Text: David E. E. Sloane, “Usher’s Nervous Fever: The Meaning of Medicine in Poe’s ‘The Fall of the House of Usher’,” Poe and His Times: The Artist and His Milieu, Baltimore: The Edgar Allan Poe Society, 1990, pp. 146-153 (This material is protected by copyright)


[page 146:]



Edgar Allan Poe knew and used a variety of items taken from the pseudo-scientific and medical doctrines of the early nineteenth century. In some cases, such as “The System of Dr. Tarr and Professor Fether,” his purpose was to burlesque scientific certainty — which he saw in conflict with the infinite capacity for cosmogenic insanity within the human mind. Using Richard Wilbur’s “House of Poe” lecture as a reference, it is simple to see medical illness as corresponding both to the inward cosmic journey Wilbur describes as well as to the more conventional motif of fear and descent in the Gothic horror tale. “The Fall of the House of Usher,” published in Burton’s Gentleman’s Magazine in 1839, is Poe’s most carefully worked development of this same theme in a serious Gothic format. Poe is known to have taken contemporary pseudo-medical artifacts from George Combe’s Phrenology; a second item of contemporary nosology (diagnostic medical nomenclature), “Nervous Fever,” plays an even more important role in the plot and imagery of “Usher.” Thus, Poe’s Gothic fiction is heavily colored by popular science; it is made more realistic and more terrible as the power of medical “fact” weighs on the poetic temperament of Usher, alters our sense of the narrator and of Madeline’s malaise, and brings the house of Usher to destruction.

As early as 1836, Poe published reviews of medical works in the Southern Literary Messenger, and his interest in George Combe — a leading British exponent of phrenology and mental and physical hygiene who was lecturing in America in 1838 and 1839 — when “Usher” was written — has been documented.(1) Poe’s interest in phrenology and mesmerism was also indicated by his review of Miles’s Phrenology in the Messenger in March, 1836 (1: 286-287), and elsewhere. Edward Hungerford has thoroughly examined the texts of Dr. Combe’s lectures as delivered in Philadelphia where Poe was resident, and published by the house of Fowler & Wells in New York in 1839 and later editions.(2) Poe’s use of phrenology, as Hungerford shows, was extensive and purposeful in “Usher.” Combe assumed that four “temperaments” ruled the emotions and exaggerated the influence of brain shape. One of these temperaments was the “nervous,” which provides descriptive details for Roderick Usher: the high forehead, pale complexion, wispy hair, bright eyes, and vivacity of intellect are virtually identical in Combe’s and Poe’s descriptions of trait and character. Poe, of course, goes farther by [page 147:] attaching similar details to the Usher mansion, with its wispy strands of moss and vacant eye-like windows, not to mention the pun of the small crack in the foundation of the skull-like house. Furthermore, Poe adapted the phrenological bump of “Ideality,” located in the area of the temple in Usher, who — like Ligeia and other Poe figures — has an unusually large ideality bump. It is Usher’s chief character trait. Usher’s poetic is consistent with Combe’s definitions: Ideality was the organ of poetry and music, both prominent in Usher’s life, and was a faculty of the most powerful intellect; linked with other traits it would give facility in language and metaphysics: Combe mentions Swedenborg, who is subsequently cited among Usher’s readings. Poe’s adaptation of phrenology to Usher and to Usher’s mansion is the brilliantly creative act of an author, not a literal or gullible transcription. He extends the literary paradigm so that it becomes a cosmos as well as an item of physical description. The expanded literary image of the house supports the kind of cosmocentric development that Richard Wilbur has found as a unifying pattern in Poe’s tales. Poe’s use of the descriptive details establishes a context of nervous Ideality that predisposes his hero to impending disaster.

With this pseudo-scientific context apparent, Usher’s story takes on extra dimensions. At first, it might be seen as a Gothic exercise only. Lonely and crazed, Roderick and Madeline are trapped by repressed physical desire in a decaying mansion where they come to destruction through the climax of their incestuous relationship in premature burial. Poe’s borrowings from the American lectures of Combe, however, elaborate upon this design by adding an overlay of contemporary culture — the phrenological terminology rampant in the late 1830s. The central figure is trapped not only in the Gothic web of sin but also in a net of predetermined mental and physiological characteristics, and his doppelgänger, Madeline, is easily imaged and imagined — as in “William Wilson” — as the split side of a deranged personality. When more phenomena from contemporary medical theory are added, Usher’s case becomes even more complex in the interweaving of external and internal forces.

