The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885

Gert H. Brieger, MD
JAMA. 1987;257(20):2832-2833. doi:10.1001/jama.1987.03390200172041.
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If therapy be acknowledged as one of the physician's central responsibilities, it is strange that so little has been written about its history. Here at last is a monograph of great distinction that addresses the history of the role of therapeutics in the medicine of 19th-century America. Professor Warner of Yale University has nicely used the rhetoric and the reality of therapeutic theory and actual practices culled from hospital records in Cincinnati and Boston to illuminate the transformation of American medicine.

He demonstrates, for instance, that in the records and writings of physicians, the word normal had replaced natural by the latter decades of the century. This, Warner rightly emphasizes, marked important conceptual shifts as well. The concept of normality denoted a growing quantification of clinical observations and an increasingly scientific approach to the study of diseases. Throughout the 19th century the physician's identity was closely linked to the therapeutic


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