Reviewed by: The Medical Imagination: Literature and Health in the Early United States by Sari Altschuler Stephen Rachman Sari Altschuler. The Medical Imagination: Literature and Health in the Early United States. Early American Studies. Philadelphia: University of Pennsylvania Press, 2018. 312 pp. Ill. $55.00 (978–0–8122–4986–6). Only a few decades ago it would have been a truism to observe that medical practitioners of the eighteenth and nineteenth centuries would have been trained in the classics with a regular humanist education, that they demonstrated familiarity with Latin and Greek, read literature with avidity, sprinkled their medical discourse and their table talk with literary references, and even wrote poetry and fiction. Well into the era of the rise of medical science, Sir William Osler would regularly stud his lectures with allusions to his wide reading, and collections of his lectures were regularly given to freshly minted doctors as a kind of Hippocratic keepsake. Much has changed in our culture since these times, and among these changes has been a decline in the genuinely liberal arts education (which always meant arts and sciences) as a means to prepare a human being for virtually any kind of career, no less one in medicine. Despite regular calls and claims for interdisciplinarity in higher education and the growth and development of medical humanities programs in the training of doctors, a discursive divide has widened to the point that “medical humanities,” rather than a fusion of the arts and sciences, has come to stand for the extent to which the science of medicine has removed itself from the arts. Enter into this divide Sari Altschuler’s thoughtful contribution to the history of, if not exactly medicine, then the history of early U.S. medical culture. Altschuler argues that imagination was “fundamental to medical and scientific work” for [End Page 122] doctors of the early republic (p .9). Altschuler organizes her investigation around what she describes as “epistemic crises . . . a central precipitating event, such as an untreatable epidemic disease, a significant discovery, or a political crisis, unseats central ideas about the health of the human body” (p. 13). In the period covered in this study, the main focal points are the American Revolution and the coinciding foundations of chemistry, the outbreaks of yellow fever and cholera that struck with great force in the first half of the nineteenth-century, and the discover of anesthetics. These crises resemble Kuhnian paradigm shifts in the natural sciences, but Altschuler asserts that medical epistemic crises, “are both more pressing and more complex.” They differ from the Copernican example found in Thomas Kuhn’s classic study because the “social, cultural, religious and political imminence of crises in medicine is distinct from crises in the physical sciences” and that medical authority is subject to challenge from “lay practitioners to the clergy” (pp. 14–15). While one might wonder whether the trial of Galileo by the Church was any less complex than the challenges facing, say, Benjamin Rush or Oliver Wendell Holmes, Sr., Altschuler’s study to its credit focuses on the complexity of the socio-cultural-medical nexus, in particular the imaginative strategies employed by physicians (she designates this “imaginative experimentation”) to address problems of medical knowledge. In this way, familiar topics for the history of medicine are given a fresh, imaginative slant. A discussion of the revolutionary era medical thought of Rush, Joseph Priestly, and Elihu Hubbard Smith dealing with phlogiston analyzes the fragmentary medical poetry of Samuel Latham Mitchill (“The Doctrine of Septon,” 1791) that reveals an allegory of oxidation within the body as form of republican representation. Mitchill postulated “septon” as a kind of master toxin, a nitrogenous agent that in decay was viewed by him as the root of all disease. “Emphasizing oxygen’s negative counterpart septon,” Altschuler explains this molecular politics, “Mitchill illustrated the need for representative forces that would act on oxygen’s behalf” (p. 45). In this way, the health of the body was related to the health of the republican body politic. Yellow fever is discussed, chiefly through Charles Brockden Brown’s Arthur Mervyn, in terms of inoculation and concepts of social immunity. Other chapters focus on anesthesia and pain in the...