Conceptual anatomy of the female genitalia using text mining and implications for patient care.

This article analyses the conceptual histories of words associated with female genital parts to explore how they may affect the lived experience of people with these parts and the quality of gynaecological care they receive. Specifically, we examine the implications of using the word 'vagina' to replace the word 'vulva', or indeed to indicate the entire female genitalia. This article does so through an analysis of existing scholarly work and through text mining methods such as word frequencies, most distinctive word collocates and word-embeddings drawn from literary and women's magazine corpora. We find that words indicating specific female genital parts are very infrequently mentioned in our corpora, which shows that there is a troubling lack of exposure and education in our socio-cultural context when it comes to the female genital anatomy. When they are mentioned, their usage reflects historical and patriarchal associations that have been primarily attached to the word 'vagina'. When it comes to the 'vagina' and 'vulva', the penis is the most prevalent association by far; whereas the most commonly occurring female genital parts are parts to do with reproduction-reinforcing a long-standing and disproportionate emphasis on the female genitalia's reproductive function. Our research also reveals a concerning emphasis on non-evidence-based female hygiene products, thus perpetuating the damaging stereotype of the dirty vagina. These findings may explain many negative patient outcomes such as stigma attached to seeking out timely gynaecological care, lack of informed medical consent and non-evidence-based practices exacerbated by problematic cultural depictions of the female genitalia. They can also explain the neglect of female sexual agency, pleasure and well-being. Understanding historical and contemporary usages of words for the female genitalia has important implications for the quality of patient care today and is a critical component of gender and reproductive justice.

The Jew's penis: circumcision and sexual pathology in eighteenth-century England.

This essay explores the contradictory, prejudicial attitudes towards circumcision and Jewish male sexuality circulating in eighteenth-century English print culture. I argue that while Jewish men had long been accused of lustfulness, effeminacy and sexual deviance, eighteenth-century culture added to these concerns a unique interest in sexual pathology, borne in part from the growing medical anxiety around venereal disease. Consequently, while Jewish men were still widely condemned for their lechery, they were also increasingly ridiculed for a range of penile and sexual disorders that were believed to make sex unsatisfying, difficult or even impossible-most notably impotence, a condition often associated with venereal disease. I link these paradoxical eighteenth-century characterisations of Jewish male sexuality with a similarly paradoxical understanding of circumcision as a procedure that could prevent, but also cause, various penile or sexual disorders. I conclude that these prejudices not only constitute an example of what Sander Gilman has identified as the 'bipolar' nature of anti-Semitism; they also indicate a darker trend towards the pathologising of the Jewish body.

John Buchan's race through life, chased by his only foe-illness.

This article examines John Buchan's experience of gastric illness, dyspepsia and duodenal ulcers within the medical context of his life during the first half of the twentieth century. In tracing some of the different and changing approaches to gastric illness over the intervening decades, it compares the medical knowledge and practices of that period with medical knowledge and treatment today. The article's low key empirical intersectional examination, too, touches on both ethics and justice. Its importance lies not only in its discussion on past and present medicine, but also in its scrutiny of Buchan's extraordinarily dutiful approach to his active and varied careers, often marred for him by sudden onsets of illness. Buchan's coping mechanisms, including mental and physical endurance, are spotlighted in his life and in some of his works, frequently written when he was in pain, or recuperating from illness. Both his fiction and non-fiction had multiple purposes: to support his extended family; to help his country; to help his fellow countrymen escape into adventure during war; and to help himself escape from pain.

Fatherlessness, sperm donors and 'so what?' parentage: arguing against the immorality of donor conception through 'world literature'.

Is biology and knowing biological ancestral information essential to the construction of identity? Bioethicist James David Velleman believes this is the case and argues that donor gamete conception is immoral because a portion of genetic heritage will be unknown. Velleman is critical of sperm donation and the absence of a biological father in donor-assisted families. His bioethical work, specifically the 2005 article 'Family History', is oft-cited in articles debating the ethics surrounding gamete donations and diverse family formations. However, I wonder to what extent Velleman's ethical stance is exhibited in contemporary culture? Velleman suggests that innate knowledge of bio-superiority helps readers and audiences appreciate the importance of biological family structures in literature and film; he says, 'When people deny the importance of biological ties, I wonder how they can read world literature with any comprehension' (2005, 369). Velleman understands the stories of Oedipus, Moses, Telemachus and Luke Skywalker as demonstrating a universal cultural comprehension that genetics are essential to identity construction. I adopt Velleman's list of stories and ask if they really can support an antidonation sentiment and suggest that most of the stories actually support diverse family structures. By exploring the significance of story-telling in cultural understandings of family and identity, it is possible to identify the ways in which story-telling can impact how society negotiates complex issues such as assisted reproduction, donor conception and donor industry regulation.

