Sari Altschuler, The Medical Imagination: Literature and Health in the Early United States (Philadelphia: University of Pennsylvania Press, 2018)

Today Laurel Daen reviews Sari Altschuler’s The Medical Imagination. Laurel Daen is the 2018-2020 NEH Postdoctoral Fellow at the Omohundro Institute of Early American History and Culture. Her current book project is about disability, authority, and the formation of the American nation state. Laurel received her PhD from William & Mary in 2016 and was an NEH Long-term Fellow at the Massachusetts Historical Society from 2017-2018.

In the early American republic, physicians wrote poetry to try out their medical theories, writers formulated concepts that made their way into medical texts, and everyday people viewed the disciplines of medicine and literature as fundamentally intertwined. Medicine and literature were mutually constitutive and reinforcing, Sari Altschuler explains in The Medical Imagination, and their relationship was seen as crucial to the production of medical knowledge. For example, medical educators urged their students to read and write fiction with the insistence that these practices would cultivate their “microscopic eye” or ability to detect and decipher disease (4). In addition, many doctors, writers, and doctor-writers used literary forms to conduct medical research, especially about topics that were difficult to test empirically. How, for instance, was one to evaluate the workings of sympathy, the universal force commonly understood to link body part to body part in a functioning human body and person to person in a functioning society? It was through literature that early national physicians and writers engaged with these types of questions, cultivating their skills in “imaginative experimentation”—or use of the imagination to craft and assess models of health (8).

This world of “epistemological flexibility” and medical knowledge derived from imagination rather than physical experimentation likely seems unusual to readers today (9). How, you might be wondering, can literature provide a testing ground for medical concepts? And what does imagination have to do with rigorous scientific research? That many of us today have these questions, Altschuler argues, is largely a product of changes in medical research and education in the early twentieth century. During this period, doctors began to insist upon strictly scientific ways of knowing in an attempt to professionalize the field. Gone were the Greek and Latin prerequisites for medical school admission and gone was the poetry that had appeared alongside case histories in medical magazines. This growing adherence to empiricism also shaped the mid-twentieth-century development of the discipline of the history of medicine. Even with the rise of social historical methods in the 1980s, Altschuler asserts, few scholars have questioned the assumption that clinical observation and experimentation comprised the bulk of historical medical research. “Historians of American medicine are still working to move beyond a version of the field that principally uses empirical methods to study the rise of empiricism,” she writes (5). All this has transpired to obscure the role of literature in producing medical knowledge in American history.

The Medical Imagination is structured around a series of “epistemic crises” during which an event, discovery, or disease unsettled prevailing concepts of health and inspired doctors and writers to use literature to resolve their uncertainties (13). In each chapter and crisis—which range from the American Revolution to the Civil War and include yellow fever and cholera outbreaks—there are countless examples of doctors and authors conducting literary medical research. For instance, after the Revolution, Benjamin Rush used literary genres like satire and sentimentality to reenvision monarchical models of health (“a central organ—either brain or heart—that ruled the body like a king”) as republican ones (millions of blood vessels working together to keep the body alive) (23). During the yellow fever epidemics in the mid-1790s, physician Elihu Hubbard Smith and author Charles Brockden Brown wrote poetry and fiction to explore how the disease spread and whether inoculation might take narrative form. In addition, in the 1830s, Edgar Allen Poe composed gothic stories to investigate whether fungus caused cholera—a theory that soon made its way into standard medical thinking (101). In all these examples, literature and medicine were inseparable. Medical texts took literary form, doctors and authors were one and the same, and the literary imagination was crucial to personal and national health.

One strength of The Medical Imagination is that Altschuler articulates the consequences of these historical intersections between medicine and literature for health care and the humanities today. As she writes in the conclusion, “the figures in this book undertook imaginative experiments as rigorous practices of knowing…It is time we returned once more to this vibrant history of imaginative experimentation to learn what more humanistic inquiry can do for the study of health and practices of health care today” (197). This contention has considerable relevance and power at a time when many people question the value of humanities disciplines and medicine is often criticized as prioritizing “routinized procedure and the bottom line” over patient care (19). Medical humanities programs hold promise, Altschuler claims, but interdisciplinary collaboration must be pursued wholeheartedly. For example, she criticizes programs that only use the humanities to promote empathy among doctors, arguing that training in these fields can also cultivate skills, from attention to historical perspective, that are useful to medical practice. “We need to be more precise about what the humanities are and what they do,” Altschuler contends (200). “Demanding such rigor will pave the way for more robust and useful iterations of the medical and health humanities” (20).

The Medical Imagination is an impressively interdisciplinary work that will interest not only historical and literary scholars of the early national period, but also health humanists, health care professionals, and higher education administrators. The questions that the book raises about the past and present intersections of medicine and literature and the potential of interdisciplinary study are fascinating and pressing—and ones that scholars will likely soon pursue. One area for further research may be into the effects of region. Altschuler’s work primarily concerns the mid-Atlantic, but how did doctors and writers engage in literary medical research differently in different places across the United States and Atlantic World? Early Americanists may also want to learn more about the circulation and reception of these literary-medical texts. How did everyday people access and interpret these works, and to what effect for their own bodily and health care experiences? Finally, scholars might more fully explore the decline in the relationship between literature and medicine. Altschuler discusses key turning points, such as the American Medical Association’s 1910 Flexner Report, but spelling out the reasons for this changing climate may prove useful in understanding the points of discord and potential resolutions between the humanities and medicine today. Such inquiries, like The Medical Imagination, will have important consequences for these disciplines.