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Reviewed by:
Lee Anderson. Internal Medicine and the Structures of Modern Medical Science: The University of Iowa, 1870–1990. Ames: Iowa State University Press, 1996. xxix + 326 pp. Ill. $49.95.

As we near the end of the twentieth century, the history of many basic structural elements of the health-care system remains unexplored. One important part of that structure is large, research-oriented academic medical institutions. Within these new creations of the latter half of the century, departments have come to dominate the landscape as never before. Of those departments, perhaps none have been so powerful as departments of internal medicine—in large and rich medical centers, usually the largest and often the richest department, and certainly one of the most important in shaping the structure of health care, educating its practitioners, and using plentiful research funds to create new knowledge. However, contrary to what one might surmise from a cursory scan of the medical history literature, not all of those institutions were located on the Eastern seaboard. Thus, this well-written volume describing the rise of the University of Iowa Department of Internal Medicine “sprung improbably from the cornfields” (p. xxiii) to national prominence will be read with interest, not only by current and former students of that institution, but also by scholars of twentieth-century medical history wishing to broaden their knowledge of that topic to include the central regions of the United States.

This systematic history makes good use of archival manuscript material to create a readable narrative of the department over the years. The author is attuned not only to scientific developments but also to social themes, such as concerns about gender balance in the department, and the attempts of leaders to achieve some measure of religious and ethnic diversity in the heartlands.

The volume was commissioned by the University of Iowa Department of Internal Medicine, apparently with the additional financial support of the state medical society and the pharmaceutical industry. While this is an excellent history, such sponsorships must be noted with caution, for at least two reasons. One is the possibility that the source of support could constrain the scope of topics or define the analytic frame of the historian. How free is a historian in such a situation to write a negative assessment of the subject? The second, more subtle, and possibly more dangerous reason is that we could wind up with histories of strong departments and not of weak ones, of survivors rather than those that did not survive.

Joel D. Howell
University of Michigan
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