Biocolonial pregnancies: Louise Erdrich's Future Home of the Living God (2017).

This article argues that the health humanities must examine biocolonialism (and representations thereof) if it is to attend to Native American experiences of reproductive healthcare in the USA. Reproductive healthcare abuses are brought into dialogue with Native American resistance to Western biomedical sciences in Future Home of the Living God (2017) by Louise Erdrich (Ojibwe). Written over the course of two reinstatements of the Mexico City Policy, Erdrich's novel invites a consideration of biocolonialism in relation to the exploitation and policing of female bodies.After a discussion of bioprospecting and female bodies, I frame unethical practices of reproductive healthcare and sterilisation as biocolonial acts. The experience of the novel's protagonist, Cedar Hawk Songmaker, will be situated alongside the broader ways in which Native Americans are subjected to surveillance. Second, this article proposes that speculative fiction allows for a temporal reframing of the colonial histories of Indigenous healthcare. As she narrates a world in which evolution 'is running backward', Cedar employs narrative reversals to resist the linear narrative of progress and 'discovery' associated with biomedical sciences.The radically changing structures of a dystopian state, as well as the revelation of her biological inheritance, complicate the cultural and medical frameworks within which Cedar narrates her pregnancy. A challenge faced by the health humanities is how the discipline might theorise ongoing, interrelated forms of domination such as those which position female Indigenous bodies as 'new colonies'. But, as I will argue, the mobilisation of Indigenous narrative forms and cultural frameworks offer productive directions for future work within the global health humanities.

Science fiction authors' perspectives on human genetic engineering.

Participants in the human gene editing debate often consider examples from science fiction but have rarely engaged directly with the science fiction community as stakeholders. To understand how science fiction authors develop and spread their views on gene editing, we created an online questionnaire that was answered by 78 authors, including 71 who had previously written about genetic engineering. When asked which ethical issues science fiction should explore, respondents most frequently mentioned affordability, new social divisions, consent and unforeseen safety risks. They rarely advocated exploring psychological effects or religious objections. When asked which works of fiction had influenced their perceptions of gene editing, the most frequent responses were the film Gattaca, the Star Trek franchise and the novels The Island of Doctor Moreau and Brave New World Unlike other stakeholders, they rarely cited Frankenstein as an influence. This article examines several differences between bioethicists, the general public and science fiction authors, and discusses how this community's involvement might benefit proponents and opponents of gene editing. It also provides an overview of works mentioned by our respondents that might serve as useful references in the debate.

'Living in a Material World': Frankenstein and new materialism.

This paper uses concepts from Karen Barad's theories from quantum physics and other theoretical approaches from new materialism to show how Frankenstein can be used to introduce this new framework and to challenge an older one based on dualism, representationalism and individualism. A new ethical understanding of the message of the text emerges from this reading-one that rethinks the prohibitions against 'playing God' or creating the unnatural and relies instead on an ethics of care.

A 'prodigious latitude' of words: vocabularies of illness in 18th-century medical treatises and women's writing.

In its examination of a selection of 18th-century medical treatises and women's writing, this essay considers a range of context-specific and historically specific medical vocabularies and tries to illuminate the various linguistic registers of physicians' and women's understandings and experiences of physio-emotional illness. In a preprofessionalised world in which medical and literary cultures overlapped significantly and medical knowledge was not yet restricted to a group of formally trained male elites, vocabularies of illness abounded, oftentimes moving freely between the permeable disciplinary boundaries of the age. Physician writers, in their efforts to define and label the cluster of related conditions commonly known as spleen, vapours, melancholy, or hypochondriacal and hysterical affliction, often operated on a principle of humility, embracing uncertainty, admitting fault and assuming a willingness to question their own assumptions. They recognised that elusive processes were at the heart of these conditions, which came with a vast amalgam of physical and psychological symptoms, as well as a long list of possible designations. For their part, Anne Finch, Lady Mary Wortley Montagu, Hester Lynch Piozzi, Elizabeth Carter, Mary Leapor, Elizabeth Tollet, Anna Seward and Susanna Blamire interpreted with a keen eye the medical information available to them, deployed the plethora of words at their disposal and created their own vocabularies of illness. As they formulated a productively unstable, fluctuating lexicon to conceptualise and define spleen and its analogous conditions, these women writers came up with new words and inventive metonyms, and drew at once on the language of medicine, social and domestic inequality, and the natural world to capture experiences of suffering.

