The Medical Imagination: Literature and Health in the Early United States by Sari Altschuler (review)

In Sari Altschuler's The Medical Imagination: Literature and Health in the Early United States, the author makes readers her guest at a crowded eighteenth-century amphitheater to hear a medical lecture. We sit beside Altschuler, who is herself rapt by the speaker, and we follow suit, listening carefully to Benjamin Rush and Robert Montgomery Bird, for example, as they challenge us, their medical students, to imagine the body and health as something beyond a dissected cadaver. Altschuler seems to be the ideal student for Rush and Bird as she practices the careful analysis a doctor should use, though her subject is not a sick or healthy body but the very words produced by her "teachers"—the figures who inhabit her book. These vivid encounters with the people and practices we recognize as foundational to medical thinking invite readers to imagine themselves as part of the process—to project themselves into the scientific and creative world of The Medical Imagination. Throughout the text, we look through the microscope Altschuler constructs to gaze on both cells and words to find traces of the imagination. By reappraising the historical link between science and the arts, The Medical Imagination seeks to make students of us all and assigns the task of reestablishing the link between disciplines.

Because Altschuler is a literary scholar, her appreciation for the imagination goes without saying, and as she shows in The Medical Imagination, the appreciation for the imagination as a medical tool—sometimes exploratory, sometimes diagnostic, sometimes therapeutic—was once an integral part of medical education and the thinking about health and healing in America. The distance between empiricism and imagination in medical training has widened since the end of the nineteenth century and the resultant gap has elided this former connection so it is only legible through deep research—the kind Altschuler has done. The fact of the lost ties between medicine and literature that Altschuler identifies in the late eighteenth and early to mid-nineteenth centuries helps explain the contemporary devaluing of the humanities we see in institutions across the country and culture at large. Therefore, Altschuler's book is a look backward to find the road forward.

The "medical imagination" and "imaginative experimentation" are key phrases in Alschuler's argument that American medical thinking in the eighteenth and nineteenth centuries was dependent on methods consistent with literary invention. These methods include poetic form, metaphor, narrative, genre, and affective language meant to move a reader—all of which Altschuler recognizes as features of the imagination. Doctors used these tools along with their scalpels and microscopes to generate medical knowledge—a reminder that medicine and the arts productively coexisted in American medical history. Imagination compensated for the limits of empiricism and "provided an avenue through which Americans could both theorize and promote health" (11). Altschuler labels this interdisciplinarity "medical imagination" and the forays into medical discovery via creative thinking as "imaginative experimentation." Although experimentation could be considered a part of any imaginative thinking, Altschuler understands experimentation as an exercise in empirical thinking.

Other historiographies of medicine shape their analyses to arrive at an innovation (see Roy Porter, John Harley Warner, and Charles Rosenberg, for example)—as in writing on smallpox that builds toward the implementation of inoculation, for instance. The Medical Imagination, however, values the intellectual exercise of wrestling through health-related questions with the use of the imagination. It is the process and not the medical outcome that has meaning. Thus, Altschuler is wise to use the language of imagination rather than aesthetics as the latter may convey a product and appreciation as opposed to the activity conveyed by the former. If there is a product or result in The Medical Imagination, it isn't a medical innovation or technique that had lasting impact, but rather a text like Benjamin Rush's Medical Inquiries and Observations (1794), the medical journal Medical Repository (1797), Charles Brockden Brown's Arthur Mervyn (1799), Robert Montgomery Bird...