Madeline’s disease is clearly outlined for the reader as having a “cataleptical character” including a gradual wasting away of the eperson and a settled apathy. Moreover, as she is entombed to protect her corpse from a sinister physician interested in the “unusual” character of her disease, the narrator notes “the mockery of a faint blush upon the bosom and the face, and that suspiciously lingering smile upon the lip which is so terrible in death.”(3) The narrator leaps to the conclusion that Madeline is dead, taking the reader with him in what appears to be an obvious Gothic cliché. The Family Physician, a popular home medical book published in New York by the firm of Greeley and [page 148:] Winchester in 1834, offers an alternative view of the case, however, under the heading “Of Hysteric Affections”:

Hysteric affections are generally considered peculiar to females, and are supposed to depend on some influence which is owing to the peculiarity of the sex . . . . Women . . . of a delicate habit. . . . and whose nervous systems are extremely irritable, are most subject to the hysterical affections . . . .

Sometimes the hysteric fit resembles a swoon or fainting fit, during which the patient lies in a sleep, only the breathing is so low as scarcely to be perceived. At other times the patient is affected with strong convulsions. The symptoms which precede the hysteric fits are likewise various in different persons. Sometimes the fits come on with coldness of the extremeties, yawning and stretching, lowness of spirits, oppression and anxiety. (p. 172)

As he will later do with Usher’s malady, Poe picks out detail from the nosology, having the narrator cite Madeline’s “settled anxiety” in addition to her gradual wasting away and “transient affections of a partially cataleptical character,” by which words Poe disguises the idea of “fits.” “Oppression” is distributed broadly, with the word applied to the clouds in the heavens, to Usher, and finally to the narrator, all in the first two pages, rather than to Usher’s sister. Thus, Poe translates medical descriptions into Gothic apparatus and establishes a double motif, for the narrator in telling us about these symptoms seems to ascribe them to mind and imagination even while noting the physicality of his surroundings with almost clinical detail.

The case becomes more complex as we encounter Usher, predisposed to nervousness by temperament, and in an environment which leads us to two other items of significance. “Nervous Fever” and “Miasma” were important phenomena in the popular nosology of the period around the 1830s. Medical practitioners were not yet free from rational empiricism, the tendency to blend observed fact with logic to reach conclusions. Medical texts show the terns linked to some extent, with Miasma representing a cause and Nervous Fever, comparable to Yellow Fever, as the effect. Benjamin Rush, the Philadelphia physician — advocate of humane healing for the mentally ill and rational empiricist — had suggested the Miasma-Yellow Fever link by empirical logic as the cause of the great Philadelphia Yellow Fever epidemic of 1793, later fictionalized in Charles Brockden Brown’s Arthur Mervyn(4) Rush’s suggestion, without any connection discovered between mosquitoes and yellow fever through scientific means, was to eliminate the source of miasmic contagion by draining the swamps surrounding [page 149:] the city. Miasma was considered to be dangerously stagnant air noxious in only a vaguely defined way, but thought to arise in mines, open cellars, and areas with rotting wood. According to The Family Physician, where we have just found a disease so like Madeline’s illness, air which stagnated in cellars was “to be avoided as the most deadly poison. — It often kills almost as quickly as lightening” (p. 39). Poe repeated these ideas in an essay noting the danger of rotting wood in street paving in 1844 (H14: 167-168), but his detailed description of the setting of Usher’s mansion focuses on this pathological detail:

I had so worked upon my imagination as really to believe that around about the whole mansion and domain there hung an atmosphere peculiar to themselves and their immediate vicinity — an atmosphere that had no affinity with the fair of heaven, but which had reeked up from the decayed trees, and the sluggish tarn, in the form of an inelastic vapor or gas — dull, sluggish, faintly discernible, and leaden-hued . . . . In this there was much that reminded me of the specious totality of old wood-work which has rotted for long years in some neglected vault, with no disturbance from the breath of the external air. (p. 146)

Usher is surrounded by the deadliest possible physical contagion, and even the narrator reports his appropriately responsive oppression. In this early version, several words suggest an almost chemical atmosphere, muted in Poe’s later texts where “inelastic vapor or gas” was modified to a “pestilent and mystic vapor,” more fictive than technical seeming. The reference to rotten wood was inescapable in its implications to a reader of the period. Thus, Poe combines the contamination of heaven — the domain of the angel Israfel and poetry — with the reeking contagion of the underground, or physical earth. The Gothic and the scientific merge.

