Book Review

An American Health Dilemma. Vol. 1. A Medical History of African Americans and the Problem of Race: Beginnings to 1900

N Engl J Med 2002; 346:458February 7, 2002

Article

An American Health Dilemma. Vol. 1. A Medical History of African Americans and the Problem of Race: Beginnings to 1900
By W. Michael Byrd and Linda A. Clayton. 541 pp., illustrated. New York, Routledge, 2000. $35. ISBN: 0-415-92449-9

A Medical History of African Americans and the Problem of Race, the first volume of An American Health Dilemma, is an ambitious and woefully overdue magnum opus. In it Byrd and Clayton present and analyze the historical roots of the apartheid that characterizes the health care experience of black Americans. Their thesis is clear: millennia of medical injustice have caused staggering racial disparities in health care. To demonstrate this point, the authors present a sweeping chronicle of the roles of people of African descent in medicine. They unflinchingly focus on the association between health care issues among blacks and the abuses of human rights and political freedom that have plagued our nation almost from its inception.

Having divided their work into two volumes, Byrd and Clayton attack their task in prose dense with detail and studded with tantalizing stories culled from sources in history, journalism, and medicine. The first volume covers the period from antiquity to 1900; the second volume, which appeared in 2001, covers the subsequent period, up to the present. The first volume is a richly researched book that combines an authoritative tone with a perspective often missing from traditional histories of medicine. With information collected from the literature of medical history, sociology, public health, and law, this volume describes black Americans' quest for justice and equity in health care. Its title pays homage to Gunnar Myrdal's seminal work, An American Dilemma: The Negro Problem and Modern Democracy (New York: Harper and Row, 1944), which devoted a section to a discussion entitled “The Negro in the Medical Profession.” But this book also seems to be the intellectual progeny of Richard Allen Williams's Textbook of Black-Related Diseases (New York: McGraw-Hill, 1975), the first comprehensive work to call on both history and culture in an analysis of disparities in health care between blacks and whites.

An American Health Dilemma neither unearths new data nor offers a definitive or even comprehensive survey of the arguments over such age-old questions as genetic intellectual inferiority. However, the authors have done a masterly job of collecting information from disparate sources about the roots of illness and inequity. The strengths of this work are the thoroughness of the research and the comprehensive scope of coverage.

The story is presented in roughly chronological order. An American Health Dilemma begins by lifting the curtain that hides the origins of African medical science, which lie in pre–Greco-Roman antiquity. Such a beginning is at odds with the contents of most primers on the history of medicine, which often begin with a survey of Egyptian medicine but ignore sub-Saharan Africa. The first section of this volume is an overview of health care disparities from antiquity through the American colonial era. The second section then begins with the 1619 arrival of African slaves in the English colonies and proceeds through 1812, and the overlap caused by the departure from strict chronology so early in the work is a bit jarring. The third section covers the period from 1812 to 1900 and focuses on the emergence of an organized health care system and the largely untenable position of blacks within it.

The authors resurrect many of the neglected contributions of black Americans to medicine. They describe the contributions of black women in health care and recount the stories of Henrietta Lacks, the Baltimore housewife whose cervical cancer was the source of the ubiquitous HeLa cell line, and of other black women who were exploited for research or mere amusement. The authors also describe how the flawed arguments in favor of black genetic inferiority have sabotaged the health of blacks. Their scientific explanations are sketchy, but they describe in detail how such beliefs affect blacks' health.

The information presented in this book is derived heavily from secondary sources, many of which have been unjustly neglected and are not always easy to find. As a result, the bibliography is encyclopedic — rich and dense enough that it could be published independently as a reference source. For all the density of references, the authors adopt a welcome populist tone, using clear footnotes and endnotes that refer to articles in the popular literature as well as to writings in scholarly tomes.

Harriet A. Washington, B.A.
National Center for Bioethics in Research and Health Care, Tuskegee, AL 36088
haw95@aol.com