Person:

Rosenberg, Charles

Erwin H. Ackerknecht was an influential member of that small group of largely émigré historians of medicine who professionalized their field in the United States. Ackerknecht was influenced by both contemporary social science and an implicitly political vision of social medicine. It was a vision reinforced by his work in social anthropology in Paris in the 1930s, and it is a tradition that has its own intellectual pedigree, one that can be traced back to the era of Rudolf Virchow. It was no accident that Ackerknecht wrote on the social and ecological dimensions of disease, and that he was a vigorous advocate of a powerfully felt but, in retrospect, inconsistent relativism. His emphases on everyday medical practice and on siting ideas in their social and institutional context seem prescient, a forerunner of contemporary trends in social and cultural history.

This essay outlines a contextual approach to disease (and thus medicine) in society. The work of Owsei Temkin is retrospectively evaluated and shown to rest on an assumed (if often implicit) contextualism. The key components of historical contextualism are then articulated, including the historicity of disease, the reification of specific disease categories in terms of language and social practice, and finally, in contemporary society, the value placed on diagnosis, the bureaucratization of disease, and a logically consistent focus on boundary management and boundary disputes. It is a contextualism that demands a role for the biological as well as the cultural, for practice as well as pathological theory.