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Intervention and Identity IN A COMMENCEMENTADDRESS toCincinnati medical students in 1877 on "the dignity and sanctity of the medical profession," the speaker asserted that "its chief excellence is, not that it is scientific, but that it is redemptive." To understand and explain illness were important parts of the physician's task, but did not constitute the whole of it. The physician was more than a natural scientist; he was also a healer. Dissenting from the emerging but still novel view that professional identity in medicine should be defined chiefly by science, the speaker admonished the graduates that "the physician is not only the inter­ preter of Nature."1 However necessary this admonition may have been by 1877, dur­ ing the first two-thirds of the nineteenth century no American phy­ sician would have questioned it. The physician's "redemptive" role, his active therapeutic intervention in an effort to redeem patients from disease, was at the core of what it meant to be a physician in America. Although Alexis de Tocqueville may have overstated Americans' valuation of practice over theory, he nonetheless perceived correctly their predilection for activity. His observation that the American was above all a "man of action" closely matched the views American phy­ sicians held of their professional role and identity. In 1833, two years before Tocqueville toured the United States, a young Bostonian study­ ing medicine in Paris proposed to his father the idea that he pursue the Parisian plan of clinical research for several years before starting practice. Pierre Louis, the student's Frenchmentor, endorsed thisscheme, and wrote to the boy's physician father, "I recommend this to you, because no one is more capable than he is of cultivating the science and thereby of making progress in the practice, for what is practice 22 ANTEBELLUM MEDICAL THERAPEUTICS but science put into operation?"2 But the father, James Jackson, Sr., could not consent to this postponement of activity for the sake of observation. He rejected his son's proposal, arguing that for an Amer­ ican physician scientific investigation was not a legitimate substitute for practice. "In this country," the elder Jackson later explained, "his course would have been so singular, as in a measure to separate him from other men. We are a business doing people. We are new. We have, as it were, but just landed on these uncultivated shores; there is a vast deal to be done; and he who will not be doing, must be set down as a drone. If he is a drone in appearance only and not in fact, it will require a long time to prove it so, when his character has once been fixed in the public mind."3 The antebellum American physician derived his professional iden­ tity from practice, in which a primary imperative was to act therapeu­ tically. Yet among the most persistent myths about medical therapeutics in America is the notion that from the 1820s through the 1860s ther­ apeutic skeptics and nihilistsappeared in the regular ranks to denounce and abandon traditional therapy. This myth matters, because it sug­ gests incorrectly that a physician could preserve proper professional identity and at the same time reject active intervention. In the United States a truly noninterventionist posture either in normative state­ ments or at the bedside was not an option. The physician had to do something; a "do-nothing" physician, as critics often caricatured skep­ tics, would be bereft of professional legitimacy, would in fact not be a physician at all. Grasping the tight connection between therapeutic intervention and professional identity is the most important key to understanding the course and meaning of nineteenth-century therapeutics. Because therapeutics in part defined professional identity, therapeutic change involved the risk of destabilizing its supports. Therapeutic ideology and debate were dominated and constrained by their implications for the profession's image and standing. The integrity of regular therapeu­ tics could not be radically challenged without an implicit threat to regular professional identity as well. Traditional remedies such as bloodletting, elements of the regular creed and identity, held a symbolic significance that transcended and added meaning to their use at the bedside. Orthodox practitioners were, after all, largely distinguishable from their sectarian competitors by their practices. The link between identity and intervention molded regular physicians' evaluation of knowledge and its sources, the ways the profession sought to portray itself and its practices, and the interactions among regular physicians sectanan practitioners, and the public. Medical treatment, the core of the physician's...


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