Book review: Touching Distance

NASTY, BRUTISH AND SHORT. Thomas Hobbes may have written it almost 150 years before the period in which Rebecca Abrams has set her dramatic debut novel, Touching Distance, but it buzzed through my mind as I read. Childbirth at home in cold, cramped conditions. Rampant illness and infections, sky-high child mortality rates and a medical fraternity run like an old boy's club – riddled with hypocrisy and fear.

Set in Aberdeen – a sprawl of fishing industry, filth and poverty – in 1790, against the backdrop of the stuttering advancement of medicine and scientific discovery of the Enlightenment, Abrams' novel is a fictionalisation of an epidemic of a deadly infection which affected women who'd recently given birth. Entirely preventable these days, in the late 18th century it was an inexplicable and devastating illness with no seeming cause or cure.

Touching Distance is not a dry, erudite history of medicine, however. It is a novel of fine characterisation and evocative description of the sights and smells of a growing city. Abrams skilfully portrays the way in which individuals become entwined with the developments of the age in which they live and the ambivalence which greets that which is defined as progress.

Alexander Gordon, an ambitious and pioneering surgeon, his emotionally fragile wife, Elizabeth, and their young daughter, Mary, provide the domestic core of the novel. As the infection spreads and women die, Abrams' protagonist, Gordon, struggles to find a way to prevent more deaths while his reputation and marriage suffer. Abrams has written a subtle and moving portrait of a man battling his own limitations, both in terms of scientific knowledge and personality, while also facing fear and ignorance from his patients and peers. In Elizabeth she conveys the stultifying and fear-filled existence of a woman utterly dependant on her husband, whose professional and intellectual life is alien to her. Abrams portrayal of their inept communication is all the more painful for its tenderness.

Born of humble origins, Gordon is a self-made man, a fine surgeon in thrall to scientific development and utterly devoted to the pursuit of progress. He's also deeply flawed, lacking in humility and inept at communicating with his wife. It's to Abrams' credit that Gordon becomes only more poignant as his limitations are painfully revealed.

Historical novels are, of course, not only enjoyable because they provide a window into the past, but also for what they reveal about the present. Childbirth in the developed world has been transformed by modern medical practices; infant and maternal mortality rates have been dramatically reduced, but it remains a topic surrounded by controversy. It's impossible therefore to read Abrams' novel without some sense of that ongoing debate. For here is a novel about childbirth and midwifery which provides no positive examples of women's involvement in that most female of processes. Midwives, interfering "howdies" as Alex Gordon perceives them, are utterly regressive, bound by superstition and fear; they are antithetical to Enlightenment principles. "He'd make farmyard brutes of good Christian women!" one says, as Gordon explains that allowing women to be on all fours rather than flat on their backs can help in childbirth.

I make no argument to suggest that the development of both gynaecology and obstetrics has improved beyond recognition women's safety during childbirth in the developed world, but it is intriguing that against the arguments that suggest birth has become too medicalised, if not pathologised, Abrams can find no good in the work that midwives do, the notion of learned practices or shared experience. In this novel, quite simply, doctors know best.

There are other flaws. Gordon's process of soul-searching in the final section as he comes to terms with the implications of his discovery is too laboured, as though Abrams is checking that her reader has understood the arc of the character rather than trusting that by this stage the difficulties Gordon faces are clear. Similarly there are moments of melodrama in Elizabeth's story as she remembers a harrowing childhood in Antigua and slips into opium addiction.

This is an accomplished novel though, successfully weaving the personal lives of characters with the overarching narrative of Enlightenment progress and its complex legacy. Visceral descriptions of the fragility and complexity of the human body co-exist with subtle and moving depictions of the Granite city and the harsh landscape in which it sits. With pace and drama, Abrams tells a tale which is at once informative and emotionally rewarding.