As the founder and director of the Centre for Health Humanities and a professor of English at the University of Reading, UK, Andrew Mangham, Ph.D., has published extensively on medicine and Victorian literature. His books include Violent Women and Sensation Fiction: Crime, Medicine, and Victorian Popular Fiction (Palgrave, 2007) and Dickens’s Forensic Realism: Truth, Bodies, Evidence (Ohio State University Press, 2016). Mangham and I exchanged questions and answers via email concerning his book, The Science of Starving in Victorian Literature, Medicine, and Political Economy (Oxford University Press, 2020).  

1, How did you arrive at the topic of your monograph? What led you to research the intersection of Victorian literature, medicine, and political economy? 

It was a bit of a circuitous route actually. At the institution where I teach, there is a key research strength in food science and food security. A few years ago, this was highlighted as an area of research focus within the University, and this got me thinking about what it was that the Victorians could bring to the table, as it were, on the question of modern food security. We’re all very familiar with the idea of the starving Victorian pauper, but I wondered what political and philosophical work this idea or image was doing on the ongoing issue of food inequity. This then set me thinking about how nineteenth-century medicine responded to the problem. Some preliminary research taught me that there was a plethora of medico-physiological works on starvation as a material phenomenon. I also noted that this side of the question had been overlooked by modern scholarship, which has tended to focus on political economy as the Victorian science of hunger. What I found, however, is that medicine spoke in very different ways about hunger and—if anything had a bearing on the birth of social problem realism as the genre of the ‘Hungry Forties’—it was this material, medical, scientific focus set against the consequentialist thinking of political economy. 

2, For readers unfamiliar with The Science of Starving, briefly sketch your main contention. Why does your study deserve attention? 

My main contention is that, in the long nineteenth century, there emerged a science of starving in which specialists in medicine and physiology spoke about what happens to the body when we starve. The realities of this process were stark and shocking, and they countered the notion, formulated mainly in the works of Thomas Malthus but swiftly adopted as ‘fire-and-brimstone’ gospel by politicians, social reformers, and authors of statutes, that those who starve are intended to do so by nature—that it is only ‘natural’ that famines sweep away large numbers of people. This propagandizing interpretation of Malthus converted the poor into a mass of immoderate and reckless burdens on the State. The physiological focus on starvation as a harrowing condition which affects individuals helped counter the conservative ideology, and it inspired the social problem fictions of Charles Kingsley, Elizabeth Gaskell, and Charles Dickens, which also take individual subjectivities, ways of interpreting poverty, and reactions to social injustices as key points of focus. Taken in conjunction, literature and medicine show us a world in which the well-meaning ideas of Malthus were exploited and warped into something much more sinister; they also show us the ways out of the problems the ideology has posed for us by returning to a consideration of the individual, the connections between people, and the material realities of modern life. 

I would argue that the book deserves attention on two major counts. First, it gives us a new context in which to read Victorian social problem fiction—a context in which we have an explanation for the emergence of realism as a socially-aware, politically-driven mode of writing. Looking at the forgotten context of Victorian food science, we see a lot of familiar and unfamiliar narratives in new light. Secondly, the book—and perhaps the most important issue—deserves attention because its questions are still with us. The conservative interpretation of Malthus has fed into and justified neoliberalism—a political approach tried and failed since the 1980s, and now enjoying a resurgence in the UK. At the heart of the neoliberal ideal is the idea that the many cannot be trusted to handle money and that economic responsibility is rightly placed in the hands of the elite few. The idea is that this will lead to a trickle-down effect, where the many will benefit from the successes of the few. The truth, as we see in the bloated account-books of internet trading companies for instance, is that wealth placed at the top tends to stay there, with some individuals now wealthier than some countries. My book can’t tackle all aspects of this issue, but it does show us where the idea of the ‘immoderate mass’ comes from; how it has justified political disenfranchisements of the poor for centuries, and that there is a more humane approach which concentrates on the experiences and the needs of individuals.  

3, Describe your research methodologies for this book. You use the first chapter to stage the broader historical context, describing the major theories of political economy and medical understandings of hunger, digestion, and gastrointestinal anatomy. Your subsequent chapters then situate medical texts alongside examples of Victorian fiction. What is your larger methodology? 

