Reviews for Amalia's Tale

In this absorbing account, Amalia Bagnacavalli’s tale is a horrific one. An impoverished Italian peasant in the late 19th century, Amalia was hired as a wet nurse and contracted syphilis from the infant assigned her by a Bologna foundling home. She in turn spread the disease to her husband and their baby daughter and sons. Her plight was common, Kertzer notes, in a Europe plagued for centuries by poverty, prostitution, venereal disease and legal-religious mores that forced unwed mothers to give up their newborns to institutions where they would be nursed by strangers. But Amalia took the very modern step of suing the foundling home and its aristocratic board, helped by a young lawyer eager to impose a scientific, bureaucratically controlled regimen on an antiquated welfare system. Amalia’s court victory over the Italian medical establishment was no feel-good triumph of justice: her lawyer screwed her out of every penny of the huge settlement she won, and the system of bottle-feeding prompted by her suit killed most of the foundlings subjected to it. Like Kertzer’s much-praised The Kidnapping of Edgardo Mortara, Amalia’s story is a rich social history, in which new values clash with old in an Italy wracked by the fitful march of progress.

Difficult though it may be to imagine from the vantage point of 2008, little more than a century ago Europe was still under the thumb of syphilis. In Bologna, the northern Italian city that is the focus of David Kertzer's study of one especially dramatic case, "soldiers . . . were a common source of women's infections, as were other men who visited prostitutes and passed the disease on to their lovers," but that was only the beginning. Throughout Italy, cities sponsored homes for foundlings, which "for centuries . . . had taken in hundreds of thousands of babies abandoned by their parents at birth." Pasteurization had not been invented, so cow's milk was unsafe. To feed the babies, the homes hired poor women from the countryside to breast-feed them. Many of these babies had been born with syphilis, which they passed on to the women. Kertzer writes:

"That syphilis could be transmitted through wet-nursing had been known practically from the time that the disease first appeared in Europe, and it was mentioned in a Latin medical text of 1498. The constant contact of the babies' mouths with their nurses' nipples put the women at extreme risk. As the nineteenth-century French syphilologist Alfred Fournier put it, 'Nothing is so dangerous to its surroundings as a syphilitic infant.' With syphilis so widespread -- it is estimated that 10 percent of all the men in Europe's cities had the disease -- foundling home directors were desperate. . . . Making the problem worse, these women often caused wider contagion in their isolated hometowns. . . . At a public health conference in 1875, a public health doctor from St. Petersburg, Russia, reported that in one peasant community in his district, eight women who had served as wet nurses in the city's foundling home returned to their own homes with syphilis and ended up infecting sixty people."

One woman who found herself caught in this trap was Amalia Bagnacavalli, who "lived in a little hamlet called Oreglia, part of the larger mountain town of Vergato, whose hamlets lay scattered across a vast area" not far from Bologna. She was 23 years old, married to a man several years her senior, with a one-year-old daughter. In 1890, with her family sorely impoverished, she rode the train to Bologna and then walked to "an institution known as the Bastardini, the home of the 'little bastards.' " She applied for work as a wet nurse, was subjected to a medical examination and found free of syphilis, then presented with a "scrawny, whimpering infant" who had around her neck a medallion identifying her as Paola Olivelli.

Not until she boarded the train back to Vergato did Amalia look really closely at the baby: "What she saw made her shudder. The baby's body was malformed, her chest strangely twisted. And something else was wrong. At the foundling home Amalia had noticed that Paola's eyes seemed suspiciously filmy. Now that she got to look more closely, Amalia realized that the baby was blind." Back at home, the baby cried constantly and "would barely suckle at Amalia's breast." Soon, "not only wasn't Paola eating, but her nose was constantly running and, more worrisome still, began to emit a strange yellow fluid that ran down her lip" and her "breath had a pungent smell."