Health, well-being, and material-ideal hybrid spaces in Yeats's writing.

Traditionally regarded as high-art, poetry is often seen as a superior form of literary achievement consecrating in verse worldviews and lives connected to ideal, transcendental realms, the pursuance of which supposedly leads to some kind of ideal health and spiritual well-being. The poet WB Yeats (Nobel Prize in Literature, 1923), who believed in the power of poetry to reveal realities and states of such perfection, thereby giving purpose to mundane life, likened this effect of poetry to the fashioning of statues as monuments of unageing intellect. However, contradictorily, he also questioned the value of poetry thus conceived by questioning whether it is healthy to aspire to embody poetically consecrated ideals in real life. Yeats's dilemmatic negotiation between these two positions suggests that better personal well-being can be achieved in living an enlightening life by being mindful of the body's sensuality and materiality. In poetic explorations of the ways in which idealism and sensuality can affect how we live our lives, Yeats used real-life examples of people he knew, often important public figures in Irish social and political history.The present paper frames these explorations in terms of Yeats's concepts of living stream and stone/statuary, augmented with Bruno Latour's concepts of traditional subject and articulated body, discussed in relation to purpose in life and closeness and empathy, proposing that an overly idealistic 'poetic' lifestyle can have adverse effects, whereas poetry that increases one's awareness of oneself as articulated body is conducive to better health and well-being.

Out of date: genetics, history and the British novel of the 1990s.

This article examines the representation of human genomics in the British historical novel of the 1990s. A form which meditates on the past and its relationship to the present, the historical novel readily lends itself to the exploration of genealogy, heredity and inheritance. Forwarding an understanding of human history, and particularly of family history, as a direct and causal function of the genes, the neo-Darwinian explanation of the genome popular in the 1990s similarly advanced its own teleological relationship between past and present. Reading Jenny Diski's Monkey's Uncle (1994), A S Byatt's Babel Tower (1996) and Zadie Smith's White Teeth (2000), this essay argues that the historical novel provides a unique form with which to critique the deterministic view of heredity promoted by neo-Darwinism. Focusing on moments of textual anachronism, asynchronicity and repetition in these family sagas, it shows how-at its most transgressive-the historical novel imagines temporal disruptions that bring the present into contact with the past in ways that defamiliarise conventions of linearity, order and progress. Refusing the idea of human history as a single, legible line that underpins neo-Darwinian ideas of genetic inheritance, Diski, Byatt and Smith's novels are able to interrogate both the temporal logics and cultural capital of 1990s genetic science. While the decade was shaped and defined by popular science speculation and large-scale genetic research projects, such as the Human Genome Project (1990-2003), the novels addressed in this essay ultimately suggest the lively and seductive genocentrism of the 1990s to be inadequate to the task of explaining the complexity and meaning of the lived genome. As Diski, Byatt and Smith's novels anticipate, the question of the uses, meanings and value of the human genome sequence continue to be of relevance within our current, postgenomic era.

Be still, my beating heart: reading pulselessness from Shakespeare to the artificial heart.

Today, patients with heart failure can be kept alive by an artificial heart while they await a heart transplant. These modern artificial hearts, or left ventricular assist devices (LVADs), remove the patient's discernible pulse while still maintaining life. This technology contradicts physiological, historical and sociocultural understandings of the pulse as central to human life. In this essay, we consider the ramifications of this contrast between the historical and cultural importance placed on the pulse (especially in relation to our sense of self) and living with a pulseless LVAD. We argue that the pulse's relationship to individual identity can be rescripted by examining its representation in formative cultural texts like the works of William Shakespeare. Through an integration of historical, literary and biomedical engineering perspectives on the pulse, this paper expands interpretations of pulselessness and advocates for the importance of cultural-as well as biomedical-knowledge to support patients with LVADs and those around them. In reconsidering figurative and literal representations of the heartbeat in the context of technology which removes the need for a pulse, this essay argues that narrative and metaphor can be used to reconceptualise the relationship between the heartbeat and identity.

Vivisection through the eyes of Wilkie Collins, HG Wells and John Galsworthy.

The article argues that, unlike Collins' adamantly negative view towards vivisection in the latter half of the nineteenth century and approaching the end of his writing career and life, Wells and Galsworthy's changing opinions responded to medical advances, reflected the dynamics of public opinion, and their own knowledge and experience at their time of writing. With its primary focus on Galsworthy, the study also explores the reactions of contemporary critics, readers, scientists and medical practitioners to these depictions of vivisection. Above all, the article argues that popular writers, particularly before modern multimedia, greatly influenced public attitudes towards changes in society, including medical research by vivisection. The ultimate change of heart towards vivisection by Nobel Prize winner Galsworthy, an indirect and eminent beneficiary of vivisection, the article concludes, would have boosted public acceptance and the cause of modern medicine.

