Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health

Studies in Social Medicine

by Keith Wailoo

This groundbreaking book chronicles the history of sickle cell anemia in the United States, tracing its transformation from an "invisible" malady to a powerful, yet contested, cultural symbol of African American pain and suffering.

Set in Memphis, home of one of the nation's first sickle cell clinics, Dying in the City of the Blues reveals how the recognition, treatment, social understanding, and symbolism of the disease evolved in the twentieth century, shaped by the politics of race, region, health care, and biomedicine. Using medical journals, patients' accounts, black newspapers, blues lyrics, and many other sources, Keith Wailoo follows the disease and its sufferers from the early days of obscurity before sickle cell's "discovery" by Western medicine; through its rise to clinical, scientific, and social prominence in the 1950s; to its politicization in the 1970s and 1980s. Looking forward, he considers the consequences of managed care on the politics of disease in the twenty-first century.

A rich and multilayered narrative, Dying in the City of the Blues offers valuable new insight into the African American experience, the impact of race relations and ideologies on health care, and the politics of science, medicine, and disease.

Genres: History, Nonfiction, History Of Medicine, Medicine, Politics, Medical, Research

352 pages, Paperback

First published March 26, 2001

Reviews

[Katie · Rating 4 out of 5]

In "Dying in the City of the Blues", Keith Wailoo traces medical knowledge and public policy response to sickle cell anemia in Memphis, Tennessee throughout the twentieth century, demonstrating the ways disease, race, and place intersect and shape our understanding (and response to) sickle cell anemia. Largely understood to be a "black" disease, Wailoo traces how sickle cell moved from the invisible to visible as medical technology and focus on childhood disease shifts. Wailoo does an excellent job at situating medical understanding of sickle cell into a larger social context - in which ideas around race, urban vs rural space, and even the political make-up of a city affects interest in a disease. Wailoo demonstrates how much factors such as race play into the response towards illness, complicating easy medical history narratives around progress and science. Throughout this book, I was missing what Roy Porter calls the "patient view" as I desperately wanted to know how individuals felt about their disease. Wailoo brings this in during the last chapter, but I would have liked to seen it more throughout. Still, an excellent, thorough, and, at times, shockingly horrible text about race, medicine, and disease.

[Sinthu Srikanthan · Rating 5 out of 5]

An excellent account of Sickle Cell Disease in Memphis, Tennessee — from a socio-cultural, historical, and economic perspectives.

I appreciate the detailed research on the influence of national and local politics as well as academic medicine.

There are many continuities of this research in other contexts.

[Alex Pulliam · Rating 4 out of 5]

Though not the most engaging of reads (it gets better after the introduction, I promise), this is an absolute must read for anyone in healthcare practicing or training in Memphis as well as anyone taking care of sickle cell patients.

[Sarah · Rating 4 out of 5]

Interesting information, but very dense. Good read to learn about Sickle cell crisis, systemic racisim and the history of medicine

[Ashley · Rating 4 out of 5]

Wailoo's "Dying in the City of Blues" presents an excellent overview of how sickle cell anemia emerged as a disease in need of political, social, and medical resources. The book focuses tightly on Memphis, TN as a site of medical developments (at St. Jude's Children's Hospital and the University of TN hospital) and unique social shifts in the mid-20th century. Although Wailoo values the role of patient voices in the clinical or political encounter, "Dying in the City of Blues" includes very few patient accounts. Instead, it traces the institutional development of research centers and charities.

Throughout the book, Wailoo emphasizes the "value" associated with sickle cell anemia. Value, in this account, has several meanings-- including social stigma or status, economic potential, research value. Wailoo suggests that various actors manipulated the shifting value of patients ("clinical material" in the dehumanizing language of medicine) to advance political or medical causes only tangentally related to sickle cell disease.

I recommend this book to readers interested in the development of America's medical system. Wailoo touches on HMOs, Medicare and Medicaid, research centers, and philanthropy. However, people interested in a more detailed study of race and health should look elsewhere. Wailoo's text assumes a fairly high degree of familiarity with health inequities, structural racism, and the Civil Rights Movement.

[Katherine · Rating 5 out of 5]

A fascinating read. I read this book because I had worked in malaria research and was familiar with sickle cell anemia as the downside of sickle cell trait, another one of those evolutionary adaptations that can also cause great suffering. I had very little understanding of the social context aside from the fact that many patients struggled to have their pain adequately treated because many sickle cell patients also fit the stereotype for someone who is drug seeking.

This book traces the disease in Memphis, from the early 20th century when it was overshadowed by the high burden of infectious disease that was characteristic of the south in general to the nineties, when it was a visible disease, and the challenges were treatments and pain management. There is a lot of interesting information on how Memphis sought to get as much federal health care money as possible, while still trying to maintain segregated facilities. The discussion of sickle cell treatment in the context of managed care is also really interesting.

Another really great feature of this book is that it is remarkably free of errors in the medical/scientific information. The only problems I found were a misspelling of Entamoeba and a reference to HLA as a substance. The latter is not inaccurate, it's just sub-optimal. I have never read a medical history or pop science written by a non-scientist book this accurate in the medical details.

[Dan · Rating 4 out of 5]

Cool approach to covering the emergence of an understanding of sickle cell anemia--Wailoo tied it to the history of the city of Memphis, particularly with respect to race relations. It ended up being a useful book about both subjects.