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  • With Words and Knives: Learning Medical Dispassion in Early Modern England
  • Philip K. Wilson
Lynda Payne . With Words and Knives: Learning Medical Dispassion in Early Modern England. The History of Medicine in Context. Aldershot, U.K.: Ashgate, 2007. x + 182 pp. Ill. $99.95 (978-0-7546-3689-2).

It is always refreshing when history provides not merely clarity in our understanding of an earlier era but also guidance in how to improve readers' lives today. In With Words and Knives, Lynda Payne helps us understand the importance of compassion in the healing arts not by seeking examples thereof but, rather, by providing counterexamples that elucidate how practitioners became increasingly "dispassionate" (i.e., clinically detached from humanity) in earlier periods.

To help us appreciate this rise of dispassion, Payne focuses on various examples of the "emotional community of practitioners" (p. 5) from seventeenth- and eighteenth-century England, ranging from William Harvey to the brothers William and John Hunter. For the quintessential stoic, William Harvey, anatomizing the dead—at whatever emotional cost—was paramount to medical progress. Feelings were repressible and public ridicule acceptable once anatomy was no longer perceived with repulsion but viewed with fascination and awe. [End Page 198]

Walter Charleton, the Oxford-educated, Royalist London practitioner, demonstrated in his literary, religious, and anatomical writings that sensitizing one's self and mind against passions, a process he termed "medical Epicureanism," (p. 57) was attainable through honing the rational mind on the "mysterious Oeconomy of Human nature" (p. 57) and practicing religious virtue. The Cotswold-based cleric-physician John Ward articulated his Neostoic Latitudinarian learning, claiming that pain was "a bodily manifestation irrelevant to the noble and spiritual life" that must be "controlled by the mind and endured by the body" (p. 67). Indeed, showing pity makes "the onlooker feel as wretched and pathetic as the sufferer"; thus, the ideal practitioner must "control his emotions and not be disturbed by others' pain" (p. 68).

More so than physicians, early modern surgeons relied on a skillful use of dispassion in their practices. To illuminate the surgeons' perspective, Payne draws extensively on the voluminous case-history record provided by the London surgeon, and later physician, Daniel Turner. Turner's cases provide credible evidence of how surgeons expected their patients to "submit to the authority of a good surgeon as a child should to a good father" and to "blindly place faith" in surgeons as "benevolent and knowledgeable" practitioners (p. 90). From Turner, we are reminded of the great extent to which rhetorical skill went hand in hand with operative skill in establishing a surgeon's ability to encourage individuals to rationally overcome their preconceived fears and to submit to the knife. Employing her own rhetorical prowess, Payne then demonstrates that what Turner learned about the importance of maintaining a "Distance with his Patient" (p. 101) from his practice was precisely the message of "necessary inhumanity" (p. 7) that the Hunters bred into the students attending their popular London lectures.

Payne offers an interdisciplinary tour de force, integrating religion, philosophy, and literature together with a primary historical focus on the career practices of the physicians and surgeons that she highlights. She convincingly contextualizes her subject several centuries before the point of clinical detachment to which historians typically turn—the Flexnerian empowerment of experimental science over Oslerian humanitarianism. Indeed, sufficient detail emerges to suggest that the apparent dehumanization within medical education and practice has a centuries-old foundation. Therefore, as Payne's examples reveal, in order to reestablish the humanitarian ideal of compassion and an emphasis on open communication as cornerstones of medical wisdom, perhaps we need to cast our attention back considerably further into history in order to begin disentangling the long-standing acknowledgment that dispassion was not only the acceptable but the preferable way of approaching patients. With Words and Knives provides us a remarkable trajectory of what first must be understood historically in order to improve future lines of clinical communication. [End Page 199]

Philip K. Wilson
Penn State University College of Medicine
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