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Against the Spirit of System

Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine

Copyright Date: 1998
Pages: 472
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  • Book Info
    Against the Spirit of System
    Book Description:

    In this wide-ranging exploration of American medical culture, John Harley Warner offers the first in-depth study of a powerful intellectual and social influence: the radical empiricism of the Paris Clinical School. After the French Revolution, Paris emerged as the most vibrant center of Western medicine, bringing fundamental changes in understanding disease and attitudes toward the human body as an object of scientific knowledge. Between the 1810s and the 1860s, hundreds of Americans studied in Parisian hospitals and dissection rooms, and then applied their new knowledge to advance their careers at home and reform American medicine. By reconstructing their experiences and interpretations, by comparing American with English depictions of French medicine, and by showing how American memories of Paris shaped the later reception of German ideals of scientific medicine, Warner reveals that the French impulse was a key ingredient in creating the modern medicine American doctors and patients live with today.

    Impressed by the opportunity to learn through direct hands-on physical examination and dissection, many American students in Paris began to decry the elaborate theoretical schemes they held responsible for the degraded state of American medicine. These reformers launched an empiricist crusade "against the spirit of system," which promised social, economic, and intellectual uplift for their profession. Using private diaries, family letters, and student notebooks, and exploring regionalism, gender, and class, Warner draws readers into the world of medical Americans while investigating tensions between the physician's identity as scientist and as healer.

    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: 978-1-4008-6466-9
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-x)
    (pp. xi-2)
  5. INTRODUCTION Storytelling and Professional Culture: American Constructions of the Paris Clinical School
    (pp. 3-16)

    Out of the reorganization of medicine in the wake of the French Revolution, the Paris hospitals emerged as the most vibrant center of Western medicine. What has come to be called the Paris Clinical School is broadly identified with a distinctive complex of institutional arrangements, clinical techniques and teaching practices, modes of organizing knowledge, and structures of medical perception that characterized Paris medicine between 1794 and the mid—nineteenth century. After Waterloo and peace, Paris became a Mecca for foreign medical students and practitioners. Between 1815 and the 1850s, some one thousand crossed the Atlantic from the United States to...

  6. CHAPTER 1 Professional Improvement and the Antebellum Medical Marketplace
    (pp. 17-31)

    Why would an American physician go to Paris? If the rich resources and intellectual vitality of the Paris Clinical School seem to offer an obvious answer, in fact it is not self-evident why an antebellum American physician would invest time and money in what was termed “professional improvement” either at home or abroad. Antebellum society required little formal training of those recognized as professional physicians, and during the decades when the numbers of Americans traveling to Paris for medical study grew, the revocation of already minimal medical-licensing laws meant that all those who wished could call themselves physicians regardless of...

  7. CHAPTER 2 Why Paris?
    (pp. 32-75)

    By the mid-1820s, with the French capital readily accessible, the American of ambition and means who considered the options for professional improvement in medicine more than likely would have included a journey to Paris among them. This was a recent development, however, and had not been the case a decade earlier. The pattern of Americans’ traveling to Europe for medical study had old roots, stretching back to those who studied in Leyden in the seventeenth century and the substantial number who visited Edinburgh and London in the eighteenth. Between 1769 and 1819, over 300 Americans attended medical lectures in Edinburgh,...

  8. CHAPTER 3 Errand to Paris
    (pp. 76-132)

    “To delineate the localities I have visited, and describe the emotion I have felt,” Ashbel Smith, newly arrived in Paris in the winter of 1832, wrote home to North Carolina, “would be to write an enormous book—which nobody would read.”¹ Smith was right on both counts. To map the Parisian medical world even at a single moment in time was a daunting task; Heinrich Ludwig Meding’s two-volumeParis médical: vade-mecum des médecins étrangers(1852–1853) ran to over nine hundred pages, and it said nothing about how the territory it charted was perceived or experienced by foreign students.²


  9. CHAPTER 4 Contexts of Transmission: Duty and Distinction
    (pp. 133-164)

    “The Physician has alas! but little occasion to distinguish himself,” Samuel Henry Dickson, long a medical professor in Charleston and more recently in New York, lamented in 1848 to his nephew, warning the young medical student not to expect much reward for intellectual attainment. “The Community concern themselves very little with the merits or demerits, and we are too practical or too prejudiced to award the palm correctly.” Therefore, Dickson advised, “it is well for us when we can [to] substitute for Ambition a strong sense of duty.”¹ Perhaps the caution was prudent. Yet for the American physicians who studied...