Waiting, strange: transplant recipient experience, medical time and queer/crip temporalities.

People who receive a 'solid' organ transplant from a deceased person may experience imaginative challenges in making sense of how the transfer impacts their own past and future, as shown in existing scholarship. Building on such work, this article considers how the temporalities of medical encounter itself may also become temporally ambiguous, posing representational challenges both pre-transplantation and post-transplantation. The dominant narrative of transplant in transplantation journals and hospital communications, both clinical and patient-facing, presents surgery as a healing moment, yet the recipient's experience of hospital, pharmacology and daily self-monitoring may be disorienting in multiple ways which resist conventional conceptions of medical temporalities of cure. Examining memoirs by Robert Pensack and Richard McCann, this article suggests the transplant temporalities may be fruitfully approached through scholarship of 'queering' time and 'crip' time. While the medical narrative of transplant focuses on the event of transplantation, these texts construct post-transplant time as still profoundly structured by waiting, expectation and suspense, the transformed body less healed than permanently contingent and fragile in different ways. I do not purport to uncover the 'truth' of bleak survival hidden within a story of the miraculous. Rather, I am reaching for a critical practice to recognise subtle entanglements of medicalised time, and identify a tension and synthesis between miracle and the chronic, an insight which may also be of service for other critical approaches to memoir of heroic medicine.

Reading heredity in racist environments: epigenetic imaginaries in Bessie Head's The Cardinals.

The field of epigenetics research shows us how we are constructed by what is without-materially, socially and environmentally-while also taking us beyond narrow genetic determinants of heredity. If misappropriated, epigenetics research risks pathologising particular social or ethnic groups as biologically damaged. However, epigenetics may also allow us to better conceptualise the biopsychosocially constitutive nature of racist environments. In this article, I argue that epigenetic understandings of embodiment allow us to follow Achille Mbembe's recommendation: that to account for postcolonial relations of power-their effectiveness and psychology-we need to go beyond the binary categories (like passivity vs resistance) so frequently deployed in the analysis of domination. To demonstrate this, I offer a literary example from apartheid South Africa. In Bessie Head's The Cardinals, embodiment is imagined as the hereditary effect of segregated environmental space. The Cardinals thus offers something like a literary imagining of the epigenetic (as a material change that is heritable), before contemporary advances in epigenetics research made the connection between environment and embodiment more sensible in molecular terms. Head radically calls into question the certainty of biological identity: characters are 'marked' deterministically by their environments but ultimately the mutability of such 'epigenetic' markers is revealed when the individual transcends apartheid's spatial and racial demarcations. Writing in the context of apartheid, Head's engagement with non-genetic understandings of identity is a motivated attempt to evade the stigmatising categories and 'genetic' assumptions of scientific racism, which constructed races as biologically distinct (modern genetic science shows us that there is no genetic basis for 'race'). Instead, Head positions environmental spaces, including the Indian Ocean (a conduit for South Asian arrivals and for new philosophies and the potential political affiliations that arrive with them) as points of genealogical origin and as constitutive of identity in non-deterministic ways.

'Never forget': fictionalising the Holocaust survivor with dementia.

This article asks what the reasons are for the frequent linking of the image of the Holocaust with that of dementia in contemporary discursive and representational practice. In doing so, it analyses some of the numerous 21st-century examples of fiction, drama and film in which the figure of a Holocaust survivor living with dementia takes centre stage. It explores the contradictory cultural effects that arise from making such a connection, in contexts that include expressions of fear at the spectacle of dementia, as well as comparisons between the person living with that condition and the inmate of a concentration camp. Detailed consideration of novels by Jillian Cantor and Harriet Scott Chessman as well as a play by Michel Wallenstein and a film by Josh Appignanesi suggests that the fictions of this kind can appear to provide solace for the impending loss of the eyewitness generation, yet also offer potential for a model for caregiving practice to those living with dementia in broader terms.

Cultivating the dispositions to connect: an exploration of therapeutic empathy.