I suppose my methodology could be identified as a kind of new-historicism, where the powers and meanings of literature are best understood when we pay attention to their original, historical and social, contexts. But this isn’t a straightforward process of identifying where an author picks up his or her ideas. I try to read literature as actively involved in the shaping of history; ideas may begin in medicine and/or political economy, for instance, but they are soon transformed and made to do something special when they work their way into works of fiction. What this work is depends on the styles and objectives of individual authors, but it is certainly the case, I think, that ideas become bolder when they are explored in works of fiction. Zola famously had the idea that the novel was an experiment—a trial of ideas and concepts—and I think that whether an author intends it or not, their work tests the meanings, potentials, and limits of ideas within a certain historical timeframe. I therefore think it’s important to read the fiction produced by any time period we are seeking to understand fully, to go back and to see how and why ideas first emerged through the ways they are tested and dissected in the form of fiction. 

4, Some readers might naturally assume a kind of intrinsic rivalry between art and medicine, fiction and scientific rationalism. Yet your book emphasizes that Victorian writers neither snubbed medical science nor regarded it as antithetical to their literary ambitions. Why is it important that these writers transcended disciplinary borders? 

It’s important that the field of ‘literature and science’, which has become quite busy in recent years, moves away from the idea of the two cultures—the notion, that is, of warring approaches to interpreting the world. This is a modern idea, forged in the twentieth century, and is not actually representative of the work science or literature does. To those of us who spend any time with the ideas of science and/or medicine, we’re used to seeing how the intellectual work involved here is no less beautiful or imaginative than the ideas of fiction and poetry. Similarly, we can point to authors whose work has all the hallmarks of scientific rationalism. It is important to see how writers transcend their so-called disciplinary borders because this shows us how ideas evolve when they are passed from specialism-to-specialism; it also shows us how ideas were never meant to be confined in disciplines. Appreciating the true interdisciplinarity of how ideas work opens up a world of possible collaborations and curiosity.  

5, Writers, as you show, were certainly influenced by the era’s medical texts, but were physicians reading the works of these literary figures? In other words, was there a mutual exchange of influence and recognition between Victorian physicians and writers? Were physicians aware of their impact on shaping the literary texts you examine? 

Yes, certainly. This question could have formed the basis of another book—volume 2 perhaps. We know that medical figures read fiction—there is a famous account of the physiologist and surgeon Benjamin Brodie reading The Pickwick Papers in his carriage between consultations; other medics saw literature as crucial to the kind of work they did. The surgeon Anthony Carlisle perceived there to be similarities with the progress of illness and/or injury and the progress of a story. He is thought to have written a gothic novel. For other medical and scientific figures, literature was a ‘switch off’ activity. We have accounts, for instance, of Charles Darwin and Richard Owen reading Dickens in the evenings. In later psychological texts of the period, Dickens’s characters are often held up as case studies of complex conditions like dementia. Whereas we have an obvious written record of medicine’s influence on literature (we can look at specialist language working its way into fictional plots), proving the inspirations in the opposite direction is more challenging, but I wonder whether the evidence is less ‘tangible’. I think the centrality of narrative in case studies and accounts of experiments, for instance, owes much to the powerful example of literature; I also think questions of causation, biological determinism, psychological wellness or aberration have their roots in the long social and psychic studies of the novel. 

6, While these writers used medical language to ground their plots and characters in the materiality of poverty, one wonders if these descriptions would have eventually desensitized readers to the shock of starvation’s physical dimensions. That is, did the language of medical science and physiology become subsumed into what later readers may have recognized (and disparaged) as sentimentality? Did the language of physiology eventually lose its trenchancy as it became an established feature of these Victorian writers’ works? 

It’s a good question. Certainly, in respect to the long nineteenth century, I think the science of poverty offered something of a stimulant to ways of reading which had become desensitized. We often hear of social-crusade literature, or poverty tourism in the nineteenth century, as intending to jolt the Victorian reader with confrontations from a world they had chosen to ignore, or which their middle-class existences sheltered them from; but by the 1840s, the world of letters, politics, and social reform were overwhelmed with newspaper reportage, government blue books, and philanthropic pamphlets. Writings about the stock figures of the starving mother and child, for instance, were very common and it’s unlikely that these would have had the confrontational power it would be all-too-easy to ascribe to them when read out of context. In the nineteenth century, however, physiology was relatively new; people were used to medicine as the treatment of the sick, and to anatomy as the study of bodies, usually dead ones, but the science of life—the science of the processes of life—was relatively fresh. This new science had new things to say about hunger—how it operates, what causes it, and how it proceeds if it is unchecked. I think this did emerge into something confrontational, something which had a powerful political ballast. I think it still does.  

7, Readers might consider the extent to which illustrations—in Dickens’s writings, specifically—also worked to visually articulate the language of physiology. For example, John Leech’s illustrations in Dickens’s Christmas Carol depict the children “Innocence and Want.” These child figures are gaunt, shivering, and spectral; their clothes are tattered. Are readers to understand these illustrations as also reflecting Dickens’s broader efforts to draw on medical science to ground material representations of starvation? 

