feelings.” (63). This shows his struggle to express emotion, which is also evident in Lydgate in Middlemarch. However, Tabitha Sparks explains: 'Gibson’s emotional detachment shapes the parenting decisions that lead to his own marital unhappiness and, over time, make Molly vulnerable to imprudent influences.' (75). This is shown when he remarries, giving Molly a step-mother because he believes she needs a female figure in her life rather than marrying for his own needs.

Both Lydgate and Mr Gibson display a separation in life emotionally; that they lack the ability to sympathize with others because of their need for professionalism in their vocation as medicine and science are constantly changing during the Victorian era. To conclude, a doctor's profession during the Victoria era became an identity in social class but it also lacked the ability to have a domesticated life due to it's demands emotionally and professionally. 

(1491 words)

Works Cited

Connor, J.T.H. "The Victorian Revolution in Surgery". Science. 2 April 2004. Vol 304 (5667). Web. 27 November 2015. <http://www.sciencemag.org/content/304/5667/54.full.pdf>

Eliot, George. Middlemarch. Middlesex: Penguin Books. 1965.

Flude, Kevin. "History of St Thomas' Hopsital" The Old Operating Theatre Museum & Herb Garret. Web. 14 Nov 2015. <http://www.thegarret.org.uk/stthomas.htm>

Gaskell, Elizabeth. Wives and Daughters. Middlesex: Penguin Books. 1969.

Spark, Tabitha. The Doctor in the Victorian Novel: Family Practices. Farnham: Ashgate. 2009.

Images

1. Behold the Stars. "Middlemarch by George Eliot". Online Image. Blogspot. 29 Dec 2013. Web. 16 Nov 2015. <http://beholdthestars.blogspot.co.uk/2013/12/middlemarch-by-george-eliot.html>

2. Flude, Kevin. "The Discovery of the Old Operating Theatre". Online Image. The Old Operating Theatre Museum & Herb Garret. 3 Aug 2011. Web. 14 Nov 2015. <http://www.thegarret.org.uk/discovery.htm>

3. Chadwick, N. "The Old Operating Theatre Museum, St Thomas St." Online Image. Geograph. 8 Dec 2008. Web. 15 Nov 2015. <http://www.geograph.org.uk/photo/1073353>

4-7. Taken by B Frost at The Old Operating Theatre Museum in St Thomas street, London. 14 Nov 2015.

8. Behold the Stars. "Wives and Daughters by Elizabeth Gaskell". Online Image. Blogspot. 28 May 2015. Web. 16 Nov 2015 <http://beholdthestars.blogspot.co.uk/2015/05/wives-and-daughters-by-elizabeth-gaskell.html>

“I struggle, bound by that terrible powerlessness which paralyses us in our dreams”: Paralysis in the Nineteenth Century

Paralysis was studied in nineteenth century art, literature, psychiatry, demonology, medicine, and (pseudo-)sociology. Having no definite form, and eluding the empiricism of medical treatment, paralysis played on many of the Victorians’ worst fears. As such, it occupied a prominent position in the Gothic canon of the era, from the stories of Guy de Maupassant and Edgar Allen Poe, to the paintings of Henry Fuseli. It was also a topic of ferocious interest to the scientific community, with pathologists, alienists (an early (and far better) name for psychiatrists), demonologists and physicians all vying to prove that the root-cause could be explained through their discipline. Two kinds of paralysis that horrified and fascinated both camps, were general paralysis of the insane (GPI), and sleep paralysis. I’ll be tracking this morbid strand through nineteenth century art, touching upon Maupassant’s death, Nietzsche’s mental collapse, premature burial, and, of course, Fuseli’s horse.

Fuseli's horse

GPI

General paralysis of the insane is defined in the Dictionary of Nursing as “a stage of tertiary syphilis characterized by dementia and spastic weakness of the limbs.” However, this syphilitic link wasn’t accepted by Victorians until the 1880s: prior to this, they considered it a “complication of insanity” (as if insanity weren’t complicated enough). This assumption, and the name of the disorder, came as a result of the prevalence of the condition in Victorian asylums. This table shows the severity of GPI in 1859:

Statistics of deaths in asylums, 1859

As can be seen from the percentage of deaths from general paralysis, the mortality rate attributed to the condition was astronomical: as many as 4.65% of patients in asylums in England were dying from GPI. Considering that the highest number of deaths from all other causes was 12.2%, GPI was clearly the primary killer. To make the threat of this incurable, deadly, and elusive disorder even more terrifying to the artists of the era, there was a received wisdom in the nineteenth century that “brain workers” (people who use their brains for work rather than their hands) were more at risk from GPI than others. Studies such as this (below) from 1928, moved to disprove this theory through sociological research into those killed by GPI. As can be seen from the table, the percentage of observed “upper class” (presumably “brain worker”) deaths from the condition was actually lower than the percentage of observed deaths in “skilled workmen” and “unskilled workmen”. While studies like this made it apparent that theories about the increased susceptibility of “brain workers” were nonsense, this sort of research wasn’t carried out until the 1920s. On top of this, a cure wasn’t in sight until the discovery of penicillin in 1928 (which eventually wiped GPI out in developed countries) by which time the condition and the fear surrounding it had produced a profound effect on the arts.

Percentages of deaths by GPI through the classes

Guy de Maupassant's death certificate

The spectre of death-by-paralysis haunted nineteenth-century literature. Guy de Maupassant, the French short story writer, processed his fears over his longstanding syphilitic symptoms through his work, which frequently featured characters suffering with paralytic or cataleptic disorders. This is grimly prophetic considering Maupassant's death certificate (pictured, left) lists his cause of death as GPI. He was syphilitic for a great chunk of his writing career, and experienced hallucinations, migraines, and fits of paralysis. His short story “Who Knows”, written in 1890, 3 years before his death, exhibits symptoms of GPI. Luis-Carlos Alvaro pointed this out in his article on neurological conditions in Maupassant's work: “Maupassant’s neurosyphilis (GPI) had advanced and its visual and mental symptoms were clearly developed.”

Guy de Maupassant, and his moustache

“Who Knows?” follows the mental collapse of its central character on his return from a night out. He’s walking home when he begins to hear a “humming noise”. The intensity of this experience steadily escalates until he sees his armchair “waddling […] through [the] garden”. Alvaro attributes these descriptions to Maupassant’s experience of migraines, hallucinations, and “elaborate visual phenomena”, through his accelerating neurosyphilis. GPI would go on to claim Maupassant’s life; but perhaps the more threatening aspect of the condition for masters such as Maupassant, was its capacity to turn the mind against itself.

Friedrich Nietzsche, and his moustache

Another figure suffered an almost concurrent collapse under GPI: Friedrich Nietzsche (lower right), the German philosopher. Nietzsche, although not considered so in his lifetime, was one of the premier thinkers of the nineteenth century. A professor of philology by the age of 24, he crammed his intellectual achievements into a very short career. Like Maupassant, Nietzsche spent a good chunk of his life with syphilis (also, curiously, both had magnificent moustaches). This is generally considered to have developed into GPI, which took his sanity and eventually his life, although this diagnosis has been challenged by more recent studies. Nietzsche was only 44 when he suffered his initial breakdown in 1889, after which his behaviour was drastically altered: he spoke to himself and wrote bizarre letters, signing them as “The Crucified One”. He was admitted to Basel mental asylum in January 1889, before being transferred to Jena, where his condition worsened. He had a confused concept of his identity, and he repeatedly urinated and soiled himself, usually proceeding to eat the faeces and drink the urine. He spent the final years of his life in the care of his family, dying in 1900. Nietzsche’s decline further demonstrates the fearful prospect that GPI represented to the genius in the nineteenth century.

Sleep paralysis

Fuseli's The Nightmare

Sleep paralysis was defined by Samuel Johnson in A Dictionary of the English Language (1755) as “nightmare”. This definition is played with in the 1781 Henry Fuseli painting The Nightmare (left). In the piece, a demon sits astride a sprawled, unconscious maiden (and the eponymous mare leers behind). This presents fairly accurately experiences of sleep paralysis; one is accosted in a state of vulnerability by some assailant, often demonic, who sits astride one, often throttling or otherwise assaulting the victim. The horse may be peculiar to Fuseli.

Maupassant described a similar experience in his short story “The Horla”:

I sleep ... a long time ... then a dream ... no ... a nightmare lays hold on me. I feel that I am in bed and asleep ... and I feel also that somebody is coming close to me, is looking at me, touching me, is getting on to my bed, is kneeling on my chest, is taking my neck between his hands and squeezing it ... squeezing it with all his might in order to strangle me. I struggle, bound by that terrible powerlessness which paralyses us in our dreams; I try to cry out - but I cannot; I want to move - I cannot; I try, with the most violent efforts and out of breath, to turn over and throw off this being which is crushing and suffocating me - I cannot! And then suddenly I wake up.