The results of exposure to Miasma offer a dramatic consequence for Usher and for the reader of the period in Nervous Fever. Here, Poe uses medical detail most profoundly to reflect the physical determinism of Usher’s disaster. The symptoms of Nervous Fever — a malady which disappeared from home medical books after the 1830s — were offered in The Family Physician between Bilious Fever and Yellow Fever, and were described as originating in decaying animal and vegetable matter. They could remain in the system for up to ten days before breaking out and would then lead to a rapidly sinking state. Various sources of the period cite the disease. Charles G. Leland, in his Memoirs for the 1839-1840 period at Hurlburt’s school in Philadelphia, remarks, in almost perfect correspondence with Poe’s Usher, “my mind, weakened by long illness, had been strangely stimulated by many disorders, [page 150:] nervous fevers being frequent among them . . . . The result of so much nervousness, excessive stimulating by medicine, and rapid growth was a too great susceptibility to poetry, humour, art, and all that was romantic, quaint, and mysterious, while I found it very hard to master any really dry subject. What would have set me all right would have been careful physical culture . . . amusement in a healthy sense, of which I had almost none whatever.”(5) Other sources treat the disease similarly.(6)

In fact, Poe’s description of Usher’s malady is so close to the symptoms cited in the 1834 Family Physician as to suggest an item by item borrowing with only the order reversed. The Family Physician offers the most striking features of Usher’s unknown malady — nervous insomnia, murmuring, and fixed staring:

Nervous Fever . . . The sleep is very much disturbed and unrefreshing; the countenance sinks or seems to change . . . to a ghastly appearance . . . . The mind broods over the most melancholy of feelings without knowing the cause; the sight of food is very unpleasant . . . . The symptoms considered very dangerous are . . . a changing of the voice from its usual tone; great vigelance or watchfulness . . . a muttering as if speaking to one’s self; a wild and fixed look, as if the eyes were riveted on some particular object . . . .

This fever originates from putrid animal and vegetable matter, mixing with the air or atmosphere we breathe, such for instance as the decaying vegetable and animal matter arising from stagnant mill ponds. (pp. 53-54)

Poe in borrowing from these details will establish the basis for a ghastly irony. The narrator continues to focus on the disease of Usher as Usher declines in the face of a greater catastrophe, the fate of his sister. The details of Usher’s malady clearly indicate Nervous fever to the narrator.

It was, he said, a constitutional and family evil . . . a mere nervous affection . . . . It displayed itself in a host of unnatural sensations . . . . He suffered much from a morbid acuteness of the senses; the most insipid food was alone endurable; he could wear only garments of a certain texture . . . . To an anomolous species of terror I found him a bounden slave.

Furthermore, Usher connects his malady with the house, its physique, and the tarn — all of which affect the morale of his existence. Woven [page 151:] into the movement of the plot is the decline, supposed death, and entombment of Madeline. As the climax of the story approaches, Usher reflects the most drastic symptoms of terror, which are synonymous with those of Nervous Fever:

And now, some days of bitter grief having elapsed, an observable change came over the features of the mental disorder of my friend. His ordinary manner had vanished. His ordinary occupations were neglected or forgotten. He roamed from chamber to chamber with hurried, unequal, and objectless step. The pallor of his countenance had assumed, if possible, a more ghastly hue — but the luminousness of his eye had utterly gone out. The once occasional huskiness of his tone was heard no more; and a tremulous quaver, as if of extreme terror, habitually characterized his utterance. There were times indeed when I thought his unceasingly agitated mind was laboring with an oppressive secret . . . . I beheld him gazing upon vacancy for long hours, in an attitude of profoundest attention. (pp. 146, 150)

