Health Culture in the Heartland, 1880–1980: An Oral History (review)

In Health Culture in the Heartland, 1880–1980: An Oral History, Lucinda McCray Beier takes a "regional case study" (p. x) approach to present the diverse history of over a century and a half of health care culture in McLean County, Illinois. McCray Beier's familiarity with the growing body of literature on region and health seems limited, but her study fits well with the work of other scholars who recognize the significance of regional developments to health care history, such as Ronald Numbers, Megan Davies, and Sandra Lee Barney. McCray Beier traverses a fair bit of geography in the book, usefully covering both urban and rural landscapes. The omission of a map to situate McLean County is somewhat perplexing.

As important as "place" is to McCray Beier's analysis, "voice" is really her focus. Drawing extensively on oral history accounts, McCray Beier successfully personalizes and humanizes the experiences of sufferers, informal caregivers, and medical professionals. To her credit, McCray Beier pays close attention to the methodological challenges of using oral histories (such as the potential role of memory in their creation) and throughout the book, other textural sources are interwoven with oral sources to support key analytical points. The quotes are interesting and illustrative, most particularly in the chapter that deals with the experiences of the people—McLean County residents. Unfortunately, at times the placement and use of long block quotes is extensive and somewhat tiring for the reader. The eighteen photographs provided in the middle of the book are a welcome inclusion, although it is telling that all but one of the photographs are clearly related to institutionalized and professional medicine. The seventeen visual pieces of historical evidence do not support McCray Beier's desire to replace the "formulaic account in which doctors occupy center stage, other care providers are invisible, and 'patients' are passive beneficiaries of professional expertise" (p. xi). Indeed, as the table of contents reveals, the monograph could be judged more formulaic than innovative in structure. Four of the six chapters are devoted to the rise of public health, hospitals, nursing, and the medical profession. As McCray Beier confesses, "resource limitations" (p. xii) mean that the stories of doctors, nurses, and lay practitioners dominate in the study. A later chapter finally gets at the "heart" of health culture in McCray Beier's heartland. In it, McCray Beier is able to mine the oral histories of residents to tell a more original and engaging story than is provided in the earlier chapters. Although it is in places more descriptive than analytical, in the tradition of Emily K. Abel and Sheila Rothman, this richly detailed chapter contributes to our understanding of individual and family experiences of birth, illness, and even death. Covering one hundred years of health care history is an ambitious undertaking. In the end, McCray Beier's study provides more evidence that the history of health care is enriched by studies that recognize the importance of place and that pay attention to a multiplicity of voices and perspective situated within the historical landscape of community health cultures.