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

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.

"Against the Spirit of the System provides the best view yet of a lost medical culture... It is enormously important for anyone seeking to understand either nineteenth-century medical life in America, or how culture and memory come to be embedded in physicians' careers."

"In this masterful description of what students encountered in Paris and how it subsequently affected medicine in American, John Warner has given us a new and far richer view of Parisian medicine of the early nineteenth century than we have heretofore had."

"John Harley Warner has produced a book which is never dull and always thought-provoking in the fields of ethics, medicine, and history. His scholarship and research is always relevant and the attention to detail is reminiscent of Ellman's biography of Oscar Wilde... It was a project that needed to be done and has been done well."

"John Harley Warner has written a magisterial book. In examining how nearly a century of American physicians remembered and reconstructed their experiences studying medicine in Paris, Warner explains how Americans invented and reinvented their own profession, shaped and expressed their values, and even developed their personal identities... This is a work of enormous ambition, and it is enormously successful... a superb medical history."

"John Harley Warner knows more about the travels of nineteenth century Americans to medical Paris than any other historian... [His] book is a stimulating example of fresh archival research that opens new windows on an important period on American medicine. It certainly stimulated me to think again about previous work on this subject."

"The book's force derives from its combination of detailed and evocative prosopography with a rigorously articulated argument about how 'Paris-returned' physicians retrospectively constructed Paris medicine to give meaning to their French sojourn in the context of American culture and society."

"This is an extremely impressive historical narrative. Not only does Warner recount in great detail the variety of experiences, meanings, and uses of French medicine to American physicians in the nineteenth century, but in providing a fine grained discursive analysis of orthodox American medicine's process of professionalization, he also showcases an outstanding model of historical methodology."

"Warner offers not only a fresh interpretation of American émigré medical education but also an analytic method that others should consider as they reread the medical narratives that have informed historians' understanding of the rise of American professionalization and specialization."

"Warner writes well, and the book is full of fascinating details and long quotes from actual letter and diaries written by Americans who made the trip to Paris. Like all good history, it says as much about the present as about the past."

"Warner's remarkably thorough research has uncovered invaluable personal papers and diaries of American physicians who studies in Paris. In Warner's hands, these materials eloquently recreate the texture of the life of a medical student in early-nineteenth-century Paris."