Against the Spirit of System: The French Impulse in Nineteenth Century American Medicine (review)

John Harley Warner. Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine. Princeton: Princeton University Press, 1998. xi + 459 pp. Ill. $49.50.

At the outset of his splendid new volume, John Harley Warner tells us how the book can be used as a sort of prism for understanding nineteenth-century medical America, no matter what our presuppositions. If we are inclined to an iatrocentric view--improvement: Paris gave us necessary new paradigms for clinical instruction and anatomical understanding--the narrative is commodious. If we are inclined to an iatrophobic view--the "darker narrative," in Warner's words: Paris led to objectification and dehumanization--the French capital also lay at the epicenter. True, and true. Whatever your bias, Against the Spirit of System provides the best view yet of a lost medical culture. Embodying an earlier genre of "scientific medicine" that now bears its vestiges in a few quasi-honorific medical clubs, that pre-Flexnerian culture is now but a dim memory for the inhabitants of present-day medicine. Yet it is enormously important for anyone seeking to understand either nineteenth-century professional life in America, or how culture and memory come to be embedded in physicians' careers.

Marshalling a wealth of evidence from a wide array of manuscript collections, Warner demonstrates the selective nature of transmission, as American physicians actively transported--and in the process, mutated and re-created--their experiences in the cliniques médicales of Paris. It is difficult in a brief review to convey the richness of detail with which he carries off this demonstration. Despite the sophisticated theory of epistemic change that undergirds his analysis--and a certain habit of repetition through illustration of the ideas embedded within it--Warner has actually managed to produce the most accessible work thus far in an already remarkable series of books and articles from his pen. He adduces no epistemological or historiographic point without supporting evidence, a lot of it homely and humorous, all of it compelling.

There is little to take exception with. I suspect Warner has exaggerated a distinction repeatedly drawn between English and American motives for visiting Paris. Broadly, he characterizes the English ideal of French medicine as one residing in "polity," meaning structures of medical education and the several foils for English scientific declinism. In contrast, he characterizes the American ideal as one residing rather in experience, by which he means the raw day-to-day access to "clinical material" and, of course, dead bodies--but also, something more. That something more was the empiricist model as a source of salvation, a career edge as well, of course, and a counter to some of the perceived excesses of system. My own view is that there was much more crossover between nations and motives--but I suspect that Professor Warner would agree and has simply sharpened the distinction between American and English tendencies, for the purposes of insight and emphasis.

Nuggets abound: Warner's touchstone (like that of many of his subjects) is the principle of plenitude. Something useful about women's medical education in Paris? It is here. Something useful about the shift, in the final decades of the century, toward the Germanic countries? Here as well. For this writer, in fact, these pieces of narrative plenitude, despite the repetition, make this volume work: while intensely and impressively documented, Against the Spirit of System, or selected chapters from it, could easily function as introductions to Parisian medicine, to the sweep of American educational valencies across the nineteenth century, or to American memory.

And it is ultimately this--memory--that becomes the driving force, the justification for the repetition, and the protagonist of John Warner's book. In an elegiac final chapter, he recounts vividly the several uses of memory: forging collegial relations; career building; delineating oft-contested boundaries with new specialties; and...