The Use of Force

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The Use of Force




William Carlos Williams's short story "The Use of Force" is about a country doctor who is summoned to the home of some poor people to examine a sick little girl. When he suspects that her persistent fever might be caused by diphtheria, a particularly deadly disease that was rampant when this story was published in the 1930s, he asks to examine her throat. The girl refuses, and what follows is an escalating battle of wills, in which the doctor loses his professionalism and reverts to a state of rage not much less savage than the girl's own fury.

If this story seems to be particularly realistic, that is because Williams knew his subject matter well. In addition to being an author, he was a practicing pediatrician in rural New Jersey for decades. The story, told from the doctor's point of view, captures the ways in which even the most calm, objective professional can fail when faced with the horrors of disease and the unthinking emotionalism of youth.

Williams was known primarily as a poet, and he is most often associated with the Imagist movement, which was a movement to write with concise imagery and language. His terse, objective poetic writing style is evident in this story, which was originally published in his 1938 short story collection Life along the Passaic River. It is available in The Doctor Stories, a 1984 collection of Williams's fiction that is still in print.


William Carlos Williams was born September 17, 1883, in Rutherford, New Jersey. His father, a businessman, was of English descent, while his mother, an amateur painter, came from a mix of French, Dutch, Spanish, and Jewish heritage. The household that Williams grew up in was morally strict, giving him the intellectual rigor and discipline needed to study medicine. In 1906, he received his M.D. degree from the University of Pennsylvania. He interned in Leipzig, Germany, from 1906 to 1909, then moved to Bergen, New Jersey, where he ran a private medical practice for more than forty years, until 1951.

Williams was interested in writing early in his life. Originally, he wrote poetry, and it is for his work in that genre that he is best known today. In 1909, he paid for the publication of his first collection, called Poems. He did not draw attention as a poet, though, until 1912, when the magazine Poetry Review printed a few of his poems with an introduction by the poet Ezra Pound. Pound, who by then was one of the most famous poets alive, had recently read some of Williams's poems, and a correspondence ensued that became the basis of a long friendship. Through Pound, he became acquainted with the greatest poets of his generation, including Hilda Doolittle (who wrote under the name "H.D."), Wallace Stevens, and Marianne Moore. His first commercial poetry collection, The Tempers, published in 1913, established Williams as an important voice in American poetry.

In his professional life as a physician, Williams maintained a quiet, stable demeanor. As a poet, however, he was on the cutting edge of the avant-garde. He followed the principle that Pound and others of his generation laid out, struggling to write a kind of poetry that the world had never seen before. Despite his renown as one of the cutting-edge artists of his day, however, most people who knew him in Bergen, New Jersey, knew him only as a local doctor, and had no idea that he was regularly published as one of the country's preeminent poets and fiction writers. Most of his stories were about people and situations that he encountered in his own life. Such is the case with "The Use of Force," which was included in his 1938 collection Life along the Passaic River, and which has been frequently included in anthologies since then.

Health problems slowed Williams down in the late 1940s, starting with the first of a series of strokes he was to suffer for the rest of his life. It was around then that he started his master work, the epic poem "Paterson," which was published in five volumes between 1946 and 1958. At the same time, he was befriended by the young writers of the time. Just when his poetic style was starting to seem dated, the publication of The Autobiography of William Carlos Williams made him interesting to members of the Beat Generation, who sought him out for artistic advice, which he gave happily. Until the end of his life on March 4, 1963 (following a series of strokes), he was active as a writer and as a member of the American poetic community. The winner of many smaller awards throughout his lifetime that gave him status among poets, Williams was recognized in the final year of his life with the Pulitzer Prize for Poetry (for Pictures from Brueghel) and the American Academy of Arts and Letters gold medal for poetry from the National Institute of Arts and Letters.


"The Use of Force" begins with the doctor arriving at the Olson house, reflecting on the fact that he has not heard much about the child that he is going to examine other than that she is "very sick."

He is met at the door by a woman, Mrs. Olson, who leads him to the kitchen: the sick child is being kept in the kitchen by the stove, where it is warm. There, he meets Mr. Olson and the child. He finds the little girl, Mathilda, to be extraordinarily pretty, like the young models in magazine spreads in the Sunday newspaper. No one from the family talks to the doctor much.

The father tells the doctor that his daughter has had a fever for three days. There is no clear cause for her fever, but the doctor, knowing that several children from the child's school have come down with diphtheria lately, suspects that it would be a good place to start the investigation. A diagnosis of diphtheria, however, relies on knowing whether the child has had a sore throat.

Mathilda views the doctor as an enemy, and refuses to talk to him. The parents say that they have asked her and she has said that her throat does not hurt, but the doctor does not believe that they have been told the truth. He decides to examine her throat for himself.

When he asks the girl to open her mouth for an examination, she refuses. Her suspicion of the doctor is made even stronger when her mother tells her that the nice doctor will not hurt her: the doctor, who understands how children think, knows that the child will focus on the word "hurt" above all others. In response, Mathilda jumps out of her chair and tries to claw the doctor's eyes with her fingernails. Though she is not successful, she does knock his glasses off, and they land on the floor a few feet from him.

When the mother, in her embarrassment, chides Mathilda and tells her to apologize, the doctor takes the child's side, telling her mother that he understands why she would not want to cooperate with a strange man who wants to put something in her mouth. He also does not, however, want to leave without taking a throat culture: the dangers of diphtheria are too great. He explains to the parents that he will go ahead with the examination, even against their daughter's will, but only if they agree to it. Making sure that they understand that the child could die if she is actually suffering from diphtheria, he nonetheless concedes that he is willing to leave Mathilda alone if they want him to. What he does not say aloud to them is that he feels great love for the child, due to her wild temperament, and that he is disgusted with the parents' attempts to suppress her natural feelings. The child is not moved by her parents' stern talk: she does not apologize, nor open her mouth for the doctor.

