Lakshmi Krishnan | Georgetown University (original) (raw)

Papers by Lakshmi Krishnan

Journal of the History of Medicine and Allied Sciences, 2024

Narrative structures, though invisible to the naked eye, guide our understanding of pandemics. Li... more Narrative structures, though invisible to the naked eye, guide our understanding of pandemics. Like curves and graphs, we can plot them, identify their patterns and organizing principles. These structures act upon our understanding of social and biological events just as much as the rhythms of viral replication and mutation. They order not only themselves but also social and health outcomes. This essay uses narrative precision to expand beyond Charles Rosenberg's influential dramaturgic model and develops new pandemic forms, scaled from the level of an individual line break to the multi-part series: Arc, a form of sequence. Cycle, a form of repetition. Sequel, a form of elongation. Caesura, a form of break. It investigates the potentialities and limitations of these forms, how they intersect, collide, and contradict, and how analysis of these interactions contributes to a deeper understanding of pandemics, their effects, and the diverse perspectives defining their structures. In doing so, it prototypes how literary methods offer conceptual frameworks for pandemic historiography and how a transdisciplinary, medical humanities analysis produces novel understandings at the intersection of health, culture, and society.

Journal of Victorian Culture, 2022

One can hardly read a Victorian text without encountering contagious diseases, those striving aga... more One can hardly read a Victorian text without encountering contagious diseases, those striving against them, or those marked by them: from the tuberculous resonances in Dracula (1897) to Jonathan Hutchinson's (1828-1913) syphilography, Mary Seacole's pioneering nursing and treatment of cholera in Panama (Wonderful Adventures of Mrs. Seacole in Many Lands, 1857), and finally Bleak House's Esther, disfigured by smallpox. This Roundtable asks how the Victorians approached contagion, examining the ways in which it became such a central preoccupation for a society already fixated upon health and illness and the transactions between life and death. Through our analysis of the long nineteenth century, we hope to illuminate our own contagious transformations. As the novel coronavirus pandemic continues to reveal our individual and communal interdependence, complicated navigation of information, panic, sickness, harm, and isolation, and as it underscores tensions between individual liberty and the collective good, Victorian understandings of contagion acquire fresh relevance to us. In Victorian studies, these interpretations remain a critical touchstone for thinking about medicine, history, narrative, and social and public policy.

Journal of Victorian Culture, 2022

In 1895, the crime-writing duo of L. T. Meade and Clifford Halifax, MD, published ' A Doctor's Di... more In 1895, the crime-writing duo of L. T. Meade and Clifford Halifax, MD, published ' A Doctor's Dilemma' in The Strand Magazine. In it, the young physician Arthur Feveral describes a recent influenza outbreak which has left an 'extraordinary sequel. .. My health is gone-my nerve has deserted me'. Influenza plays a central role in this fiction, but Feveral's story is simply one of many-documentary and fictionalized-that populate the pages of late nineteenth-century British periodicals. The 'Russian' influenza pandemic of 1889-1894 was the last great European outbreak of the nineteenth century, leaving in its wake such widely discussed neurological effects (neurasthenia, psychosis, and melancholy) that they earned their own nosography: 'influenza nervosa'. This paper examines the pandemic's enduring cultural and biosocial impact through the framework of sequelae-chronic conditions arising in the aftermath of acute illness. Drawing on medical case histories, criminal reports, illness narratives, and works of fiction, it explores how the Victorians taxonomized and theorized such long-term effects of infectious disease. First, sequelae became a category separate from 'complications' , vital to broader preoccupations with prolonged illness, uncertainty, and moral and bodily weakness and degeneracy, and the Victorians scaffolded around it notions of vigour and debility, difference, predisposition, and heredity. Second, they domesticated and repurposed colonial and tropical theories of hygiene as explanatory frameworks. Through close readings of 'long influenza' in the clinic and in fiction, this paper also frames the kinds of narratives which gained especial purchase, and the sufferers deemed both susceptible and sympathetic. Finally, it argues that the acute phase of infectious anxiety gave way to a longue durée of sequelae, and that Victorian responses provide critical insights and warnings for our own era.

