Mary Breckinridge: The Frontier Nursing Service and Rural Health in Appalachia by Melanie Beals Goan (review)

82 BOOK REVIEWS OHIO VALLEY HISTORY towns offered fewer job opportunities for women. So as women, arriving later in the chain of migration, came to be more numerous, more African Americans chose to live in the Midwest’s largest cities. On the much debated question of the role of antiblack violence as a push factor, Blocker acknowledges lynching in the South as important, but insists that it was “only one part of a much larger and more complex story,” noting that the lower Midwest was also a violent place for African Americans (215). Small towns’ “durable white hostility to black achievement ” may have promoted secondary migration to big cities as much or more as outright violence. Blocker, like many predecessors , finds that by the 1920s a “new race consciousness” propelled African Americans to the big cities (219). Jack Blocker’s judicious and carefully qualified assessments will not rewrite the story of the Great Migration. But A Little More Freedom offers a good deal more than a little on its topic, by demonstrating the importance and variety of black experiences in the Midwest’s smaller towns and cities from 1860 to 1930. T. Stephen Whitman Mount St. Mary’s University. Although her family name is familiar to students of Kentucky history , Mary Breckinridge and her Frontier Nursing Service have not drawn the historical analysis they deserve until now. Melanie Beals Goan’s treatment of Breckinridge and her work is balanced, thorough, and carefully documented. She situates both within the context of Progressive Era reform, women’s connections within benevolence work, and the Appalachian uplift movement. Her work adds to the growing body of literature on women whose lives and work spanned the transitional times between the end of the nineteenth century and the first few decades of the twentieth century and who found themselves bound by the traditions and expectations of the former even as they embraced and attempted to live the challenges of the latter. Their times, social standing or lack of it, economic circumstances, educational backgrounds, and family obligations shaped their individual identities and reform ethos and also placed many of them squarely on the horns of the traditional versus modern dilemma. Mary Breckinridge, like many of her contemporaries, was a complex woman whose public role and private life converged in familiar patterns and ways, but Goan resists the temptation to render a monochromatic portrait that fits her subject neatly into historical poses, constructs, paradigms, and categories, noting that the picture may seem “complicated and at times inconsistent,” but that is intentional. Goan’s analysis of Mary Breckinridge: The Frontier Nursing Service and Rural Health in Appalachia by Melanie Beals Goan SPRING 2009 83 BOOK REVIEWS Chapel Hill: The University of North Carolina Press, 2008. 348 pp. ISBN: 9780807832110 (cloth), $45.00. Breckinridge’s decisions and actions is designed to take into account “the limitations she faced . . . within the context of the era in which she lived” (11). For the most part she is successful, but in trying to avoid the pedestal, the author occasionally falls into the trap of expecting too much. Her analysis, like some others who have written on Appalachian uplift, challenges David Whisnant’s “presentist” view that asks women reformers to transcend their time and place by “expos[ing] structural inequality” and “declar[ing] war on capitalism” (8). Certainly historical analyses of the contentiousness and violence permeating mining communities and camps in the 1930s has shown the role of women and families in challenging the coal barons and extractive industrial magnates whose wealth seemed particularly obscene when contrasted with the wages they paid and the squalor they imposed. Although she acknowledges the difficulties Breckinridge faced in courting the elite (including the Henry Ford family) to elicit needed donations for her work, Goan is critical of Breckinridge’s failure to get the federal government to extend the Cumberland forest area eastward to include Leslie County. Doubtless, such legislation would have altered the pattern of strip mining that so devastated the area, and Goan concludes that “her unwillingness to challenge the industrialists . . . contributed to the area’s later destruction .” Faulting Breckinridge’s failure to “hold industrialists’ feet to the fire” by suggesting “innovative strategies for moving the...