The father, though he is big and strong enough to hold onto his daughter, lets her squirm out of his hands before the doctor can pry her mouth open with a wooden tongue depressor because he is afraid of hurting her. He is near fainting when the doctor, angry, tells him to put Mathilda on his lap and hold her wrists. When the father does, the girl tries a new tactic: instead of keeping her mouth shut, she opens it and screams out that she is in pain, that the force her father is exerting is killing her. The doctor tries to ignore her words and go on with his examination.

He is finally able to pry a wooden tongue depressor into her mouth, and is about to use it to pry her jaw open so that he can look at her throat when she brings her teeth together with enough ferocity to shatter the wooden tool into splinters. Once again, her mother tries to embarrass the girl, telling her that she ought to be ashamed to behave in such a way in front of the doctor.

In a swirl of emotions that include anger, frustration, and fear that this child whom he admires so much might be dying with diphtheria, the doctor sends the mother to bring a metal spoon with a smooth handle. Though he realizes that he might be better able to perform the required task if he were to come back later, after his temper has cooled, he lets his rage get the better of him, and he throws himself into the task of taking a throat culture with no willingness to accept failure.

He makes a final attack, lunging at Mathilda with the silver spoon, forcing her jaws open and shoving the utensil down her throat, making her gag. When her mouth opens, he can see her tonsils, and they are covered with mucus, a sign that she does indeed have diphtheria. He knows that she has had a sore throat all of the times that her fever has risen, and that she has been lying to her parents about it, keeping it a secret, even though it could have potentially fatal results.

Having had her secret forced out into the open, the child tries to pounce at the doctor, though her father is still holding her. In her eyes, the doctor can see tears of defeat. The doctor's own feelings are a complex mixture of admiration and concern, love and hatred, tenderness and aggression, but he ends his story without telling the reader how he feels.



The doctor is the narrator of this story. His name is not given because he thinks very little about himself, instead focusing his thoughts on his reactions to the other characters.

It is clear that this doctor knows his business. He understands the sorts of people who would call on him, interpreting the silence of Mr. and Mrs. Olson as a sign that, poor as they are, they want him to work for his money and come up with a diagnosis on his own. He knows enough about disease, and about children, to realize that Mathilda's claim that her throat is not sore does not fit with her other symptoms, and to conclude that she is probably lying. He also knows that he cannot give in to her refusal to have her throat examined because doing so, though it might seem kind, could kill her.

Though the doctor knows that he must examine the child against her will, his job is complicated by the fact that he likes her. He finds her to be a beautiful child when he first meets her, but that does not affect his formal approach to her. He becomes truly interested in her after she strikes out at him: her spirit and unwillingness to bend to her parents' pleas or threats make her admirable.

The doctor is professional enough to know that he must continue with his examination even though the child is against it, but then he runs into an even deeper emotional conflict. Because he likes her, he becomes emotionally involved in the struggle against her. Under other circumstances, he would not be too insistent that Mathilda give in to his demand to see her throat. At one point, he even admits, after the fact, that it might have been better to walk away until all tempers were given time to cool. But his fondness for the girl stirs up his concern for her health, and the fact that he acknowledges emotions at all opens the possibility for his own anger. By the end of the examination, the doctor is as unreasonable as the child, acting out of anger rather than reason.

Mathilda Olson

This story is centered around the stubbornness of a little girl, Mathilda. She has had a fever for three days, and her parents do not know the cause of it. She has told them that she does not have a sore throat, but the doctor who has been called to examine her is not sure that she has told the truth. When he asks to examine her, she refuses to cooperate, and when he tries to force her to let him look at her throat she struggles against him. In the end, when she is overcome and the examination reveals that her throat really was covered with secretions after all, the girl is not grateful that her life has been saved: instead, she becomes even more enraged than before, lunging at the doctor who has violated her sanctity and revealed her secret.

Mathilda's actions are dangerous, possibly even life-threatening, but the doctor admires her fierce independence. He understands her unwillingness to be examined, but, unlike her parents, he is not willing to let her have her way simply because she is unhappy. As a result, Mathilda takes a two-step approach to stopping the examination. When she cries in pain, her parents become uncertain of themselves, and instinctually act to calm her: this tactic accelerates until Mathilda shouts out hysterically: "You're killing me!" Even though he is fond of her, the doctor does not allow himself to be moved by her cries. Seeing this makes Mathilda even more upset, and she strikes out at him. The first time she does this, she catches him by surprise, knocking his glasses off his face, but after that her father knows enough to hold tight to her. In the end, when her jaw has been forced open against her will, she is still struggling against her father's grip to strike out at the doctor, even though he poses no threat to her anymore. The shame of her defeat leaves Mathilda angrier than ever, and her fury displays the savage liveliness that the doctor finds admirable.

Mr. Olson

Mr. Olson is the father of the sick girl. He is described as a large, awkward man, uncertain of how to handle himself in this situation. He does not talk much, and when he does talk, his poor grammar indicates a lack of formal education.

Throughout the story, the girl, Mathilda, sits on her father's lap. When the father first arrives, she is there, presumably for comfort. Once the doctor realizes that he needs to examine her, and that she is not willing to be examined, he enlists Mr. Olson's help, telling him to hold his daughter still. Although Mr. Olson realizes the importance of this examination and takes the child's hands, his fear of hurting her and his shame at the way that she is behaving cause him to use a grip that proves too light, and she is able to pull herself away. He does, however, recognize the serious consequences that would befall her if she has diphtheria that is not treated, and so he tells the doctor to continue with the examination, humbly accepting the doctor's command about how to hold his daughter still.

When his wife shows concern for the daughter, as she is screaming about the pain of being held too tightly, Mr. Olson impresses on her the gravity of the situation. Though the husband and wife are similar in their skeptical view of the doctor, Mr. Olson understands the practical need for having Mathilda examined. He is somewhat emotional about his daughter, but he forces himself to put his emotions aside and be pragmatic.

In the story's last paragraph, after the examination is over and the evidence of diphtheria has been uncovered, Mr. Olson keeps a tight hold on his daughter. Here, the force that he uses on her is not meant to ensure her health, but to protect the doctor who has possibly saved her life.

