The Therapeutic Perspective

The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885

John Harley Warner
Copyright Date: 1997
Pages: 384
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  • Book Info
    The Therapeutic Perspective
    Book Description:

    This new paperback edition makes available John Harley Warner's highly influential, revisionary history of nineteenth-century American medicine. Deftly integrating social and intellectual perspectives, Warner explores a crucial shift in medical history, when physicians no longer took for granted such established therapies as bloodletting, alcohol, and opium and began to question the sources and character of their therapeutic knowledge. He examines what this transformation meant in terms of patient care and assesses the impact of clinical research, educational reform, unorthodox medical movements, newly imported European method, and the products of laboratory science on medical ideology and action.

    Originally published in 1997.

    ThePrinceton Legacy Libraryuses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

    eISBN: 978-1-4008-6463-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Preface
    (pp. vii-xii)
  3. Acknowledgments
    (pp. xiii-xiv)
  4. Table of Contents
    (pp. xv-xviii)
  5. Introduction: Therapeutics and the Transformation of American Medicine
    (pp. 1-8)

    Between the 1820s and the 1880s medical therapeutics in America was fundamentally altered. Traditional medical practices, founded on assumptions about disease shared by doctor and patient and oriented toward visibly altering the symptoms of sick individuals, began to be supplanted by strategies grounded in experimental science that objectified disease while minimizing differences among patients. Concurrently the bases of physicians’ professional identity were also transformed. Through the mid-nineteenth century professional identity was based on proper behavior and on a medical theory that stressed the principle of specificity, the notion that treatment had to be matched to the idiosyncratic characteristics of individual...

  6. Part I Antebellum Medical Therapeutics
    • 1 Intervention and Identity
      (pp. 11-36)

      In a commencement address to Cincinnati 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...

    • 2 Epistemology, Social Change, and the Reorganization of Knowledge
      (pp. 37-57)

      Between the 1820s and the 1850s American physicians held steadfast to their belief in the necessity of therapeutic activism and in the value in principle of traditional remedies. Yet far from being static, this was a period of signal change in therapeutics. Although they retained their faith in such established therapies as bloodletting, alcohol, and opium, practitioners began to use these treatments with frequencies and intensities that deviated sharply from earlier conventions. More fundamentally they increasingly questioned the sources and character of their therapeutic knowledge. How could the practitioner assess the worth of therapeutic practices, and how was therapeutic progress...

    • 3 The Principle of Specificity
      (pp. 58-80)

      Underlying most of the criticisms regular physicians brought against rationalistic systems of practice was the objection that they fostered mechanical, indiscriminate treatment. That physicians actively regarded the specter of treatment by rote as such a menace to both therapeutic success and the profession’s standing reflects the pivotal place the principle of specificity occupied in professional values. Specificity—an individualized match between medical therapy and the specific characteristics of a particular patient and of the social and physical environments—was an essential component of proper therapeutics. Treatment was to be sensitively gauged not to a disease entity but to such distinctive...

  7. Part II The Process of Change
    • 4 Therapeutic Change
      (pp. 83-161)

      To be fully exploited as a probe into the mind of nineteenth-century American physicians, therapeutic rhetoric must be interpreted against the backdrop of behavior. Only by knowing what physicians actuallydidis it possible to assess the significance of what they said they did and ought to be doing. The kinds of sources historians most often rely on are indispensable for describing how physicians portrayed their activities and for understanding the purposes and justifications of their therapeutic procedures, but they do not reveal their actions. Although some insights into therapeutic activity can be gleaned from such narrative sources as diaries,...

    • 5 Attitudes toward Change
      (pp. 162-184)

      Because therapeutics was so central to both the professional identity and the daily tasks of nineteenth-century American physicians, the process by which it changed was inevitably complex and disturbing to them. Looking hard at the way they regarded change and at the place and meaning it held in their values and institutions helps make sense of that process. One key to understanding their attitudes toward change is to recognize how the structure of medical theory minimized the disruptiveness of permutations in therapeutic practice, a disruptiveness that the profession’s institutions further mollified. Another is to see that most of the factors...

    • 6 Attitudes toward Foreign Knowledge
      (pp. 185-206)

      However much the course of American medicine was determined by socioeconomic forces and conceptual resources within the American environment, it was also persistently shaped by European tutelage. American physicians abroad traveled principally to the lecture halls of Edinburgh before the early nineteenth century and to German laboratories 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 French skeptical empiricism commanded its American proponents to critically re-evaluate existing practices. The more detailed knowledge of the...

    • 7 The Arbitration of Change
      (pp. 207-232)

      Tensions between the commitment to progress and loyalty to tradition became particularly acute in the discussions about therapeutic change that flourished in medical circles from the 1850s through the 1870s. The function of these discussions was at once explanatory and normative, for through them physicians sought to account for the dramatic transformation that had taken place in practice since the early decades of the century and to establish a consensus for current and future practice. Evaluation of past therapeutic change and disputation of present therapeutic truth were parts of a single endeavor. This endeavor is illustrated here by an analysis...

  8. Part III Therapeutic Reconstruction
    • 8 Physiological Therapeutics and the Dissipation of Therapeutic Gloom
      (pp. 235-257)

      The proposition that experimental laboratory science 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’ expectations 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...

    • 9 Cui Bono?
      (pp. 258-284)

      Between the mid-1860s and the mid-1880s, some American physicians began to articulate an expansive program for reconstructing medicine on the foundation of experimental science. The claim of laboratory science to practical relevance in medical therapeutics did much more than challenge the reign of empiricism: it urged a thoroughgoing rearrangement of the relationships among therapeutic practice, knowledge, and professional identity. As the proponents of the newly laid basis for treatment teased out the implications of physiological therapeutics, they portrayed it as an integral part of a new medical ethos gradually taking shape.

      A few practitioners fully gave their hearts and minds...

  9. Abbreviations Used in the Notes
    (pp. 285-288)
  10. Notes
    (pp. 289-344)
  11. A Note on Sources for the History of Therapeutics
    (pp. 345-352)
  12. Index
    (pp. 353-365)
  13. Back Matter
    (pp. 366-366)