Literature and Medicine, 2023

In “The Murders in the Rue Morgue” (1841), Poe invents the detective story in English, introducin... more In “The Murders in the Rue Morgue” (1841), Poe invents the detective story in English, introducing his gentleman sleuth Auguste Dupin as he solves the locked-room mystery of two women found bru- tally murdered in a Paris apartment. In L’Amante Anglaise (1967), Duras revisits the detective form, fictionalizing the true 1949 crime of a woman murdering and dismembering her cousin in Viorne, France. These literary detective stories highlight the powerful but unspoken role of affective ex- perience in driving what appears, on the surface, to be a forensic medical or psychological investigation. In both tales, peculiarity is an affective and cognitive force that, contrary to what the majority of affect literature argues, inherently moves toward resolution and closure. Using peculiar- ity as an analytical concept, we argue that the concealment / discovery binary must acknowledge its affective origins, breaking a barrier between narrative scholarship and medical practice.

BMJ Medical Humanities, 2023

The electronic health record (EHR) is a focus of contentious debate, having become as essential t... more The electronic health record (EHR) is a focus of contentious debate, having become as essential to contemporary clinical practice as it is polarising. Debates about the EHR raise questions about physicians' professional identity, the nature of clinical work, evolution of the patient/practitioner relationship, and narratives of technological optimism and pessimism. The metaphors by which clinicians stake our identities-are we historians, detectives, educators, technicians, or something else?-animate the history of the early computer-based medical record in the mid-to-late twentieth-century USA. Proponents and detractors were equally interested in what the EHR revealed about clinician identity, and how it might fundamentally reshape it. This paper follows key moments in the history of the early computer-based patient record from the late 1950s to the EHR of the present day. In linking physician identity development, clinical epistemological structures, and the rise of the computer-based medical record in the USA in the mid-to-late twentieth century, we ask why the EHR is such a polarising entity in contemporary medicine, and situate clinician/EHR tensions in a longer history of aspirational physician identity and a kind of technological optimism that soon gave way to pessimism surrounding computer-based clinical work.

Journal of Law, Medicine & Ethics, 2021

In 1889, The British Medical Journal published a piece titled, “Detective Medicine,” which descri... more In 1889, The British Medical Journal published a piece titled, “Detective Medicine,” which describes feats of medical detection performed by physicians attending malingering prisoners. Though simulating illness had a long history, the medicalization of malingering at the fin de siècle led to a proliferation of such case histories and cheerful records of pathological feigners thwarted.

Annals of Internal Medicine, 2020

The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic mi... more The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic minority communities and magnifying existing disparities in health care access and treatment. To understand this crisis, physicians and public health researchers have searched history for insights, especially from a great outbreak approximately a century ago: the 1918 influenza pandemic. However, of the accounts examining the 1918 influenza pandemic and COVID-19, only a notable few discuss race. Yet, a rich, broader scholarship on race and epidemic disease as a “sampling device for social analysis” exists. This commentary examines the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex and sometimes surprising ways it operated, triggering particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. This analysis reveals that critical structural inequities and health care gaps have historically contributed to and continue to compound disparate health outcomes among communities of color. Shifting from this context to the present, this article frames a discussion of racial health disparities through a resilience approach rather than a deficit approach and offers a blueprint for approaching the COVID-19 crisis and its afterlives through the lens of health equity.

Tuberculosis Research and Treatment, 2014

Background. Tuberculosis (TB) remains a significant global public health problem with known gende... more Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified "inductive coding" system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gendervariable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services.