Yes, I think so. ‘Ignorance and Want’ was an image I originally intended to include in the book but left it out in the end because it will be very familiar to a lot of my readers. We know that Dickens exerted a pernickety attention to detail when it came to his illustrations and, as John Leech set about creating the engraving, Dickens would have overseen the process closely. What’s interesting about this image is the fact that it is set in London and yet has a mill in the background, which would have been more identifiable with an industrial town like Manchester. This is an obvious nod to the industrial context—how the inequities of the profits of capitalism result in ignorance and want. The image pays particular attention to bodies in a way that echoes how the literature develops what Terry Eagleton has called ‘corporeal materialism’; in the contexts provided by the spectacle of starvation, skinny, gaunt and raggedy bodies spoke a radical, political message against the status-quo. 

8, At the time these writers were drawing on medical science to recalibrate literary representations of starvation and poverty, did the era’s readers and literary critics observe, even minimally, this changing perspective? Did book reviews, for example, detect this shift in language and representation by responding to or critiquing its efficacy? If not, what may have accounted for this critical oversight? 

Reader response is a difficult thing to measure, but reviews are an interesting insight. These differed wildly and depended, of course, on the politics of the reviewer and the magazine or newspaper they were writing for. There certainly was an acknowledgement of the social aspects of the literature and some account of the realism as well. I think that the radical qualities of the literature can be seen in just how often it raises the heckles of a conservative reviewer. It was not uncommon, for instance, for authors to take umbrage with the dogged materialism of an author like Gaskell (which is not an entirely accurate summation—she was very much interested in religion, spirituality, and feeling); Kingsley was also taken to task for his focus on bodies—unseemly, some said, in a man of cloth. And Dickens himself was attacked for the unrelenting nature of his focuses on the poor—for his seeming preference for the characters and situations of low life. Not many critics saw this—at the time—as part of a new way of thinking about poverty, but it’s certainly the case that materialism had long been associated with radicalism. Those readers who appreciated these authors often spoke of their truth and their accuracy and I think this is part of a larger, cultural (largely unspoken) acknowledgement of the powers of social problem realism. By the time we get to the next wave of social problem fiction—Arthur Morrison, George Moore, George Gissing—we’re in different territory and there is, I think, a more critical and analytical reflection on corporeal materialities.  

9, Historians of medicine, political scientists, and literary scholars will certainly note the importance of The Science of Starving. Aside from these readers, what do you want your research to convey to today’s medical students and practicing physicians? 

I’m fairly happy leaving medical students and practicing physicians in peace. They do extraordinary work and don’t need me to tell them how to make their work more humane or socially responsible. Politicians, on the other hand, I’m very happy, in the words of Dickens, to ‘fall upon’. The emergence of the far right, the zombie-like persistence of neoliberalism, and general intolerance among conservative politicians are all things which suggest that some of our civil servants might take a leaf out of the book of the nineteenth century. I would love it if my research could convey to some individuals that consequentialist thinking, knee-jerk policies, and political essentialisms have all been tried and tested, have failed, and done irreparable damage. One thing the authors of fiction and the pioneers of science and medicine have taught us is the power of thought—the importance of keeping an open mind and being willing to abandon ways of thinking whose fixedness is preventing us from growing as individuals and societies. We can learn a lot by looking to the past and we need these lessons more now than ever. 

Andre Mangham’s most recent book is We Are All Monsters: How Deviant Organisms Came to Define Us published in February 2023 by MIT Press.  

An earlier version of this interview was published in the NYU Literature, Arts, and Medicine Database (Litmed).
Web image from The Cleveland Museum of Art

The Science of Starving in Victorian Literature, Medicine, and Political Economy  by Andrew Mangham 

Sebastian Galbo Jun 2, 2025

A compelling study of how Victorian writers used medical science to expose and challenge political economy’s misconceptions about starvation.

Undergirding Victorian-era political economy was the influential work of the British cleric-economist, Thomas Malthus, and the rise of statistics. Malthus’s well-entrenched theories maintained that starvation, or large-scale famine, was a natural (and therefore inevitable) response to overpopulation. “In Malthus’s thinking,” Mangham clarifies, “hunger is the greatest tragedy in human economics: in the worst of times it rises up as a horrible check on those nations whose resources have been overrun by improvident birth rates” (1). These theories further solidified within religious contexts, which produced the peculiar notion of “salutary starvation” (26) or “the providential law of starvation” (30)—an understanding of famine and other disasters as just consequences for exceeding the material capacities of God’s “natural system” (26). Malthus’s theories, imbued with religious interpretations, were pernicious and far-reaching, seeping into how the British government and affluent classes viewed and (mis)understood poverty.  

