Abstract

This work is the first volume of a projected two‐volume examination of the black experience with the practices and institutions of Western medicine from its earliest beginnings to the end of the twentieth century. As a reference source, W. Michael Byrd and Linda Clayton's history is certainly valuable: its thirty‐page bibliography and nearly one hundred pages of notes offer a rich field of information for anyone who wants to know the “what” and “how” of the intersection of black history and Western medicine.Still, after having read the book, I have more questions—about the work itself: its purpose, its intended audience, and the apparent lack of editing . Further, in a quest for completeness Byrd and Clayton tend to introduce material that, for me, slows their story more than it advances what I believe is their central argument: that difference has a way of becoming deviance, which then produces long‐term consequences for those not a party to the original decision; that it becomes institutional racism.In their preface Byrd and Clayton explain how the book came to be; in the introduction they describe what it is intended to accomplish. Their principal objective, they say, was “to perform a history‐based descriptive and structured analysis of the U.S. health system from an African American perspective,” a point they will repeat elsewhere in a slightly different guise. Such an analysis is necessary, they argue, because although the American public has become more aware of the national crisis in health care and of the need for major reform of the health system, too many commentators appear to have overlooked the “older, more ominous, culturally driven health crisis afflicting African American and other poor populations” . To some extent this crisis “can be explained on the basis of a medical‐social culture hundreds of years old that is heavily laden and burdened by race and class problems compounding continued social and economic deprivation.” This contention is followed by a list of assumptions, beginning with “Poor health status and outcomes for Blacks and the poor are ‘normal’ and acceptable” and ending with “Racially and ethnically divided health professions have factions that are often contentious, conflicting, and contemptuous of each other.”In the introduction, too, Byrd and Clayton describe both the topics the book will cover and the many sources they consulted to substantiate their historical and structured analysis. The materials included and the need for close editing of the entire text leave one wondering who will read this book and what they might derive from it. Still, it is a thorough effort from start to finish.The book first undertakes “a history‐based examination and evaluation of the U.S. health delivery system from an African American perspective.” Second, it reassesses “the relationship between the medical profession and issues of race and racism in Western culture and the United States.” Third, it evaluates the impact of race and racism as key variables that must be factored into the complex equation necessary to resolve the “American health dilemma.” Fourth, the book offers “a series of explanatory hypotheses that clarify and help explain the results of the ongoing relationships between race, the biomedical and other life sciences, health, and healthcare delivery in the United States from their ancient Afro‐European beginnings” to 1900. The remainder of the book is divided into three sections: background, “Race, Medicine, and Health in the North American Colonies and the Early U.S. Republic,” and “Race, Medicine, and Health in the United States from 1812 to 1900.”The background section provides a reassessment of the relationship between race, biology, and health in the United States and establishes the groundwork for the remainder of the book—though the information on the evolution of race, science, and medicine in Western culture is perhaps more than the average reader can comfortably digest and assimilate. Part 2 and a portion of Part 3 track the health‐care experiences of Blacks under slavery and their importance in the evolution of a dual health system that will become more rigid with time. The balance of Part 3 reviews black health care and the evolution of health policy and practice alongside the maturation of the medical profession after the collapse of the peculiar institution to the end of the nineteenth century.Although health care for black people did improve after the Civil War and Reconstruction, African Americans and the poor in general still experience a kind of differential access that has been exacerbated by the fee‐for‐service system—that the system is not equal and is still bedeviled by prejudicial attitudes and discriminatory behavior left over from days gone by is a given. The question that remains is, How do we improve it? Clearly this book, despite its flaws, is a step in the right direction. By providing a historical overview of how things evolved to be the way they are, the authors also provide insight into how to correct existing conditions