So Amalia took Paola to Carlo Dalmonte, Vergato's town doctor, who had seen all too many cases of syphilis among babies brought from the Bologna foundling home, the women who suckled them, the children and husbands and lovers of these women. He "told the frightened Amalia never to nurse the baby again, and he made her promise to take Paola back to the foundling home without delay." She did so the following day. Soon a "strange sore" appeared near her left nipple. She returned to Dalmonte, who wrote a medical certificate saying he had detected an initial syphiloma on her breast. He also stated the cause -- Amalia "had been given syphilis by the foundling Paola Olivelli" -- and he "urged her to get a lawyer and sue."

This was almost unheard of. Amalia was poor, ignorant and utterly powerless. The foundling home was a charitable undertaking of Bologna's rich, educated and powerful, in particular "its president, Count Francesco Isolani, one of Bologna's leading noblemen." But, as Kertzer is at pains to document, in the late 19th century, Italy was in the midst of profound political and social change. The old order of balkanized city states and an almighty Vatican had been replaced by the Risorgimento, a movement for the country's political unification. By 1871, Rome fell to the army of an Italy united for the first time and became the capital, while "the defeated pope, Pius IX, retreated to his Vatican palaces as a self-styled prisoner." Reform was in the air, and workers and peasants began to clamor for their rights:

"The tale of Amalia Bagnacavalli is the story of people living amid this historic upheaval. Her story can scarcely be imagined any earlier in Italian history. It would have been inconceivable that an illiterate peasant woman could take legal action against one of Bologna's foremost aristocrats and one of the major urban institutions of her time -- the Bologna foundling home. For all this to take place, a host of major changes had to appear. There had to be an established legal system that would allow such a suit to be filed and pursued. There would have to be a crusading lawyer who, motivated by a new ideology and social ambitions unleashed by the loosening of aristocratic control, would champion her cause. And there would have to be a change in legal philosophy in the courts, with lowly workers seen as having certain basic rights."

From Amalia's point of view, the crucial figure was Augusto Barbieri, a 28-year-old lawyer who saw himself -- and was seen by his peers -- as part of "an enlightened elite whose mission was to transform Italy into a modern country." A "man of strong convictions, he liked to see himself as a champion of more scientific government, a protector of the poor. But he was also deeply ambitious." His young practice had yet to take off, and he seems to have realized at once that taking on Count Isolani -- better yet, beating Count Isolani -- would make him a public figure, attracting more clients to his office and perhaps giving a push to the political aspirations he nurtured.

Between the time Amalia came to his office and the final resolution of the case, a full decade passed. Amalia's little girl died from syphilis, her husband Luigi contracted the disease, other children with whom she became pregnant died at, or soon after, birth. Her "life had become a tale of woe." She had absolutely no understanding of all the legal maneuvering that surrounded her, and she had little more than a pittance to live on. She persisted in the vague hope, encouraged by Barbieri, that a pot of gold lay at the end of this strange rainbow, but she was far too innocent to have any real idea what it would be or what it would mean to her.

As it evolved over the years, Amalia's case pitted her and Barbieri against "the entire medical establishment of Bologna." After one particularly disheartening setback, Barbieri seemed to have "nothing but his own righteous anger and his long-suffering client." Although he had told her that he would not collect his fee until a final judgment had been rendered in his favor, he took out loans to pay witnesses and other expenses.

The case was a roller coaster. There were victories, defeats, appeals and, in the end, a negotiated settlement with the foundling home that left Amalia virtually as penniless as she had been when it all started. She and Luigi received 22,500 lire -- a stupefying sum for anyone of their class -- but had to turn it all over to Barbieri to settle their debts. "How," Kertzer asks, "did Amalia and Luigi react to this news? Did they use the rich palette of profanity their mountain dialect provided to denounce their erstwhile defender? Did they remind him of all the assurances he had given them over the years, how many times he had told them that they should trust him completely?"

We can't know, for Barbieri did not record this in his otherwise voluminous records. But what we do know, as Kertzer says at the end, "is that back then, as today, when the world of the rich collides with that of the poor, it is rarely the rich who suffer."

