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Explaining Epidemics and Other Studies in the History of Medicine.

Explaining Epidemics collects in one volume essays spanning over a quarter of a century of Charles Rosenberg's work. Only the Introduction, the prefatory notes to each chapter, and Chapter 14, the essay from which the title of the book is taken, were written exclusively for this volume. The work is organized into three thematic parts each of which focuses on related but distinct aspects of Rosenberg's research. Part I examines the ways in which nineteenth-century Western European and American ideas about disease both reflected and created social meaning. Part II explores the complex relationship between society and the development of health and medical institutions in nineteenth century America. Part III affirms the importance of understanding the historical rootedness of both the medical system and our social response to disease if we are to meet the challenges of contemporary health care. Each essay is marked by the detailed, lucid, striking prose for which Rosenberg is known.

In the introduction Rosenberg asserts that one of the fundamental problems with the historiography of medical history since the 1960s when professional historians began working in the field is" . . . the explosive fragmentation . . . "(5) resulting from their work. This collection serves as an attempt at reintegrating studies from the work of one historian in the area. Indeed, the juxtapositioning of essays on such diverse topics does allow for insights into the parallel development of the ideas, institutions, and practices of medicine. These disparate works reveal important links among various trends in medical history, thereby illustrating the overall unity in the evolution of Western European and American medicine in the nineteenth and twentieth centuries.

By selecting essays on varied topics, Rosenberg also avoids the oversimplification which marked earlier vocational histories of medicine. In the section on medical ideas as actors, the separate chapters reinforce the point that ideas about health and disease result from social negotiation, rather than simply arising from either the ignorance or the self-interested rationalization of physicians. He rejects the tendency to see these ideas as antiquated and wrong, calling on his readers to begin ". . . taking ideas seriously, no matter how alien and even inconsistent they may seem . . . ." (90) Part two takes us from the cultural meaning of ideas to the ways in which the urban/industrial nexus was essential to the evolution of both ideas and practices in medicine. But this link is never presented as unicausal or unidirectional. Rather, by leading the reader through general practice, the establishment of medical institutions, to the practice of one man, Rosenberg shows the interdependence of society and medicine in the nineteenth-century northeastern United States.

In terms of historiography, Rosenberg's selections consciously provide his readers with a map to the career of one historian of medicine. The introduction and the brief prefatory notes to each chapter engage the reader in tracing the development of one historian's insights and interests. We are told why and under what circumstances most of the essays were written; the importance of contemporary medical problems in the questions historians ask is particularly salient in the final section of the work where Rosenberg examines the role of psychiatry, the impact of AIDS, and the hospital crisis.

A chronological reading of the essays reveals important changes in the academy, as well as in the history of medicine. For example, earlier essays use gender-exclusive language and do not contain much attention to the presence of women (aside from Nightingale) in the medical establishment. But Chapter 16, written in 1990, uses generally inclusive language and incorporates recent studies of the role of nurses in the institutional history of hospitals. The volume provides students of the academic enterprise with a microcosm for examining the evolution of the profession in the last half of the twentieth century.

However, the multi-dimensional character of the book may also be its major weakness. First, each essay originally was written with a specific audience in mind--practicing physicians, historians of medicine, the reading public, medical reformers, and academicians in general. Rosenberg asserts in the introduction that this volume is intended for both an academic and a general audience, but little has been done to alter the original works to specifically address that audience. As a result the work as a whole does not seem to meet the needs of any particular audience, aside from those interested in the work of Charles Rosenberg.

Additionally, while the final section does indeed begin to pull some of the strands in each essay together, most of the integration of ideas from each chapter is left to the sophistication of the reader. Essays are organized thematically rather than chronologically. Even within the first section, the chapters are out of order in terms of the dates at which they were written. Little editing was done within essays to link them together. As a result some ideas or points get repeated in almost every essay. Those already familiar with the nineteenth-century idea that disease is the result of disequilibrium within the body and between the body and its environment may find the introduction of this point in almost every essay rather tedious. While Rosenberg has culled excellent articles from his prolific career to create this volume, a more ruthless editing style would have made for a tighter, more forceful argument.

That said, I find the greatest value of the work in the final section where Rosenberg takes the sagacity he has gained from his long study of the history of medicine and applies it to the problems of contemporary medicine. This section illustrates, as nothing else I have read, the rootedness of the current health crisis in the American past. For example, he demonstrates that our response to AIDS cannot be understood apart from the general disease history of the twentieth century and the historical response of our society to epidemics. He depicts the ways in which the current flaws in the U.S. system of hospital care arise from the imperatives of early twentieth-century medical science and practice. He sounds a clarion call to all those interested in health reform to take into account the past, since it is indeed always with us. This section clarifies why it is vital we understand the evolution of nineteenth and twentieth-century medicine and its multifaceted relationship with society. Without that understanding no government task force, no matter how well intentioned Ms. Clinton, will be able to make lasting change.

Jacqueline S. Wilkie Luther College
COPYRIGHT 1994 Journal of Social History
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Copyright 1994, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Wilkie, Jacqueline S.
Publication:Journal of Social History
Article Type:Book Review
Date:Dec 22, 1994
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