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Book Review

 

Olson, James S. Bathsheba's Breast: Women, Cancer and History (Baltimore, MD: Johns Hopkins University Press, 2004). 302 pp, $16.95.

 
      In February 2006, the National Center for Health Statistics released fatality statistics on cancer between 2002 and 2003. Total annual deaths from cancer had declined for the first time since the NCHS had begun keeping statistics in 1930, while the death rate for breast cancer had been declining about 2% per year since 1990. Statistics like these mirror the final chapter in James S. Olson's Bathsheba's Breast: Women, Cancer and History. Earlier detection, combined with improvements in treatment, means that breast cancer was no longer an automatic death sentence and women can actually live with cancer and enjoy a relatively good quality of life. 1
    Olson begins that same chapter, however, with Jill Ireland's death in 1990 after six years of battling breast cancer to remind readers of breast cancer's devastating toll despite the latest medical advances. Her tragic story, one of dozens Olson retells, is central to the book's significance and appeal. Bathsheba's Breast stands as an important addition to the thin literature on cancer history especially because the story it tells is so personal. I studied under Olson at Sam Houston State University where he is Distinguished Professor of History. He lost his left hand and forearm while writing the book and the empathy it engendered in him for the women whom he profiles helps to make Bathsheba's Breast accessible and instructive for both specialists and students. 2
    Olson constructs a unique narrative by telling the history of cancer through individual vignettes of patients and doctors, strung together with his underlying themes of gender, power, and change. For most of history, breast cancer's victims were powerless objects treated by authoritarian male doctors whose own understanding of the disease meant a rush to destructive surgery. Portraits of women like "Nabby" Adams and Klara Hitler put under the knife by men who eagerly performed the earliest mastectomies, or who were later proponents of William Halsted's radical mastectomy, make the gender divide unmistakable. Only 70 years after Hitler's death when feminism and the sexual revolution had begun to challenge that same divide could Rose Kushner write that women should make treatment decisions for themselves because, "Our lives are at stake, not a surgeon's." (174) 3
     Surgeons and researchers, however, are just as central to the story of cancer as the patients. Olson reveals an ongoing dynamic between predominantly male surgeons and scientists whose medical knowledge gave them the power to define and redefine the terms upon which the female patient would confront her disease. His vignettes also underline how for generations the medical establishment treated breast cancer as a local disease, only recently recognizing it as a systemic disorder. This evolving consensus has had immense implications for treatment practices and in turn how women have lived through, or died from, cancer. Olson, however, always keeps the doctors rooted in their own time and reveals them to be men (and recently women like Dr. Susan Love) struggling to master an incredibly confounding and complex disease, but who are nevertheless products of their cultural biases and priorities. The mastectomy, for instance, made sense only as long as medicine believed cancer could be confined locally. As evidence slowly grew over time that it moved through the bloodstream from the beginning, less disfiguring approaches like chemotherapy and estrogen treatments assumed priority. By the close of the twentieth century patient and doctor had begun to enter into a far more cooperative relationship that centered on her quality of life, not the surgeon's eagerness to operate. 4
     Bathsheba's Breast is perhaps not the ideal text for a study of disease within the field of world history. With the exception of Olson's tale of the Persian Queen Atosa's ancient encounter with breast cancer, his examples are drawn exclusively from Western, and primarily American, history. It is difficult to judge in that case to what degree the battle against breast cancer has varied between Western and non-Western cultures. Using it in conjunction with The Cambridge World History of Disease or Sheldon Watts' Disease and Medicine in World History, however, instructors could begin to establish a comparative setting for understanding how breast cancer has been treated as well as its impact on the changing social status of women outside the West. These works would enable a discussion of how the cultural construction of gender, identity, and authority set the terms for the treatment of disease and the part of the patient. For instance, by demonstrating that the Western empirical method initially led to a treatment of breast cancer that was particularly destructive of women's bodies and self-image, Olson's work makes an essential point about medicine as a battleground for male authority and female identity that instructors should discuss across cultural boundaries. Furthermore, considering how changes in Western attitudes about sexuality and beauty transformed the treatment of breast cancer would be an entry point for discussing those attitudes in a world historical context.  5
     Yet above all, Bathsheba's Breast makes the fact plain that regardless of improvements in treatment or survival rates, breast cancer, like all disease, is incredibly disruptive. So often, Olson's vignettes begin with a woman discovering a lump while shaving or being stunned by a positive mammogram. Immediately, they too were hitched "on cancer's emotional roller coaster." Beyond the political activism, the resistance to change, and the medical advancements that run throughout the book, Olson forces readers to empathize with cancer's victims, and like the disease itself, rocks them out of their complacency.  6
Thaddeus M. Romansky
Texas A&M University

 
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