Health and the City brings an interdisciplinary approach to the study of late Progressive Era public health programs in the United States. This is a well-developed field of scholarly inquiry with several works, including Susan L. Smith's Sick and Tired of Being Sick and Tired (1995), Judith Walzer Leavitt's Typhoid Mary (1996), and Nancy Tomes's The Gospel of Germs (1998), offering important insights into the development of public health programs shaped by race, region, class, and gender. Hart builds on this scholarship and on her earlier work on the history of black motherhood and disease to explore the interface between civic health reformers and African American, British West Indian, and southern Italian immigrants in New York City during the first three decades of the twentieth century.

Hart's approach helps to sensitively recover the voices and agency of a generation of women, who faced significant challenges at a time of momentous change. By drawing on medical journals, social-work files, and sociological data, as well as literature, plays, and music, she argues that although the health services provided by civic reformers were rooted in racialized assumptions, they nevertheless offered pioneering health care to marginalized populations. She further contends that while immigrant black and Italian women were targeted by these health campaigns, they were not passive recipients of a reformist agenda, but negotiated the system to maintain cultural identity and improve health.

Health in the City is arranged thematically around the implementation of maternal and child health programs in the racially conceived “sanitary districts” (188) of New York City. The first chapters uncover the experiences of migrant families, as well as the growing professionalization of health and medical practitioners. Hart reveals the motivations of immigrants, their expectations of New York City, and how they were received upon arrival. She counterbalances the drudgery, dangers, and disappointments experienced by many new arrivals with their hopes for a better life. The ideological shift from sanitarianism to germ theory, combined with the growing power of public health bureaucracy, placed immigrants under close scrutiny. The next chapters examine the cultures fostered by African American, British West Indian, and southern Italian migrants and the health work undertaken in their communities. The final chapters turn to community-focussed case studies of Columbus Hill and the Mulberry District. Hart shows how assumptions and institutional priorities affected the delivery of health programs; indeed, the myth of black Americans as a “syphilis-soaked race” (147) rationalized attention to the treatment of maternal syphilis rather than respiratory diseases in Columbus Hill. Meanwhile, in the Mulberry District, the stereotype of southern Italians as “intellectually inferior and morally inadequate” (54) informed efforts to reform birthing practices and reduce the influence of midwives. While these immigrant women accommodated the programs they considered beneficial, they also fought for practices they believed were safe or essential to their identity.

The book is ultimately successful in its use of literature, poetry, and lyrics to recover working-class and domestic female cultures. Representations of mothering and womanhood are effectively embodied in the blues songs of Bessie Smith and Memphis Minnie. Hart's attention to three racialized immigrant groups is effective, since it allows for comparison and an assessment of the finer distinctions of how conceptions of race functioned in society. The scrutiny of historical data sets in order to understand the successes and failures of public health programs is useful; by comparing the evidence recorded by health workers with other sources, she traces data-collection problems and reporting biases in Columbus Hill and the Mulberry District (180–84, 230–32). She shows how civic reformers’ racially informed health priorities may have increased risks associated with the testing and treatment of syphilis among black women. Moreover, although midwife-attended deliveries were shown to be safe, the efforts of health workers to curtail their use among southern Italian women largely failed, while at the same time increasing distrust and introducing risks associated with “invasive birthing tools” (216). Despite its strong points, the book is laden with an overwhelming amount of historical context and historiographical analysis, which in some sections impedes flow and focus. Furthermore, questions of stigma, immorality, and reproductive excess are raised by Hart, but are not explored in adequate detail. Nevertheless, the book provides a valuable case study for historians of American race, gender, and health, as well as a useful resource for students studying introductory courses in history.