Mangham also maintains that Malthus’s theories were augmented by the emergence of statistics during the first several decades of the century, which enabled the government to measure and evaluate epidemiological patterns, demographic data, and other information about human populations (53). He notes that while statistics were used to collect data about starvation, the data were frequently presented in ways that skewed the prevalence of malnutrition, food scarcity, and diseases and mortality rates related to starvation (56). Using a range of literary and primary sources, Mangham underscores that support for statistics was far from monolithic, that for all the scientific certitude that government officials invested in the discipline, there were critics who vociferated about how statistics were often reductive representations of human experience. In other words, masses of tabulated numbers created a cold, mathematical distance between government authorities and those human lives suffering starvation (56–57). Overall, Mangham outlines a bleak picture of Victorian political economy and its views of material privation. 
 
For Mangham, then, one of the most injurious consequences of political economy was its failure to observe starvation (and its manifold health complications) as a material, indeed physiological, experience. As noted, political economists viewed starvation as anything but a form of bodily suffering, using theories instead to explain the naturalness and necessity of hunger and thus blaming the poor, not government and industry, for their problems (31).  

While political theorists were preoccupied with these explanations, Mangham traces the era’s concurrent developments in medicine that examined the physiology of hunger and digestion. The gastrointestinal research of the Italian Lazzaro Spallanzani influenced Victorian physicians, namely John Hunter, Charles Thackrah, George Henry Lewes, Thomas Southwood Smith, and others, who sought to describe the anatomical workings of the stomach and explain the bodily sensations of hunger (36). Against this backdrop, Mangham argues that Charles Kingsley, Elizabeth Gaskell, and Charles Dickens—united in their “antipathy towards Malthusianism” (17)—recognized the power in articulating starvation using physiological terms, and turned to science to limn “. . . the material sufferings of the starving and, more importantly, on detailed analysis of what it means to go hungry and to observe and to write about it in a way that seeks to be truthful” (16). In chapters that individually examine each author’s literary works (among them Kingsley’s Yeast, Alton Locke, and Two Years Ago; Gaskell’s Mary Barton, North and South, and Sylvia’s Lovers; and Dickens’s Bleak House and others), Mangham demonstrates how “. . . physiological ideas offered both an alternative way of thinking about hunger and an exploration of the ways in which it might be interpreted” (47). This volume’s close readings of these authors’ various novels, journalism, and speeches reveal that medical science offered a language that could undermine theories that misunderstood human starvation and the sociopolitical conditions that perpetuate it.  

Mangham’s study traces compelling connections among nineteenth-century political economy, medicine, and literature, demonstrating that writers looked to science for inspiration to critique feckless government policy and represent the concrete physicality of hunger. If writers could emphasize that impoverished people experiencing starvation were undergoing an “unnecessary, unjust, and unnatural” process, their stories could begin to demystify for readers the opposite claims of political economy (18). Kingsley, Gaskell, and Dickens used new science to depict not only physiologically accurate but also humanized renderings of the poor and Mangham provides close readings of novels to emphasize how these authors used physiology’s vocabulary to describe the material dimensions of poverty, which enabled them to push back against the theories of political economy. It is not that Victorian writers resorted to stale clinical language, but instead worked in confidence, knowing that what they represented in their narratives was grounded in scientific fact. Mangham’s analysis shows how literature and medicine intersected in ways that produced trenchant critiques of government policy. 

The Science of Starving in Victorian Literature, Medicine, and Political Economy
Author Andrew Mangham 
Publisher Oxford University Press 
Place Published United Kingdom 
Edition 2020 
Page Count 240 

An earlier version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).
Web photo from The Cleveland Museum of Art 

Interview with Andre Mangham

Sebastian Galbo Jun 2, 2025

Andrew Mangham explores how Victorian literature, medicine, and political economy intersected to shape powerful narratives about hunger and poverty.

Born in Berlin to a Jewish father and a Christian mother, Harry Benjamin (1885-1986) became a physician in 1912 at a time when German physiology and medicine had much to celebrate. He ended his days in New York City more than a century later, a much lauded, if controversial founder of the entirely new field of transgender medicine. The path was not easy as his own transitions were often painfully turbulent: bullied as a schoolboy for being neither Jew nor Christian, shunned in wartime America for being German, accused of quackery for being an advocate of glandular therapy. And he transited the Atlantic many times always both at home and alien on two continents. Nevertheless, he kept his faith in the miraculous effects of hormones and held fast to an undiminished will to help people live happier lives. 

