BOOKREVIEWS
jective, the integration of Black women into
nursing, had been met.
Historical vignettes of Black leaders,
whose contributions to the professionaliza-
tion of Black nursing were exemplary, are
the basis of chapter seven. Significantly,
these vignettes portray Black nurses who
also deserve recognition, but generally have
not received it: Eunice Rivers, a public
health nurse who was involved with the Tus-
keegee syphilis study for 40 years; Francis
Elliott Davis; the first Black Red Cross
nurse; and Salaria Key, the only Black nurse
to serve in the Spanish Civil War.
Chapter eight, appropriately titled “ ‘We
Shall Not Be Left Out’: World War I1 and
the Integration of Nursing,” exemplifies the
resistance of Black nurses to the racism in
nursing. In this chapter, Hine meticulously
documents the actions and events that led up
to the desegregation of nursing in the armed
forces. It is here that one can see the formi-
dable forces that resulted when the Black
nurses and the Black community united and
used their political savvy to create change.
In the last chapter, Hine concludes that the
treatment of Black nurses by the white nurs-
ing establishment meant that the latter sim-
ply did not want Black women to be nurses
and would not treat them as equals. Here,
Hine deals with more contemporary events,
most notably, the 1972 creation of the Na-
tional Black Nurses Association (NBNA).
Although 1950 was the presumed end of
overt discrimination in nursing, subtle as
well as not so subtle forms of institutional-
ized racism continued. The NBNA was spe-
cifically formed because of racism in
nursing. Like its predecessor, the NACGN,
one of the chief obpctives of the NBNA is
improvement of Black people’s health. Hine
also draws parallels between early Black
nurses’ concerns with Black health status
and current Black nurses’ efforts, chiefly
through the NBNA, to increase awareness
and to deal with some of the health problems
afflicting Blacks and concerns about dis-
crimination and racism in contemporary col-
405
legiate nursing education. The book con-
cludes with an appendix, consisting of eight
tables, that provides valuable, historical data
about Black hospitals, nurse training
schools. and presidents of the National As-
sociation of Colored Graduate Nurses
(NACGN).
Black Women in White should be of inter-
est to nurses, medical anthropologists, medi-
cal sociologists, medical historians, and
health professionals who are concerned with
Black health care. All health professionals
should be made aware of the issues that
Black nurses have historically dealt with and
are confronting currently: poor Black health
status, paucity of Black nurses, and few
Black nursing students. Black Women in
White stands as a testimony to the historical
concern of Black women for the health of the
Black community.
Anthropology and Nuising. Pat Holden
and Jenny Littlewood, eds. London: Rout-
ledge, 1991. x + 228 pp.
KATHRYN
HOPKINS
KAVANACH
School of Nursing
University of Maryland at Baltimore
Nursing’s use of anthropology as a source
of sensitivity, knowledge, and skills to facili-
tate practice among divergent peoples is a
familiar theme. Although the title Anrhro-
pology and Nursing suggests further exami-
nation of that relationship, Holden and
Littlewood’s book actually addresses the an-
thropology of nursing. m e authors of the
book’s eleven chapters bring together, from
disparate but relevant areas of anthropologi-
cal study, critical analyses of nursing as a
muted female discipline. Originally drawn
together in a 1986 workshop, the ideas are
no less viable today. While curing and caring
tend to be conceptualized as separate do-
mains and roles in modem societies, anthro-
pology continues to pay little attention to
nursing. Nursing has been equally slow to
406
develop serious interest in power as a funda-
mental dimension of the discipline’s diverse
past and present roles and statuses.
Anthropology and Nursing’s critical ap-
proach contributes a sociohistorical context
often lacking in nursing. Traditionally ne-
glected by historians,nursing has had to fend
for itself in reconstructing its antecedents.
Although that situation has improved, his-
torical nursing research seldom ventures
outside Western European tradition. It is
refreshing to find chapters focused on nurs-
ing in such settings as ancient Greece,India,
Japan, and Uganda.
Helen King, elucidating the similarity of
“doctoring” and “nursing” in ancient
Greece, lays the groundwork for central
questions about power and control as dimen-
sions of male-female relationships in mod-
em societies. Although ancient “doctors”
performed “nursing” tasks, every society’s
“good nurse” seems to repeat the general-
ized image of “good woman.” In patriarchal
societies, that leaves the busy male doctor
being noble and the caring female nurse
unnoticed.
Julia Leslie and Dominik Wujastyk pre-
sent nursing as described in ancient Indian
medical texts where, as the doctor’s assis-
tant, the nurse owed loyalty and devotion to
the master-doctor rather than to the patient.
Geeta Somjee contemporizes the discussion
of nursing as an intricate web of caste, colo-
nial and postcolonial expectations, con-
straints, and opportunities.
In Uganda, Westem-style training left
nurses ill prepared to deal with crisis and up-
heaval. Pat Holden depicts nursing there as a
class-ridden concem and its professionaliza-
tion as another version of regulation of female
sexuality.Nursing,oftenthoughtofintheWest
as essential (regardless of its status con-
straints),hasbeenperipheralizedintoan uncer-
tain role with diminished prestige.
