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A Note on Sources for the History of Therapeutics The particular primary sources I have cited in this study by and large have no singular virtue to recommend them to the attention of the historian interested in exploring deeper into medical therapeutics in nineteenth-century America. In some instances I have selected the most forceful example I know of to make my point, as in using Elisha Bartlett's Philosophy of Medical Science (1844) to illustrate the Amer­ ican commitment to Parisian empiricism. With some exceptions this study could have argued the same points drawing upon a substantially different evidential foundation; more often than not, the examples I cite could readily be replicatedon the basis of research in other archives or publications. I have generally kept supporting references in the notes to a minimum, and the reader whocares willfind fuller documentation in my "The Therapeutic Perspective: Medical Knowledge, Practice, and Professional Identity in America, 1820-1885" (Ph.D. diss., Harvard University, 1984). In any event, it isdifficult indeed toidentify primary records of nineteenth-century medicine that do not in some way inform the history of therapeutics as I have approached it. Therefore although the historian interested in therapeutics will find something useful in the sources I happen to cite in the notes, he or she will gain more by considering the types of sources I have exploited and their peculiar values and limitations. Published nineteenth-century medical literature is at its most use­ ful and most reliable when used as a source of knowledge about ther­ apeutic theory and principle, about assumptions on the nature of therapeutic knowledge, and about professional programs for proper be­ havior and change. Formaladdresses, including the oratory that opened and closed each session at medical schools, introduced each professor's course of lectures, and annually gave the presidents of medical societies the opportunity of displaying their classical learning, are especially 346 A NOTE ON SOURCES telling. They reveal what physicians held to be important and what they saw as threatening. In perhaps no other context is the symbolic function of medical therapeutics for the regular profession so clear. This means, however, that even more than most medical literature, such discourses must not be taken at face value, especially when they purport to describe something like therapeutic activity. They are best regarded as liturgical literature that accompanied professional rituals and should be read with the caveats appropriate to that genre in mind. Textbooks on therapeutics, materia medica, and the practice of medicine are perhaps the most treacherous source for the history of therapeutics. As representations of a single person's views, often ap­ pearing in an exaggerated form that served internal consistency, they have considerable value. Danger lies in assuming that they represent the views of their readers rather than just their authors. Knowing that a particular textbook was widely used suggests that the ideas it es­ poused were prevalent among American physicians, but it says very little about the extent to which those ideas were accepted or applied. Manuscript records left by physicians so often controvert the propo­ sition that they adhered to textbook instructions that texts have little evidential authority. The time lags between principleand practicegrew especially long in the case of textbooks. Sometimes these volumes were in the vanguard, but frequently they represented older teachings that few regarded as extensively applicable to contemporary practice. Like other monographic literature, textbooks can be read as valid sources for what one person believed therapeutics ought to be like; when they are taken to be more than this, their validity becomes doubtful. Medical journal literature is the richest sourceof knowledge about therapeutic theory and principle. It presents a diversity of views from a broader cross section of the upper levels of the profession than the sources already mentioned. The chief pitfall in using journal literature as a gauge of therapeutic principle (aside from confusing principle with practice] is the risk of missing critical discussion by presuming incor­ rectly where in journals pertinent information will be contained. For many purposes, a journal's index—even the most complete one—is virtually worthless. While it leads to articles on some types of topics, it is misleading as a guide to movements in therapeutic thought. For example, if the historian wants to understand the extent, locus, and animus of regular physicians' discussion on bloodletting between the 1840s and 1870s, he or she will get a disastrously skewed notion of what was in fact going on if the only articles examined...


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