This is almost an exact reconstruction of Fuseli’s Nightmare (minus the mare). Alvaro interprets this dream as a manifestation of “anxiety bordering on a panic attack”. This both further characterises Maupassant’s experience of neurosyphilis, and points towards a more cultural sickness; the fear over the dormant self. The rise of “alienists” in the medical sphere prompted a growing awareness of the unconscious mind; and with awareness, came fear. What was this uncontrollable segment of the brain up to? Hence, this fear over sleep expressed a fear over the unconscious mind -- linked to another rising fear, over premature burial.

Premature burial

A diagram showing the function

An advertisement for a safety coffin

The word for the fear of being buried alive is Taphophobia, and in the nineteenth century, it was rampant. There was a thriving trade in safety coffins (left and right), which allowed the cadaver to signal to those above ground that it wasn’t dead, if it should cease to be so. There was also a Society for the Prevention of People Being Buried Alive, founded 1896, and a Hospital for Doubtful Life, opened 1792, where corpses were kept in warm surroundings until they began to rot. Just to make sure.

Edgar Allen Poe, seizing upon the widespread fear over live burials, wrote a short horror story called “The Premature Burial” in 1844. In this story, the narrator recounts a few horrific tales of premature burial, before revealing that “for several years I have been subject to attacks of the singular disorder which physicians have agreed to term catalepsy”. Catalepsy is defined as “a condition of suspended animation”, in which the body can, for months at a time, assume the appearances of death. The narrator fears that this condition will lead to his premature burial: “I talked ‘of worms, of tombs, of epitaphs’”. His fear, however, centres not around the fits of catalepsy that seize him in his waking hours, but around sleep: “When the nature could endure wakefulness no longer, it was with a struggle that I consented to sleep – for I shuddered to reflect that, upon waking, I might find myself tenant of a grave.” The narrator is not primarily fearful of the deception of his body, but of his mind; and more specifically, his unconscious mind. The narrative proceeds, with the narrator taking increasingly paranoid and drastic measures to pre-empt his premature burial. Eventually, he experiences what he thinks is premature interment, only to realise after minutes of panic that he is merely sleeping in a cramped berth on a boat. The horror of thinking that he had been buried alive causes him to embrace life anew: “I dismissed forever my charnel apprehension, and with them vanished the cataleptic disorder, of which, perhaps, they had been less the consequence than the cause.” This demonstrates neatly the syndrome often expressed in sleep paralysis at the time: fear over the unconscious mind led to frightening unconscious activity, and a cycle began.

What GPI, sleep paralysis, and premature burial all prompted, was a fear of the unknowable. Paralysis negated and resisted both literally and metaphorically the ceaseless onward-motion of the nineteenth century, and thus occupied a ghostly space in Victorian art, science, and minds.

 Works Cited

Álvaro, Luis-Carlos. "Hallucinations and Pathological Visual Perceptions in Maupassant's Fantastical Short Stories- A Neurological Approach."Journal of the History of the Neurosciences 14.2 (2005): 100-15.MedicLatina [EBSCO]. Web. 30 Oct. 2015.

Bondeson, Jan. Buried Alive: The Terrifying History of Our Most Primal Fear. New York: Norton, 2001. Print.

"catalepsy". Dictionary.com Unabridged. Random House, Inc. 27 Nov. 2015. <Dictionary.comhttp://dictionary.reference.com/browse/catalepsy>.

Hurn, Juliet D. The History of General Paralysis of the Insane in Britain, 1830 to 1950. Thesis. Thesis (Ph. D.), 1998. N.p.: n.p., n.d. UCL Discovery. Web. 30 Oct. 2015. <http://discovery.ucl.ac.uk/1349281/1/339949.pdf>.

Johnson, Samuel. "Nightmare." A Dictionary of the English Language. 1755. Johnsonsdictionaryonline.com. Web. 28 Oct. 2015. <http://johnsonsdictionaryonline.com/?page_id=7070&i=1363>.

