by Paul J Croce
While this relationship did lend itself to empirical observation, the rigor or
even the attention of the guiding preceptor varied widely, and only a few
doctors had ongoing relations with hospitals to allow the apprentices to see
many cases. Going to medical school, like going to Paris, was a good status-
enhancing supplement to apprenticeship, but it was not a strict requirement
for practice. By the end of the eigh teenth century, there were only four
medical schools in the United States, but after significant growth in the next
century, at least seventy were in operation by the 1870s. Because the schools
were generally dependent on tuition, they were very sensitive to the wishes
of students, and this kept the terms short and the requirements low. With
almost no full- time faculty, most schools were commercial enterprises as
side businesses for practicing doctors, and the competition for enrollment
stiffened so that by midcentury the standards became still lower. 7
James’s education was exceptional since Harvard had many full- time
teachers and affiliation with a hospital, the Mas sa chu setts General Hospital,
founded in 1821. This medical school and hospital were intimately connected
even before many American doctors had returned from France heralding
such practice. The medical school associated with Harvard was founded
even earlier, in 1782, even though it went by many names and moved many
times. It was often called the Mas sa chu setts Medical College until the 1860s
when it became widely known as Harvard Medical School. The growing
consensus about the name symbolized its closer relation with the rest of the
college and medicine’s interaction with the sciences in general— just as the
Paris clinicians had been insisting— and it was housed in a building imme-
diately adjacent to the general hospital. In the last three de cades of the
century, with the rise of postgraduate training within research universities,
the medical school was still more fully integrated into the university. In
fact, the type of teaching across the scientific curriculum and medical school
that James experienced became a model for those trends and gave James
firsthand experience with them. These professionalizing impulses began
with the French innovations, especially the insistence that medical educa-
tion requires extensive clinical experience and grounding in the biological
sciences.8
James trained in both of these professional spheres. In classes, he re-
ceived extensive anatomical training with lectures and laboratory dissec-
tion. Returning from Brazil in January 1866 and convinced not to become a
84 Young William James Thinking
field naturalist, he wanted to add clinical training to his medical studies, so
he was “anxious to get into the hospital,” that is, as a student to gain practi-
cal experience; and he did in fact serve as “acting house surgeon in the
Mass. Gen. Hospital.” In late 1866, he applied for a longer- term position in
the hospital for the next year. However, by the next spring, although he re-
ceived the “hospital appointment,” he sent a formal letter to the trustees of
the hospital turning down the position of “Office of House Pupil” explain-
ing that “certain circumstances . . . will render it impossible for me to per-
form” the hospital job. More specifically, he was eager to go to Germany
both to supplement his clinical work with enrichment of his laboratory
training in physiology and to study the impact of the ner vous system on
psy chol ogy.9
In 1863 James had already displayed substantial interest in the mental
health side of “medecine,” as he often flippantly misspelled the name of his
formal field, and he fi nally began work in asylums during his medical train-
ing. This work, along with his study of physiological psy chol ogy in Ger-
many, would become impor tant to his career as a psychologist, but at the
time he was unclear about his own vocational direction, and the field of
psy chol ogy itself had not even formed yet. Learning German physiological
laboratory innovations would put him at the cutting edge of medical innova-
tions, much like his peer and friend Henry Bowditch, who started at Har-
vard Medical School about the same time as James and also added Eu ro pean
training in physiology; but Bowditch stayed focused on supporting its
emerging status as a science basic to medicine. Harvard appointed him to
teach physiology full time in 1871, by splitting the chair that had been for
both anatomy and physiology, a step that reflected increased scientific spe-
cialization. Through these years, James and Bowditch collaborated closely
on physiological investigations, holding out hope, as Bowditch declared with
keen faith in scientific pro gress, that although physiology had as yet made
little impact on actual medical therapeutics, “the most fundamental experi-
ments in this direction are yet to be made.” 10 Bowditch’s career illustrates
an emerging trend for the nonpracticing, research- oriented physician—which
is tacitly what James himself became in 1869. His training in physiology,
which would eventually lead him to psy chol ogy, served in the 1860s as
preparation for a biological appointment as a teacher of his new specialty.
He soon achieved that vocational goal, when Bowditch took a research
leave allowing for James’s first job, an appointment to teach physiology in
the spring of 1873.
Between Scientific and Sectarian Medicine 85
Clinical and Laboratory Study at Harvard Medical School.
Harrington, The Harvard Medical School (1905), on the page facing 2:509.
