All too often, histories of the American founders focus on the heroic and the lofty, as though the day-to-day experiences of these mortal human beings were not also comprised of deeply felt struggles with health and sickness. Jeanne E. Abrams sets out in Revolutionary Medicine to offer just such a recasting. Her presentation puts familiar characters – the Washingtons, Franklins, Adamses, Jeffersons and, to a lesser extent, the Madisons – in a new light. Many of the major medical questions of the day are engaged here, from excruciatingly high miscarriage and neonatal death rates, to struggles with disease in an age of poor hygiene, especially malaria and smallpox.
Readers will take several major themes from Abrams’s narrative. They will be struck by the centrality of dentistry to general health, a centrality still unheeded in post-health care reform America. Abrams reminds readers that even the brightest among us can get caught up in medical fads – bloodletting chief among them for the founders – much to our detriment. The difference, for Abrams, is that the founders were committed to the spirit of science, ‘though unfortunately many of their advanced ideas were lost over the next several decades’ (31). Such a commitment, she suggests, facilitates national progress. This theme is especially resonant to the contemporary ear in Abrams’s detailed depiction of early debates about vaccination.
Abrams wishes to set public health as a cornerstone of civic-mindedness. She notes, for example, that ‘The founders were witness to the fact that epidemics not only brought personal devastation to individuals, families, and communities; they also played havoc with commerce’ (3). Abrams’s narrative concludes, appropriately, with Jefferson, who spent much of the end of his life envisioning medical education in America, culminating in the establishment of the University of Virginia. As Abrams notes, however, Jefferson’s concern was not only the development of a medical profession, but the training of ‘laymen with a good understanding of contemporary medicine …that would enable them to make more informed decisions about treatment for themselves and their families and provide them with the tools to lead a healthy lifestyle’ (223). Jefferson’s politics and his views of medicine were intertwined. Abrams’s discussions of the role the men played as statesmen, and their wives as homemakers (which included medical care), offer readers rich detail. And one cannot help but marvel at how far we have come – especially with reducing infant mortality – at least for some Americans with access to the best care.
Abrams makes clear that for these founders, medical progress, and the distribution of its fruits, were measures of the new nation’s success. At the same time the book’s scope raises questions. First, focusing as she does on a limited selection of elite subjects, Abrams does not offer readers a full picture of the book’s larger promise of chronicling ‘revolutionary medicine.’ For example, one could quibble with Abrams’s selection of ‘Founding Fathers and Mothers’ and ask why these figures should be the focus aside from the fact that they are the most famous figures of the era. This introduces a degree of class bias that undermines the book’s larger project. Abrams notes, for example, with the death of the Adams’ son, Charles, that ‘illness and death were a constant factor in the daily lives of people from all walks of life during the era, and the well-to-do and powerful were far from immune’ (158). Similarly, Abrams fails to discuss the medical care afforded slaves (with the exception of Jefferson’s decision to vaccinate his) and the health of non-elite rank and file soldiers who fought in the revolutionary war. Given the extraordinary role wealth – as well as race–plays in access to healthcare, one can profitably read Abrams’s text specifically for its elisions of inequality.
Second, we might applaud Abrams for steering clear, for over 200 pages, of the shark-ridden waters of contemporary health care reform. Yet, in the final pages she could not keep up her resistance. Here, small things may matter. For example, Abrams refers to the Patient Protection and Affordable Care Act (ACA) as ‘the Affordable Health Care Act,’ not only not the ACA’s correct name, but possibly an allusion to the GOP’s 2009 House draft bill of that name which never became law. More problematically, in the final passages, after noting the founder’s civic-mindedness and interest in public health, Abrams claims that the founders would have ‘balked’ at the ACA’s mandate to purchase health care. While this might be true, the claim is worthy of discussion. After all, as Abrams shows, the founders were also pragmatic men plugged into the science of their day. They loathed anachronism. Assessing the founders’ views of the individual mandate (which is designed to minimise free-riding and moral hazard) would require situating those views fully in contemporary America, with its large population and economic complexity, as well as the extraordinary cost and technological sophistication of medical care itself. One can only guess how context would inflect their civic mindedness. It is too bad that Abrams does not engage with this question more fully.
Taken within its scope, however, Revolutionary Medicine achieves its aim. Those interested in adding to their understanding of the most famous American founders will benefit from Abrams’s focus on medicine. Public health scholars interested in this history may want more, however. Accordingly, they could use Abrams’s text as a starting point to undertake a more expansive study of what the American political tradition teaches us about the intersections of medicine and politics, and the interrelations of liberty, public health and civic obligation.
