‘Medical Paratexts from Medieval to Modern: Dissecting the Page’: Book Review

Sara Öberg Strådal reviews Medical Paratexts from Medieval to Modern: Dissecting the Page, edited by Hannah C. Tweed and Diane G. Scott (Basingstoke: Palgrave Macmillan 2018)

This collection of essays, Medical Paratexts from Medieval to Modern: Dissecting the Page, edited by Hannah C. Tweed and Diane G. Scott for the Palgrave Studies in Literature, Science and Medicine series (2018) contains a wide range of essays with diverse interpretations and understandings of both texts and paratexts. The concept of paratext is defined by Gérard Genette and Marie Maclean ‘as the means by which a text makes a book of itself and proposes itself as such to its readers.’[1] Traditionally the term refers to prefaces, titles, epigraphs, images, and even publicity associated with the publication of a book. The editors and authors of this book have, in line with our modern understanding of the varied nature of medical and medicalised texts, broadened the definitions of both terms; while some essays focus on traditional texts and paratexts, such as printed treatises with prefaces, introductions, or marginalia, there are also examples of essays employing a much broader definition of these terms. In the introductory chapter, Tweed and Scott discuss the paratexts of publications concerning Mary Toft, whose supposed birth of live rabbits made her well known in Early Modern England. By examining the prefaces and other paratextual material they discuss the intentions of the authors and publishers, as well as tracing public opinions about medical practitioners. This understanding of the page as a ‘site of tension’ between authors, publishers, printers, as well as their varied audiences is a theme that is prevalent throughout the essays in this collection.[2]

The book is divided in to two parts, ‘Production, Reception and Use’ and ‘Authority, Access and Distribution’. The first section focuses on medical texts and material aimed at professional and lay audiences; it considers both traditional and non-traditional paratexts. Through consideration of marginal marks, annotations, drawings and the layout of printed images, Harry Newman and Louise Powell both draw attention to the tension and conflicts between publishers and audiences (perceived and possible) in their respective articles on paratexts in Helkiah Crookes’ Mikrokosmographia and Early Modern midwifery manuals. Both essays demonstrate how texts and paratexts can be understood to represent different, simultaneous discourses and their combination on the page renders that tension visible to modern readers. Similarly, Roberta Mullini and Laura Mainwaring discuss the paratexts included in promotional material: images included on handbills of seventeenth-century irregular medical practitioners in London and the visual and textual material included in medical advertising during the Long Nineteenth Century. By considering paratexts and text in dialogue, the essays illuminate the complex functions and uses of printed materials when facilitating relationships between medical authorities and their audiences.

The second part focuses on the authorial and authoritative voices in several very different types of writing, employing a non-traditional definition of both texts and paratexts. Natalie Calder considers texts about spiritual despair published at Syon Abbey for a lay audience as paratextual within the larger landscape of late medieval spirituality focusing on intense meditation. Likewise, Elspeth Jajdelska investigates the paratextual culture demonstrated on the pages of the 1657 publication Physick for the Poor. She shows that the paratexts mirror socially acceptable speech, a feature which is used as a justification for addressing those of higher social standing.

The last three essays concern modern readership and possible engagement with paratextual sources. In her essay on the diaries of female voluntary nurses in the First World War, Tweed shows that the later additions to the texts by the diarists themselves illustrate that they were intended to be read by others. Tweed also discusses the problems of rendering this material in print: as Alice Lighthall recycled her diaries the presentation on the manuscript page is necessarily diasynchronic, juxtaposing entries and events from different years, thus a chronological narrative hides the tension visible on the page. Deborah Ellen Thorpe takes an innovative approach to graphology, the study of handwriting, and the increased popular interest bestowed on the field. Through analysis of the edits and meta-data to the Wikipedia entry for this discipline and meta-analysis of scholarly articles, she illustrates how modern paratexts can be used to investigate the changing popular and scientific understandings of a discipline. The final essay provides a very good overview of the Glasgow Incunabula Project and some examples of the treasures that can be found in the University of Glasgow Special Collection. Robert MacLean stresses the importance of cataloguing and digitising annotations in medical texts. Although some recent publications have tried to address these issues, such as the Vesalius Census project (2018), MacLean’s sobering discussion on the realities of archives and special collections funding in a time of austerity is interesting, as are the suggestions for collaborations between scholars and depositories of rare books and manuscripts.

This is an interdisciplinary book, which beyond medical humanities and medical history, draws on history of art, literary criticism, codicology, digital humanities and a range of other fields. By expanding the definition of texts and paratexts in this manner the authors and editors are encouraging others to consider marginalia, annotations, illustrations, juxtaposition of different texts, and the construction of visual material as paratext and carriers of additional meaning. Although only considering European and North American material, this broad scope and consideration of medical source can certainly be applied to non-Western medical cultures as well, demonstrating new approaches to the study of medical and medicalised texts. This book will be useful for specialists in medical humanities and related fields.

[1] Gérard Genette and Marie Maclean, ‘Introduction to the Paratext’, New Literary History 22 (1991): 262.

[2] Hannah C. Tweed and Diane G. Scott, ‘Authority, Authenticity and Reputation: An Introduction to Medical Paratexts’ Medical Paratexts from Medieval to Modern: Dissecting the Page, ed by Hannah C. Tweed and Diane G. Scott (Palgrave MacMillan, 2018): 4.


Sara Öberg Strådal is a Teaching Fellow in Medieval Art History at the University of Edinburgh. She is interested in diagrams and images in medieval medical manuscripts as well as the material culture of medicine and science in pre-modern Europe.

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