Victorian Lunacy: Richard M. Bucke and the Practice ...

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functions epistemological reorientation served for a profession seeking to consolidate its legitimacy, prestige and authority" (p. 39). His editors also let down the author and his reader, who wades willing but baffled through the verbal plethora, by the unfortunate accident that the indexed page numbers for all reference notes are out by two. On the other hand, this reviewer found that Warner's diction and constructions, though difficult, are a delightful reflection of the century he studies, and his excellent use of quotation adds welcome color and humor. The issues he addresses are not simple; the explanations are necessarily complex. What Warner has to say makes sense and more than repays any effort to understand. It is ironic that Warner accepts as a given Ackerknecht's delineation of French therapeutic "skepticism" and uses it over and over again as touchstone and contrast for his portrayal of American practice. Ackerknecht based his conclusions on a thorough reading of textbooks and journals. A few scholars, like Madame Lydie Boulle, are only now beginning to explore the wealth of French hospital and private clinical records. Ackerknecht may well have been right about gallic "skepticism," but we will not know with certainty until others are inspired to accept this bold challenge and do for France what Warner has done brilliantly for the United States. JACALYN DUFFIN

Queen's University

Victorian Lunacy: Richard M. Bucke and the Practice of Late Nineteenth-Century Psychiatry S. E. D. Shortt Cambridge and New York: Cambridge University Press, 1986, 207 p., $29.95 (U.S.) R. M. Bucke (1837-1902) was medical superintendent of the London Asylum for the Insane from 1877 until his premature death in 1902. In many respects an average practitioner of late nineteenth-century mental medicine, Bucke distinguished himself from his colleagues on several counts. As the friend and biographer of the American poet Walt Whitman, his name has retained familiarity amongst literary historians. As expositor of a doctrine of the evolution of consciousness, Bucke is also widely known as the author of Cosmic Consciousness (1901), which, as recently as 1975, was translated into German. Finally, Bucke attained local notoriety towards the end of his career for his pursuit of a series of gynecological operations amongst asylum inmates. However, it is more for what is ordinary or average in Bucke's thought and career that his present biographer has undertaken this study. The stated intent of the book is to use Bucke's career to illustrate the central tendencies of psychiatric thought at the end of the nineteenth century, and thereby isolate the constraints on and sources of Bucke's own actions. Chapter one recounts Bucke' s early life and medical education at McGill and in London and Paris, where he studied under a number of eminent British and French specialists. In 1863, Bucke returned to Canada to take over his deceased CBMH/ BCHM I Volume 5: 1988 I p. 196-98

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brother's medical practice. He remained a general practitioner until 1877 when, through the good offices of his poker partner, the provincial secretary, he was named asylum superintendent. As an administrator, Bucke became thoroughly enmeshed in the details of asylum management, leaving therapeutic innovation to be imposed from above or generated from below. Alienated from his staff, envious of his colleagues and aloof from his patients, Bucke was nonetheless an able asylum manager. Certainly, his cure rates were no worse than other Ontario or foreign asylums. Bucke's creative energy, it seems, was directed more towards intellectual pursuits, namely the cultivation of a physiology of mind which was presented in two books: Man's Moral Nature (1877) and the aforementioned Cosmic Consciousness. Poorly received, the first book advanced the claim that human morality had evolved along lines parallel to its somatic support, man's moral nature being embedded in the sympathetic nervous system. According to Shortt, the most important sources for Bucke's attempt to find a physical basis for the moral aspects of life were Alexander Bain's association psychology, W. B. Carpenter's physiology, and Auguste Comte's philosophy of science. Despite appearances, Bucke's view of moral life was not one of physical reductionism. As Shortt emphasizes, Bucke's vision retained the optimistic notion of redemption-namely, lower moral natures could be raised through poetrywith which Bucke had become acquainted during an early association with the protestant cult of Universalism. Derived from a variety of nineteenth-century doctrines, Shortt estimates the significance of Bucke's first work to lie in its exemplification of a larger trend of secularization of physiological thought. The upshot of this development was to be the mobilization of "the authority of biomedical knowledge to an expanding range of social situations" (93). In Cosmic Consciousness Bucke pursued his evolutionary physiology of Inind, proposing that humanity had evolved a form of insight that went beyond self-consciousness to an understanding of the order of the universe. Although this mental faculty was restricted to a few outstanding individuals-notably Walt Whitman-its generalization was inevitable and was to lead to happy days. To prq.vide a context for these thoughts, Shortt makes a number of detours before concluding that the book represents an attempt to extend medical psychology's authority to the unconscious. This attempt, in part a consequence of the above-mentioned secularization, was, according to Shortt, provoked by the late nineteenth-century rise of spiritualism and its challenge to "neuroscientific orthodoxy." To meet this challenge, "psychiatry was forced to incorporate a new view of a dynamic unconscious, potentially at odds with the traditional notions of the primacy of the will" (123). The fifth and final chapter of Shortt's book is devoted to Bucke's therapeutic attitudes and experiences. Here, as Shortt points out, Bucke was at the mercy of both local and international influences. Shortly after his appointment as asylum superintendent, Bucke launched a surgical attack on masturbatory insanity, following a Scottish technique. The failure of the operation left Bucke a therapeutic pessimist until the 1890s. He was nonetheless capable of change. Initially suspicious of the doctrine of non-restraint, Bucke was ultimately convinced of its utility by the Asylum Inspector and his own medical assistant.

