Disease significantly shapes the course of history. Epidemics often prove decisive on the battlefield, depleting armies and reducing soldiers' morale. Ideas about illness and the treatments that develop commonly serve key social functions, as people try to make sense of their ailments and certain groups establish authoritative roles in health and medicine. Governing elites respond to demographic fears by creating regulatory systems to improve medical treatment and sustain a healthy and productive citizenry. During the sixteenth and seventeenth centuries the search for medicinal cures took adventurous entrepreneurs across the world. The products they brought back to Europe sparked a scientific culture, as individuals began conducting experiments in search of effective treatments and commercial opportunities. A worldwide drugs trade developed that connected far-flung locales, and laid the foundation for a global economic system. At the economic, social, political, intellectual, and cultural levels, disease and medicine play an important role influencing the development of societies across the world.

Two recent books by Elaine Breslaw and Jeanne Abrams contribute to the history of medicine by synthesizing scholarship focussed on the social and political history of health and disease in early America. In Lotions, Potions, Pills, and Medicine, Breslaw explores illness and medical treatment in the development of sections of North American society over the first three centuries of its history. Less expansive in scope, Abrams's Revolutionary Medicine focusses on the lives of five Founding Fathers and three of their wives – George and Martha Washington, Benjamin Franklin, Thomas Jefferson, John and Abigail Adams, and James and Dolley Madison. Abrams probes the connections between personal experiences of illness and their political ideas during the formative period of the American Republic. Both studies attribute the high mortality rates throughout the period to an underdeveloped medical sector with only a small number of qualified physicians; to ineffective treatments; and to multiple, violent epidemics of smallpox, malaria, and yellow fever. A common theme underscores both books: while Europe developed effective health-care systems and innovative approaches to medicine, America lagged behind until the late nineteenth century.

Synthesizing a large body of scholarship, Breslaw's informative study traces professional and informal medical practices in North America from the earliest settlements to the late nineteenth century. She focusses on the healing practices conducted by a broad spectrum of society, including physicians, slaves, and indigenous groups. This approach shows diverse experiences of illness and the varied treatments that developed in a largely unregulated medical marketplace. More could be made of the exchange of medical ideas between different groups, but this is a good summary of the wide-ranging medical ideas circulating in this context.

Case studies illuminate key themes in each chapter, while introducing fundamental debates in scholarship. For example, chapter 1 explores ongoing scholarly debates about the role of disease in causing the demographic disaster of the early European–indigenous contact. The remaining nine chapters cover medical treatments during significant events, including the smallpox epidemics in the seventeenth century, conflicts between military medical men and licensed physicians during the Revolutionary wars, and debates about yellow fever and sanitation in the nation-building period. Readers also discover changing conceptions of disease, childbirth practices, food habits, and public-health issues. This accessible study offers a solid overview of key themes in the history of early American health, most notably emphasizing the lack of advances in medical practices.

Breslaw argues that medical treatment remained ineffective throughout this period due to the failure of licensed medical practitioners to keep up with advances in European medicine. Abundant food and the formation of isolated rural communities meant that early American societies enjoyed good health. Few people sought professional medical care. While qualifications gave licensed doctors an aura of authority, the lack of patients inhibited their motivation to innovate. In Breslaw's account, they cut themselves off from scientific communities in Europe and continued to administer purging techniques such as induced vomiting and bloodletting.

As poverty grew and urbanization amplified the number of costly epidemics in the late eighteenth century, tensions appeared between licensed practitioners and the public. Increasingly, people turned to the less painful and cheaper treatments offered by those peddling natural and spiritual cures. An alternative health industry boomed. Yet the licensed practitioners refused to adapt, largely due to a stubborn and elitist sensibility. Throughout the nineteenth century Americans chose between a diversity of therapeutic options underpinned by folkloric and spiritual rationales and the ineffective brutal treatments offered by licensed medical practitioners. No scientific understanding of disease developed. American medicine stagnated.