Mrs. Olson

If there is an antagonist in this story, it is Mathilda's mother: with her well-meaning but soft-hearted expressions of concern for her daughter, she unwittingly encourages the child to rebel while displaying a personality type that the doctor finds irritating. From the first, when she answers the door with the remote phrasing "Is this the doctor," Mrs. Olson shows her skepticism about the coming examination. When Mathilda proves to be resistant to the doctor, her mother tries to give her comfort, but the things that she tells the child to comfort her are, in the doctor's opinion, just wrong. For instance, telling her that the doctor will not hurt her is less likely to make Mathilda think she will not be hurt than it is to make her focus on the word "hurt," reminding her of the pain that might be forthcoming. When her mother calls the doctor a "nice man," he tells her to not use that phrase, since Mathilda obviously does not think that he is nice. He is offended by the mother's willingness to lie to her daughter in this life-or-death situation.

The doctor's demeanor, and his exasperation with Mrs. Olson, spreads to the girl's father in the course of the examination, and eventually he, too, becomes impatient with Mrs. Olson, directly telling her to stop worrying because he knows how serious the results of the examination can be. After that, Mrs. Olson stops talking, cooperating with the doctor's request for a spoon silently, so that she will not say anything that will cause trouble.


Violence as a Useful Function

Violence is generally associated with destruction and is therefore avoided in our society. In this story, Williams regretfully acknowledges that violence does serve a useful function. One of the most obvious themes in this story is its examination of how violence, though regrettable, might be used in selective circumstances to serve a greater good.

When the doctor arrives at the Olson house, he surveys the situation and finds it tense. The parents are country people, suspicious of outsiders like him, and the child who needs medical help is suspicious of him and of her own parents. When he hears that the child claims to not have a sore throat, her claim does not make sense with his diagnosis of her prolonged fever. His decision that examining her throat is more important than her refusal to be examined gives him no other recourse than to use violence to get the examination done.

The parents' initial skepticism about the doctor gives Mathilda a chance to divide the adults against each other: when she acts as if the force the doctor is using is causing her unbearable pain, her parents consider stopping the exam. Her father is the first one to think through to the results that could occur if she had diphtheria and left it undiagnosed, and so he reluctantly holds her steady, even though it means repressing his natural level of concern for his daughter's cries. Her mother continues to worry about the violence being done to Mathilda until her husband and the doctor convince her of the urgency of the situation.

Even though he knows that it is the best course of action, given the circumstances, the doctor is not able to use violence and remain dispassionate about it. Halfway through the forced examination, after Mathilda counters his violence with her own violent act of biting his tongue depressor in half, the doctor finds himself ablaze with anger. He later acknowledges that continuing with the examination when everyone's emotions were so high was probably not the wisest course of action, but at the time, caught up in the moment, he can only think of countering Mathilda's violent action with one of his own. It is in this way that Williams shows that, even when undertaken for a noble cause, violence begets violence and takes on a life of its own.


Though the doctor comes into the Olson house with a cold professional demeanor and conducts his examination as if he has no personal concern for the sick girl, his narration lets readers know that he feels compassion that grows from the moment that he meets Mathilda. His first impression is positive, as he is struck by what a beautiful child she is, likening her looks to those of children featured in photo spreads in the Sunday newspaper. His empathy for her grows when he hears her mother tell Mathilda that the doctor will not hurt her, because he knows that the only thing she will take from that claim is the idea of being hurt, and not her mother's denial that it would happen. By this point, the doctor sees the situation from Mathilda's perspective more clearly than he sees it from the adult perspective.

Of course, even though he feels great compassion for the girl, the doctor does not allow that compassion to keep him from examining her throat. If he were to allow his fondness for her to stop him, the result might be much, much worse for Mathilda than the short-term discomfort she would undergo during a throat exam. The message for readers is that compassion does not always mean the same thing as gentleness, and that force is not necessarily the same thing as the anger with which it is so often associated.


In the last line of this story, Mathilda is crying over the defeat that she has suffered because of the forced examination. By that point, readers can see clearly that the main driving force behind her struggle has been nothing more than a power struggle against her parents and the doctor. Since there is no good reason for her opposition to the exam, and plenty of reasons for her to have cooperated with it, her ultimate humiliation could seem a minor detail. The doctor understands her so well, though, that readers are moved to feel pity when they see her taking defeat so seriously.


  • When this story was published, there was an antitoxin available to treat diphtheria, but no vaccine to prevent it. Research how anti-toxins and vaccines work, particularly on this disease, and show your class a presentation explaining the science behind them.
  • Research the history and theories of the Imagist movement. Take a poem published in a current publication and write an essay in which you explain what you think might be examples of the Imagists' influence on the poem.
  • Research the Depression and today's economic climate. Based on your findings, write a dialog between the doctor and Mr. and Mrs. Olsen as it might occur if this story took place today, instead of during the Depression. How do these vastly different economies change the story?
  • William Carlos Williams was a doctor in poor rural areas, just like the doctor in the story. Read The Autobiography of William Carlos Williams and other biographies about the author. Based on what you've learned, can "The Use of Force" be said to be autobiographical or no? Why or why not? Explain your thesis in an essay.

The humiliation of Mathilda is not the same thing as a victory for her doctor, who could be seen as her opponent in this struggle. Because he empathizes with her, the doctor feels her humiliation, even though he is the one who has forced her, against her will, to open her mouth. Although

the doctor does admit at one point that he finds pleasure in attacking her, in overcoming her obstinacy, her humiliation in the end is presented as an unfortunate turn of events for everyone.

Professional and Personal Contempt

While the doctor's attitude toward Mathilda changes throughout the course of their struggle, he feels a steady sense of contempt for her parents from the start of the story to the end. At first, he does not admit any dislike, noting their suspicion of him without commenting on it: he views them with a professional detachment, expecting no more from them than help in the examination at hand. His dislike for them becomes personal, however, when he observes how their attitude toward their daughter encourages her in the dangerous refusal to have her throat examined. Because he understands how the girl feels, he knows what she must think when her mother says that he is a nice man who will not hurt her, and he knows that it will have the exact opposite effect on her than her mother intended.

