150 BOOK REVIEWS a Portuguese converso [convert; in this case from Judaism] family, combined the works of predecessors and learned authorities, and drew on his own experience as a practitioner, to reinstate the position of medicine and identify the qualities of the ideal physician: ‘male, virtuous and expert in medicine’. Arrizabalaga argues that the strong presence of converso practitioners in developing the literary genre of the perfect physician suggests that, although their views are varied, this genre offered them an important vehicle to understand their social, cultural, and professional position. This volume represents just the start of the work that still remains to be done to integrate the Iberian Peninsula into the wider systems of medical knowledge and practices of early modern Europe. A greater sense of dialogue between the papers might have been desirable, as there are obvious interactions across the papers, particularly with regard to notions of medical pluralism, which could have been taken even further. Collectively, these essays provide an important vision of the wide variety of competing medical practitioners and epistemologies (and to a lesser extent, practices) borne of the specific structural, political, and intellectual contexts of the peninsula at this period. SUSAN BROOMHALL UNIVERSITY OF WESTERN AUSTRALIA Susan E. Klepp, Revolutionary Conceptions: Women, Fertility and Family Limitations in America, 1760–1820 (Chapel Hill, North Carolina: The University of North Carolina Press, 2009). ISBN 9780 -8078-5992-6 (PB). 28 B&W illustrations, 12 figures, 13 tables, appends., 328 pp. Susan Klepp, a professor of colonial America and women’s history at Temple University, has produced a fascinating study that explores reproduction and family limitation in the Revolutionary Age in the United States. Klepp focuses on the experiences and attitudes of American women, persuasively arguing that over the course of the late eighteenth century, fundamental shifts took place in terms of the way that American women thought about and experienced family size, child bearing, and reproduction. Klepp begins with a chapter detailing the crude birth and marital fertility rates, focusing on quite detailed statistical evidence that Health & History ● 12/2 ● 2010 151 focuses heavily on the mid-Atlantic states of New York, New Jersey, Pennsylvania and Delaware, and is taken from the available surveys and censuses so as to allow comparison of birth rates for free and enslaved, as well as rural and urban women. The story these figures tell provides the basis around which the rest of the book is structured. In the colonial era, American families were large, reaching their peak in the 1750s and early 1760s. This period of high fertility was so notable that the size of colonial American families prompted international attention, and colonial American men and women extolled the benefits and blessings of bountiful, abundant, teeming families. Only a few short years later, family sizes began to contract for almost all segments of the population (from an average of seven children in 1800, to five in 1850, to three and a half by 1900). Klepp’s book is an exploration of why such a dramatic shift took place. She approaches the issue of family limitation from multiple perspectives and she foregrounds the words and experiences of women. She is careful never to overstate women’s actual agency and power with regards to their reproductive lives, but does provide compelling evidence about both why women began to try and control their fertility and how they attempted to do this. Klepp foregrounds the way that a woman’s status shaped both her exposure to the new ideas about family life, as well as her access to reproductive technologies and her general ability to limit family size. In particular, she notes that female slaves were both wanted for their ability to (re) produce new assets, but also, simultaneously, deplored as animalistic and uncivilised once smaller families became the social norm. One of the central themes in the book is the way that eighteenthcentury intellectual and spiritual currents altered ideas about reproduction, female children, family size, and the social role of women. Klepp strongly argues that the Great Awakening and the American Revolution helped make Enlightenment ideas about equality, liberty, rationality, and natural rights a part of the lived reality of many American women, and that...