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Bulletin of the History of Medicine 77.3 (2003) 741-743



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Samuel W. Bloom. The Word as Scalpel: A History of Medical Sociology. Oxford: Oxford University Press, 2002. vii + 348 pp. $60.00 (cloth, 0-19-507232-4), $24.95 (paperbound, 0-19-514929-7).

Samuel Bloom considers medical sociology to be an interdisciplinary field that studies the relationship between social factors and health and illness: one of "the greatest hopes" of the founders of medical sociology fifty years ago "was that it would create a place for sociologists in a new academic role in medical schools" (p. 275). The Word as Scalpel begins in the late nineteenth century with the recognition of social determinants of health and disease and the differentiation of American sociology from other social science disciplines. During the 1920s and 1930s sociologists established academic departments and developed concepts such as social roles, organizations, socialization, and social systems, all later used by medical sociologists. The value of sociological methods was shown in the [End Page 741] 1930s reports of the Committee on the Costs of Medical Care and the Ogburn Commission established by President Herbert Hoover.

The book provides much biographical information on early medical sociologists and their intellectual progenitors and successors. The University of Chicago's department of sociology was the dominant department in the 1920s and 1930s. After mid-century, medical sociology developed at Harvard, Columbia, and Yale, where it adopted the structural-functionalist theories of the physician Lawrence J. Henderson and the sociologists Talcott Parsons and Robert K. Merton. Its closest relationships in medicine were with psychiatry, which recognized the importance of social factors in mental illness during World War II.

Federal government research agencies played a key role in the development of medical sociology, especially the National Institute of Mental Health (NIMH), created in 1946. The NIMH grouped sociology, anthropology, and social psychology into the "behavioral sciences" (p. 161). It funded social science research training and much research, including the Midtown Manhattan study of the epidemiology of mental illness. The private foundations that supported research in medical sociology included the Commonwealth Fund, the Milbank Memorial Fund, the Rockefeller Foundation, and especially the Russell Sage Foundation. They funded and provided intellectual leadership for the well-known studies of comprehensive care, socialization of medical students, and innovations in medical education. After 1980, the foundations turned to economic and political issues of health policy.

The Section on Medical Sociology of the American Sociological Association functioned for many years as the field's professional society. The semiautonomous section included anthropologists, physicians, psychologists, and social workers, and contributed to the success of the Journal of Health and Social Behavior. Over time, medical sociology moved away from psychiatry and closer to public health and preventive medicine in issues such as access to and quality of care. Since 1980, medical sociology has existed primarily in sociology departments and a few multidisciplinary centers of health services research. Federal funding for training and research has declined with the emphasis on biological mechanisms of disease. Bloom concludes that medical sociologists remain "outsiders" (p. 283) in medical institutions.

This reviewer, a sociologist, believes that the formative research in medical sociology occurred in social epidemiology. Early twentieth-century researchers such as Louis Dublin and Robert M. Woodbury identified and examined social factors related to health and disease, using testable models and quantitative methods. Most of the medical sociologists described by Bloom adopted the social factors but rejected social epidemiology and its methods. Because of their commitment to structural-functionalism, their analyses idealized physicians and their research methods were unscientific and subjective. In addition, their anxieties about being accepted by medical schools led them to ignore studies by Oliver Garceau and others that described the self-serving actions of medical societies and medical schools. As a result, much of their research was one-sided and suggested that medical sociologists were not capable of studying health policy [End Page 742] objectively. Bloom's references omit important recent scholarship. In short, this is a history of a particular school of medical sociology that...

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