With Words and Knives: Learning Medical Dispassion in Early Modern England (review)

The role of affect, of the emotions, of emotional attachment and detachment, is not well understood in histories of medicine, anatomy, and science, or in broader histories of Western culture. On the latter, Barbara Rosenwein has recently provided some explanations for the oversight, highlighting the influence of Huizinga's depiction of the childlike emotional life of the Middle Ages and of Elias's characterization of emotions as irrational, primitive, and in need of regulation (or a civilizing process) (Review Essay, AHR 107 [2002], 821-45). Histories of medicine tend to treat emotions as they appear in anecdotes of patients' experiences, and histories of anatomy locate affect in the ghoulish episodes of grave robbing that began in the mid-sixteenth century and culminated in the Resurrectionists of the eighteenth century and in suspected accounts of human vivisection. The emotions, that is, have been kept outside, in the fray, among the common folk. They have not entered into our understanding of the anatomists, students, and surgeons who open and immerse themselves in decaying and sickly bodies. We know precious little about the anatomist's ability to manage his emotions as he operated on corpses. Lynda Payne's study of medical dispassion, however, changes our understanding of the emotions in the history of anatomy and medicine. Dispassion, she argues, was transformed into a medical virtue, endorsed in the medical communities of early modern England, and rigorously taught to generations of students. This is a story of medical professionalization, for medical dispassion became an essential feature of the eighteenth-century practitioner. It is also a story of how the patient came to be objectified and treated as a dead, voiceless body, an object of experimentation.

Taking Rosenwein's notion of emotional community —it has "systems of feeling" and modes of emotional expression, based on what its members "expect, encourage, tolerate, and deplore" (842) —Payne investigates the emotional communities of medical men in England, ca. 1650-1800. She demonstrates the following: dispassion was learned by the anatomist as a response to the olfactory apprehension of rotting flesh (chapter 1); it was then reconstituted within a Cartesian matrix (chapter 2) and combined with a Neostoic revival after a period of religious strife (chapter 3). Moving through these phases, dispassion accrued meaning. It became an appropriate response to stench, to the body, to pleasure, and to irrational and spiritual experience. It became a recognizable medical virtue. Circulating in medical institutions, it appeared in various guises as advice for surgeons and patients (chapter 4) and as a pedagogical goal among instructors like William Hunter and John Hunter (chapter 5). The study is organized around a series of portraits of William Harvey, Walter Charleton, John Ward, Daniel Turner, William Hunter, and John Hunter, but it also develops the social and philosophical foundations of medical dispassion.

This study contributes to the history of medicine in several ways. It makes the emotions internally constitutive of anatomical and medical practice. In addition, it shows how educational institutions, particularly the flourishing anatomy schools in eighteenth-century London, endorsed medical dispassion, crafted pedagogies to replicate it, and deepened its significance. So fully was medical dispassion endorsed that the discomfort and pain of the patient could be submerged in the medical authority and investigative spirit of the practitioner —even when the patient and practitioner were one and the same. This was the case, for example, when John Hunter experimented (for three years) with venereal treatments on his own penis. Finally, this study provides a medical counterpart to studies of the Royal Society and other extra-academic societies in the history of science. The parallels between dispassionate medicine and gentlemanly science are so clear that one wonders about the extent to which the latter might derive from the former.

Carefully controlled, this study does not develop dispassion as a part of the history of objectivity; it does not connect visual...