William James’s only degree was an M.D. from Harvard Medical School, then
often called Mas sa chu setts Medical College. His medical training included both
academic laboratory study and clinical work around the corner at Mas sa chu setts
General Hospital. This shows James’s immersion in two major trends of mainstream
medicine; clinical practice dominated through the early nineteenth century, and
laboratory work gained greater influence later in the century.
The Promise of Laboratory Medicine
The diagnostic innovations of the Paris clinics were major steps toward sci-
entific medicine, and the trends continued with the first incorporation of
physiological laboratory training into medical education in the de cades be-
fore James took this turn himself. Claude Bernard played a leading role in
French efforts to supplement clinical training with physiological investiga-
tions based on the chemistry of organic systems; his work offers a promi-
nent example of trends toward materialistic understanding of health and
medicine already emerging within clinical practice. Positivist Auguste
Comte had put the biological sciences fairly low on the hierarchy of sciences
because of the fallibility of self- inquiry into physiological states, although
his followers, most notably chemist William Draper, proposed that recent
research had allowed physiology’s passage from speculation to a positive
science. Bernard led the way with his physical and chemical experiments
86 Young William James Thinkin
g
on organic bodies designed to place the princi ples of medicine on a firm
chemical and physical basis, with fixed laws of physiology identifying the
mechanisms of the body’s systems. This knowledge offered therapeutic
promise through the hope of identifying causes in medical pathology, even
though at this point mainstream therapies were still largely unreliable. In
his review of Bernard’s recent work in 1868, James was both enthused about
the new scientific possibilities that the French physiologist’s work prom-
ised and wary about the still- remote medical therapeutics that would come
of this work. 11 The new physiological research was motivated by the propo-
sition that a better understanding of life pro cesses at the cellular level and
in their chemical and physical interactions would become crucial tools for
understanding the body’s health and its diseases, eventually providing thera-
peutics for innovative cures.
William James gained firsthand encounters with Bernard’s laboratory
orientation during the 1866–67 school year when Edouard Brown- Séquard
brought his colorful lectures, his laboratory equipment, and his cages of
animals for physiological investigation to the medical school. The ardent
experimentalist had recently been appointed professor of the physiology
and pathology of the ner vous system at Harvard, but he did not stay long
there or anywhere else during his global career. He crossed the Atlantic
sixty times, in addition to his trips to and from his native Mauritius, a for-
mer French colony in the Indian Ocean under British sovereignty since
1814. With his British citizenship, French mother, and American father,
Brown- Séquard pursued lecturing and research opportunities on both
sides of the Atlantic. At the age of twenty, in 1837, the young colonial trav-
eled with his widowed mother to seek an education in France. He had little
money, but intense ambitions, which he briefly directed toward lit er a ture.
When he did not succeed with his plays and stories, he burned them, and
brought that same intensity to the Faculty of Medicine in Paris, where he
immediately enrolled. He worked relentlessly, often in Spartan conditions,
as he fiercely devoted himself to the scientific transformation of medicine.
As a student, he began his lifelong practice of experimenting on himself to
test for physiological impacts—he even permanently para lyzed two of his
fin gers from a laboratory wound. Some of his experimental research, espe-
cially on the physiology of the spinal cord, coincided with the work of Ber-
nard, and they were frequent professional and intellectual rivals. Bernard
was appointed to the professorship in medicine at the Collège de France
Between Scientific and Sectarian Medicine 87
when Brown- Séquard had also applied, and then he took his place when
Bernard died in 1878. 12
In an era of increasing professional rigor, Brown- Séquard developed an
international reputation as a specialist in the physiology of the ner vous sys-
tem. A major theme of his work was his challenge to the emerging emphasis
on ce re bral localization. In contrast to the theory that “each function of the
brain is carried on by special organs,” he proposed that “a great many parts
of the brain . . . contain the ele ments endowed with each of the vari ous
functions that we know to exist in the [ whole] brain.” He was able to show,
through meticulous research on brains with one- sided injuries, that the organ’s
other side was able to perform functions of the brain as a whole. Brown-
Séquard provided James’s first exposure to scientific work portraying the ner-
vous system in terms of pro cesses rather than structures, with suggestions
for explaining mental states by emergent factors rather than only by reduc-
tion to physiological terms, a scientific precursor to his later theory of con-
sciousness as a function, not a thing. 13
Brown- Séquard was also an innovator in the clinical and laboratory
