How the Idea of Profession Changed the Writing of Medical History (review)

John C. Burnham. How the Idea of Profession Changed the Writing of Medical History. Medical History, suppl. no. 18. London: Wellcome Institute for the History of Medicine, 1998. xi + 195 pp. Ill. $50.00 (U.S.A.); £32.00 (worldwide).

As a rule, historians are not a very introspective bunch when compared to, say, anthropologists. Most are more taken by the writing of history than by writing about how history has been written. Still, introspection is valuable, and we all should perhaps take a harder look now and again at how our craft developed. John C. Burnham does just that in investigating how one notion affected the writing of medical history: the idea of profession.

Burnham's book offers "a case study of the way in which the writing of history was affected by a systematic concept" (p. 1). He covers as well the rise of the history of medicine as a scholarly pursuit. His text and especially his footnotes brim with useful bibliographic references. While the topic itself might be narrow, Burnham's reading in several literatures is not. He draws heavily on the prehistory of modern medical history, and then ranges into general history and sociology as well, in showing how the idea of profession came to influence medical historians strongly. To historians working in the last days of the twentieth century, professionalization arguments seem to be everywhere--but Burnham shows how slow, perhaps even how reluctant, medical historians were to accept the concept.

This is a long story, reaching well back into the seventeenth century, and no short review can sketch out all the issues Burnham raises. Still, a few major turning points drive his narrative and sustain his argument--for there is indeed an argument here, and not only a chronicle, and far less a hagiography.

Medical historians who worked in what Burnham calls the "classic configuration" (biography, biobibliography, and history of ideas) were slow to see "profession" as anything more than a collective noun describing physicians; so, too, were early social historians. After World War II, however, sociologists provided new perspectives on the professions. At about the same time, one also saw the creation of a historical subfield: the history of the professions. By the 1960s and the 1970s, "systematic treatments [of the professions] in both history and sociology were available" (p. 89), although historians of medicine were by no means in the vanguard, nor did they even draw on sociological writings in any systematic manner. As a more general social history of medicine came to thrive in the same decades, it interacted with other trends to accelerate the study of professions. Historians of science, for example, stressed the difference between "internal" and "external" approaches; cultural criticisms of modern technocratic medicine multiplied; and Michel Foucault chimed in with his basically pessimistic analysis of clinical medicine. The cumulative result was that historians began to write about a process of professionalization rather than a "group of medical men." By the 1980s, medical historians were exploiting the "sociological constellation" (p. 143) and mining rich primary sources; in short, they produced, according to Burnham, a "compelling narrative of change" that utilized a "multidimensional model of professionalization [that] . . . included the ideas of both market and monopoly along with older attributes of professionalization" (pp. 143-44). This new history of medical professions went far beyond what sociologists accomplished, for instance, in criticizing functionalism and in employing historical and crosscultural empirical data.

Burnham leads us surefootedly through a maze of conflicting perspectives and sorts out a welter of information. His account is modest and principled. A list of section subtitles gives a flavor of how painstakingly he builds his case. In chapter 5 ("Medical Historians Take Over the Concept: The Late Twentieth Century"), for instance, we learn about "Reservations Among General Historians of Professions," discover the "1970s Harbingers of a Wave of New Historians of Professions...