I often get asked to recommend survey books on the history of medicine, and there are many good ones, including Jacalyn Duffin's History of Medicine: A Scandalously Short Introduction and William Bynum's The History of Medicine: A Very Short [End Page 442] Introduction.1 To this list is now added Burnham's history, although it is of health care—not medicine—and is not short at 596 pages.
Health Care in America is a labor of love, in the best sense. Who among we historians are both willing and able to painstakingly review sources back to the seventeenth century, and then cover fairly dry topics such as the licensing of physicians in the late 1800s, the rise of subspecialization in the early to mid-twentieth century and the Hill-Burton Act of 1946? Burnham covers these and myriad other topics with clear writing and impressive documentation.
Organizing such a vast historical landscape is a challenge. Burnham chooses to divide his history into three epochs. The first, from the 1600s to the mid-1800s, highlights the original institutions, beliefs, and folk customs that characterized early American health care. The second epoch, from the 1880s to the 1980s, emphasizes modernization, including the growth of the technologically advanced hospital, the expansion of surgery, and the introduction of antibiotics and other curative interventions. The third epoch, from the 1980s to the present, chronicles the rise of genetic and personalized medicine, which calls into question concepts of disease that were developed in the second epoch. Within each epoch, Burnham has identified eras, further explicating change.
Surveys such as this book run the risk of becoming "great man history," a story of progress in which the role of doctors and their triumphs take too much precedence. Burnham avoids this pitfall ably. Health Care in America is solid social history, demonstrating how changes in health care occurred due to specific historical circumstances over time—and the choices that historical figures made. "The events and struggles that I describe," Burnham writes, "were not the inevitable outcome of some forces or scheme" (p. xiv).
Thus, one will find in this book, sometimes in understandably small dollops, all of the themes that professors of the history of health care and medicine want their students to know. Particularly good is Burnham's section on "Physicians, Public Health and Progressivism," which places health care firmly within a major era in American history. So, too, we read about the rise of epidemiology and how research into smoking and lung cancer helped to validate this field. There is a lot of coverage of favorite topics in the history of medicine, such as tuberculosis and typhoid fever.
Another challenge of survey books is how to cover issues such as race, gender, and class. Critics at times believe that such topics are added as appendages to a larger story of white, university-based health care. Burnham, however, tries hard not to treat these issues as peripheral. For example, he addresses the state of African-American health at several points in the book and cites well-known historians in the field, such as Keith Wailoo. Women's growing role in health care is duly noted, both as physicians and nurses but also as patient-activists. I was pleased to see a picture of the Boston Women's Health Collective, whose path [End Page 443] breaking book Our Bodies, Ourselves symbolized the entrance of both feminism and consumerism into medicine. Speaking of images, Burnham managed to get his editor to include dozens, including not only photos but cartoons and graphs. We should all be so lucky.
Perhaps the one thing missing from Health Care in America is much historiography. To some extent, Burnham's version of the history of health care reads as if it is the version. For example, in the brief section on Louis Pasteur, Gerald Geison's revisionist book on the French scientist's ethics is not mentioned.2 The infamous Tuskegee Syphilis Study, the subject of countless historical interpretations, is mentioned...