The Empty Cradle: Infertility in America from Colonial Times to the Present.

The Empty Cradle: Infertility in America from Colonial Times to the Present is a welcome addition to a historiography which, until very recently, lacked any serious studies of infertility in America. Marsh and Ronner present "a history both of the ways in which Americans have experienced infertility and of the ways in which medical practitioners have diagnosed and treated it." (p. x) Marsh, a historian, and Ronner, a physician, have combined their expertise to explore noteworthy physicians, medical-technological achievements and treatments, as well as how American couples have dealt with the inability to bear children. The Empty Cradle, therefore, provides two perspectives on the history of infertility in America. The book's strength is that it offers an excellent overview of the development of infertility treatment in medical practice as well as an analysis of infertility within a cultural context. Further, Marsh and Ronner also address how couples adapted to their infertility by including discussions on adoption, donor insemination and adjustment to a childless marriage, as a means of providing a very comprehensive study of the options available to infertile couples.

The authors argue that the frequency with which women sought infertility treatment in the past was dependent largely on pronatalist sentiment and faith in the efficacy of technological developments. There was little direct relationship between technological advances and demand for infertility therapy. The experience of infertility reflects changing values and social norms. Women, although active agents of change themselves, sought infertility treatment in order to conform to cultural expectation. This is not to be interpreted as a cultural imperative, the motherhood mandate, for women had numerous choices, but cultural values motivated them to seek infertility treatment on a wide scale. The book, conveniently organized chronologically, provides ample proof of the authors' theories, and chapter six, which deals with post World War II America, is especially illuminating in this regard.

One of the key premises of the book is that infertility, although defined as a medical condition, cannot be isolated from its cultural context. True enough, but it also cannot be completely separated from its broader medical context. Throughout the book, the authors cite changes in people's attitudes toward related reproductive and medical issues without noting how those perceptions reflect a change in the way people viewed medicine in general. In chapter one, for example, Marsh and Ronner discuss how infertility evolved from a condition to be addressed from a religious perspective to one that became a medical oddity. This shift occurred in many other aspects of medicine, infertility being just one example. (pp. 10, 16) To further exemplify the point, in chapter three Marsh and Ronner note that doctors were reluctant to accept gonorrhea as the cause of sterility. Cultural factors aside, doctors were frequently unwilling to accept new theories which often brought their treatments and diagnostic abilities into question. (p. 89)

As with any good research, certain questions remain unanswered. The Empty Cradle provides an excellent starting point from which to explore infertility, its diagnosis and treatment, in the context of the professionalization of medicine in general and gynecology in particular. This is one aspect of the infertility story not yet told that would serve to explain the development of a medical specialty. The authors note that the development of endocrinology had implications for the specialty of gynecology which was primarily a surgical area, but do not elaborate as to how doctors responded to such developments. (p.137) How did doctors perceive those developments and what did they do to maintain their "surgical" specialty? Following World War II, infertility experts objected to other practitioners caring for infertility patients, for they "wished to keep the procedure within the tight control of a few specialists," (p.165) reflecting a long-standing theme of specialists attempting to find a place for themselves within organized medicine. It seems that infertility played a major role in building the practice of gynecology, but that role has not been addressed here and awaits further elaboration.

Although social historians might suggest that the book suffers from too much emphasis on the development of new surgical procedures and infertility technology, that information is essential in order to develop a comprehensive view of infertility treatment over time. Chapters two, five, and six, of a total of seven, are devoted almost exclusively to a discussion of pioneers in the field and the development of new technologies. The chapters, however, do more than just explain past discoveries and developments, for they glorify instrumental gynecologists such as J. Marion Sims, giving him far more credit for influencing the direction of gynecological practice than is perhaps merited. This attention to such leaders in the specialty implicitly suggests they may have had a far greater role in women's acceptance of medical treatment for infertility than is warranted, perhaps, contradicting the authors' argument that perceptions regarding technology were more important.

In the same vein, certain sources could have been put to better use. The authors had access to the papers of John Rock, which included numerous letters written by women. Marsh and Ronner utilize the letters and Rock's responses to analyze his views rather than exploring the feelings women expressed about infertility. In addition, it appears that the generalizations that are offered regarding women's views are made with limited sources - from Sims' hospital records and a handful of other case records.

Overall, however, in spite of the seeming reluctance to analyze infertility within the context of the history of medicine, The Empty Cradle helps define important additional questions to address, and provides an excellent foundation from which historians could launch further research projects in this vast area which, until this book was published, has been ignored. Marsh and Ronner offer historians of medicine with a well written, enjoyable, and thoroughly researched medical and social history of American couples' experience with infertility.

Carolyn Leonard Carson Carnegie Mellon University