assessment of the importance of the adrenal glands, and he developed some
early versions of hormone replacement therapy, with his use of testicular
extracts to reverse the effects of aging and disease. He enthusiastically re-
corded the increased strength in his muscles and the force of his urine after
taking these extracts. Although he himself showed no interest in marketing
his insights, his name was used to sell vari ous serums that promised to re-
vive youthful vigor and increase sexual potency. One advertisement from
1912 for “Sequarine, the Medicine of the Future,” pictured Brown- Séquard
and credited him with the insights that have enabled “[s]cientists . . . to
transfer energy from one animal body to another.” His hormone research
and this ballyhooed product show the role of physiological research in the
widespread concerns about energy depletion and in neurasthenic evaluation
of ways to preserve and resupply that nerve force. James himself engaged in
similar therapies, including use of Roberts- Hawley lymph compound, which
contained an extract of bulls’ testicles, designed to lift his stock of energy,
both mentally and physically. In 1908 he said proudly of the lymph com-
pound, “I have had now an eight years experience of it and the results are
perfectly uniform. In a week all symptoms begin to improve, fatigue dimin-
ishes, sleep improves, digestion ditto, courage & aggressiveness replace pu-
sillanimity etc., etc.” 14 James’s interest stemmed from his lifelong curiosity
88 Young William James Thinking
about material impacts on nonmaterial parts of life; so he was willing to try
alternative therapies, even if unorthodox, as ways to experiment for further
insight, especially if he found them effective.
For Brown- Séquard, research was the prime commitment, but he was
also able to show its practical benefits in his own successful medical prac-
tice, especially in the treatment of ailments of the ner vous system. He was a
vigorous spokesperson for the use of science within regular medical practice,
emphasizing the importance of physiological knowledge, because complex
cases could then be understood in terms of the material conditions main-
stream doctors proposed as causal agents of ill health. He was a bold presence
at scientific gatherings and an inspiration to students with his devotion to
experimental science, even as they often felt he was speaking over their
heads. With his wholehearted devotion to experimental science, he also
polarized audiences with his uncompromising commitment to animal
experimentation and vivisection. Brown- Séquard regularly dissected and
administered chemicals to animals, living and dead, to expand physiologi-
cal knowledge and develop medical therapies, but a rising chorus of anti-
vivisectionists took issue with this widespread practice, regarding him as
the “ great torturer”; showing his enthusiasm for science, James took the
side of his teacher but characteristically grew toward a mediating position,
emphasizing scientific pro gress and limits on cruelty. Thomas Huxley, him-
self no stranger to controversy, said to
Brown- Séquard, “[Y]our appearance
would have the effect of a red rag upon a bull.” 15
The Harvard Medical School was likewise committed to the scientific
transformation of medicine, and the faculty was very proud to add Brown-
Séquard to its numbers. The school was so pleased to have him that it even
directed the janitor to pay “increased attention to the wants of Professor
Brown- Séquard”— namely, the care of his experimental animals. He had
the honor of delivering the opening address for the new school year in the
fall of 1866, when James reenrolled after his return from Brazil. One of his
first pieces of “Advice to Students” was to encourage them to form student
groups to reinforce new learning and debate points of inquiry. The main
thrust of his talk was to convey to students the excitement of the “complete
revolution which is now taking place in every branch of the science of medi-
cine.” He urged these beginners in medicine to study anatomy and physiology
because they offer “floods of new light . . . on the mysteries of disease, and on
the painful uncertainties of therapeutics.” Like most doctors of his time, he
knew that the mainstream profession of medicine could not offer many ef-
Between Scientific and Sectarian Medicine 89
fective remedies, but he held out hope that scientific research would change
that. He boasted of the improvements in diagnosis that had already emerged
with careful clinical work and new laboratory inquiries; referring to his
own close observation and research on the muscular and ner vous repercus-
sions of a stab wound, he proudly concluded that “anatomy and physiology
now explain easily all these symptoms.” Distancing himself from the older
clinical tradition, Brown- Séquard declared that medicine “is now begin-
ning at last to become rational, instead of being purely empirical as it was.”
The new explanatory power of medicine would incorporate and enhance
empirical research, so he counseled students to be scrupulously attentive to
facts— facts should supersede the authority of authors or of accepted theo-
ries, older explanations that had produced little improved therapy. Brown-
Séquard presented James with a model of cutting- edge science; and during
a course with the influential scientist in 1866–67, James put these scientific