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

When tasked with writing the history of American medicine, it may seem counterintuitive to say that imagination, genre, and literary devices supply an integral part. We might concede that the body beset by diverse ailments in the early years of the republic provides excellent fodder for fiction. Think, for example, of American gothic thrillers about yellow-fever epidemics, such as Charles Brockden Brown's Arthur Mervyn (1799), or a girl rendered strangely emotionally numb from a snakebite in the womb, such as Oliver Wendell Holmes's Elsie Venner (1861). However, we might also ask, don't such fictions simply reflect medical attitudes of the day about anesthesia or a devastating outbreak? In this monograph, Sari Altschuler makes the argument for why literature and literary study should not been seen as mere handmaidens to American medical history. Without a nuanced analysis of what she calls the medical imagination, our understanding of the healing arts in the early United States remains incomplete and impoverished.

The Medical Imagination: Literature and Health in the Early United States provides a fresh, provocative approach to medical history by uncovering how doctors in the early republic relied unquestioningly upon creative critical thinking and literary form in their pursuit of knowledge about health and well-being. Altschuler makes a valuable methodological intervention with this argument and introduces a new way to "move beyond a version of the field that principally uses empirical methods to study the rise of empiricism" (5). She questions a tendency to privilege historiographical narratives that are oriented toward unpacking the turn from medical rationalism and its heroic measures of bleeding, purging, and blistering patients to empiricism's reliance on clinical observation and scientific experimentation. Such a focus might bolster our confidence in what we see as the contemporary successes of medicine by recounting a progress narrative about how it all began. But is that shift how American physicians saw the driving force behind medicine's evolution in the nineteenth century? Altschuler's answer to this question is a resounding "no."

The strength of Altschuler's method lies in bringing the critical tools of science studies to bear on her analysis precisely because it exposes the different epistemological commitments of this earlier era. Its epistemic crises were not our own, which is why the imagination played such a crucial role—and why we can't continue to rely on rationalism and empiricism as the only conceptual frames for writing American medical history. Altschuler eschews looking to "important figures, milestones, and breakthroughs" to define the contours of this history (5). Instead, she draws on the work of Thomas Kuhn and other historians of scientific knowledge by focusing on epistemic crises during which "a central precipitating event, such as an untreatable epidemic disease, a significant discovery, or a political crisis, unseats central ideas about the health of the human body" (13). Developing a history around moments when knowledge was challenged and innovation demanded establishes the inseparability of literary and medical pursuits.

American practitioners relied on what Altschuler calls "imaginative experimentation" to construct new medical knowledge. Five chapters each focus on a specific "precipitating event": the American Revolution, yellow fever, global cholera pandemics, emerging sciences of anatomical difference, and the discovery of anesthesia. In each case, imaginative experimentation complemented either rationalist explanations of embodied phenomena or empiricist observations of the physical world. For example, physician and signatory of the Declaration of Independence Benjamin Rush sought to solve the problem of how to re-conceive of health in republican terms. Instead of depicting the heart as a king or ruler over the body, he envisioned it as an empty ocean to be filled with blood only after blood vessels did their work. Another chapter discusses the unpredictable movements of cholera across the globe, which led to the fear that mapping alone could not account for the disorder as a dynamic, living system. Gothic forms allowed friends Edgar Allan Poe and John...