Prescribed Norms: Women and Health in Canada and the United States since 1800 (review)

Prescribed Norms: Women and Health in Canada and the United States since 1800 is a very ambitious work. Warsh’s explicit goal is to present a synthesis of some of the best scholarship in three areas. The first deals with female biology, primarily menstruation and menopause; the second with the medicalization of women’s health, specifically childbirth; and the third with the professionalization of women healthcare workers, namely as physicians and as nurses. Warsh’s bibliography and notes document the breadth of her research. The title and the outline of the book’s structure suggest the extent of her subjects. The result is an impressively bold book that, however, often promises more than it can deliver.

The first section is the most problematic. One chapter covers menstruation medically, culturally, and commercially. The discussion of the medical model stretches from Galen to the twenty-first century and that of premenstrual syndrome and toxic shock syndrome illustrates the interrelationship of biomedical and cultural constructs: all in forty-four pages. This approach has positives and negatives. Though there is little new here for most historians and instructors familiar with these issues, Warsh’s book brings the information together in a well-written chapter that is a good introduction for the general interested reader or an undergraduate class. At the same time, such a comprehensive chapter—over time (one paragraph stretching from the Renaissance to the late nineteenth century), over space (both Canada and the United States, with frequent mentions of Europe), and over cultures (encompassing First Nations, ancient Greek, Jewish, early Christian, Japanese, and more)—can do little more than note historical highlights and name significant doctors and theorists. In the chapter on menopause, Warsh devotes as much attention to women in Ireland and in Japan as to women in Canada and the United States, and then, with no explanation, she briefly mentions naturopathic and homeopathic medicines. Warsh has little space for analysis and less to place her points in a historical and cultural context. Thus her admirable goal of inclusiveness has resulted in a rushed pace and scattered points that rarely coalesce into a coherent analysis.

The second and third parts of the book are more satisfying to the reader. In her discussion of childbirth, Warsh brings alive the experiences of parturient women and their attendants, drawing out significant similarities and critical differences between the two national situations. She cogently describes the increasing medicalization of prenatal care and childbirth in Canada and the United States. The chapters on professionals—nurses and physicians—clearly address the issue of gender and how that has influenced women’s potential roles. The author builds on the work of leading historians of women physicians to present a well-delineated analysis of the feminist and professional arguments that facilitated and inhibited the entrance of women into medicine in the nineteenth and twentieth centuries, stories with similar outlines in the United States and Canada. On the other hand, military needs over the past two hundred years, as well as gender, influenced the histories of nursing in both countries, yet with crucial differences. Most significant is the existence of national health care in Canada, which gave that federal government a greater role in defining nursing practice. Warsh teases out an interesting contrast in the area of public health nursing, pointing out “radical roots south of the border and elitist imperialist roots in the north” (246), namely, in the States the profession was characterized by high prestige, authority, and autonomy; in Canada, it was organized within the Victorian Order of Nurses that emphasized the subordinate role of the nurse.

Despite their strengths, these chapters are weakened again by an overly comprehensive scope. The nursing chapter covers nursing before 1800, nursing education, military nursing, professional organization and registration, public health nursing, psychiatric nursing, sexuality and popular culture, and minorities in nursing. With such a broad range, there...