Introduction Chapter 1. Revolution Chapter 2. Yellow Fever Chapter 3. Cholera Chapter 4. Difference Chapter 5. Anesthesia Conclusion. Humanistic Inquiry in Medicine, Then and Now Notes Bibliography Index Acknowledgments * * * * * IntroductionEXPER''IMENT, Experimen''tum ; same etymon. (F.
) Expérience . A trial, made on the bodies of men or animals, for the purpose of detecting the effect of a remedy, or of becoming better acquainted with their structure, functions, or peculiarities. In a more general sense, it means any trial instituted with the intent of becoming better acquainted with any thing. --Robley Dunglison ("The Father of American Physiology"), Medical Lexicon (1839)In the fall of 1841, physician and novelist Dr. Robert Montgomery Bird (1806-1854) stood before a group of new medical students and delivered what must have been a dispiriting talk. In The Difficulties of Medical Science , Bird explained that medicine faced many challenges. Every science, he told his students, was, "and of a necessity must be, imperfect," but the difficulties of medicine were "greater and more numerous." It was hard to reproduce results, for example.
It was impossible to observe healthy, functioning organs. The senses were imperfect, and human bodies were incommensurably unique. "It is physically impossible," Bird stressed, to "know many things it would delight Medicine to know." Bird was committed to medicine, whose "whole object" was to benefit humanity and to reduce suffering, but he worried about the immense physical and ethical impediments to medical research. "How shall we detect the workings of the invisible and intangible enemies around us?" he asked. "How shall we trace the mechanism of a disease? how shall we follow even the operation of a remedy, through the darkness of a microcosm of which we are so ignorant?" "We have no window of Momus," Bird lamented, "to give us vistas of living pathology." Invoking Momus, the classical figure who teased Hephaestus for making the body without a window through which to see the human heart, Bird offered a humanist''s alternative to the insufficiencies of medical observation and physical experimentation. Doctors and surgeons had difficulty safely or ethically opening up the living human body--especially before the development of anesthesia and germ theory.
Unable to see physiology or "living pathology," doctors could observe little about how the body worked. Momus was the god of satire, whom Laurence Sterne called the "arch-critick." In conjuring Momus, Bird not only invited his students to integrate classical learning into their understanding of medicine (not unusual in a time when classical education was necessary for the serious study of medicine) but also asked his students to think critically and creatively about the tools at their disposal for medical inquiry. Throughout his life as in his lecture, Bird''s literary and medical interests intersected. He used the classics, quoted verse, and invoked Shakespeare in his medical writings. He wrote poetry while he studied medicine, and his extant medical notes can be found on the backs and in the margins of history, drama, and fiction manuscripts. Bird likely found pleasure scribbling his lecture on "artificial stimulants" on the back of a diatribe against American business practices from one of his novels and medication notes on the back of a page about race and immigration. The repeated proximity of these projects--fiction and medicine, often on the same pages--suggests Bird was working on them simultaneously and that they informed each other (Figure 1).
It may have been physically impossible to know certain aspects of health, but, like many doctors of his era, Bird also used imagination and literary form to explore challenging questions in medicine. Bird was a physician who understood that genres were strategies; their different forms allowed writers to examine different facets of health. This was especially true in his novels. He used fiction to investigate aspects of health that were difficult--if not "impossible"--to test physically, as well as those that were better pursued through humanistic methods. Like the eponymous narrator of his 1836 novel Sheppard Lee: Written by Himself , Bird hoped readers would "have a more liberal understanding of the subjects of knowledge." Robert Montgomery Bird offers a particularly illuminating, but by no means unique, window onto the medical work of literature; in fact, medicine and literature had a long, entangled history in the Atlantic world. Richard Blackmore (1655-1729), Samuel Garth (1661-1719), John Armstrong (1709-1779), Mark Akenside (1721-1770), and John Keats (1795-1821) were just some of Britain''s notable physician-poets during the eighteenth and early nineteenth centuries, and doctors like Tobias Smollett (1721-1771) and Oliver Goldsmith (1730-1774) composed in other literary genres. In the Caribbean, men like James Grainger (1721-1766) wrote medical poems and sent them back to the metropole, hoping to make their fame.
