Concepts of health, wellness, illness, injury, and disease have evolved since antiquity. At issue in Dale L. Hutchinson's American Health and Wellness in Archaeology and History is how that evolution has influenced health care provided by practitioners in domestic and institutional settings, and how that evolution has influenced concepts of wellness among patients and communities.
Homo sapiens sapiens, both on an individual and aggregate basis, has striven for survival, health, and wellness throughout its existence, utilizing both preventive regimens and therapeutic remedies. Those regimens and remedies did not evolve in vacuo, because they have been influenced by biological, psychological, ecological, and environmental factors and processes.
The author is professor emeritus at the University of North Carolina in Chapel Hill. His experience as an adolescent assisting in the pharmacy owned by his parents and his formal education in bioarchaeology, human osteology, forensic anthropology, and agriculture/nutrition/health provided the milieu for his scholarly endeavors, with specific interests in their manifestations in the eastern coastal regions of the United States.
Hutchinson's book summarizes transformations of health-care systems and perspectives regarding wellness along the Eastern Seaboard of the United States from 1600 to 1950. His arguments derive from several archaeological analyses of material culture and osteological specimens and numerous primary and secondary historical documents.
Trends in American health care and wellness, as in the human condition, have been nonlinear. Hutchinson argues that those trends are “meandering, popular, and culturally bound phenomena” (p. 4). His analyses are stratified topically and chronologically by stages, and his insights are both descriptive and analytical.
Stage I (Colonial Years, 1600–1750) is characterized by the commingling of the philosophies and traditions of Indigenous Native American, African, and European cohorts—including their respective native pharmacopoeias, religious and spiritual practices, and informally educated practitioners, such as shamans and midwives.
Stage II (Medical Specialization, 1750–1850) encompasses the earliest format of medical education in the United States, in which expertise was acquired by domestic experiences or apprenticeships within a community. University-educated European physicians were rare, and they practiced predominantly in urban locales. Disparities of health care occurred because of the stratification and tension among those practitioners, and also because of the socioeconomic stratification of the populace in a burgeoning mercantile economy. Almshouses and state hospitals emerged for the care of the destitute and the homeless, but they proved to be wholly inadequate, which amplified public distrust of the entire health-care system.
Stage III (Reformation of the Health Care System, 1850–1900) occurred, ironically, as a consequence of the US Civil War (1861–1865), which necessitated the care of ill and injured soldiers. Dramatic reforms of hospital architecture; medical, surgical, antiseptic, and anesthetic regimens; and concepts of sanitation and hygiene emerged in both military and civilian settings. More specifically, the imperatives of clean water, healthy ventilation, and proper disposal of biological waste (n.b., p. 116, 18 euphemisms for “toilet”); a scientific understanding of infectious diseases; and the development of specialized hospitals to care for patients with infectious diseases and psychiatric illnesses were accepted and implemented.
Stage IV (Health Care and Wellness, 1900–1950) was noteworthy for continued reforms that were evermore formalized, institutionalized, and technologically advanced; continued tension between specialist and nonspecialist practitioners, vis-à-vis educational attainments, licensure, certifications, regulations, competence, and expertise; persistent disparities of health care among the populace; and increased emphasis on personal responsibility of individuals for their health care and wellness. The latter marked a trend toward direct-to-patient consumerism via marketing of proprietary medicines, many of which contained alcohol and/or opium derivatives, specialized diets, nutritional and vitamin supplements, exercise regimens, enrollment in health clubs, and reservations at spas or mineral water resorts.
This overview by Hutchinson through the lenses of archaeological analyses and historical documents substantiates his main thesis that American concepts of health care and perspectives regarding wellness were influenced by not only biological, psychological, ecological, and environmental factors but also ethnic, economic, religious, sociopolitical, legal, and cultural ones. The succinct table of contents, the well-captioned figures, the numerous references cited, and the well-organized index superbly complement the text.
I have one disagreement with the author. In the subsection entitled “Tuberculosis Sanatoria” (pp. 142–145), Hutchinson vividly describes a specialty hospital. However, the causative agent of tuberculosis is not a spirochete. Rather, it is a filamentous rod-shaped bacterium, Mycobacterium tuberculosis (family: Mycobacteriaceae).
Finally, you and I will inevitably experience illness, injury, and disease during our mortal existence, and we will all require domestic or institutional health care to restore us to health and wellness. Hutchinson aptly places the contemporary American health-care system into a very relevant and germane historical context, given that the current health-care system emphasizes personalized and patient-centric care, the bio-psycho-sociological determinants of health and disease, the imperative of health-care equity, and the mitigation of pandemics. I applaud Hutchinson for this lucidly written and fascinating book, which will be of substantive interest to aspiring students and established professionals who serve as physicians; nurses; dentists; historians, ethicists, and philosophers of medicine and science; and archaeologists and anthropologists who study the historic and modern world. As George Santayana, Spanish-born and American educator, philosopher, and poet has argued, “Those who cannot remember the past are condemned to repeat it” (The Life of Reason, 1905).
