A Matter of Life and Death: Health, Illness and Medicine in McLean County, 1830-1995 (review)

Lucinda Beier argues that “the experience of McLean County [Illinois] residents during the past 160 years has illustrated national trends. The communities, neighborhoods, health care providers and individuals of this midwestern American county reflect the sweeping changes in health, illness and medical care which have occurred elsewhere in the United States and, indeed, the developed world” (p. 235). In nine chapters Beier outlines national trends along with illustrative examples from McLean county. She covers early days, physicians and doctoring in the nineteenth century, public health, patent medicines, hospital development, and nursing. She also presents aspects of twentieth-century medicine from the viewpoints of physicians and laypeople, primarily through quotes from oral histories undertaken—not by the author—during the 1980s and 1990s.

The oral histories, at least to this reviewer, contribute to an unevenness in approach to the nineteenth- and twentieth-century stories. In fact, Beier’s organization of her text makes it difficult to follow themes throughout the book’s time frame. Thus a specific chapter on “Patent Medicines and Self-treatment” closes with the 1906 Pure Food and Drug Act (though some pertinent information appears in later chapters). A discussion of the relationships between regular and irregular practitioners also stops around 1906.

This is an interesting and useful book, but it raises basic questions about the relationship between local history and the “big picture.” Local history provides opportunities to examine broad historical generalizations through the fine-grained pictures it can provide. In particular, oral history from local players can provide much fine detail, at least after questions about the accuracy of informants’ memories are dealt with. Yet Beier’s use of such history to illustrate national trends raises difficulties. Although selection and editing are always needed, her use of quotes for specific purposes leaves this reader uncertain about the context of many of the remarks.

Beier is also short on context and detail with respect to relevant happenings in the rest of Illinois. Indeed, we are not shown where McLean county is situated. Nor is consideration given to questions about, say, whether the growing power and complex politics of Chicago affected the county—albeit recognizing that Springfield is the state capital. No attention is given to possible influences from the state medical society, or to whether or not McLean inhabitants behaved as did other Illinoisians in the face of such diseases as cholera and malaria. Detail is also lacking, perhaps because of unavailable information, on such topics as the distribution of locally made patent medicines or the issue of split medical fees.

In regard to the matter of context, the book’s cover design is noteworthy: it is another to use Luke Fildes’s renowned picture The Doctor. The absence of any attribution or comment on this in the text may make the general reader, to whom the book appears to be directed, wonder why the picture was chosen, and how it is relevant to the story. Does it represent the human touch, the human frailty bound with local circumstances, that one expects from local history? In fact, these features, although present in the book, are far from conspicuous. This is partly due to the editing of the voices, to the lack of context of Illinois health care, and to the absence of interpretations of the important trends in medical care.

A reviewer should not ask for a book that the author did not intend to write, or for information that is not available. However, there is now a rich body of existing local history studies, beyond the eulogistic biographies of physicians, that offer challenges for new studies.