Modern Language Review, 2018

Victorian Poetry, 2014

Numerous critics have noted Browning's famous invocation to "lyric Love," the spirit of EBB (I.13... more Numerous critics have noted Browning's famous invocation to "lyric Love," the spirit of EBB (I.1391). Less frequently cited, however, is the preceding apostrophe, "Such, British Public, ye who like me not, / (God love you!)-whom I yet have laboured for, / Perchance more careful whoso runs may read / Than erst when all, it seemed, could read who ran" (I.1379-82). Thus writes the Poetspeaker, charging the unseeing, judgemental "British Public" that neither likes nor understands him. Anger is the prevailing tone here: Browning's anger against his critics, the public for whom he "labours," and the uncomprehending readers who he mistakenly thought would understand his verse. Is it coincidence, then, that he chooses to frame a poem about a murder-trial with this invocation? Browning, the object of critical antagonism, is accused of violating accepted poetic practice and on trial, defending himself and his art before the British Public. In these circumstances, he makes use of an intelligent anger: anger as a rhetorical device, tool of revenge, creative force, and, ultimately, instrument of self-definition. In this, he bears similarities to the hero-villain of the piece, Guido Franceschini, also on trial. But the poet's anger refracts throughout The Ring and the Book, "deformed, transformed, reformed, informed, conformed" (XI.2063) in monologues offering a prismatic view of this emotive and cognitive force. Like so many lenses, Guido, Pompilia, Caponsacchi and the Roman public in the shapes of Half-Rome, Other Half-Rome, and Tertium Quid, produce different images of anger. While it is "wolfnature[d]" Guido (XI.2318) whose rage has received most attention, Browning's other characters, Pompilia especially, contribute to his interpretation of anger in its many, colourful forms. Recognizing anger as one of its design elements opens up a fresh approach to The Ring and the Book which connects it with other works by Browning and other aspects of his poetics.

Victorian Literature and Culture, Sep 2013

Modern Language Review, Apr 2009

Brontë Studies, Mar 2007

Many Victorian medical theorists shared the notion that the will functions as an intermediary, ho... more Many Victorian medical theorists shared the notion that the will functions as an intermediary, holding the mind and body in tension. Psychosomatic illnesses, physiological ailments rooted in mental distress, figure prominently in both Sir Walter Scott's The Bride of Lammermoor and Emily Brontë's Wuthering Heights. Where Scott regards sickness as the product of a weakened will, Emily Brontë's characters exercise their wills to facilitate illness, thereby exerting power over their circumstances. Scott depicts a society breaking its members, forcing them to lapse into illness and madness, troublesome and tragic symbols of disorder. Emily Brontë, in contrast, interprets illness not as a collapse, but rather an exertion of the will's strength.

Book Reviews by Lakshmi Krishnan

The Oxonian Review, Jun 15, 2009

Journal of the History of Medicine and Allied Sciences, 2024

Narrative structures, though invisible to the naked eye, guide our understanding of pandemics. Li... more Narrative structures, though invisible to the naked eye, guide our understanding of pandemics. Like curves and graphs, we can plot them, identify their patterns and organizing principles. These structures act upon our understanding of social and biological events just as much as the rhythms of viral replication and mutation. They order not only themselves but also social and health outcomes. This essay uses narrative precision to expand beyond Charles Rosenberg's influential dramaturgic model and develops new pandemic forms, scaled from the level of an individual line break to the multi-part series: Arc, a form of sequence. Cycle, a form of repetition. Sequel, a form of elongation. Caesura, a form of break. It investigates the potentialities and limitations of these forms, how they intersect, collide, and contradict, and how analysis of these interactions contributes to a deeper understanding of pandemics, their effects, and the diverse perspectives defining their structures. In doing so, it prototypes how literary methods offer conceptual frameworks for pandemic historiography and how a transdisciplinary, medical humanities analysis produces novel understandings at the intersection of health, culture, and society.

Journal of Victorian Culture, 2022

One can hardly read a Victorian text without encountering contagious diseases, those striving aga... more One can hardly read a Victorian text without encountering contagious diseases, those striving against them, or those marked by them: from the tuberculous resonances in Dracula (1897) to Jonathan Hutchinson's (1828-1913) syphilography, Mary Seacole's pioneering nursing and treatment of cholera in Panama (Wonderful Adventures of Mrs. Seacole in Many Lands, 1857), and finally Bleak House's Esther, disfigured by smallpox. This Roundtable asks how the Victorians approached contagion, examining the ways in which it became such a central preoccupation for a society already fixated upon health and illness and the transactions between life and death. Through our analysis of the long nineteenth century, we hope to illuminate our own contagious transformations. As the novel coronavirus pandemic continues to reveal our individual and communal interdependence, complicated navigation of information, panic, sickness, harm, and isolation, and as it underscores tensions between individual liberty and the collective good, Victorian understandings of contagion acquire fresh relevance to us. In Victorian studies, these interpretations remain a critical touchstone for thinking about medicine, history, narrative, and social and public policy.

