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

Emily K. Abel. Hearts of Wisdom: American Women Caring for Kin, 1850-1940. Cambridge: Harvard University Press, 2000. ix + 326 pp. $49.95 (0-674-00314-4).

Despite the size of the contemporary medical establishment, family members continue to play an important role in the lives of the sick and dying. To better understand that phenomenon, Emily Abel has investigated the history of domestic caregiving in the United States. The first part of her book uses women's diaries and slave narratives for the period from 1850 to 1890. During these years, on the basis of their practical experience and empathy, women controlled the sickroom, for the most part successfully resisting physicians' efforts to challenge their authority. Between 1890 and 1940, power shifted toward medical professionals. Abel sees four forces as particularly influential here: "the bacteriological revolution, new concepts of disease, the transformation of the formal health system, and the spread of domestic technologies" (p. 3). Although their work consequently lost status, women did not shed the burden of care. Instead, to old duties were added new tasks—most notably that of negotiating between the sick, on the one hand, and physicians, charitable organizations, and the state, on the other.

For the most part, Abel concentrates on families struggling with chronic illnesses and conditions. During the nineteenth century, she finds, caregivers were more likely than their twentieth-century counterparts to get help from others. However, she argues, it is important not to romanticize their situation. Although watching over the sick and dying was often emotionally and spiritually satisfying, it also could reopen wounds for those who had suffered past bereavements and leave women so exhausted that even the most arduous jobs outside the home provided welcome relief. In addition, caregivers tended toward parochialism, so obsessed with finding help for their sick that they had little, if any, interest in the medical problems of others. In making such observations, Abel's purpose is not to criticize but to suggest ways in which caregivers' efforts might be enhanced. Today, she notes, for a variety of medical and political reasons, caregiving lasts even longer than in the past and is an increasingly lonely enterprise, for which there is little cultural support.

Thus, Abel's work has a clear policy orientation. At the same time, it is built on careful historical research and analysis. She adroitly moves back and forth between the published scholarship in medical history and her own findings. For example, her investigation of the medical responsibilities of a Midwestern woman, Martha Farnsworth, between 1890 and 1924 builds on and adds to Joan Lynaugh's history of the American hospital's intermediate years.¹ In caring for herself, two husbands, an infant daughter, and a niece, Farnsworth took advantage of new technologies, from the X ray to the telephone and the automobile. Yet, although these changed her responsibilities, they did not diminish them, for she was forced to spend ever more time monitoring and supplementing professional health care.

Particularly devastating to the authority of caregivers such as Farnsworth was the medical profession's increasingly successful denigration of the emotional and spiritual aspects of care. To explore this shift, Abel first looks at maternal advice books and then turns to the letters written by family members of tubercular patients to a Philadelphia physician, Lawrence F. Flick, between 1906 and 1925. Again and again, Flick insisted on institutionalization for his patients, dismissing as irrational mothers' fears that young children, in particular, would not do well in large sanatoria far from home. Abel finds similar themes in the case records of tubercular families maintained by the New York Charity Organization Society between 1894 and 1918. Charity workers also advocated institutionalization, using the threat of discontinuing desperately needed help to force adherence to their public health directives.

In a subsequent chapter, Abel assesses the impact of the Great Depression on families' medical experiences. Here, she...