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Journal of Health Politics, Policy and Law 29.4 (2004) 757-780



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Grand Narrative and Its Discontents:

Medical History and the Social Transformation of American Medicine

Yale University

There can be little doubt that Paul Starr's The Social Transformation of American Medicine (1982) (referred to in short as TSTAM), a study in the history of medicine, has enjoyed its most prominent success in realms outside the history of medicine (see Howell, this issue, and Jost, this issue). When the book appeared in 1982, reviews written by historians of medicine and health care acknowledged its achievement as a major work of synthesis, but tempered admiration with the repeated refrain that TSTAM—most especially in book one, which covered the period up to 1930 and is the focus of this essay—really said very little that was new. Over the ensuing two decades, moreover, Starr is nowhere to be found among the authors most cited in the medical history journal literature (Amsterdamska and Hiddinga 2004). Even works that have implicitly dealt major blows to the story Starr told have not often paused to register that fact. For example, in 1985 medical historian Ronald L. Numbers deftly pointed out that far from succumbing to a hegemonic "scientific medicine"—as Starr like most other writers had assumed—alternative practitioners in early-twentieth-century America remained a vigorous competitive presence. Yet, even though Numbers's praise (1983: 838) from his review in Science appeared on the back of the softcover edition of TSTAM—"If you read [End Page 757] only one book about American medicine, this is the one you should read"—in his 1985 essay he did not cite Starr, a pattern of implicit challenge without explicit engagement that other historians have followed as well.1 On the one hand, the book is still the best synthetic statement we have of the history of medicine in America, and in its general outline the story it tells is now part of a structuring Grand Narrative about the medical profession and the wielding of professional power that was taking shape in the 1970s. On the other hand, it is difficult to avoid the sense that, for the period of my focus here, historians have been more likely to place the book on graduate students' reading lists, or to cite it merely as a convenient source of background for newcomers to American medical history, than to grapple with its arguments in their own research and writing. Certainly TSTAM did not create a new research program in the history of medicine. A historical work that pointed to Starr's as an authoritative history might even risk the dismissive conclusion that the investigator was unaware of the more rigorous historical scholarship.

Why such apparent neglect? Synthesis envy was surely one ingredient. "In the final analysis," posited the unsigned review in Choice (1983), "virtually all medical historians would admit that they would love to have written this book." Some historians surely would contest that assertion, but most would have to admit some envy of the success that volume enjoyed. The sometimes catty informal reception of TSTAM—conversations in hallways and around seminar tables, not least of all at the university where at the time Starr was teaching—certainly betrayed some measure of jealousy. This sentiment was compounded by the fact that it was a sociologist rather than a historian who had written what was indisputably a confident, beautifully crafted, and sweeping narrative of American medicine. Starr, moreover, was a young scholar who had not paid his dues as a contributor to the institutional and professional life of the history of medicine as a field, yet he was skimming off some of the best recent historical work and making it accessible, without giving historians (who had done the hard labor in the archive) what many of them regarded as sufficient credit.

This was more than merely another episode in the uneasy symbiosis between historians and historical sociologists, however. Animating the reactions of...

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