Even the narrator feels himself “infected” by the malaise, a calculated effect by Poe. Ironically, he diverts the narrator from the greater psychological horror to come in favor of the mundane horror of the miasmic contagion. Usher’s doom is absolute: all levels of the action condemn him, from details in the setting, to historical fact, to contemporary science, and to the highest level of sympathetic and spiritual interaction with his universal soul-mate, Madeline, his other self. Physical and spiritual dissolution are combined; the story’s irony is that the narrator fails to grasp the full enormity of the action because of his immersion in worldly detail. Poe makes the larger comsic entity of the house crumble as well, completing the metaphoric dissolution.

The significance of Poe’s use of medicine in “Usher” lies in its reduplicative effects on the Gothic environment of the story. Not only is Usher condemned by the incestuous ancestral environment and the cosmogenic forces pulling downward upon the spirit and the split psyche of himself and his sister. Science, at a more mundane level in Dr. Combe, Dr. Rush, and the corruptive forces of earthly matter as found in The Family Physician, also conspire against the tortured ideality of a soul degraded from pure spirit to corruptible physical mortality.

Poe’s practice actually pervades a range of stories from this period. “Berenice,” for example, seems to derive much from Benjamin Rush’s essay on dentistry to evoke a similar theme.(7) Poe’s medicine in this earlier story subjects the hero to a cosmic irony when he pulls the [page 152:] heroine’s teeth in an effort to free her from corruption. “Usher” uses medicine somewhat more complexly. For a suitably unimaginative reader, the pathology is sufficient to explain the events of the story until the climax bursts upon him as a surprise. Details are appropriate to this end, and are presented by the narrator in such a way as to show him, too, to be such a person of limited imagination. Thematically, however, the details correspond to Poe’s major themes surrounding the fever of life and the inevitable corruption of the physical — its entrapment of the metaphysical and spiritual in a corruptible shell. Thus, the meaning of medicine in “Usher” is that the spirit within the physical form is subject to malaise and death, and the attendant horror of that decline is inescapable at any level of the story. Nervous Fever, the vaguely defined malady of the period, merely provided Poe with another means of expressing this vision.


[page 152, continued:]


1.  Southern Literary Messenger, 2(1836), 785-786, shows Poe’s sense of medical writers. See David E. E. Sloane, “Early Nineteenth-Century Medicine in Poe’s Short Stories” (Unpublished M.A. Thesis, Duke University, 1966); David E. Whisnant, “Edgar Allan Poe’s Study of Science” (Unpublished M.A. Thesis, Duke University, 1962); and Carroll D. Laverty, “Science and Pseudo-Science in the Works of Edgar Allan Poe” (Unpublished Ph.D. Dissertation, Duke University, 1951).

2.  Edward Hungerford, “Poe and Phrenology,” AL, 4(1930), 209-231. For Mesmerism, see Sydney E. Lind, “Poe and Mesmerism,” PMLA, 62(1947), 1077-1094.

3.  “The Fall of the House of Usher,” Burton’s Gentleman’s Magazine, 5(1839), 145-152; further citations are to this text.

4.  Medical Inquiries and Observations, 5th ed. (Philadelphia, 1818), and Observations Upon the Origin of the Malignant Bilious or Yellow Fever in Philadelphia and Upon the Means of Preventing It: Addresses to the Citizens of Philadelphia by Benjamin Rush (Philadelphia, 1799).

5.  (New York, 1893), 1:81.

6.  “New England Sixty Years Ago,” Parlour Magazine, 1(1840), 36, describes “a slow nervous fever” running sixty days before reaching a climax, for example. Mrs. M. A. Ford, in “An Essay on American Literature and its Prospects,” Graham’s Magazine, 36(1850), 185, a decade later, comments that in medical learning the American author is the best guide to diseases that differ so much in their nature from those of Europe, so contemporary critics [page 153:] seem to be aware of the practice of American writers in using local scientific detail.

7.  David E. E. Sloane, “Gothic Romanticism and Rational Empiricism in Poe’s ‘Berenice’,” ATQ, 19(1973), 19-25.






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