As they go on with the exam, his contempt wears off on the father, who adapts the doctor's attitude somewhat when he shouts at the mother while she is trying to comfort their daughter. At first, the father is only concerned with making the fragile little girl feel more comfortable, as his wife is, but the doctor's contempt for their softness moves him to see how grave the situation is, and his new insight into what is going on makes him lash out at the mother, blaming her just as the doctor has blamed the parents for what is happening.


The Absence of Quotation Marks

Like most works of fiction, "The Use of Force" alternates between narrative description of the action and direct quotation. Williams breaks with standard of style, however, by presenting direct quotations from characters without using quotation marks to indicate that these are things that were actually said out loud.

By leaving out the quotation marks, Williams takes a chance that he will confuse his readers. He does indicate that the words presented are spoken by using the word "said" before and after quotes, but readers who are accustomed to seeing quotes set off in quotation marks might wonder, at least until they catch on to Williams's style, whether these are actually the exact words the character is supposed to have said.

That ambiguity in the mind of the reader creates an effect that fits with the tone of the story. Throughout the story, the doctor speaks in an objective, impersonal voice, in an attempt to relate the events with as little emotion as possible. By leaving the quotation marks off of dialog that was spoken out loud, Williams removes some of the drama from the situation, flattening the tone so that readers can focus on the complex relationships rather than the style of speaking that each individual has. Although the story is made of both narrative and quotations, the tone of the entire story remains consistent.

Use of Symbolism

Williams tells this story with very little comment, and so readers are left to find the impact of the story through careful reading. In order to steer readers to the conclusions that he wants them to reach, he uses strong symbols, or physical objects that can be used to emphasize the points he is making.

The most striking images used here are the two items that the doctor inserts into Mathilda's mouth to pry her jaws open. The first is a wooden tongue depressor, a standard tool of doctors who are conducting a throat exam. When she bites down on it, it becomes a symbol of her rage. The fact that her bite is powerful enough to break it to splinters is a symbol that she has in her a level of ferocity beyond what one would expect of a little girl. The fact that the splinters of what is left cause her mouth to bleed provides readers with a visual image of Mathilda as a savage animal, as blood drips from her teeth.

When the tongue depressor is shattered, the doctor is given a silver spoon to conduct his examination. Generally, the phrase "silver spoon" is used in American culture to indicate a childhood of wealth and privilege, which is certainly not the case with the Olson family. What it does represent, however, is the rise of overpowering technological force. If the child's jaws have an equal chance with the naturally grown wood probe, they have no chance against a metal instrument, which is as overwhelmingly powerful as the adults' hands that hold her. The change of tools is as important as the change from empathy to force.


The Depression

When Williams wrote this story, America was in the middle of the Depression. Historians generally identify the start of the Depression as October 24, 1929, when the U.S. stock market was hit with a massive sell-off. That day, commonly referred to as "Black Thursday," U.S. stock values took an unprecedented drop in value. The ensuing panic, as people tried to cash in their stocks, created an even worse crisis, so that by November, stock prices were down 40 percent from where they had been in September. The lack of money caused a chain reaction: businesses were wiped out and unable to pay their bills, which ruined other businesses, putting people out of jobs, which glutted the employment market with skilled workers. The Depression spread to other countries and become a worldwide event.

The New Deal policies of Franklin Delano Roosevelt, elected first in 1932, helped to ease the economic pressure on some of the country's poorest citizens. The New Deal was a mixture of policies involving dozens of agencies that were started to employ citizens for diverse jobs such as construction work and social programs. Though employment did help individuals, the U.S. economy stayed weak throughout the 1930s and only began to thrive again when the country entered World War II in 1941.


Diphtheria is a disease that attacks the respiratory tract. It is characterized by a sore throat, low-grade fever, and the formation of a membrane around the tonsils. The membrane grows until it blocks the breathing passages, causing the infected person to eventually suffocate.

Throughout human history, diphtheria has been feared as one of the most dreaded and potentially devastating diseases to attack humankind. It is very contagious, and outbreaks of the disease spread quickly through communities that had practically no defense against it. In colonial New England, for example, a diphtheria epidemic was estimated to have killed 80 percent of the population of children under 10 in some towns in the five years between 1735 and 1740. In the 1920s, when William Carlos Williams was a practicing physician, there were an estimated 100,000 to 200,000 cases of diphtheria in the United States each year, resulting in an average annual death toll close to 15,000. The 1925 outbreak that threatened to decimate the population of children in Nome, Alaska, led to a convoy of dog sled teams moving diphtheria serum from Anchorage, an event that is commemorated every year with the famous Iditarod sled dog race.

A cure for diphtheria was slow in coming. Early treatments in the 1800s entailed inserting a tube down through the respiratory tract, to hold off the development of the membrane and allow the patient to continue breathing. An antitoxin against the disease won the first Nobel Prize in the 1890s, but it only neutralized the poisons that the disease caused in the patient and it did not stop diphtheria itself. A vaccine to prevent the drug was developed in 1923, but it was not until the post-war years of the 1950s that there came an antibiotic that could effectively treat patients who already had diphtheria.

Today, thanks to inoculation and early treatment, diphtheria is very uncommon. Between 2000 and 2007, for example, only five people in the United States died of the disease.


William Carlos Williams is remembered first as a poet and second as a short story writer. His fiction reflects his poetic style. Williams was one of the earliest writers associated with a style called Imagism.

The Imagist movement came into being around 1909, just as Williams was starting his career in poetry. It was spearheaded by Williams's friend and mentor, Ezra Pound, and Chicago poet Harriet Moore, who, after lengthy discussions with other poets and critics about the problems faced by modern poets, published an anthology in 1914 called Des Imagistes: An Anthology, featuring poetry that they felt represented their artistic views.

