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

"Cultural critics and medical researchers have repeatedly marveled at the serendipitous instances in which 'fiction anticipates science,'" writes Sari Altschuler in her monograph, The Medical Imagination: Literature and Health in the Early United States, "rather than understanding fiction could produce it" (5; emphasis added). Using texts and writers from eighteenth- and nineteenth-century America, Altschuler traces the way that literature was used as a way to examine and explore the human body and its related maladies, particularly in moments when physical experimentation failed to produce the kind of medical knowledge that was needed. Although early developments in medical knowledge were closely aligned with artistic endeavors across the globe, The Medical Imagination focuses on early America for an important political reason: while we now understand the spread of illness to have transnational ramifications, unbounded by borders, early Americans often understood health as nationally defined, linking bodily and political systems in their representations of health and illness.

Altschuler is especially interested in the overlapping roles of physician and writer, examining figures such as Robert Montgomery Bird, Edgar Allan Poe, Charles Brockden Brown, Martin Robison Delany, William Arthur Caruthers, Oliver Wendell Holmes, and Silas Weir Mitchell. In particular, her book complicates the historical transition from rationalism to empiricism in science and medicine, focusing instead on a third term: imagination. For the physician-writers she examines in The Medical Imagination, the ability to move in between scientific and literary genres, modes, and audiences allowed for broader circulation of ideas about health. In addition to spreading information, this cross-genre and cross-audience work also created a space for what Altschuler calls "imaginative experimentation," whereby creative work was used to "craft, test, and implement their theories of health and the role literary forms played in developing that work" (8). This experimentation was especially important in the eighteenth and nineteenth centuries, when Americans largely believed that internal, imaginative experiences could have somatic effects.

Although Altschuler's argument revolves around the medical and literary output of both well-known and lesser-known physician-writers, the book itself is organized around moments she refers to as epistemic crises, in 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). In the opening chapter, "Revolution," Altschuler unpacks the effects of revolutionary thinking on perceptions of health and the body. In the post-Revolutionary moment, physician-writers investigated the possibility of creating new "republican models of health" (23). European theories of the body situated a central organ—typically the brain or the heart—in control of the body, modeling European monarchical models of governance. In contrast, American physicians such as Benjamin Rush imagined a more interconnected body in which minute stimuli circulated. The notion of "sympathy" as the primary bodily system of regulation was in vogue, promoting the belief that there was a checks-and-balances relationship within the body as within the country, and suggesting that all the parts of the body worked together to make a healthier whole.

In the second chapter, "Yellow Fever," Altschuler demonstrates how medical writing and literature alike portray the two conflicting arguments about how yellow fever is spread: on one side, the "climatists," who thought it spread through the local environment; on the other, the "contagionists," who believed it was spread by people, animals, or objects (52). As the fever epidemic reached Philadelphia in 1793, disrupting major government and business activities, information (and illness) slowly spread outside the city center. The chapter thus takes up the idea of "communication," considering how the fever was spread as well as tracing the spread of information, narrative, emotion, anxiety, and argument. Part of the emotional effect that accompanied news of the fever was the belief that the news itself could communicate sickness. As Altschuler suggests: "Literary form was understood to be simultaneously a means of investigating the communication of yellow fever...