Even prominent physicians who were not well-known for their poetic aspirations, like vaccine inventor Edward Jenner (1749-1823), penned verse that circulated in both literary and medical contexts. In this period of classical revival, doctors fashioned themselves after Apollo, god of both medicine and poetry. Physician-writers were not anomalies but rather actors engaging in a long and robust tradition of literature and medicine. Founding Father and famed physician Benjamin Rush (1746-1813), the most famous American doctor for nearly a century, explained why: "Exactly the same thing takes place in the act of judgment in selecting and combining related ideas and rejecting such as are not related, as takes place in selecting and combining words, in writing poetry and rhyme. The ear combines related words, or such as--to use a common phrase--do not jangle with each other; and rejects such as are not related." With practice, this cognitive process came to seem natural rather than nurtured, but Rush pressed his students not to be deceived: good medical thinking was the product of a well-trained mind, and poetry was an excellent tool for developing one. Poetry also helped train the perceptions that made judgment possible. Given the value Rush placed on poetry, it is not surprising that he also made "frequent recurrences to the poets" in his medical writing because they viewed phenomena, "whether natural or morbid, with a microscopic eye , and hence many things arrest their attention, which escape the notice of physicians.
" In describing poetic vision as a "microscopic eye," Rush radically repurposed a phrase that had a long European genealogy to describe the valuable role poetry ought to play in producing medical knowledge. Whereas eighteenth-century writers like Alexander Pope (1688-1744) claimed no one had a microscopic eye (it would be painful and dangerous, he argued), Rush celebrated this faculty. In Rush''s view, poetry was creative and exacting--essential for mastering the kind of thought and perception that lay at the heart of good medical practice and discovery. From the earliest days of medicine in the United States doctors turned heroic couplets toward the ends of heroic medicine. Samuel Latham Mitchill (1764-1831) used poetry in 1797 to make his case about the geography of human health, as did Joseph Young when he quoted Alexander Pope''s verse in the pages of the New York journal the Medical Repository to defend the use of analogy in place of observation in science. A North Carolinian student of Rush, Charles Caldwell (1772-1853), urged doctors to be poetic and imaginative in their medicine in 1797, hoping they would follow the example of British physician-poet Erasmus Darwin and combine "the researches and decisions of the understanding , with the sportings [ sic ] and flights of imagination ." A physician-poet himself, Caldwell believed it would not be long before an American Darwin emerged: "From the rapid and general diffusion of physical science throughout our country, and from the growing taste for the beauties of literature acquiring such depth of root in the American mind," he wrote, "we are . encouraged to flatter ourselves, that [the arrival of such a figure] is not deeply buried in the ever-teeming matrix of time.
" Emphasizing Darwin''s history as a country doctor, Caldwell pushed his counterparts in the United States to consider the physician-poet path for themselves. In the late eighteenth and early nineteenth centuries, doctors wrote poetry that was formally strict; constrained meter and rhyme organized their theories and observations. Ordered poetic form kept a tight rein on doctors'' imaginations. Although doctors'' poetry filled the pages of American journals and magazines well into the nineteenth century, their work has gone largely unnoticed because much of the verse--highly structured and widely practiced as it was--has seemed uninteresting to a more modern eye. Its form was, however, largely the point, and the practice of writing this kind of poetry was valuable training for the medical mind. Writers outside the medical establishment also found literary forms valuable for producing medical knowledge. In the 1790s Charles Brockden Brown experimented with the potentially fatal "force of imagination" in his novel Ormond , just as he understood his fictional story Arthur Mervyn "methodize[d] reflections" that contributed to "medical and political discussions . now afloat in the community.
" Likewise, Bird''s contemporary Edgar Allan Poe penned "prescient descriptions" in short stories that were celebrated in elite medical journals from JAMA to the Lancet . The prevalence of nineteenth-century d.