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by Caitlin Burke

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Margaret Marsh, Ph.D., is a professor of history at Temple University, and her sister, Wanda Ronner, M.D., is an obstetrician gynecologist in Philadelphia. Together, they sought a grant from the American College of Obstetrics and Gynecology, funded by Ortho, to study nineteenth-century surgical and instrumented interventions for infertility in the United States. They began working on Empty Cradle the year after their presentation at the ACOG's 1989 meeting. The authors' intellectual traditions combined with their obvious sensitivity to their topic has yielded a highly readable and persuasive book. They succeed in their aim in producing Empty Cradle -- to offer a useful history of infertility in the United States -- countering in particular three claims: that infertility is rising in incidence, that surgical intervention is a new phenomenon, and that women are victimized by reproductive medicine.

Empty Cradle is constructed simply, discussing infertility in terms of social context and available medical care, primarily during the nineteenth and twentieth centuries. Marsh and Ronner also offer an interesting history of the treatment of infertility in particular, from early and misguided attempts to "correct" female anatomy surgically to today's in vitro fertilization and surrogate motherhood. Modern infertility treatment is both extremely expensive and relatively ineffective, and modern infertility itself, at least on the level of couples attempting to conceive, is not much different in prevalence from infertility about a century ago. Marsh and Ronner approach the development of medical treatments -- some of which were not only ineffective but mutilating -- with an essentially positive view of medicine in general but no discernible sentimentality, particularly when discussing the occasionally brutal tactics and techniques of early gynecologists, from doctor-patient relationship to the actual procedures chosen.

Marsh and Ronner do not offer simplistic or sweeping interpretations about the significance of infertility treatment, whether for humans in general or for women in particular. They review a wide range of opinions, and while they show preferences for particular sources, Empty Cradle is a balanced discussion of infertility in its social context. This is pleasantly clear as they discuss the shift in infertility treatment from an opportunity for gynecologists to imbue patients with social conventions, such as suggesting that a college education or career can cause infertility, to the modern symbolic value of "assisted reproduction" as a gender-politics flashpoint, bringing to mind every kind of Brave New World scenario.

Marsh and Ronner are interested in the myriad ways infertility has been imagined and received by various people who have encountered it -- women who want children, the physicians they visit, or the theorists that ponder the meanings of the options available to produce children. The authors carefully chart the changing terms for the inability to have children, from barren to sterile to infertile, as well as the focus of this inability, from the woman to the couple. At they same time, they remain acutely aware of the way that larger social conceptions of gender mediate, sometimes very strongly, the specific ways that those terms and focuses are perceived. Empty Cradle is not a fairy tale about women's increasingly better control of their reproductive choices, but it does demonstrate that women -- whether motivated by their perceptions of their roles in society or by a simple desire to be mothers -- were active in seeking infertility treatment as soon as they believed it was available.

Empty Cradle is well conceived and well written, offering information that is both useful and engaging. Margaret Marsh and Wanda Ronner are knowledgeable professionals with a keen eye for nuance and organization. This book doesn't touch the dioxin debate and the mysterious dropping sperm counts of European men, but its discussion of cultural attitudes toward fertility and infertility can serve as a useful framework for the critique of just about any notion about reproduction.


Empty Cradle: Infertility in America from Colonial Times to the Present is published by the American Association for the History of Medicine and the Johns Hopkins University Press as part of the Henry E. Sigerist Series in the History of Medicine. Topics in this series range from profiles of specific diseases to the development of the doctor-patient relationship and from Revolutionary Paris to modern America.

An interesting thumbnail sketch of women's health over the past two centuries can be found at the University of Toledo Libraries.

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