Pound, who was living in Paris during the early 1900s, met regularly with other poets to discuss what they felt to be a pressing problem of modern poetry; namely, how words could be used to capture the vagaries of existence. To them, the poetry of previous generations, most notably the Victorian writing that evolved out of the Romantic style, was too rigid, too stiff, too focused on emotion and morality. Pound, Moore, and the others, including Pound's ex-lover Hilda Doolittle (who wrote under the name "H.D.") and her new fiancè, Richard Aldington, looked to the French Symbolist poets and Japanese haiku for models of how poetry could convey its meaning without ever discussing intangible emotions, if the right imagery was chosen. From their discussions, critic T. E. Hulme developed the artistic philosophy called Imagism. The word became familiar to readers when Poetry magazine, which Moore edited, published H.D.'s first poems in 1913, and then through Pound's anthology in 1914.

Williams was one of the dozens of young poets who began publishing in the 1910s and was strongly influenced by the Imagist philosophy. Though he was never a member of the core Parisian group, he was very involved in the poetry scene in New York City in the 1920s, with which Pound was also frequently active. Williams's poem "The Red Wheelbarrow" is considered to be not only a prime example of Imagist theory in practice, but also one of the greatest American poems ever published. It presents one single image without comment, just as "The Use of Force" presents a situation but leaves readers to determine the moral implications for themselves.


  • 1930s: The United States is mired in the Depression. People struggle to find jobs; money and resources are scarce.

    Today: The economy continues to fluctuate and reaches a Depression-like low in the early 2000s, with banks and auto companies asking for federal assistance.

  • 1930s: Diphtheria is a common fatal illness, killing thousands of people, particularly children, each year.

    Today: With vaccines and modern antibiotics, diphtheria has practically been eliminated.

  • 1930s: A doctor making the decision that force is necessary to conduct an examination on a child would feel free to do so.

    Today: A doctor, or any other professional for that matter, would have to consider whether he or she might be taken to court later or be professionally disciplined for actions that cause harm, even unintentionally.

The Imagist movement was short-lived: poet Amy Lowell published a few more anthologies under the names Some Imagist Poetry in 1915, 1916, and 1917, but the founders of the movement

disagreed about each other's artistic principles, so that by the time of the final book there was little agreement among even its adherents as to what exactly Imagism was. Still, its impact reaches to today, as the movement and its stated philosophy altered the course of poetry and the idea of what a poem should and could accomplish.


While William Carlos Williams is often considered one of the great literary figures of the twentieth century, it is usually his poetry that earns him praise: critics mention his fiction, and no in-depth study of his career would be complete without an analysis of his novels and short stories, but they are seldom discussed on their own, without some mention of how they are related to his poetry. In the 1920s and 1930s, when he wrote it, Williams's fiction was generally viewed as a welcome diversion between poetic works. His novels were more studied for their experimental qualities than appreciated as works of art unto themselves. An example of this can be seen in William Carlos Williams: An American Artist by James E. Breslin. Breslin praises the novel White Mule, published in 1937, for creating "an immaculate surface, swiftly recording domestic events in all their casualness … to bring through fundamental qualities of character." Breslin contrasts this with Williams's 1923 experimental book The Great American Novel, which was considered more of an exercise than a novel and was all but forgotten not long after its publication.

Williams's shorter fiction has always been more widely respected, though it was not commercially successful in its time. In particular, critics have applauded the authenticity in his stories about doctors in rural New Jersey. As Cid Corman says in an essay in William Carlos Williams: A Collection of Critical Essays, "The Use of Force" is "for all its anthologizing, a beautiful clean thing, prose, direct in its attack, sure in its sense of when to leave off, its language crisp and true, touching." This success when dealing with autobiographical material also crosses over into Williams's poetry, such as Williams's long, multi-volume poem Paterson, about the town in New Jersey where Williams spent most of his life. Robert Lowell, one of the twentieth century's best-known poets, says of Paterson in Profile of William Carlos Williams: "By personifying Paterson and by ‘Patersonizing’ himself, he [Williams] is in possession of all the materials that he can use." This statement speaks for most critics over the years, many of whom have appreciated Williams's fiction, its short, controlled bursts and its intimate connection between Williams's life and work—of which "The Use of Force" is a prime example.


David Kelly

Kelly is an instructor of creative writing and literature. In this essay on "The Use of Force," he explores the idea that the central conflict in this story is not between the doctor and the child, and that they are instead kindred spirits in their opposition to the girl's parents.

People who read William Carlos Williams's short story "The Use of Force" are inclined to describe it as a struggle of wills between the two main characters: an adult doctor, who finds himself increasingly unable to maintain his professional demeanor, and a sick girl who fights throughout her examination. As the narrator of the story, the doctor is the character whom readers watch most closely. In a classic short story arc, the doctor starts as one thing, a man of reason, and by the final paragraph is convincingly transformed into its opposite, a mindless savage. It would be difficult to refute that this is the story's main point. But it is scarcely the only point. Williams packs the corners of this very short work with depth and nuance, so that elements that might be missed in the first reading prove to carry an importance that was not originally clear.

Of all of the elements, the most easy to overlook is the importance of the girl's parents. Readers tend to pay the parents little attention because the doctor gives them little attention, dismissing them quickly as nuisances rather than as an integral part of their child's life. Williams has his narrator treat them decently, even as his patience with the whole situation wears thin, but he thinks of them with disdain throughout. He tries to forget them while he is locked in a combat with the little girl, Mathilda. And that, to some extent, is the point: as the doctor's focus on the child drags him further and further from the balance and compromise that the adult world requires, the girl's parents seem more and more ridiculous to him and to the reader. In fact, though, they are not that ridiculous at all.


  • Anton Chekhov is recognized as a great short story writer, and, like Williams, he was a practicing doctor. Readers can get a sense of Chekhov's tone and themes from "Gooseberries," one of his most popular stories, published in 1898. It is often anthologized and is included in Anton Chekhov's Short Stories (1979).
  • For a sense of how prevalent diphtheria once was, and how it came to be controlled, read Epidemics Laid Low: A History of What Happened in Rich Countries (2006), by Patrick Bourdelais. It examines the responses to epidemics from Bubonic Plague to AIDS, and how these diseases have affected societies.
  • Much of Williams's work, both fiction and poetry, was drawn from his life. The Autobiography of William Carlos Williams (1949) is considered one of the great literary biographies, full of insight and self-awareness, showing the author to be quite the same kind of man as the stoic characters he wrote about.
  • Robert Coles's 1975 analysis of Williams's fiction, William Carlos Williams: The Knack of Survival in America, devotes a long section to explaining the themes and biographical background of the stories in Life along the Passaic River.