Using intimate diaries, letters, and interviews in both German and English, Alison Li has written a sensitive, insightful biography that not only traces this remarkable life, but also tracks the birth of endocrinology and the advent of an unprecedented discursive consciousness that challenged social norms. Her earlier biography of J.B. Collip, biochemist of insulin fame, provided her with extensive knowledge of emerging hormones; she handles the technicalities with deft, accessible prose.  

From witnessing the “resurrection” of a moribund patient with dried thyroid medication, Benjamin was captivated by the potential of hormones to bring even the sickest of people to perfect health. Initially intent on the rejuvenating possibilities, he thought of his work as “gerontotherapy” –treatment of the elderly – not so much to live longer but to live better. He became a devoté of Eugen Steinach and his procedure – which aimed to enhance hormone production of the gonads by suppression (through X-irradiation) of their competing elaboration of eggs or sperm. As the female and male hormones became commercially available as pills, they were added to the protocol. Inevitable slippage led to equating (or reducing) these goals to enhancing sexual prowess and attractiveness. 

Along the way, Benjamin encountered many prominent figures, and we read their impressions of each other. Havelock Ellis, Alfred Kinsey, Robert Masters, and Robert A. Wilson make appearances. The semi-autobiographical novel Black Oxen (1923) of his ever-loyal Californian patient, Gertrude Atherton, proclaimed the power of glandular therapy to a wide public and cemented Benjamin’s reputation for dealing with problems of sexuality. From listening carefully to each patient, he realized that the socially pervasive male/female binary failed to reflect individual identifications and orientations; gender was not a duality but a spectrum. Language had to evolve too and that is another theme of the book.  

Married to a much younger woman, Benjamin consulted Sigmund Freud when his desire for her waned; however, thinking of himself as a courtly ladies’ man, he was offended by Freud’s suggestion that he could be a latent homosexual. The experience conditioned his mistrust of psychoanalysis. Choosing physiology over psychology, both men, we learn, underwent Steinach’s treatment.  

With an office in New York City and later a satellite in San Francisco, Benjamin moved in a heady circle of artists, writers, politicians, and intellectuals—striving to find comfort in their own identities. He viewed the source of what became gender dysphoria as something biological.  Instead of fixing the mind, he sought to repair bodies to match minds. For some, peace came from simply living as one of the opposite sex, for others it was hormones, and eventually, for some, it was surgery. Benjamin befriended Christine Jorgensen and collaborated with a few surgeons willing –even eager–to develop operative interventions that resulted in physical sex change. After their transition, he continued to follow his patients to understand if and how the procedures had helped their quality of life. 

Always in private practice, never associated with academe except through research organizations of his own creation, Benjamin was dismayed by how his work was shunned by the medical establishment. From 1929 to 1935, he waged a lengthy lawsuit against Morris Fishbein the crusty leader of the American Medical Association for having disparaged him and his work. Benjamin wanted a retraction and an opportunity to explain in the pages of JAMA how his treatments were based in scientific research. He never got it. 

Nevertheless, at the end of his long career Benjamin witnessed the establishment of gender identity clinics at universities beginning with John Hopkins University and extending to some twenty sites by the late 1970s. He also witnessed their numerous closures in the 1980s as a struggle was waged between those who saw gender dysphoria as a mental illness– not deserving of physical intervention, and those who followed Benjamin’s pragmatic, biological approach.   

With curiosity and tolerance, Li probes the convoluted path of Benjamin’s career. She recreates the atmospheric ambience of exotic pre-war Berlin and the heady optimism of post-war America. She privileges the stories and perspectives of well-known trans people –Renée Richards, Reid Erickson, Jan Morris and many others. Without defensiveness, she presents the current criticisms of Benjamin and his so-called “standards” that had been generated to guide the medical approach to people with gender dysphoria. She treats the critics with the same attentive balance and consideration that Benjamin gave to his patients.  

As a physician, Benjamin could scarcely formulate solutions to the distress of those who sought his help in any way other than through a disease model. His efforts brought their plight out of the shadows of deviance and crime to the attention of well-intentioned minds who applied pills and procedures to serve their complex needs, empowering them to live openly, and enabling them to eventually reject the disease model entirely. Trans is diversity—one of many to populate the postmodern world. This is a very good book. 

Wondrous Transformations: A Maverick Physician, the Science of Hormones and the Birth of the Transgender Revolution   
Alison Li
Chapel Hill NC: University of North Carolina Press, 2023 

https://uncpress.org/book/9781469674858/wondrous-transformations
https://alisonli.com