Martin, Elizabeth A. "General Paralysis of the Insane." Oxford Dictionary of Nursing. Ed. Tanya A. McFerran. Oxford: Oxford UP, 2014. Oxford Reference Online [Oxford UP]. Web. 5 Nov. 2015.

Maupassant, Guy De. Complete Short Stories of Guy De Maupassant. Garden City, NY: Hanover House, 1955. Print.

Mckinlay, Peter L. "The Proportional Frequency of General Paralysis of the Insane and Locomotor Ataxia in Different Social Classes." Journal of Hygiene J. Hyg. 27.02 (1928): 174-82. PubMed. Web. 27 Oct. 2015.

Orth, M., and M. R. Trimble. "Friedrich Nietzsche's Mental Illness -- General Paralysis of the Insane vs. Frontotemporal Dementia." Acta Psychiatrica Scandinavica Acta Psychiatr Scand 114.6 (2006): 439-44. Academic Search Premier [EBSCO]. Web. 29 Oct. 2015.

Poe, Edgar Allan. Complete Stories and Poems of Edgar Allan Poe. Garden City, NY: Doubleday, 1966. Print.

"taphophobia". Dictionary.com's 21st Century Lexicon. Dictionary.com, LLC. 27 Nov. 2015. <Dictionary.comhttp://dictionary.reference.com/browse/taphophobia>.

Images Used

Brushfield, Mr. An image of Mr Brushfield's Statistics of Asylums for 1859. Digital image. PB Works. N.p., n.d. Web. 27 Oct. 2015. <http://victoriancontexts.pbworks.com/w/page/12407425/Mr%20Brushfield%27s%20Statistics%20of%20Asylums%20for%201889>.

Fuseli, Henry. The Nightmare. Digital image. TeachArt Wiki. N.p., n.d. Web. 20 Oct. 2015. <https://teachartwiki.wikispaces.com/The+Nightmare--Henry+Fuseli>.

Image of an advertising flier for safety coffin. Digital image. Grave Matters. N.p., n.d. Web. 20 Nov. 2015. <http://www.marjoleinplatjee.com/2015/08/>.

Image of Guy de Maupassant's death certificate. Digital image.Allposters.com. N.p., n.d. Web. 7 Nov. 2015. <http://www.allposters.com/-sp/Death-Certificate-of-Guy-De-Maupassant-1850-93-7th-July-1893-Detail-Posters_i10073544_.htm>.

Image of sketch of safety coffin operation. Digital image. Gothic.life. N.p., n.d. Web. 21 Nov. 2015. <http://gothic.life/why-victorians-had-bells-on-their-graves/image/1/>.

McKinlay, Peter L. Cropped image of table from journal article. Digital image.NCBI. PMC, n.d. Web. 3 Nov. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2167761/?page=5>.

Unknown. Image of 1883 photograph of Guy de Maupassant. Digital image.Exilio. N.p., n.d. Web. 4 Nov. 2015. <http://exilioss.blogspot.co.uk/2012/02/guy-de-maupassant-18501893.html>.

Unknown. Image of photograph of Friedrich Nietzsche. Digital image.Dasein.is. N.p., n.d. Web. 29 Oct. 2015. <http://dasein.is/nietzsche/>.

Bibliography

Adler, Shelley R. Sleep Paralysis: Night-mares, Nocebos, and the Mind-body Connection. New Brunswick, NJ: Rutgers UP, 2011. ProQuest Ebrary. Jan. 2011. Web. 15 Oct. 2015.

Andrew Roberts. "Mental Health History 1842-1844." Andrew Roberts' Web Site. N.p., n.d. Web. 27 Oct. 2015. <http://studymore.org.uk/4_13_ta.htm>.

Frenzel, Ivo, and Joachim Neugroschel. Friedrich Nietzsche: An Illustrated Biography. New York: Pegasus, 1967. Print.

Hide, Louise. "Making Sense of Pain: Delusions, Syphilis, and Somatic Pain in London County Council Asylums, C. 1900." Interdisciplinary Studies in the Long Nineteenth Century 0.15 (2012): n. pag. Open Library of Humanities. Web. 20 Oct. 2015.

Hirsch, Harold L., and Lawrence E. Putnam. Penicillin. New York: Medical Encyclopedia, 1958. Print.

Lerner, Michael G. Maupassant. New York: G. Braziller, 1975. Print.