Kertzer, a respected anthropologist and scholar of Italian history who is provost of Brown University, practices in Amalia's Tale what he calls "serious history for a general audience," and he places narrative ahead of footnote-by-footnote documentation. As he admits, this may well disturb some in academia who are chained to apparatus, but it will please the general reader who seeks a glimpse into a part of the past about which we know virtually nothing. Kertzer is correct to say that now, with "HIV-positive mothers" passing AIDS to infants, Amalia's story has continuing pertinence. He has told that story well.

In August 1890, peasant woman Amalia Bagnacavalli traveled from her mountain village to Bologna in northern Italy to meet with Augusto Barbieri, a 28-year old lawyer. Their meeting spawned an unlikely 10-year odyssey in which the illiterate Amalia and her politically-minded attorney took on the medical establishment in Bologna and effectively changed the laws governing the treatment of wet nurses, while reaping a huge settlement.

Author David Kertzer's achievement with "Amalia's Tale" is to render an obscure and fascinating case as a riveting courtroom drama that touches on medical, legal and charitable ethics on the cusp of the 20th century. "Today too we witness the drama of a terrible disease passed between baby and the breast, but now it is infants, not the women who are nursing them, whose lives are at risk, threatened with infection by HIV-positive mothers," Kertzer points out. "Today the kind of legal action that Amalia took, which then had no name, has become so common that it is part of a well-known category, the medical malpractice suit."

Abandoned babies were such a huge problem in Italy that a series of Foundling hospitals were set up to attend to them. But then so many of those babies born with syphilis ended up passing it on to their wet nurses, young peasant women such as Amalia who were paid nine lire a month to nurse. (The train ride from Amalia's hometown to Bologna was five lire.) "The nineteenth century was something of a high-water mark for syphilis in Europe," Kertzer explains.

This was not an isolated issue - in the 1880s "34 former wet nurses had approached the hospital claiming they had been infected with the disease," while "276 foundlings had been struck with syphilis." The Bologna Foundling Hospital had a policy of paying for the treatment of the illness, on the quiet. The treatment included the use of mercury, which had a number of awful side effects.

At the heart of it all is Amalia, utterly baffled by the labyrinthine legal proceedings the author renders with such readable simplicity here. At the end of their case, Amalia and her husband Luigi are called into Barbieri's office only to be informed that they can take no part in the ultimate settlement of 22,500 lire. It is an affecting scene, all the more so because it spells out the attorney's gradual cynicism - the passion for social justice at 28 has curdled to a bullying opportunism within 10 years, devastating the couple who trusted him completely.

Amalia Bagnacavalli, an illiterate peasant from a mountain hamlet, “could only have gawked,” writes Kertzer, when she arrived in 1890 at the massive city wall of bustling Bologna. She had gone to take on a baby from a foundling hospital as a wet nurse for a fee of 9 lire per month. Five months later, suffering from the syphilis she had contracted from the foundling (and passed on to her infant daughter and husband), Bagnacavalli returned to Bologna, to the law office of Augusto Barbieri. Challenging the city’s medical establishment, Barbieri tenaciously fought a decade-long, pioneering malpractice lawsuit to force the foundling hospital to compensate Bagnacavalli. Kertzer, the provost of Brown University and the author of several books on Italian history, keeps in the background of his courtroom drama the class tensions between the unbowed nobility, the ascendant professionals and the radicalized poor in a modernizing post-Risorgimento Italy. Barbieri’s aristocratic foil and chief opponent was Count Francesco Isolani, the president of Bologna’s hospital board. Kertzer resists the temptation to glorify Barbieri, who didn’t seem so liberal when Bagnacavalli’s bill came due, or to vilify Isolani, who was tormented by the case and by the agonizing revision to hospital procedure it prompted: to protect wet nurses, babies with any sign of syphilis were fed animals’ milk, which in the age before pasteurization meant death for the majority of them. Kertzer handles the medical and legal details with confidence in this book, which is of modest scale but brims with compassion and insight.

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 Bagancavalli’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.