Healthcare in America: A History by John C. Burnham (review)

One of the more positive recent trends in academia is the more regular presence of historians of medicine, science, and technology in faculty ranks at universities and colleges across the country. The result is that course offerings in the study of disease identity, medicine, and science are not nearly as unusual as they might have been twenty years ago. As a result, there is an important need for scholarship (monographs, articles, and textbooks) that helps synthesize the broad and complex history of American medicine. John Burnham’s Health Care in America: A History will become an important contribution to this scholarship.

Burnham is a well-published scholar in the medical history field and certainly has the background to produce what was surely a monumental task of bringing the rich and complex threads of American medicine together in a single book. The book is broken down into four sections and thirteen chapters: Part I centers on the arrival of Europeans and their initial interactions with the environmental landscape and disease, as well as the depopulation of Native American groups, culminating in the era leading up to germ theory. Part II moves from the “Age of Surgery” and germ theory in the 1880s to the “Era of Antibiotics” after World War II, also focusing on the rise of physiological medicine and public health during the Progressive Era. Part III narrates healthcare in the age of technological medicine, the re-shaping of physician and patient roles by mid-century, and the slow emergence of environmental health. Part IV focuses briefly on the rise of disease identities like SARS and West Nile, and genetic medicine by the early twenty-first century.

Historians of medicine and science will immediately recognize all of the trends and themes of the book as part of the so-called traditional history of medicine. As a result, Burnham puts forth a mostly triumphalist and top-down narrative of American medicine from the seventeenth century to the present. A book that proposes to cover four hundred years of medical history cannot cover every aspect, nuance, or complication of any topic. Nevertheless, scholars outside of the history of medicine might have also benefited from this important work had Burnham provided more space for the voices of African Americans, women, Native Americans, Asians, Mexicans, and other Spanish-speaking peoples in this country. In recent years, there has been a growth of scholarship on medicine and slavery in the Atlantic World, ranging from the diseases enslaved Africans suffered aboard slaving vessels to the ways in which enslaved persons treated sick family and friends within plantation economies outside of the surveillance of whites. Importantly, recent scholarship has also extended to include the conditions of dire poverty that resulted in disease among African Americans during the Civil War and immediately following Emancipation.

Similarly, significant moments in the broader history of medicine might have included more discussion on how these trends affected minorities and women on a local level. The Flexner era, for instance, is important for thinking about Progressive Era politics and the ways in which medical education and training of physicians attempted to squeeze out and eliminate so-called unorthodox or poorly trained physicians; in the period of segregation, however, the Flexner Era also significantly curtailed the training of black physicians and women in ways that influenced health patterns for decades to come. Finally, the Hill–Burton Act of 1946, which led to hospital construction throughout the South, would also become a point of contention and legal battle on behalf of the National Association for the Advancement of Colored People, who began employing test cases to desegregate hospital facilities in the 1950s and 1960s on the argument that hospitals constructed or renovated with Hill–Burton funds applied the inherently unequal “separate but equal clause.”

Burnham hits most of the major contributions of American medicine, with some topics handled especially well. The examination of germ theory, for instance...