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FW: H-South Review: Haberland on Barney, _Authorized to Heal_

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  • A.J. Wright
    fyi...aj wright // ajwright@uab.edu ... From: H-South Review Editor Ian Binnington [mailto:binningt@uiuc.edu] Sent: Wednesday, January 24, 2001 7:00 AM To:
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      -----Original Message-----
      From: H-South Review Editor Ian Binnington [mailto:binningt@...]
      Sent: Wednesday, January 24, 2001 7:00 AM
      To: H-SOUTH@...
      Subject: H-South Review: Haberland on Barney, _Authorized to Heal_


      H-NET BOOK REVIEW
      Published by H-South@... (January 2001)

      Sandra Lee Barney. _Authorized to Heal: Gender, Class, and the
      Transformation of Medicine in Appalachia, 1880-1930_. Chapel Hill and
      London: University of North Carolina Press, 2000. xii + 222 pp.
      Illustrations, tables, map, notes, bibliography, and index. $39.95 (cloth)
      ISBN 0-8078-2522-0; $17.95 (paper) ISBN 0-8078-4834-4.

      Reviewed for H-South by Michelle Haberland,
      michelle@..., Department of History, Tulane University

      In an era of almost daily breakthroughs in the technology of scientific
      medicine, it is easy to overlook the profound impact of medicine on less
      technologically sophisticated eras. When did healing become enveloped in a
      scientific robe? And how did ordinary people, especially rural people,
      respond to the emergence of professional physicians? Sandra Lee Barney
      examines this transition from folk medicine to scientific medicine in
      _Authorized to Heal: Gender, Class, and the Transformation of Medicine in
      Appalachia, 1880-1930_. This is a cleverly conceived study, one that
      positions itself at the nexus of several distinct disciplines. _Authorized
      to Heal_ offers insights into the history of gender and class relations,
      the history of medicine, southern history, and Appalachian history.

      Perhaps most interesting, however, is Barney's examination of the
      Progressive era in a rural context. Barney explores the transition of
      medicine from the end of the nineteenth century through the early twentieth
      century, as scientifically-based medicine gained a foothold among the often
      widely scattered communities of southern Appalachia. Against a backdrop of
      class and gender conflict, Barney illustrates the professionalization of
      medicine and its many consequences for the mountaineers of Appalachia. In
      _Authorized to Heal_ Barney takes the history of progressivism to the
      southern mountains, where she uncovers a complex network of gender- and
      class-based relationships behind the professionalization of medicine.

      In the 1880s, there were few physicians in the rural mountain counties of
      Kentucky, Virginia, and West Virginia that Barney examines. And of this
      small number of physicians, very few had formal medical training. In
      Appalachia, rural people frequently relied on themselves and midwives for
      medical treatment. Labor historians will be interested to learn that
      coal-mining companies were often responsible for drawing the first formally
      trained physicians to many parts of Appalachia. Employed as company
      doctors, these physicians were often viewed with suspicion. The first
      chapters of Barney's study chronicle a growing tension between traditional
      healers and more expensive and scientifically-trained physicians.

      Barney argues that the slow spread of scientific-based medicine through the
      southern mountains stemmed from "mountain poverty and isolation," for
      Appalachian residents quickly learned that formally trained physicians
      charged higher fees than traditional healers (p. 27). The tension between
      lay healers and younger physicians grew stronger near the turn of the
      century, as the physicians organized themselves into statewide professional
      associations. Barney describes how physicians created a professional
      discourse and carved a niche for themselves in the elite sectors of their
      Appalachian communities. These professional physicians associations often
      openly attacked lay healers, especially midwives, by pursuing state
      legislation requiring licensing and registration fees of informally trained
      lay practitioners.

      Midwives, clubwomen, public health nurses and settlement workers are at the
      center of much of Barney's narrative. In the early years of this study,
      physicians utilized the maternalism of women volunteers and reformers in an
      effort to attract rural people, especially women and children, to their
      services. Soon after the emergence of class-based allegiances between male
      physicians and women volunteers, healing was transformed into a
      professional occupation. Middle-class women reformers went to work on
      behalf of the physicians, educating Appalachian residents about the
      benefits of scientific medicine and easing the transition from traditional
      healers to college-trained doctors.

      The public health dimension of Progressive era reform was particularly
      useful to this crusade. Barney laments, however, the ways in which
      physicians later pushed midwives and women health assistants aside after
      the turn of the century. As public health advocates became more strident
      and their independent associations grew stronger during the Progressive
      era, Appalachian physicians began to see the women's activities as a threat
      to their professional monopoly over rural medicine.

      Eventually some women public health nurses and clinic workers realized that
      working for benevolent associations and independent clinics distanced them
      from the financial support and scientific legitimacy physicians and
      hospitals could provide. Others remained long-time activists for widespread
      access to medical care and public health. And finally, in the latter stages
      of the Progressive era, middle-class reformers began to identify more with
      their own developing professional echelon and less with their working-class
      clients. In the end, Barney argues, it was female activists who brought
      scientific medicine to the southern mountains and eased the transition from
      traditional medicine to scientific medicine.

      Barney's study is particularly noteworthy because of its applicability to a
      number of other fields of study. Historians interested in the study of the
      South, gender, class, Appalachia, medicine, progressivism or reform will
      find much to consider in Barney's concise work. Her careful research of
      local and state records of Appalachian women's clubs, medical associations
      and colleges, and charitable organizations reveals a history of the
      Progressive era that will have a wide influence and appeal. Appalachian
      medicine underwent important changes in the years between 1880 and 1930 and
      Barney's insightful analysis underscores the importance of class and gender
      to regional histories.

      However, these same sources compel Barney to write primarily from the
      perspective of elite reformers, whether as male physicians or as female
      public health practitioners and advocates. The voices of the working class
      subjects of this transformation of medicine are rather quiet in _Authorized
      to Heal_. Those readers expecting to find accounts of an individual's or
      family's first experience with scientifically-based medicine will find only
      brief mentions. In this history, women nurses and public health advocates
      are the heroes and midwives and traditional healers are the victims of a
      modernizing society. Men physicians colluded and conspired to undermine the
      position of local healers and are cast in a negative light.

      Despite the undeniable efforts of physicians to attain a lucrative monopoly
      over medical practice in Appalachia, it seems that scientifically trained
      medical practitioners must have been responsible for at least some moderate
      improvements in the overall health of their patients and have contributed
      significantly toward the containment of contagious diseases. Barney makes
      only a handful of references to the efficacy of scientific medicine in an
      era that witnessed important advances in the understanding of bacteria and
      viruses.

      Nevertheless, these minor oversights do little to detract from the
      importance of Barney's book. The transformation of medical care in the
      South is an important subject and one that has received little attention
      from recent scholars. Paying close attention to the dynamics of class and
      gender, Barney contextualizes that history and, as a result, historians
      will find much to praise in _Authorized to Heal_.

      Copyright (c) 2001 by H-Net, all rights reserved. This work may be copied
      for non-profit educational use if proper credit is given to the author and
      the list. For other permission, please contact H-Net@....
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