Hearts of Wisdom: American Women Caring for Kin 1850-1940. (Reviews).

Hearts of Wisdom: American Women Caring for Kin 1850-1940. By Emily K. Abel (Cambridge, MA: Harvard University Press, 2000. ix plus 326 pp. $49.95).

Although social historians have documented and analyzed a wide range of American women's past experiences and activities, they have not focused extensively on the traditionally female role of caregiver within and beyond the immediate family. The central part played by women's support networks in the process of childbirth is well-known, but the function of such networks and the efforts of individual women in private, domestic health care more generally have not been analyzed. With this comprehensive, carefully researched study, Emily K. Abel has taken a giant step toward filling this gap in the social history of women, the family, and health and medicine, and she has addressed a topic of increasing importance and concern for Americans in the 21st century.

Hearts of Wisdom provides an interesting and well-developed historical perspective on the gendered experience of caring for sick and disabled family members during a period when the traditional American female role as medical provider intersected and clashed with the professionalization of medicine and the expansion of public health policies and programs. Abel argues that caregiving dominated women's lives throughout the nineteenth century. This responsibility could be burdensome and disruptive, but it could also be a source of pride and of emotional and spiritual satisfaction. Despite the fact that female caregivers consistently came into conflict with orthodox physicians who sought to discredit their efforts, women retained their authority as healers as the century progressed. While they did not necessarily lose responsibility for health care after 1890, their interactions with doctors and other medical authorities in the growing formal sector of health care changed significantly. Yet women continued to exe rcise personal agency, questioning medical advice and seeking the best care for their loved ones even while their autonomy as private caregivers gave way to the growing power of professional practitioners and public institutions.

The book is organized into two sections. Part I, 1850-1890, begins with a detailed description of the demanding and extensive caregiving experiences of an Iowa mother and daughter, Emily Hawley Gillespie and Sarah Gillespie, over the thirty-year period between 1858 and 1888. A broader overview of the traditional healing roles of nineteenth-century white and enslaved African American women follows. The first half of the volume concludes with an examination of the emerging power struggle between physicians and female caregivers, setting the stage for the analysis of change and continuity in caregiving in the rest of the volume.

Part II, 1890-1940, first describes the specific experiences of Martha Shaw Farnsworth in Kansas between 1890 and 1924 and suggests that the rise of the health care industry and other changes--new transportation and communication technologies, mass production of goods and services, electricity, gas, indoor plumbing, and store-bought foods--altered the nature of domestic healing. Subsequent chapters in this section consider the relationships between different groups of caregivers and various medical authorities. Here Abel discusses mothers' quests for advice and assistance from the Children's Bureau, from a prominent tuberculosis specialist, and from Eleanor and Franklin D. Roosevelt during the Depression. Other topics covered include interactions between public health nurses and Native American caregivers on reservations; maternal responses to social pressures to institutionalize children labeled "feeble-minded" or epileptic; and maternal efforts to conform to the tenets of oralism rather than focus on sign l anguage in rearing deaf children. The book's conclusion briefly describes the transformation of caregiving since 1940, suggests several reasons for the decline of cultural respect for this work, and addresses current policy decisions in light of the historical legacy.

This volume reflects a prodigious amount of research and incorporates a tremendous amount of material drawn from diverse primary sources and a wide range of relevant secondary sources in women's history and the social history of health and medicine. These sources include the letters and diaries of individual white women; published slave narratives and secondary literature on slavery; reports of field nurses on Native American reservations and Sioux oral histories; files and records of charity workers and government officials; and articles and correspondence from the journal of the American Association to Promote the Teaching of Speech to the Deaf. As the author notes in her introduction, insights into privileged white women's caregiving experiences emerge easily from their letters and diaries, while the experiences of poor women, immigrant women, and women of color must be cautiously inferred from reports and records--"texts of the dominant" (p.6)--in which their voices are not as clearly heard.

While this discrepancy is hardly unique to Abel's project, she applies a creative and fruitful approach to the challenging task of documenting diversity of experience in segments of society other than the white middle class. Indeed one of the book's greatest strengths is its breadth of coverage. In a sense, however, this characteristic detracts from its effectiveness as well. Despite the author's judicious and skilled efforts to summarize and generalize, both within and at the end of chapters, the sheer quantity of information and the range of topics covered occasionally distract the reader from the volume's central focus. Repetitious passages here and there also highlight the difficulty of integrating the quantity and variety of evidence.

Nevertheless, Hearts of Wisdom successfully conveys the significance and complexity of the experience of caregiving between 1850 and 1940. It captures the voices of female caregivers across the boundaries of race, class, and ethnicity, and thus it enhances our understanding of the experiences and interactions of women in different social and economic positions. We learn a great deal about their skills and expertise as nurses and healers and as advocates for chronically ill and disabled family members. Not surprisingly, while the evidence documents empathy and understanding among middle-class white women who shared the burdens associated with caregiving, we also learn that such mutuality rarely crossed the lines of class and race. Finally, we learn that although the content of caregiving and the cultural expectations and meanings attached to care have clearly changed overtime, subtle continuities link past and present in these areas. Hence this book provides a valuable historical context for the examination and evaluation of the dilemmas and issues surrounding caregiving in contemporary American society.