Jeanne Abrams would largely agree with Breslaw's portrayal of an inadequate and inflexible medical establishment in her study of the diseases that afflicted the families of the first four American Presidents and Benjamin Franklin. Illuminating the diverse but ineffective medical treatments available to Americans in the early republic, Abrams underscores the weakness of the medical establishment in this context. With limited numbers of qualified physicians, groups working outside the medical establishment, such as the clergy, played important roles in advancing American science. In Revolutionary Medicine, key Founding Fathers led the charge.

Analyzing the personal letters, published texts, and political actions of her historical subjects, Abrams argues that personal experiences of illness sparked a zealous interest in medical advancement and public health. Separate chapters focus on George and Martha Washington, Benjamin Franklin, and Abigail and John Adams, and two on Thomas Jefferson, revealing that serious ailments afflicted these figures throughout their lives. George Washington, for example, suffered from smallpox early in his life as well as from recurrent bouts of malaria. Like many families in this period they grieved the loss of children. Five of Thomas Jefferson's six children predeceased him. Insights into the private worries and sorrows humanize these famous figures. The chapter on Abigail and John Adams, in particular, reveals a loving and supportive relationship and a constant concern for each other's health: “My anxiety for your welfare will never leave me but with my parting breath,” Abigail wrote to John in 1776 (119). Along with their wives, they read medical manuals and engaged leading physicians on both sides of the Atlantic in discussion. Deeply influenced by Enlightenment conceptions of useful knowledge, they experimented with different therapeutic cures on their families, and their slaves in some cases. All vaccinated their families against smallpox, a controversial measure at the time. In contrast to the conservative licensed physicians, according to Abrams, this band of national leaders stood at the forefront of medical innovation.

Their unique position as national leaders put public health-care provision and medical advancement at the heart of their political ideas and actions. With a shared belief in civic duty, they advocated national smallpox inoculations, challenged conceptions of disease held by the medical establishment, supported community sanitary measures, and emphasized public education on the importance of nutrition and hygiene. Following the devastation of the Continental Army after a smallpox epidemic in 1776, Washington ordered mandatory inoculation of all military personnel. As President, Jefferson attempted to make immunizations available throughout the country. Madison passed the Vaccine Act in 1813, one of the earliest health-care bills in the Republic. In 1798 John Adams signed into law an Act that required the Treasury to “provide for the relief and maintenance of disabled seamen” (2). This ruling established the government-subsidized Marine Hospital Service, which developed into the Public Health Service. While these actions largely failed to overturn the conservatism of the professional medical establishment, they did “lay a framework for improvements in medicine and the development of a national public health program” (32). Abrams, perhaps, overemphasizes the importance of personal experience of illness as the driving force behind the Founding Fathers' interest in public health; their republican ideals of social responsibility and the economic benefits of a healthy population seem more plausible explanations. She does, however, make a convincing case for considering the connections between their belief in the health of the individual and the health of the American nation.

These two books address contemporary debates about health care in the United States. They both highlight the importance to the nation of a professional medical establishment open to innovation. In her epilogue, Breslaw draws parallels between the medical absolutism of early American history and the current medical establishment. She suggests that while contemporary doctors show a greater degree of accommodation to alternative cures than did their predecessors, they could conduct more experiments with unconventional therapies: “The result may be an improvement in medical knowledge as experimenters investigate the possibilities of these unorthodox methods to allow some of them to become part of regular medicine, truly complementary and supportive” (199–200). Like Breslaw, Abrams finds instructive lessons in the questions raised by her study. Addressing contemporary debates about the appropriate role of government in public health, she argues that the founders would approve of providing access to health care for all Americans but not of mandatory requirements to purchase insurance. This balanced conclusion demonstrates that many contemporary debates about health-care provision resonate with the issues that preoccupied the founders.

The conclusions reached by Breslaw and Abrams aim to provoke by drawing on important national figures and events, reflecting the national framework that structures their studies. But should historians seek such direct lessons from the past? This approach runs the risk of their accounts being considered more for their nation-building capacity than for objective history. Their analysis is most powerful when exploring medical practices, experiences of disease, and the precariousness of health firmly rooted in historical context. These insights demonstrate that disease and human responses to it played a vital role in the development of early American society and the first century of the independent republic, without the unnecessary distraction of contemporary debates. As introductions to key themes in early American medical history, however, these studies are clearly written and informative.