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Attitudes toward Foreign Knowledge HOWEVER MUCH the course of American medicine was determined by socioeconomic forces and conceptual resources within the Ameri­ can environment, it wasalso persistently shaped by European tutelage. American physicians abroad traveled principally to the lecture halls of Edinburgh before the early nineteenth century and to German labo­ ratories in its final third. In between, it was the vision of medicine they brought back from the Paris hospitals that was the most forceful European propellant of medicine's transformation in the United States. In therapeutics Frenchskeptical empiricism commanded its American proponents to critically re-evaluate existing practices. The more de­ tailed knowledge of the natural history of diseases generated in the Paris clinic served as a backdrop against which Americans could assess for themselves the efficacyof their treatments, an endeavor sometimes ordered by the numerical method. The strongest single impulse French medicine contributed to the reform of American therapeutic practice, however, was directed toward moderation—greater reliance on the healing power of nature and less on drugging. In conscious acknowl­ edgment of the term's partially French parentage, American physicians widely adopted the phrase midecme expectante to describe this pos­ ture. French medicine did not create this therapeutic stance in the United States, but it did reinforce a tendency toward gentleness in prescribing that had native roots. Thus even James Jackson, Sr., could call the expectant approach therapeutics "a la frangaise.'n Although French medicine catalyzed therapeutic change in the United States, it did not present a model of practice Americans cared to emulate, and profound ambivalence underlay American attitudes toward French teachings. Physicians saw in the Parisian medical ex- 186 THE PROCESS OF CHANGE ample sources not only of medical advancement but also of ineffica­ cious therapy, moral corruption, and professional debasement. To the American medical mind, the French school presented a dangerous model of professional behavior and morality that threatened to vitiate the practitioner's character. While Americans revered some categories of Parisian medical knowledge, many facets of French patient care re­ pelled them. Therapeutics (regarded as a body of knowledge about ther­ apy and a program of bedside behavior, as distinguished from its epistemological underpinnings and methods for improving knowledge) was the weakest aspect of French medicine, in the appraisal of most Americans. This judgment, coupled with reservations about the ap­ plicability of European knowledge to American practice that were based on the principle of specificity, encouraged American physicians to see therapeutic knowledgeas the least valuable component of French med­ icine. American physicians were highly selective about which aspects of Parisian medicine they elected to transmit to the United States and which ones to eschew, and nowhere was this selectivity more pro­ nounced than in therapeutics.Many Americanstudents of French med­ icine energetically embraced the skeptical empiricist epistemology that underlay French therapeutics and regarded it as among the most im­ portant messages of the Paris clinical school. They aggressively used Parisian therapeutic empiricism in combatting rationalistic systems of practice, making it pivotal to both therapeutic reform and profes­ sional upliftment. In striking contrast, American physicians who stud­ ied in Paris on the wholeshunned French knowledgeabout therapeutic practice as probably irrelevant and perhaps dangerous forthe American context. The stress here on France should not imply that it was the only important foreign source of change. Britain was the steadiest foreign referent for therapeutic practice in America during the antebellum period and was regarded in some respects as a more reliable source of authority than France. But British medicine posed nosubstantive chal­ lenge to American therapeutics. Furthermore, Americans harbored many of their objections against French medicine against British practice as well, and made similar criticisms of German clinical medicine, espe­ cially practice in Vienna. The rise of laboratory medicine beginning in the 1860s, particularly in German centers, also elicited new sorts of criticism and enthusiasm from Americans. Despite these several cur­ rents, American ambivalence toward European therapeutic knowledge between the 1820s and the 1860s is most clearly illustrated in the example of the Paris clinical school. Attitudes toward Foreign Knowledge 187 French medical thought was brought to America by medical journals and monographs, but mostpowerfully by the American physicians who supplemented their training with study in the Paris hospitals.2 It was largely they who translated and edited French medical writings for an American readership. Moreover, these physicians on their return filled an inordinately large number of professorships in American medical schools, and from these positions proselytized French medicine tostu­ dents. They frequently used their own...


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