The relationship between the doctor and Mathilda, and in particular the change in his personality that she elicits, is so clear and powerful that readers are not likely to focus on anything else in the story. For one thing, it a physical, violent relationship, carrying the "force" referred to in the story's title. He grips her roughly; she tries to scratch his eyes; he forces a piece of wood in her mouth and she counters by crushing it with her jaws, even though the resulting splinters cause her pain; he overcomes her in the end by forcing a metal spoon into her mouth, and then she loses any semblance of self-control. Their struggle against each other is magnified by the differences between them. They could not be any less alike: the doctor, a grown man with a medical degree, a professional who has clearly dealt with reluctant children before, is brought down to the same emotional level as an unreasoning, helpless child. Williams clearly understands how such a change in the doctor's personality is possible, and he renders it convincingly in a short space. The intensity of this central relationship relegates all other aspects of the story—most notably, the girl's parents—to the corners.

But the parents, slow and superficial as they may be, still provide an effective counterbalance against Mathilda and the doctor. While the doctor is Mathilda's opponent in the physical struggle to examine her throat, he is also, in the struggle against her parents' stifling ways, the little girl's partner. The whole conflict with Mathilda is the result of his attraction to her. He finds her to be a strikingly beautiful child when they first meet, and he understands and respects her fear of being examined by a stranger. His fondness for her clouds his judgment, filling him with a degree of anxiety that makes it difficult for him to maintain a professional demeanor, which then leaves him with little recourse against her tantrum but force, which in turn makes her even more loud and violent—and on and on in a self-perpetuating spiral. They hate each other, they love each other, but the most obvious point is that together they have little use for Mathilda's parents.

The easiest way to interpret this would be to take the doctor at his word and write the parents off as despicable. But Williams gives the parents each just enough character traits to dignify and humanize them, which he would not do if they were merely meant to be despicable foils to the story's central figures. The fact that they have individual personalities makes it possible to explore what each one means to this story's overall message.

Mathilda's parents, in fact, represent the two elements of the doctor's personality that are central to the emotional conflict in this story. He comes into the Olson household as a man of reason and compassion and ends up letting his forceful side take control. The same struggle that goes on within the doctor's mind manifests itself externally within the Olson family.

When the doctor arrives, the parents are treated as one. The story does not differentiate between them in their silence and suspicion. They do not have much personality to him, but he does not have much individuality to them, either. Mrs. Olson meets him at the door with "Is this the doctor?" as if she is talking to a third party, and not to him. She does not ask his name, but he does not introduce himself, either.

The main distinction separating the doctor from the other two adults in the story seems to be one of social class. He is an educated professional, and, though there is no explicit indication of what they might do, it is clear from their stilted and informal diction that they are uneducated people. The class distinction is made clear by the way the mother apologizes to the doctor for making him go through the inconvenience of walking to the back of their house to see the little girl, as if making him look at their humble possessions might be asking too much of him. From his perspective, the doctor writes off the Olsons as a certain type of people he has encountered before, and assumes the ability to read their thoughts about him.

During the troublesome examination of Mathilda, the girl's father becomes more acceptable to the doctor. He is quiet and functional, exerting force against the girl when the doctor needs help holding her still. He is somewhat hesitant to do what the doctor feels must be done, but he does seem to be trying, and the doctor gives him credit for that. "The father tried his best," he narrates at one point, empathizing with the man's natural hesitancy to see harm come to his daughter, even though he still, by the time that sentence comes to an end, states that "I wanted to kill him." The father's hesitance toward forcing an examination on his daughter is exasperating, but understandable.

The narrator is less charitable about the girl's mother. To the doctor, the mother is meddling, making an already difficult job even more difficult with her attempts to calm the child. She tells Mathilda that the doctor is a good man, that his examination will not hurt; the doctor, who understands the child so well, knows that Mathilda will hear in her mother's words only insincerity and vulnerability that she can exploit. It is the mother who drives the narrator to raise his voice and speak harshly. He finds her offensive for the same reason that he finds the child admirable: there is a level of phoniness about what she says, it is the inverse of the raw honesty of Mathilda's shrill tantrum.

The doctor's greater level of disdain for the girl's mother could be a result of the sexist times the story takes place in, but it also can be caused just by social understandings that, while related to sexism, are more pronounced. During the exam, Mr. Olson starts out being fairly quiet, and he becomes even quieter still: like the doctor, he becomes drawn more and more toward the perspective that what is called for in this situation is silent force. Mrs. Olson, on the other hand, tries to comfort her daughter by talking to her, then tries to shame her for embarrassing them in front of the doctor. Even though these two approaches, force versus reasoning, may correspond to traditional gender roles in Western society, the more important aspect is that they correspond to the change that the doctor undergoes in this story. The doctor does not necessarily dislike Mrs. Olson because she is a woman, but because she talks too much. As he loses his calm bearing, he sees nothing but the falseness of soothing words, and the honesty of physical action.

When the girl's mother voices her concern for Mathilda, who is crying out and exaggerating her pain, Mr. Olson tells her: "You get out." Williams leaves this expression intentionally vague. The words themselves command the woman to leave, to go somewhere else and let the men handle this situation with force. Still, the rural dialects that the Olsons use, and the fact that the mother does not in fact leave the room, indicate that the real meaning is more along the line of "be quiet." When she does talk again, it is not to comfort the girl, but to chastise her for embarrassing them in front of the doctor: she lines up on the doctor's side and submissively fetches a spoon when he requests one, no longer questioning his judgment.

