The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America

THE THERAPEUTIC REVOLUTION: MEDICINE, MEANING, AND SOCIAL CHANGE IN NINETEENTH-CENTURY AMERICA* CHARLES E. ROSENBERGf Medical therapeutics changed in some ways remarkably little in the 2 millennia preceding 1800; by the end of the century, traditional therapeutics had altered fundamentally. This is a significant event not only in the history of medicine, but in social history as well. Yet historians have not only failed to delineate this change in detail, they have hardly begun to place it in a framework of explanation which would relate it to all those other changes which shaped the twentieth-century Western world. Medical historians have always found therapeutics an awkward piece of business. On the whole, they have responded by ignoring it.1 Most historians who have addressed traditional therapeutics have approached it as a source of anecdote, or as a murky bog of routinism from which a comforting path led upward to an ultimately enlightened and scientifically based therapeutics. Isolated incidents such as the introduction of quinine or digitalis seemed only to emphasize the darkness of traditional practice in which they appeared. Among twentieth-century students of medical history, the generally unquestioned criterion for understanding pre-nineteenth-century therapeutics has been physiological , not historical: did a particular practice act in a way that twentiethcentury understanding would regard as efficacious? Did it work? Yet therapeutics is after all a good deal more than a series of pharmacological or surgical experiments. It involves emotions and personal *This discussion is abstracted from a larger projected history ofmedical care in America, 1790-1910. tProfessor of history, University of Pennsylvania, Philadelphia, Pennsylvania 19174. I would like to acknowledge the support of the Rockefeller Foundation during the academic year 1976-77. I should also like to acknowledge the advice and encouragement over many years by my teachers Erwin H. Ackerknecht and the late Ludwig Edelstein. Drew Gilpin Faust, Saul Jarcho, Owsei Temkin, and Anthony F. C. Wallace read the manuscript carefully and made a number of important suggestions. 'For examples of work which try to place traditional therapeutics in a more general framework, see: [1-3]. Perspectives in Biology and Medicine ¦ Summer 1977 \ 485 relationships and incorporates all of those cultural factors which determine belief, identity, and status. The meaning oftraditional therapeutics must be sought within a particular cultural context; this is a task more closely akin to that of the cultural anthropologist than the physiologist. Individuals become sick, demand care and reassurance, are treated by designated healers. Both physician and patient must share a compatible—though not necessarily identical—framework of explanation . To understand therapeutics in the opening decades of the nineteenth-century, its would-be historian must see that it relates on the one hand to a cognitive system of explanation and on the other to a patterned interaction between doctor and patient, one which evolved over centuries into a conventionalized social ritual. Yet past therapeutics has most frequently been studied by scholars obsessed with change as progress and concerned with defining such change as an essentially intellectual process. And historians have come to accept a view of nineteenth-century therapeutics which incorporates such priorities. The revolution in practice which took place during the century, the conventional argument follows, reflected the gradual triumph of a critical spirit over ancient obscurantism. The increasingly aggressive empiricism of the early nineteenth century pointed toward the need for evaluating every aspect of clinical practice; nothing was to be accepted on faith and only those therapeutic modalities which proved themselves in controlled clinical trials were to remain in the physician's arsenal. Spurred by such arguments, increasing numbers of physicians grew skeptical of their ability to alter the course of particular ills and by midcentury, this interpretation continues, traditional medical practice had become far milder and less intrusive than it had been at the beginning of the century. Physicians had come to place ever more faith in the healing power of nature and the natural tendency toward recovery which seemed to characterize most ills. This view of change in nineteenth-century therapeutics constitutes accepted wisdom though it has been modified in recent years. An increasingly influential emphasis sees therapeutics as part of a more general pattern of economically oriented behavior which helped...