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

In The Medical Imagination: Literature and Health in the Early United States, literary scholar and historian Sari Altschuler demands a reconsideration of the role of imaginative thinking in early American medical knowledge production. Rooted in an interrogation of the works of nineteenth-century literary doctors, Altschuler argues that, rather than "literature simply reflecting medical ideas of the period," nineteenth-century physicians such as Benjamin Rush, Samuel George Morton, and Oliver Wendell Holmes used imaginative writing as a way to produce new medical concepts that could not be ascertained through empirical observation (p. 18-19). Thus, The Medical Imagination asks readers to not just re-examine the relationship between early American fiction and medicine, but also the potential modern-day application of humanistic "creative analytic thinking" in contemporary medical training, especially in the medical humanities classroom (p. 200). Both Altschuler's analysis of early American medicine and her critique of empathy-centric medical humanities programs make The Medical Imagination essential reading for historians of medicine and a new starting point for thinking about the pedagogical value of the medical humanities.

Altschuler organizes the book around five "epistemic crises" in the history of early American medicine: the American Revolution, the yellow fever epidemics of the 1790s, the twenty-year cholera pandemic from 1829-1849, debates over supposed embodied sexual and racial difference in the antebellum era, and the discovery of anesthesia. Each chapter focuses on one epistemic crisis. Building on the work of Ludwick Fleck, Bruno Latour, and Thomas Kuhn, Altschuler defines each crisis as "a central precipitating event" that "unseats central ideas about the health of the human body" (p. 13). For example, the shift from monarchy to republicanism after the Revolution had a significant bodily impact on Americans, and physicians such as Rush were forced to imagine new operating principles for the body. Rather than circulation being dominated by a monarchial organ like the heart, it was directed by blood vessels defused throughout the body.

The next two chapters examine crises caused by epidemics, illustrating Altschuler's effective use of non-white actors such as Absalom Jones, Richard Allen, and Martin Robison Delany to better understand the white male dominated field of allopathic medicine. During the period, imaginative explorations of yellow fever represented a key to understanding the ailment. They also had potential to either spread or inoculate against the fever, which was exemplified by Charles Brockden Brown's 1799 medical novel Arthur Mervyn. In the case of cholera, an unpredictable and global scourge, doctors reimagined the borders of American health through disease maps and novels.

In the chapter "Difference," fiction plays a vital role in speculative medicine, taking the racial categories constructed by anatomists and imagining these differences as lived physiology. In physician Robert Montgomery Bird's novel Sheppard Lee (1836), the deceased titular white character's spirit inhabits a diversity of American bodies, and he physiologically sympathizes with white bodies, but is incapable of fully connecting to African-descended and Jewish people's bodies. The last chapter explores how physician-writers like Oliver Wendell Holmes and S. Weir Mitchell rethought pain in the wake of anesthesia. These chapters serve as a valuable reminder that the anatomical and empirical impulses of antebellum medicine were far from hegemonic, even in the minds of major proponents of pathological anatomy and physiology.

In the conclusion, Altschuler perhaps makes her strongest stamp on the field of medical humanities, examining what has been lost to medical thinking since the Flexner Report (1910), notably creativity, analytical thinking, and the imagination. While it might be tempting to think instruction in the medical humanities fills this void, Altschuler explains that this discipline has been focused more on cultivating a vague empathy in physicians, rather than a commitment to the notion that humanistic analysis can improve the science of medicine. Altschuler insists that instructors in the medical...