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

To judge from recent scholarship, we are living in an era of scientific globalization. Historical, ethnographic, and sociological studies of topics ranging from colonial science to international bioinformatics have generated new ways of thinking about the production and movement of scientific knowledge. Yet in a moment in which information speeds through worldwide networks with unprecedented facility, we would do well to reflect upon earlier patterns of scientific migration and exchange. The appearance of John Harley Warner's marvelous Against the Spirit of System in paperback is a boon to scholars interested in such questions. Warner's deft use of the historian's craft and his remarkable story-telling ability demonstrate how the movement of knowledge and the creation of scientific centers and peripheries are socially and historically contingent phenomena. Just as important, Warner's book makes clear that such projects are as dependent upon the intellectual and professional contexts in which knowledge is sought and received as they are on those in which knowledge is produced.

Equal parts social, intellectual, and professional history, Against the Spirit of System explores the apotheosis of "Paris medicine" in the American medical imagination in the early 19th century. Warner's major concerns include why and how Paris attained this exalted position, and how a Paris education affected not only the careers of American physicians, but the profession of American medicine itself. By tracing the stories of dozens of American physicians who moved in and out of the soi-disant hub of scientific medicine in Paris, Warner poses a range of fascinating questions. What motivated American medical students and physicians to seek training abroad for months or even years at a time? Perhaps more important, why Paris? Language barriers and the difficulties of gaining entrée into the elite circles of French medicine would seem to militate in favor of study in England. Yet roughly a thousand Americans made the journey to Paris between 1815 and 1850, and Warner's analysis of a large sample of their writings reveals that such obstacles were trumped by the trip's purported advantages.

Merely posing these questions takes the historical study of Paris medicine in exciting new directions. Whether celebrating Paris as the birthplace of modern clinical science and medical progress, or seeing in this history what Warner calls a "darker tale" of submission to medical power, most of the existing scholarship on Paris medicine takes its centrality in the early 19th century for granted (Ackerknecht 1967; Foucault 1973; Waddington 1973). Warner, however, demonstrates convincingly that Paris's alleged intellectual superiority to other European centers ranked low on many Americans' priority lists, and that other factors often drove them to study in Parisian hospitals. Warner's rich exploration of the American medical marketplace in the antebellum period drives his conviction that "professional improvement," variously defined, was a critical motivating factor for study abroad. The largely unregulated medical landscape of early 19th-century America produced fierce competition for patients among healers of various stripes. In an era when an MD degree and licensing were easily attained, experience was imagined by many practitioners to confer an important advantage. Apprenticeship to a rural physician provided limited access to patients and diseases, and many students deemed even a lengthy education in American hospitals an insufficient pathway to professional excellence. Although lectures in Boston or Philadelphia offered solid academic training, work among the thousands of patients in much larger European hospitals promised greater opportunities for experience at the bedside and in the dissection room.

It was at this practical level that American esteem for the Paris school originated. Many Americans boasted of their attendance at the lectures of Parisian lions such as Pierre Louis, François Broussais, and Claude Bernard. Yet Warner argues that American students were less interested in formal lectures—most of which they could scarcely understand—than they were in gaining access to bodies living and dead. Following great physicians on...