Syphilis of the Innocent

Amalia’s Tale: An Impoverished Peasant Woman, an Ambitious Attorney, and A Fight for Justice.

By David I. Kertzer

Boston: Houghton Mifflin, 2008, 237 pp., $24.00, hardcover

Reviewed by Susan M. Reverby

Breastfeeding can be the most intimate and private of acts between a mother and her child. Yet milk-laden breasts have been commoditized, and a woman’s labor of feeding rented, sold, or enslaved. Indeed, many historians consider wet-nursing, the suckling of another’s child, to be women’s second-oldest profession. From the biblical Moses’ mother Jocheved, whom the Pharaoh’s daughter unknowingly chose to nurse the future prophet, to rural peasants who were sent the foundlings of urban single women and married aristocrats, to current Hollywood starlets with implants who hire women with unaltered breasts to nurse their babies, class politics and health have determined the dynamics among the triad of mother, baby, and wet-nurse.

In Amalia’s Tale, anthropologist-historian David I. Kertzer examines late nineteenth-century wet-nursing in Italy, and the political economy and moral outlook that shaped it. Since Catholic social policy did not allow single women to keep their babies—lest they escape punishment for their immoral acts—foundling hospitals took in the infants. (Meanwhile, the babies’ fathers were neither named nor asked to support their children.) Separated from their mothers, the infants were then either sent to women in the presumed-to-be-healthier countryside to nurse, directly fed from goats, or given other animals’ milk—often a death sentence because of the lack of pasteurization.

Amalia Bagnacavalli, a peasant woman, lived with her husband and his family and the couple’s infant daughter in the small hill town of Orgelia in the 1890s. Like many women in her community, Bagnacavalli decided to contribute to her family’s income by nursing an infant from the foundling hospital in nearby Bologna. The baby girl she received appeared blind and listless, and Bagnacavalli hoped her milk would help her. The last thing she expected to get from the experience was syphilis, the sexually transmitted disease that can also be passed from infected mother to fetus, and then from infant to wet-nurse.

When Bagnacavalli found a sore on her breast, she went to the local physician. Recognizing it as a syphilitic chancre, and having seen other rural women harmed in this way, the doctor urged her to take the unusual step of finding an up-and-coming young lawyer in Bologna. The attorney agreed to take her case and sue the hospital.

From the records of the lawsuit, which went on for more than a decade, Kertzer has created this intricate tale. Unlike romanticized paeans to the Italian countryside such as Frances Mayes’ Under the Tuscan Sun, this book is a John Grisham-style legal thriller, in which Kertzer weaves together syphilis, bureaucratic negligence, and the dilemmas that faced those running urban hospitals. Underlying this very time-and-place specific drama, however, lies the deep question of how societies decide who is innocent and in need of protection, and who is guilty and deserving of punishment—a determination that becomes especially complicated when medical uncertainty prevails and morality, not health equity, shapes the options.

Will Bagnacavalli be compensated? Can her lawyer beat the power of the local count and the other failing aristocrats who run the foundling hospital? Should a rural doctor’s opinion trump those of a series of specialists—whose medical judgments vary? Whom will the judges believe as the case wends its way through the courts? What will happen to Bagnacavalli, her husband, and their subsequent children? Will the lawyer take all the money if they win and leave her with nothing? The arguments over syphilis and its contagious nature, the hospital’s responsibility for knowing whether the infant was ill, the autopsy results when the child dies, and how malpractice can turn into negligence make for gripping drama as Bagnacavalli, her baby, her husband, and finally her two stillborns are all affected by the syphilis.

Just when Kertzer has us firmly on the side of Bagnacavalli, the wronged innocent, he requires us to listen to the hospital’s position and wonder: what else could it have done? Using animal milk was a death-sentence for the foundlings. Flouting the Church by allowing single mothers to nurse was inconceivable. So, it tried its best to discern whether mothers and babies were ill—a difficult diagnosis before the invention of blood tests for syphilis—and handed the infants over to peasant women desperate for work. Syphilis, in this scenario, is an occupational disease, and the life of the child takes priority over that of the wet-nurse—and her family.

Kertzer, a well-known anthropologist of the historical and modern Italian family and politics, uses his knowledge to reveal the quotidian details of Bagnacavalli’s life. As in other “microhistories,” in which the historian’s imagination comes close to the surface, many of his sentences include qualifiers such as “would have,” “must have,” or “perhaps,” which lend a fictional quality to the narrative as the Bagnacavalli family’s tragedy grows. As a women’s historian, I wished I could hear Bagnacavalli’s voice more clearly, even though is obvious that Kertzer found out as much as he could, carefully extrapolating her experiences from stacks of legal documents and his decades of research about peasant families. Unfortunately for the more academically inclined, in the interest of readability, he refrains from much footnoting, listing his Italian sources in a bibliography—which makes it difficult to tell exactly where particular pieces of information come from.

This carefully plotted book almost sneaks the politics and problems into the narrative. While the reader awaits the next ruling on Bagnacavalli’s various appeals, Kertzer discusses the legal rights of the peasantry and analyzes the back and forth of Italian politics in an era of state build-up and democratic growth. He also describes in graphic detail the mercury “cure” for syphilis that turned the skin of Amalia Bagnacavalli and her husband Luigi an ashen grey and left their syphilitic pains with them forever. Their infant child and two stillborns pay the cost of the disease, although eventually one child survives birth and lives on. In the end, Bagnacavalli’s lawyer wins her case, but the court and legal costs rob her of any compensation.

Kertzer’s focus is on the legal conundrums and the effect on Bagancavelli’s family. Yet we need more medical information to put the heavy metal treatment in context. As Bagnacavalli’s case was going through the courts, doubts were being raised in Europe about mercury treatment. At the university hospital in Oslo, Norway, the chief of the syphilis clinic withheld the treatment from his patients on the assumption that it did them more harm then good. Kertzer does not indicate if this new thinking made it to Italy and whether any of the family’s ills are caused by the mercury rather than the syphilis.

Amalia’s Tale is not the first time syphilis has been used as a source of drama. Norwegian playwright Henrik Ibsen’s Ghosts (about congenital syphilis) was first staged in Chicago in 1882 and in London in 1891, just as Amalia Bagnacavalli was bringing her ill foundling home. Just after the Bagnacavalli case ended, in 1903, the French playwright Eugene Brieux published (although was not allowed to produce) Les Avaries, known in its English translation as Damaged Goods. Produced on Broadway to great acclaim in 1907, it was rewritten as a novel by Upton Sinclair and made into a film in the 1930s. Like the Bagnacavalli case, Brieux’s drama spoke to the growing moral power of the doctor and the danger to families and wet-nurses of the male silence around syphilis and of quack cures.

Syphilis of the Innocent, as the title of a 1922 American book puts it, has always been central to the medical and moral concerns surrounding this disease. In Amalia’s Tale, Kertzer forces us to consider how complicated it is to determine guilt or innocence, and the limitations of setting up such a binary in the first place. This question has a familiar ring to those of us who have struggled for abortion rights and thought about the needs of women versus those of their fetuses and infants. In Bagnacavalli’s case, the life of the critically ill child received priority, although the lawsuit forced the hospital to rethink its policies, and the blood tests and pasturization gave them more options. Amalia’s Tale is a powerful reminder that women’s safety ultimately depends not only on political lawyers or courageous doctors but also on the value the culture places upon the lives of those whose voices we do not often hear.

Susan M. Reverby is the McLean Professor in the History of Ideas and professor of Women’s Studies at Wellesley College. Her book, The Infamous Study: Tuskegee, Syphilis, and American Lore is forthcoming.


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