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Explaining Epidemics and Other Studies in the History of Medicine.

The history of medicine was once the sole purview of physicians writing for other physicians. As such it was the chronicle of discovery and success where knowledge gradually but inexorably supplanted superstition. Only physicians were endowed with the knowledge and compassion necessary to understand and write about the special doctor-patient relationship. Charles Rosenberg has helped change all that. Explaining Epidemics represents three decades of Rosenberg's scholarship on the history of American medicine. His stated purpose is to "make sense" of the present semipermanent crisis in American health care system (especially in hospital organization and the AIDS epidemic) using historical precedent and example.

Rosenberg's fundamental theme of the "integrative" quality of the history of medicine sees the origins of medicine in the social response to the unchanging realities of pain, death, childbirth, trauma, and the life cycle. Change in medical ideas and practices can be judged against this baseline. It is in that social response that historians are able to study relationships between social thought and social structure in a particular place and time. But, as Rosenberg argues, our perceptions of, and reactions to, illness and epidemics are as ancient as disease itself.

Explaining Epidemics is divided into three sections. The first two sections form the base with a discussion of the ideas, institutions, and the practice of medicine in the nineteenth-century. For those familiar with Rosenberg's work the articles in these sections present nothing new. But for anyone attempting to understand such diffuse topics as nineteenth-century therapeutics, the rise of the general hospital, or Florence Nightingale's influence, these sections are invaluable. Student and specialist alike will benefit from having "Rosenberg" all in one place.

Rosenberg asks not if the nineteenth-century therapeutics of purges, emetics, and cathartics "worked," but rather he asks why patients and physicians believed they might. He finds in nineteenth-century American society a shared belief between patient and doctor in the ideas of disease causation and cure. The "revolution" in therapeutics came with the ascendance of science and the laboratory at the end of the century, a reflection of an increasingly secular society. Medical knowledge became specialized; the shared belief became a faith in science itself. One of the implications of this change can be found in the emergence of hospitals. From their humble beginnings as almshouse and repository for the unwanted and "dependent," the hospital was transformed by the needs of the medical profession into its present form as an acute-care-oriented institution. As Rosenberg states, the monitoring of particular organs has become the responsibility of specialists, "the patient constitutes a residual category" (p. 273).

In section three of Explaining Epidemics Rosenberg uses current examples from our experience with AIDS and the problems of hospital organization to develop an ecological approach where medical knowledge and practice are interdependent and interactive. His discussion of some of the themes in the history of medicine is valuable for both the general reader and specialist. The reductionists of the 1930s and 1940s, best exemplified by Henry Sigerist, saw medical knowledge as a tool and rationale for social intervention. Disease was the consequence of social and economic inequality; "social medicine" reflected an optimistic faith in science and medicine to cure society's ills. (It is worth noting that in 1944 Sigerist headed the Health Services Survey Commission [Sigerist Commission] that laid the foundation for the Saskatchewan C.C.F. government's health programs culminating in universal health insurance nearly twenty years later).

Much of the optimism of social medicine was displaced in the 1960s by the delegitimizing tools of cultural relativism that saw the physician as a social actor whose role in defining and treating disease could be used to legitimize professional, class, or gender interests. Foucault and his students declared that disease does not exist, only practices exist. Rosenberg sees the problems of the de-institutionalizing of the mentally ill as one of the implications of this trend. But, according to Rosenberg, these are monocausal explanations that fail to grasp the fundamental notion that it is in the process of defining disease, naming it, that we must look to find its social impact. For example, does the diagnosis of premenstrual syndrome liberate or enslave women?

Rosenberg argues that it is the AIDS epidemic that has brought us into the postrelativist age. AIDS is not just a device for labelling deviance, but a biological fact. But it is cultural as well: value-free medical terms such as "risk" can easily be seen as guilt, sickness as punishment. The AIDS epidemic has also brought us to acknowledge the ancient rite that is an epidemic. Coping with the randomness of an epidemic provides an opportunity to reassert social values, and to blame the victims: "The desire to explain sickness and death in terms of volition - of acts done or left undone - is ancient and powerful" (p. 274).

Explaining Epidemics might spark criticism by historians for its journalistic aspects, or for its attempts at relevance. Those very qualities will, however, make it available and appealing to a wider audience. There is a place for Explaining Epidemics among a generation that, until AIDS, has never witnessed or experienced an epidemic; indeed, a generation that was raised in the faith that such a thing could never happen.
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Author:Lux, Maureen K.
Publication:Canadian Journal of History
Article Type:Book Review
Date:Aug 1, 1993
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