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Physiological Therapeutics and the Dissipation of Therapeutic Gloom THE PROPOSITION that experimental laboratoryscience should inform therapeutic practice and advancement became securely established in the twentieth century. During the two decades following the Civil War its acceptance was far from certain, however, for it represented but one of a number of programs envisaged for therapeutics. Physicians' ex­ pectations about the future of medical therapeutics were as diverse as were their perspectives on its past and present so evident in their discussions about change.Most practitioners agreed that the empiricist pruning of rationalistic systems had greatly improved practice, but by the 1860s they also concurred that progress along this axis had slowed to a near standstill. Therapeutics had begun to stagnate, many physi­ cians believed, and the profession hadfallen prey to therapeutic gloom. Concern over this state of things made these decades a time of ex­ ceedingly active reflection about what was to become of therapeutics, marked also by bickering about the most promising plan for escaping pessimism. Between the mid-1860s and the mid-1880s programs for thera­ peutic change abounded. Some advocated the selective revival of rem­ edies earlier in vogue, while others urged physicians to emphasize hygienic more than drug therapy, to improve practice through inten­ sified empirical observation of drug effects, or even to turn their at­ tention fromhealing individuals to the greater promise of state-sponsored preventive medicine. Of all the designs for therapeutics put on the market, the one that was most forcefully to remold medical enterprise held that knowledge produced by laboratory experimentation should become the new foundation for medical therapeutics. In many ways this plan was also the most radical departure from 236 THERAPEUTIC RECONSTRUCTION the past. It postulated a new source of therapeutic knowledge and authority, defined a new epistemologicalcategory for therapeutics, and carried with it an aggressive optimism its advocates contended should signal the dissipation of therapeutic gloom. It had fundamental impli­ cations for therapeutic practice and professional identity and morality, and these are analyzed in Chapter 9. To understand the therapeutic claims of experimental science, it is necessary to know why the New Rationalism that characterized "experimental" or "physiological" therapeutics so appealed to some physicians and so repelled others. Recognizing how much the epistemological implications of this new program mattered to American physicians is crucial to understanding its reception. Beginning in the late 1850s physicians increasingly complained that even though basic medical science was swiftly progressing, medical therapeutics was by comparison static."It seems that every other branch of medicin has gon on to great perfection but the treatment of dis­ ease ... would seem almost dormant,"a medicalstudent in Charleston began his thesis in 1859.1 Dissatisfaction with thisstate of affairs grew during the two decades following the Civil War. Although not new in form, this complaint far exceeded in strength anything witnessed ear­ lier in the century. Frustrated by the contrast between stagnancy in therapeutics and brisk advancement in experimental physiology, bio­ logical chemistry, and microscopic pathology, practitioners saw the gap between medical knowledge and therapeutic activity widening. Postbellum physicians generally agreed that therapeutic practice had improved since the earlydecades of the century, but this judgment revealed a disparaging appraisal of prior practice more than content­ ment withits present state. They nearlyuniversally deemed thedemise of rationalistic systems and their concomitant extremism to be signs of progress. They had learned from a fuller knowledge of the natural history of disease and the healing power of nature what they could and could not accomplish by drugging. In the 1830s only an elite minority had defended the notion that most diseases were self-limited, but half a century later this had become commonly accepted wisdom.2 Such a stance did urge attention to patients' hygienic management, but its main practical message, as most practitioners understood it, was to do less. Although physicians recognized the heightened appreciation of the limitations of their art and the tendency toward therapeutic mod­ eration as progress, they saw it as negative progress. The impulse of skeptical French empiricism that had changed American medicine for Physiological Therapeutics 237 the better was in its essence destructive. "In the use of medicine, the knowledge attained has been negative," one physician wrote. "Physi­ cians have ascertained what medicine cannot do, rather than what it can do."3 Henry Ingersoll Bowditch, reviewing the history of medicine in the United States at the nation's centennial, proposed that the period from the early 1830s through the end of the 1860s was best typified by...

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Additional Information

ISBN
9781400864638
MARC Record
OCLC
889252597
Pages
380
Launched on MUSE
2015-01-01
Language
English
Open Access
No
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