Journal of Victorian Culture, 2022

In 1895, the crime-writing duo of L. T. Meade and Clifford Halifax, MD, published ' A Doctor's Di... more In 1895, the crime-writing duo of L. T. Meade and Clifford Halifax, MD, published ' A Doctor's Dilemma' in The Strand Magazine. In it, the young physician Arthur Feveral describes a recent influenza outbreak which has left an 'extraordinary sequel. .. My health is gone-my nerve has deserted me'. Influenza plays a central role in this fiction, but Feveral's story is simply one of many-documentary and fictionalized-that populate the pages of late nineteenth-century British periodicals. The 'Russian' influenza pandemic of 1889-1894 was the last great European outbreak of the nineteenth century, leaving in its wake such widely discussed neurological effects (neurasthenia, psychosis, and melancholy) that they earned their own nosography: 'influenza nervosa'. This paper examines the pandemic's enduring cultural and biosocial impact through the framework of sequelae-chronic conditions arising in the aftermath of acute illness. Drawing on medical case histories, criminal reports, illness narratives, and works of fiction, it explores how the Victorians taxonomized and theorized such long-term effects of infectious disease. First, sequelae became a category separate from 'complications' , vital to broader preoccupations with prolonged illness, uncertainty, and moral and bodily weakness and degeneracy, and the Victorians scaffolded around it notions of vigour and debility, difference, predisposition, and heredity. Second, they domesticated and repurposed colonial and tropical theories of hygiene as explanatory frameworks. Through close readings of 'long influenza' in the clinic and in fiction, this paper also frames the kinds of narratives which gained especial purchase, and the sufferers deemed both susceptible and sympathetic. Finally, it argues that the acute phase of infectious anxiety gave way to a longue durée of sequelae, and that Victorian responses provide critical insights and warnings for our own era.

Literature and Medicine, 2023

In “The Murders in the Rue Morgue” (1841), Poe invents the detective story in English, introducin... more In “The Murders in the Rue Morgue” (1841), Poe invents the detective story in English, introducing his gentleman sleuth Auguste Dupin as he solves the locked-room mystery of two women found bru- tally murdered in a Paris apartment. In L’Amante Anglaise (1967), Duras revisits the detective form, fictionalizing the true 1949 crime of a woman murdering and dismembering her cousin in Viorne, France. These literary detective stories highlight the powerful but unspoken role of affective ex- perience in driving what appears, on the surface, to be a forensic medical or psychological investigation. In both tales, peculiarity is an affective and cognitive force that, contrary to what the majority of affect literature argues, inherently moves toward resolution and closure. Using peculiar- ity as an analytical concept, we argue that the concealment / discovery binary must acknowledge its affective origins, breaking a barrier between narrative scholarship and medical practice.

BMJ Medical Humanities, 2023

The electronic health record (EHR) is a focus of contentious debate, having become as essential t... more The electronic health record (EHR) is a focus of contentious debate, having become as essential to contemporary clinical practice as it is polarising. Debates about the EHR raise questions about physicians' professional identity, the nature of clinical work, evolution of the patient/practitioner relationship, and narratives of technological optimism and pessimism. The metaphors by which clinicians stake our identities-are we historians, detectives, educators, technicians, or something else?-animate the history of the early computer-based medical record in the mid-to-late twentieth-century USA. Proponents and detractors were equally interested in what the EHR revealed about clinician identity, and how it might fundamentally reshape it. This paper follows key moments in the history of the early computer-based patient record from the late 1950s to the EHR of the present day. In linking physician identity development, clinical epistemological structures, and the rise of the computer-based medical record in the USA in the mid-to-late twentieth century, we ask why the EHR is such a polarising entity in contemporary medicine, and situate clinician/EHR tensions in a longer history of aspirational physician identity and a kind of technological optimism that soon gave way to pessimism surrounding computer-based clinical work.

