Against the spirit of system: the French impulse in nineteenth-century American medicine

John Harley Warner knows more about the travels of nineteenth-century Americans to medical Paris than any other historian. For more than a decade he has published articles and delivered papers about these Americans abroad: their fascination with the practical, empirical study of medicine in the French capital, their disinterest compared with the English in the structure and polity of French medicine, and the lingering memories of Paris that filtered through the haze of their passing years. Throughout, his interest has been more in such current concepts as professional identity, historical memory, and storytelling than in a narrative description of the impact of Parisian travel on American medicine. The research he has undertaken is staggeringnearly a hundred repositories in the United States and abroad are listed in the present work-and his command of the published literature is excellent. Against the spirit of system is an elaboration of his previous accounts and an extension of them to the whole spectrum and meaning of the French influence on American medicine. Beginning with an analysis of the competitive antebellum atmosphere in medicine and the reasons for American travel to Paris, the book centres on how American physicians viewed French medicine and sought to apply it at home, and concludes with a section on the waning impact of the Paris school in an era of German ascendancy. At the risk of oversimplification, the principal themes seem to be: (1) Americans went to Paris primarily to set themselves apart from their fierce competitors; (2) while there, they sought practical experience at the bedside and dissecting table rather than in mastery of the scientific work of the professors; (3) they learned most from private, for-fee courses in such subjects as lung disease, use of the stethoscope, and midwifery; (4) they returned with an animus against speculation and in favour of an empirical search for knowledge; (5) they showed less interest than the English in the organization and social structure of French medicine; (6) they disdained French callousness towards patients and their sceptical attitude toward traditional remedies, yet curiously thought themselves better "healers" than the French (a strange paradox, since closer observation and better diagnosis clearly had to precede better therapeutics); (7) their successors, many of them, continued to go to Paris for clinical experience as late as the 1860s despite the growing ascendancy of German study; (8) they continued to cling to their memories of Paris in face of the growing challenge to their professional identity of the German-influenced generation around them. What then is new in the present work? Primarily the organizing theme that the Paris experience was central to a strong American reaction against "the spirit of system". Here Warner's strength in amassing large amounts of material to sustain a sharply focused argument-e.g. that Americans went to Paris for practical rather than scientific reasons-fails him. The book's theme is repeatedly asserted but never really argued or proven. To demonstrate that foreign travel uniquely caused or deepened the spirit of empiricism in American medicine, it is necessary to show that the travellers began their studies with a bias toward rationalism and systems, then changed their views in Paris in favour of empirical observation and clinical experimentation, and finally were successful in applying new viewpoints in the average American classroom, in frequently used texts, in teaching apprentices (still the principal way of leaming clinical medicine), and in the treatment of patientsand that the sharp turn toward empiricism would not have come if this relative handful of Americans had stayed at home. In actual fact,