McDowall, T. W. "Trephining Followed By Drainage Of The Subarachnoid Space In General Paralysis Of The Insane." The British Medical Journal2 (1893): 462-63. JSTOR [JSTOR]. Web. 28 Oct. 2015.

Myrone, Martin. Gothic Nightmares: Fuseli, Blake and the Romantic Imagination. Ed. Christopher Frayling and Marina Warner. London: Tate, 2006. Print.

Wolf, Peter. "Epilepsy and Catalepsy in Anglo-American Literature between Romanticism and Realism: Tennyson, Poe, Eliot and Collins." Journal of the History of the Neurosciences 9.3 (2000): 286-93. Academic Search Premier [EBSCO]. Web. 27 Oct. 2015.

Further Reading

On GPI:

For an overview, see: "General Paresis: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 2015. <https://www.nlm.nih.gov/medlineplus/ency/article/000748.htm>.

For more information on medical knowledge of the disorder in the context discussed in this blog, see this from 1904: Kraepelin, Emil. Lectures on Clinical Psychiatry. New York: Hafner Pub., 1968. Print. (See in particular lectures V, X, XII, and XX for GPI).

For a more detailed insight see from 1886: Mickle, William Julius. General Paralysis of the Insane. London: Lewis, 1886. Print.

Or find online at: Mickle, William Julius. "General Paralysis of the Insane." General Paralysis of the Insane. Internet Archive, <https://archive.org/stream/generalparalysi00mickgoog#page/n14/mode/2up>.

On sleep paralysis:

For analysis in literary/psychoanalytical contexts see: Schatz, Stephanie L. "Between Freud and Coleridge: Contemporary Scholarship on Victorian Literature and the Science of Dream-states." Literature Compass 12.2 (2015): 72-82. Academic Search Premier [EBSCO]. Web.

For studies of sleep disorders/paralysis in Dickens, see: Greaney, Michael. "Sleep and Sleep-watching in Dickens: The Case of Barnaby Rudge." Studies in the Novel 46.1 (2014): 1-19. Project MUSE [Johns Hopkins UP]. Web.

For a more modern, cultural study, see: Hinton, D. E. "Culture and Sleep Paralysis." Transcultural Psychiatry 42.1 (2005): 5-10. Sage Journals. Web.

On premature burial:

For an essay on Poe’s tale see: Forbes, Erin. "From Prison Cell to Slave Ship: Social Death in 'The Premature Burial'" Poe Studies 46.1 (2013): 32-59. Project MUSE [Johns Hopkins UP]. Web.

For analysis of the fear in general, see: Wojcicka, Natalia. "The Living Dead: The Uncanny and Nineteenth-Century Moral Panic over Premature Burial." Styles of Communcation 2010.2 (2010): 176-87. Academic Search Premier [EBSCO]. Web.

For Victorian literature that discusses paralysis:

Burnett, Frances Hodgson. The Secret Garden. London: Vintage, 2012. Print.

Collins, Wilkie. Man and Wife. Ed. Norman Page. London: Oxford UP, 1995. Print.

Corelli, Marie. The Sorrows of Satan, Or, The Strange Experience of One Geoffrey Tempest, Millionaire: A Romance. Oxford: Oxford UP, 1996. Print.

Craik, Dinah Maria Mulock. John Halifax, Gentleman: With an Introd. by Robin Denniston. Ed. Geoffrey Whittam. London: Collins, 1954. Print.

Dickens, Charles. Dombey and Son. Ed. E. A. Horsman and Dennis Walder. Oxford: Oxford UP, 2008. Print.

Gaskell, Elizabeth Cleghorn. Mary Barton. Ed. Macdonald Daly. London: Penguin, 1996. Print.

My Lady Ludlow from: Gaskell, Elizabeth Cleghorn. The Cranford Chronicles. Lexington, KY: Seven Treasures Publications, 2010. Print.

Marryat, Florence. The Blood of the Vampire. Ed. Greta Depledge. Brighton: Victorian Secrets, 2010. Print.

Marsh, Richard. The Beetle: A Mystery. Ware: Wordsworth Editions, 2007. Print.

Find for free on Kindle: Maurier, George du. The Martian. eBook.

“The Adventures of the Resident Patient” from: Doyle, Arthur Conan. The Mysterious Adventures of Sherlock Holmes. New York: Puffin, 1995. Print.

Find for free on Kindle: Trollope, Anthony. The Belton Estate. eBook.