Journal of Law, Medicine & Ethics, 2021

In 1889, The British Medical Journal published a piece titled, “Detective Medicine,” which descri... more In 1889, The British Medical Journal published a piece titled, “Detective Medicine,” which describes feats of medical detection performed by physicians attending malingering prisoners. Though simulating illness had a long history, the medicalization of malingering at the fin de siècle led to a proliferation of such case histories and cheerful records of pathological feigners thwarted.

Annals of Internal Medicine, 2020

The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic mi... more The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic minority communities and magnifying existing disparities in health care access and treatment. To understand this crisis, physicians and public health researchers have searched history for insights, especially from a great outbreak approximately a century ago: the 1918 influenza pandemic. However, of the accounts examining the 1918 influenza pandemic and COVID-19, only a notable few discuss race. Yet, a rich, broader scholarship on race and epidemic disease as a “sampling device for social analysis” exists. This commentary examines the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex and sometimes surprising ways it operated, triggering particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. This analysis reveals that critical structural inequities and health care gaps have historically contributed to and continue to compound disparate health outcomes among communities of color. Shifting from this context to the present, this article frames a discussion of racial health disparities through a resilience approach rather than a deficit approach and offers a blueprint for approaching the COVID-19 crisis and its afterlives through the lens of health equity.

Tuberculosis Research and Treatment, 2014

Background. Tuberculosis (TB) remains a significant global public health problem with known gende... more Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified "inductive coding" system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gendervariable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services.

Modern Language Review, 2018

Victorian Poetry, 2014

Numerous critics have noted Browning's famous invocation to "lyric Love," the spirit of EBB (I.13... more Numerous critics have noted Browning's famous invocation to "lyric Love," the spirit of EBB (I.1391). Less frequently cited, however, is the preceding apostrophe, "Such, British Public, ye who like me not, / (God love you!)-whom I yet have laboured for, / Perchance more careful whoso runs may read / Than erst when all, it seemed, could read who ran" (I.1379-82). Thus writes the Poetspeaker, charging the unseeing, judgemental "British Public" that neither likes nor understands him. Anger is the prevailing tone here: Browning's anger against his critics, the public for whom he "labours," and the uncomprehending readers who he mistakenly thought would understand his verse. Is it coincidence, then, that he chooses to frame a poem about a murder-trial with this invocation? Browning, the object of critical antagonism, is accused of violating accepted poetic practice and on trial, defending himself and his art before the British Public. In these circumstances, he makes use of an intelligent anger: anger as a rhetorical device, tool of revenge, creative force, and, ultimately, instrument of self-definition. In this, he bears similarities to the hero-villain of the piece, Guido Franceschini, also on trial. But the poet's anger refracts throughout The Ring and the Book, "deformed, transformed, reformed, informed, conformed" (XI.2063) in monologues offering a prismatic view of this emotive and cognitive force. Like so many lenses, Guido, Pompilia, Caponsacchi and the Roman public in the shapes of Half-Rome, Other Half-Rome, and Tertium Quid, produce different images of anger. While it is "wolfnature[d]" Guido (XI.2318) whose rage has received most attention, Browning's other characters, Pompilia especially, contribute to his interpretation of anger in its many, colourful forms. Recognizing anger as one of its design elements opens up a fresh approach to The Ring and the Book which connects it with other works by Browning and other aspects of his poetics.

Victorian Literature and Culture, Sep 2013

Modern Language Review, Apr 2009

Brontë Studies, Mar 2007

Many Victorian medical theorists shared the notion that the will functions as an intermediary, ho... more Many Victorian medical theorists shared the notion that the will functions as an intermediary, holding the mind and body in tension. Psychosomatic illnesses, physiological ailments rooted in mental distress, figure prominently in both Sir Walter Scott's The Bride of Lammermoor and Emily Brontë's Wuthering Heights. Where Scott regards sickness as the product of a weakened will, Emily Brontë's characters exercise their wills to facilitate illness, thereby exerting power over their circumstances. Scott depicts a society breaking its members, forcing them to lapse into illness and madness, troublesome and tragic symbols of disorder. Emily Brontë, in contrast, interprets illness not as a collapse, but rather an exertion of the will's strength.