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Bucke's most daring experiment in therapeutics, his gynecological operations, seems to have been initiated by yet another of his medical assistants, Dr. J. T. Hobbs. Beginning in 1895, the two physicians submitted several hundred women to a variety of surgical procedures including dilation, cervical amputation, and hysterectomy. Although diagnosis and choice of procedure were based on physical examination, it was subsequently claimed that the operations had secured improvements in mental status. While Bucke and Hobbs were quite pleased with the results, Shortt, through a statistical analysis comparing the surgical population with a group of female inmates of similar age, concludes the program was a failure. A similar verdict was reached by Bucke's contemporaries. Seeking a rationale for what even then appeared somewhat idiosyncratic, Shortt suggests that Bucke was merely reacting to asylum psychiatry's threatened status as a medical discipline. According to Shortt, given the asylum's low rate of cure at the end of the century, asylum physicians were induced to cast around for whatever therapies were at hand in order to boost sagging figures . In Bucke's case, recent advances in gynecological surgery provided the opportunity; the motive, "professional aspirations," was already present. As previously mentioned, Shortt's biography of Bucke is also intended to be an analysis of late nineteenth-century Anglo-American psychiatry. Such a combination of objectives has its advantages as well as its disadvantages. Against the medical and philosophical background provided by Shortt, Bucke's movement through the last quarter of the last century takes on a coherence not likely to have been provided by a less ambitious biographer. In the process, however, nineteenth-century medicine and philosophy get short shrift. Much is uncritically affirmed from secondary sources and, no doubt because of the need to cover such vast territory in such a short space, the argument is too often couched in terms of "parallels," "resonances," "congruencies," and "consistencies." While it is clear how Bucke conformed to the nineteenth century, one suspects that, in this biography, much of the nineteenth century has been adapted to Bucke. PETER KEATING

Concordia University

Les historiens frans:ais de la medecine aux XIXe siecle et leur bibliographie Isabelle Wohlnich-Despaigne Paris: Libraire philos. J. Vrin, 1987, 423 p. Voila un livre essentiel, reflet d'un travail considerable. 7 471 titres y sont recenses, de !'in-folio a la plaquette, faisant surgir des ouvrages d'importance et d e qualite diverses. Et c' est ce regroupement, dans son heterogeneite qui est remarquable car, comme y insiste Pierre Chaunu, dans sa courte, mais enthousiaste preface, se trouve ainsi constitue un corpus qui «vaut, au-dela de chacune des pieces de I' edifice, par !'architecture de I'ensemble». CBMH/BCHM I Volume 5: 1988 Ip. 198-99