Coleridge and the Doctors (review)

Samuel Taylor Coleridge, a key architect of British Romanticism, was also an infamous opium addict. That he lost his creative poetic powers from "dejection" has been widely appreciated as related to his addiction, but the full nature of his ailments and the rationale for their treatment present a beguiling puzzle for his students. Although this study focuses on Coleridge's understanding of medicine during the crucial years that witnessed his collapse, it is also an important case study of medicine's transition at the turn of the nineteenth century.

A literary polymath, Coleridge was well acquainted with the science of his age and the theories governing clinical practice; thus his reflections on disease and his own speculative "researches" represent a rich refraction of the era. Because science and philosophy were closely aligned, he felt comfortable in distilling medical writings. Indeed, he understood, embraced, and practiced the most advanced treatments for his gout, "scrofula," and apparent flares of rheumatic fever. Unfortunately, these therapies included the injudicious use of opiates, whose addictive properties he apparently did not appreciate.

Although one might focus on why Coleridge became addicted, the more interesting issue is his conception of the diseases for which he was treating himself. This broader question requires comprehending both the relevant clinical descriptions and the rationale for treatments current at the time. These in turn were grounded, as always, in a deeper science, whose own character was marked by contentious debate that ranged over a wide spectrum of theoretical arguments concerned with materialism, mentalism, and the pursuit of "stimulant" balance.

The nature of Coleridge's illness, and the particular rationale for the use of opium, require teasing apart a web of clinical beliefs from diverse conceptual sources, parsing the sociology of clinical practice, and sorting the various theories of medicine as they evolved within their own tradition and in the larger economy of ideas. Neil Vickers accepts this broad agenda and appropriately devotes half of this erudite study to explaining the debates about disease, which guided Coleridge's own self-appraisals of his afflictions and their treatment. The second part, the focus of this monograph, then demonstrates how competing medical orientations expressly influenced the development of Coleridge's own philosophical and aesthetic ideas. Although this aspect of Vickers's project may be tangential to historians of medicine, it does bring full circle the integration of Romantic medicine with its underlying philosophies by showing how the poet and patient dialectically informed each other. From this vantage, historians are being offered a rich case study.

Medicine of the late eighteenth century, like all deeply entrenched cultural activities, embraced the metaphysical presuppositions of its era. Indeed, science cannot be separated from that discourse. Coleridge was party to an intense debate among physicians (hardly to be differentiated from metaphysicians!) about the relationship of mind and body, and how imbalances of one affected the other. According to Vickers, Coleridge eventually aligned himself with the advocates of medical mentalism, and despite the powerful influence of materialism, this latter orientation would only supply the constraints to a view more consistent with Coleridge's other romantic endeavors.

The most prominent debate concerned how disease resulted from inefficient or overactive irritability (or sensibility), and how control might be obtained by the appropriate use of stimulants or sedatives to rectify such imbalance. Vickers tracks the theoretical steps leading Thomas Beddoes, Coleridge's close friend and physician, to adopt John Brown's doctrine, which arrayed pathology (and normal physiology) along a scale of excitability. Excitability was regarded in terms of a physics operative in the body-at-large, and accordingly, local disease was only a manifestation of systematic dysfunction. Treatment meant restoring the balance between excessive or insufficient stimulation. Because Coleridge's prominent ailments were regarded as deficiency states, he took the stimulants, alcohol and opium, to boost his system. The therapy was fully justified based on the most advanced thinking of the time. The untoward effects were recognized too late.

One need not be a devotee of Coleridge to appreciate the...