Several chapters include insightful obser-
vations on differences in the interactive
tones of nursing as they relate to the modem
conclusion of the nurturing aspects of caring
MEDICAL
ANTHROPOLOGY
QUARTERLY
with “mothering.” In Indian society, for ex-
ample, nurses do not “mother” their patients
but, acting as knowledgeable guides, may
“elder” them. Nursing in Japan, on the other
hand, is described by Joy Hendry and Lola
Martinez not as mothering, but as a type of
guardianship .
Strategically located in the middle of the
book is a chapter by Liz Hart, whose com-
pelling classic ethnographic study of the
stigmatized identity of hospital domestics
presents a juxtaposition with nursing down,
rather than up, the hierarchy. The symbolism
is keen; nurses are routinely contrasted with
physicians, which reiterates the male-female
dichotomy, whereas “cleaners” are (like
nurses) usually women, specifically those
women who do the work too dirty or too
menial for nurses, but who remain muted
and invisible to nearly all other levels of
society. Changes in socially perceived need
to control women always reflect society as a
whole, and Hart’s housekeeping staff under-
goes reductions in hours and compensations
to the extent that the value of working is
questioned. As Helle Samuelson points out
in the book’s final chapter, nurses may even-
tually improve their position relative to doc-
tors, “but the patients with whom the nurses
declare allegiance remain muted” (p. 201).
So do the cleaners, whose reality is made
more pivotal by its focus on dirt.
Whether serving as traditional advocates
for people during liminal periods of sickness
or focusing on wellness and health promo-
tion, nurses deal with ambiguity through
beliefs and practices related to caring in
ways that reflect society’s cultural values.
While mirroring widely held values, nurses
face those aspects of life and living that most
others avoid. Jenny Littlewood sums up the
nurse as not so much tolerant of ambiguity
as out to manage it. In itself an ambiguous
situation, this relates to the theme of clean-
liness and its symbolic equations of purity
and impurity that are associated with nursing
(and women) everywhere. Several chapters
discuss the impact that rigid notions of pol-
BOOKREVIEWS
lution have on distribution of nursing func-
tions and direct physical care to members of
lower castes and classes. Negotiating care,
maintaining rules of behavior, and generally
controlling boundaries, nurses create order
out of disorder. Efficiently replacing filth
and chaos, whether symbolic or real, nurses
are always vulnerable to relegation to
“cleaner” status.
Eva Gamarnikow examines nursing as
women’s work that was reorganized at the
turn of this century in a way that led to
ambivalence toward nursing because it was
an adjunct to medicine that lacked the com-
placency of “previously unproblematic sub-
ordination” (p. 115). Not only did nurses
insist on shaping doctors’ orders into nurs-
ing frameworks, but reform threatened
medicine by vesting control of wards and
units in nurses, sharing medical knowledge
with them, and increasing the ambiguity of
the relationship between nursing and medi-
cine. But despite significant change, the
transformation remained incomplete: subor-
dination was then justified on professional
rather than gender grounds. That is the cru-
cial observation that eludes many analysts of
nursing.
Lee Ann Hoff challenges both nurses and
anthropologists to be more attentive to per-
sonal violence and its medicalization. More
basic than even that acute necessity, how-
ever, is her observation that nursing, for the
most part, continues to draw from general
systems theory rather than from more critical
views and social models that focus on pa-
tients’ responses, which typically do not
conform to mechanistic models. Hoff deftly
exposes the process by which the narrow
systems perspective obscures nurses’ views
of themselves as casualties of social devalu-
ation as women, as victims of the public’s
response of indifference or blame, and, in
turn, as internalizing their own inferior
status.
Anthropology and Nursing’s collage of
macro- and microlevel perspectives is com-
plemented by a chapter by Roland Little-
407
wood on contemporary culture-bound syn-
dromes, which, although fortuitously rare,
tend to occur among nurses. These forms of
psychopathology are associated with the
medicalization of women, their socialization
to sick roles, relationships between patients
(including nurses as patients) and doctors,
and the need for the nurturing to be nurtured.
While nursing often implies either a call-
ing or a job, this book impresses the reader
with many additional meanings and func-
tions of nursing, for example, opportunities
for worthwhile work and relationships, fmd-
ing doctor husbands, and emigration. When
employment is valued, nursing, despite its
undertone of undesirable tasks,is as good as
any other profession in practical terms.
Focused primarily on here and now inter-
vention aimed at health promotion and dis-
ease prevention, nursing has produced few
critical analyses of itself of the type that
require the broad perspective of anthropol-
ogy. This book, by people who know both
anthropology and nursing well, makes that
need explicit. Establishing a reputable start,
Anthropology and Nursing is a fascinating
compendium of thought-provoking ideas
and bits of information (many of which are
tucked away in lengthy scholarly footnotes)
that is recommended for anyone interested
in women’s issues, symbolism, or health
care and healing.
Complementary Medicine Today: Practi-
tioners and Patients. Ursula Sharma. New
York: Routledge, 1992. x + 235 pp.
NANCYWAXLER-MORRISON
University of British Columbia
Complementary medicines, for Sharma,
are the alternative systemsof treatment, such
as osteopathy, homeopathy, herbal medi-
cine, acupuncture, and reflexology, that
have become increasingly popular and avail-
able in Britain (and, ofcourse,elsewhere) in
the past 20 years.