In the course of this story, the doctor never does make Mathilda agree to his examination. He does overpower her, but his ability to do so is never really in question. The story of a man engaged in a battle of wills with a child and losing his professional detachment is an interesting one, but even more interesting is watching how the same dynamics that can bring a stranger to use force against a little girl can eventually convince her parents that sympathy and compassion will not work.

Source: David Kelly, Critical Essay on "The Use of Force," in Short Stories for Students, Gale, Cengage Learning, 2009.

William Baker

In the following article, Baker analyzes common interpretations of "The Use of Force" and presents his own view of the story's primary conflicts.

Note the urgency and immediacy of the opening paragraph: "They were new patients to me, all I had was the name, Olson. Please come down as soon as you can, my daughter is very sick." The two sentences might have been punctuated as four, but William Carlos Williams, anxious to get to his point, uses commas to keep us flowing with him. Here and throughout he omits quotation marks for the direct address, another device to convey urgency. From the first rushing sentences Williams comes on like the Ancient Mariner, grabbing our lapels to tell of the doctor's compulsion. At first we think we might have a classic rescued-from-death tale, since early on we read, "As it happens we had been having a number of cases of diptheria in the school to which this child went during the month." The last two thirds of the story, though, is not about death but about the strange problem of getting to see the girl's throat.

On his first try, the doctor almost gets his face clawed. On his second, the girl bites through the wooden tongue depressor. On his third he is successful, but he is ashamed of overpowering the little girl. He hates her parents who collaborated in his "unreasoning assault," and, finding the girl "an unusually attractive little thing," he says, "I had already fallen in love with the savage brat." Her tonsils were covered with membrane, but if we anticipate that the girl was diagnosed, treated, and then recovered, we are disappointed, for still urgently, almost obsessively, getting the story off his chest, the doctor ends by saying, "Now truly she was furious. She had been on the defensive before but now she attacked. Tried to get off her father's lap and fly at me while tears of defeat blinded her eyes." Initially, we are puzzled that the story ends here.

What does this compulsively told narrative mean? On the surface, it is the story of a doctor overpowering a girl, but we sense immediately that such a "meaning" is too superficial, and that the story is too short.

The pseudo-Freudians move in and suggest the symbolic story of sexual conquest (or a rape), for the invasion is made against the girl's will and the sanctity of her privateness is violated. They point out the suggestiveness of the line, "Will you open it now by yourself or shall we have to open it for you?" And they try to clinch their case by noting the doctor's lines, "It was a pleasure to attack her. My face was burning with it."

A more reasonable Freudian analysis was made by Fergal Gallagher in the May, 1972, CEA Critic. He suggested that the parents represent the super-ego (conventions of society), the girl the id (instinct), and the doctor the ego (reason), with the doctor surprised to discover his id taking over when he resorts to force. An interpretation that depends on identifying characters as symbols seems to me to be a little too neat.

There are two conflicts: one within the girl and the other within the doctor. The girl feels, I believe, that if evil is not discovered it does not exist. As long as we keep evil to ourselves, it is containable and controllable. When others discover our secret, we are no longer in control and all is lost. Thus, the little girl hid her sore throat for the same reason that some of us avoid a dentist who will find cavities in our teeth. We know we are acting unreasonably, but we don't go to the same lengths, nor is our fear as strong as the girl's, for she fought with supreme effort, crying bitterly when she lost.

The second conflict, more interesting to Williams the writer rather than Williams the medical doctor, is about an adult's anger at himself when he is required to use force to accomplish his aim—even if the aim is noble in itself. Force is alien to a mature and cultivated mind, though learning about its psychological effect is part of growing up. When all else fails, reason tells us we must resort to force, but we are disgusted with ourselves when we give in. The anger and disgust rob the occasion of any sense of satisfaction: we win the physical battle but lose the war within our psyche.

A common-sense analysis would point out that it is natural to feel anger and disgust when using violent force, as in rape. The doctor says, "Perhaps I should have desisted and come back in an hour or more. No doubt it would have been better." The solution then is patience and a sensible and safe relief of frustration, but that's a story with a moral.

The power of the story is its sense of urgency and its brevity. The author doesn't have time to fill in the blanks. His intention is not character-development nor plot-exposition in the usual sense. His intention is to get in and get out quickly, focusing on what he has discovered about the use of force.

Source: William Baker, "Williams' ‘The Use of Force,’" in Explicator, Vol. 37, No. 1, Fall 1978, 2 pp.

Fergal Gallagher

In the following article, Gallagher aligns the characters in "The Use of Force" with the components of the human psyche as defined by psychologist Sigmund Freud.

In his interesting article on William Carlos Williams' "The Use of Force," R. F. Dietrich points out the sexual connotations of the story that "are there because they express the savagery in human nature that, lying so close to the surface, can erupt at any moment in a flow of irrational behavior …" (Studies in Short Fiction, Summer 1966). The interpretation of the doctor-child conflict in terms of a sexual encounter does indeed appear to be valid when one considers the sexual overtones of the language of the story as Dietrich does. However, I would like to suggest a further interpretation based upon Freudian theory. I believe that the three sets of characters in "The Use of Force"—the doctor, the parents, and the child—are motivated by the three zones of the human psyche, the ego, the super-ego, and the id, respectively, and I also believe that the doctor, at first governed by the ego, permits his id to dominate him during his encounter with the child.

It is evident that the child, in her unrestrained passion and aggression, is acting entirely according to the dictates of the id, which Freud describes in his New Introductory Lectures on Psychoanalysis as "striving to bring about the satisfaction of the instinctual needs subject to the observance of the pleasure principle." The aim of the id is to seek pleasure and to avoid pain, functioning without regard for the conventional restraints of society or morality, and even without regard for self-preservation. The id, as Freud remarks, "knows no judgements of value: no good and evil, no morality." Mathilda's blind fury and her instinctual, hysterical attack on the doctor, when he moves closer to examine her, indicate that she is completely unconcerned about the doctor either as someone capable of helping her or in his role in society as someone to be respected. Describing her as lunging at him with "one catlike movement" while "both her hands clawed instinctively" for his eyes, the doctor emphasizes Mathilda's instinctual, animal-like aggressiveness, characteristic of an individual governed by the id. In other words, the child appears to be dominated by the id, and reason or conventional morality (the ego and the super-ego) form little part of her psyche.