  10. CHAPTER 5 Telling a Historical Story
    (pp. 165-186)

    Of all the messages American physicians transmitted home from Paris, the one that most distinctly characterized their program for American medicine was the animus against speculation and for the empirical pursuit of truth, against rationalistic systems and for knowledge rooted in the collection of observed facts. Most antebellum American intellectuals would have claimed this cluster of commitments as their own, and would have readily affirmed that they and these reform-minded physicians were marching together under the banner of Baconianism. In fields ranging from natural science to religion, appeals to Baconianism were pervasive.¹ This was by no means strictly the philosophy...

  11. CHAPTER 6 “They Manage These Things Better in France”: Polity and Reform
    (pp. 187-222)

    The account of medical history that the American disciples of the Paris School related to propel their campaign “against the spirit of system” conveyed a highly selective and peculiarly American image of French medicine. Out of the complex and changing realities of the Parisian medical world, Americans persistently tended to select its characteristic epistemological stance—strident empiricism and equally strident antirationalism—as its most prominent feature. There was nothing inevitable about this particular way of depicting French medicine, however, as English comparison shows, for the English instead tended to stress French medical polity (a term used at the time), that...

  12. CHAPTER 7 “Against the Spirit of System”: Epistemology and Reform
    (pp. 223-252)

    The gap between English and American uses of the French model in programs to elevate the medical profession, pronounced in the case of medical polity, was even wider in the case of medical epistemology. While English reformers who drew on the French example made relatively little reference to French epistemology, Americans made it central in their plan for reform. The most valuable lesson of the Paris School, as they depicted it, was its stand for empiricism and against rationalism, and in an allegiance to that example they saw the greatest promise of transforming not only medical knowledge and practice but...

  13. CHAPTER 8 Science, Healing, and the Moral Order of Medicine
    (pp. 253-290)

    American and English observers, however much they differed in assessing French models of medical polity and epistemology, were in remarkable agreement in their evaluation of another aspect of French medicine—the performance of the Paris clinicians as healers. Both the Americans and the English insisted that the French were inferior as healers and that their inferiority stemmed from a flawed value system. This French model was not to be emulated, even selectively, but to be denounced and shunned. Instead of promising professional uplift it threatened corruption, and even those who gave their hearts and minds to French ways took seriously...

  14. CHAPTER 9 Americans and Paris in an Age of German Ascendancy
    (pp. 291-329)

    By the middle of the nineteenth century, Erwin Ackerknecht asserted, “French medicine had maneuvered itself into a dead end, as all empiricisms had done so far in medical history.” He argued that “by 1848, Paris ‘hospital medicine’ had come to a dead end, its momentum spent,” while the dust jacket of his book declared that the Paris School was “swept away by the Revolution of 1848.” Ackerknecht went on to invoke the massive shift toward German cities in the stream of foreign medical students that once flowed to Paris as the most powerful testimony to the exhaustion of the French...

  15. CHAPTER 10 Remembering Paris
    (pp. 330-364)

    As migration to Germany continued, the stature of Paris medicine within the United States was increasingly eroded. Even if access to clinical experience had largely initiated the shift, once the redirection across the Rhine had become pronounced the reasons animating it were open to multiple interpretations. After returning home, young American physicians who spent their time chiefly in Germany and rooted their claims to special identity in that experience were inclined to proclaim the superiority of the German medical ethos and to denigrate the Paris School. “American Physicians [have been] held too long by the brilliant but illusory French writers,”...

    (pp. 365-368)
  17. NOTES
    (pp. 369-444)
  18. INDEX
    (pp. 445-459)
  19. Back Matter
    (pp. 460-460)