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

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 21th 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 exercise 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 language 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...