According to Freud, the instinctual aggressions and passions of the normal adult psyche are regulated and repressed by the reason (the ego) and the conventions of society and morality (the super-ego). As Mathilda's behavior would seem to indicate that she is dominated by the id, the control and repression of her untamed aggression must be supplied from some external source. Freud points out that "young children are amoral and possess no internal inhibitions against their impulses striving for pleasure. The part which is later taken on by the super-ego is played to begin with by an external power, by parental authority." In their physical attempt to hold their daughter still so that the doctor can examine her throat, the parents are, in effect, attempting to repress her passion and aggression. In Freudian terms the super-ego is attempting to repress the id. In regarding the parents as the super-ego, I think it is worth noting that their reaction to Mathilda's behavior is not one of anger, but rather one of extreme embarrassment and mortification. At the child's first attack on the doctor, "both the mother and father almost turned themselves inside out in embarrassment and apology." The father releases her at the critical moment because of his "shame at her behavior and his dread of hurting her." When Mathilda reduces the wooden spatula to splinters, her mother asks her: "Aren't you ashamed to act like that in front of the doctor?" Rather than considering the doctor as one who can help their child, the parents seem to regard him as one socially superior to them because of his professional status. This is why they are embarrassed rather than angered at their child's behavior. And this display of embarrassment on the part of the parents is indicative of the feelings of guilt associated with the super-ego.

Whereas the parents are governed by the super-ego, the doctor, understanding the practical nature of the problem, is governed by the ego, which, Freud says, "stands for reason and good sense." The physician realizes that he "had to have a throat culture for her own protection." He is annoyed with the mother when she refers to him as a nice man. He realizes he has a job to do: "For heaven's sake, I broke in. Don't call me a nice man to her. I'm here to look at her throat on the chance that she might have diphtheria and possibly die of it." This is the reasonableness of the ego opposing the super-ego's concern with social convention.

No change occurs in the behavior of the parents or the child. Throughout the story the parents remain dominated by the super-ego, and Mathilda is governed by the id. But there is a remarkable change in the behavior of the physician. He loses control of himself, or, in Freudian terms, he permits his id to dominate the ego. As he first encounters the patient he behaves with reason and circumspection. He is annoyed at the stupidity of the parents and is determined to obtain the necessary throat culture. After the second fruitless assault, the doctor reasons with himself whether he should continue or try again later. But he realizes the urgency of the situation and tries again to force open the patient's mouth. Up to this point the doctor is controlled by the ego, and even in the motivation for his final forceful attempt to obtain the throat culture he is behaving rationally, for he realizes the necessity of force under the circumstances. But, in the use of force, he loses his ability to reason as he attacks the girl with the same blind fury with which she resists him: "But the worst of it was that I too had got beyond reason. I could have torn the child apart in my own fury and enjoyed it. It was a pleasure to attack her." So in a "final unreasoning assault" the doctor manages to force open Mathilda's mouth and examine her throat. But, in so doing, he loses his ability to reason and permits his passions and aggressions to govern him. The doctor's ego submits to the id as he enjoys the momentary release of instinctual aggression. It should be noticed here, however, that this is not a total domination of the ego. For if the doctor were totally governed by the id, he would have probably merely struck the girl in blind fury. Perhaps it was Williams' intention here to demonstrate the usefulness of force in such a crisis. Without the use of force, it would not have been possible for the doctor to obtain the necessary throat culture. Nevertheless, there is no doubt that the doctor derives pleasure from his attack, even if only for a moment.

According to Freud, in the normal individual the ego acts as a mediator between the id and the super-ego. At the beginning of "The Use of Force" the doctor, governed by the ego, serves as the intermediary between the parents dominated by the super-ego and the child controlled by the id. Thus, as we should expect, the physician is the one who acts with reason and circumspection. But in the process of examining his patient he, too, becomes momentarily unbalanced. Therefore, "The Use of Force" deals not only with the conflict between doctor and patient, but also with the inner conflict between the psychic forces of reason and aggressive passion, between the ego and the id.

Source: Fergal Gallagher, "Further Freudian Implications in William Carlos Williams' ‘The Use of Force,’" in CEA Critic, Vol. 34, No. 4, May 1972, pp. 20-21.


Breslin, James E., William Carlos Williams: An American Artist, Oxford University Press, 1970, pp. 163, 165.

Corman, Cid, "The Farmer's Daughters: A True Story about People," in William Carlos Williams: A Collection of Critical Essays, edited by J. Hillis Miller, Prentice-Hall, 1966, p. 164.

Lowell, Robert, "Paterson I and II," in Profile of William Carlos Williams, compiled by Jerome Mazzaro, Charles E. Merrill Publishing, 1971, p. 72.

Williams, William Carlos, "The Use of Force," in The Doctor Stories, New Directions, 1984, pp. 56-60.


Dietrich, R. F., "Connotations of Rape in ‘The Use of Force,’" in Studies in Short Fiction, Vol. 3, No. 4, Summer 1966, pp. 446-50.

Dietrich's essay does not imply that the doctor's actions in this story constitute actual sexual abuse, but it looks at ways in which the doctor's actions can be seen to have sexual overtones.

Engel, Jonathan, Poor People's Medicine: Medicaid and American Charity Care since 1965, Duke University Press, 2006.

Told in a series of anecdotes, this book offers an opportunity to compare and contrast the doctor's visit that Williams describes with the way rural health care for the poor is handled in today's post-Medicaid world.

Guimond, James Williams, The Art of William Carlos Williams: The Discovery and Possession of America, University of Illinois Press, 1968.

Though this book, like many literary overviews, focuses mainly on Williams's career as a poet, its insights into his uniquely American style apply to his fiction as well.

Mariani, Paul, William Carlos Williams: A New World Naked, W. W. Norton, 1990.

One of the most detailed and extensive biographies of Williams available, this massive book is presented in a compelling style.

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