Empathy is a broad concept that involves the various ways in which we come to know and make connections with one another. As medical practice becomes progressively orientated towards a model of engaged partnership, empathy is increasingly important in healthcare. This is often conceived more specifically through the concept of therapeutic empathy, which has two aspects: interpersonal understanding and caring action. The question of how we make connections with one another was also central to the work of the novelist E.M. Forster. In this article we analyse Forster's interpretation of connection-particularly in the novel Howards End-in order to explore and advance current debates on therapeutic empathy. We argue that Forster conceived of connection as a socially embedded act, reminding us that we need to consider how social structures, cultural norms and institutional constraints serve to affect interpersonal connections. From this, we develop a dispositional account of therapeutic empathy in which connection is conceived as neither an instinctive occurrence nor a process of representational inference, but a dynamic process of embodied, embedded and actively engaged enquiry. Our account also suggests that therapeutic empathy is not merely an untrainable reflex but something that can be cultivated. We thus promote two key ideas. First, that empathy should be considered as much a social as an individual phenomenon, and second that empathy training can and should be given to clinicians.

Sarah Orne Jewett's depictions of women in a changing medical profession: Nan Prince and Almira Todd.

Sarah Orne Jewett, who lived from 1849 to 1909, witnessed a revolution in medicine that led to the formation of the medical profession as it is recognised today. By comparing two of the author's works, one written at the outset of her career and the other written much later, this paper discusses how Jewett's views about women's role in medicine changed and developed. In the first novel, A Country Doctor, a young Jewett celebrates the new-found power of scientific medicine in the period directly after germ theory was widely adopted. The author depicts a female physician as a pioneer bravely breaking into a male-dominated field. Later, in The Country of the Pointed Firs, Jewett's depiction of a female medical practitioner is much more nuanced- the matured writer's views are accompanied by discrete but deep-seated criticisms of medical ideology as she saw it developing. The comparison of these novels gives us insight into Jewett's world, and leaves questions for readers today. Most importantly, how should women today approach traditional medicine given the discipline's deeply misogynist roots? Jewett's unique perspectives serve as a catalyst for this discussion.

Lessons from Frankenstein: narrative myth as ethical model.

As Frankenstein's 200th anniversary nears, its use as a shorthand for ethical critique only increases. This article argues, though, that its lessons inhere in its unique structure, which enacts an interpretive process that models the multiplicity and uncertainty constitutive of ethical decision-making. Frankenstein deliberately functions as a modern myth, rewriting classical and Christian mythology to challenge the straightforward moral lessons often ascribed to the text. Complex portrayals of the creature and of Victor Frankenstein in the context of contemporary science make it impossible to read Victor as villain, victim or hero, or to take a consequentialist or nature-based stance in which the outcome of his research dictates its wrongness. The use of Paradise Lost insists on the creature's fundamental humanity. Indeed, the creature's voice frames the entire novel and serves as its structural centrepiece. His experience counters Victor's and vividly expresses the harm in a narrow focus on discovery and in the denial of responsibility for scientific work as it moves beyond the laboratory. Both the creature's and Captain Walton's stories stress the need to hear other voices and honour their distinct lived experiences. While Frankenstein-as-myth (re)produces science as the fundamental explanatory paradigm, it presents a vision of science as passionately personal and societally situated. Repeated disruptions of narrative cohesion question accuracy and causality, producing instead an acute awareness of perspective. Frankenstein argues for a reflective and dialogical narrative ethics: choices must be made and evaluated not according to a priori abstract rules, but within the attached stories.

"A kind of agonie in my thoughts": writing puritan and non-conformist women's pain in 17th-century England.

The relationship between pain as a physical and emotional experience and the concept of suffering as an essential aspect of sanctification for faithful believers was a paradoxical and pressing theological and phenomenological issue for puritan and non-conformist communities in 17th-century England. Pain allows the paradox of non-conformists' valorisation and suppression of corporeality to be explored due to its simultaneous impact on the mind and body and its tendency to leak across boundaries separating an individual believer from other members of their family or faith community. The material world and the human body were celebrated as theatres for the display of God's glory through the doctrines of creation and providence despite the fall. Pain as a concept and experience captures this tension as it was represented and communicated in a range of literary genres written by and about puritan and non-conformist women including manuscript letters, spiritual journals, biographies and commonplace books. For such women, targeted by state authorities for transgressing gender norms and the religion established by law, making sense of the pain they experienced was both a personal devotional duty and a political act. Three case studies comprise a microhistory of 17th-century English puritan and non-conformist women's lived experience, interpretation and representation of pain, inscribed in a series of manuscripts designed to nurture the spiritual and political activism of their communities. This microhistory contributes to a better understanding of pain in early modern England through its excavation of the connections that such writers drew between the imperative to be visibly godly, their marginalised subject position as a proscribed religious minority and their interpretation of the pain they experienced as a result.