- The Medical Imagination: Literature and Health in the Early United States by Sari Altschuler
Over the course of the nineteenth century, the American medical consensus gradually moved away from explanatory models rooted in the humoral theories of Galen and Hippocrates and toward an empirical approach that prioritized collection and comparison of discrete data obtained through experimental methods. Sari Altschuler's The Medical Imagination explores this halting age of transition and "the varied epistemological uses of imagination and literary form to produce medical knowledge, especially but not exclusively in moments where physical experimentation proved insufficient for medical knowing" (16). The doctors, dreamers, and dilettantes at the heart of the story challenge any simplistically whiggish model of science conquering superstition and illustrate the varied ways that medical thinkers continued to make use of inspiration as well as empiricism.
The existing literature of the "medical humanities" (19) has largely focused on how medical thinkers communicated their ideas to a broader public audience. Physical bodies make ready metaphors for bodies politic, and throughout the early modern era, the language of medicine interpreted and reified corporeal political metaphors even when its practice could not deliver effective treatment of illness. Accordingly, a growing scholarship on the political and social dimensions of medical rhetoric in early America has begun to chart how discourses of health and disease were marshaled to achieve religious, cultural, and imperial goals.1 [End Page 797]
By contrast, The Medical Imagination treats the value of narrative for developing medical ideas. Across five elegantly argued chapters, the book builds a case around a series of "epistemic crises" (13) spanning from the War of Independence to the Civil War and beyond. In Altschuler's telling—informed by both Bruno Latour's actor-network theory and Thomas S. Kuhn's model of scientific revolutions—these ruptures opened at moments when scientific findings incongruent with established models converged with social or cultural currents and historical contingencies such as sudden outbreaks of disease or advancements in diagnostic and therapeutic technology.2 Altschuler's great contribution is in her exploration of rhetoric and genre as technologies of knowledge "production" (9), rather than merely instruments of persuasion.
Altschuler highlights medical thinkers who, at moments of impasse when empirical methods offered no path forward, embraced literary imagination as a vehicle for speculative exploration of untestable possibilities. Chapters 1 and 4 examine epistemic crises arising from broader political and social debates. As detailed in chapter 1, Benjamin Rush and Samuel Latham Mitchill worked in the aftermath of the revolution to develop a theory and practice of "republican health" (33) that would liberate American medicine as the war had liberated American politics; in chapter 4 Robert Montgomery Bird's Sheppard Lee exemplifies the role of literary speculation in medical debates over racial difference.3 The two intervening chapters examine communities tested by epidemics of yellow fever and cholera, which were inexplicable by existing theories and uncontrollable by standard preventative methods and thus invited narrative speculation to fill the explanatory gap. Mathew Carey and Charles Brockden Brown take center stage during the yellow fever outbreaks of the 1790s, while the "Age of Cholera" (120) is represented by both canonical authors (Edgar Allan Poe and Harriet Beecher Stowe) and the lesser-known Martin Robison Delany. Finally, chapter 5 introduces a crisis resulting from technological change, as Silas Weir Mitchell and Oliver Wendell Holmes grapple with the philosophical implications of anesthesia in the antebellum era and the Civil War. As this range of sources suggests, Altschuler happily puts literary authors and medical practitioners in the same conversation, unencumbered by the professional boundaries that would eventually come to wall medicine off from the humanities.
The concept of "sympathy" serves as the common thread winding through each chapter and linking these varied subjects. Sympathy was a slippery and malleable concept; as Altschuler notes, it was "one of the eighteenth [End Page 798] century's most highly contested and unstable terms" (129). William Cullen, who mentored the generation of American medical students who flocked to Edinburgh...