How does the experience of sickness, death, and loss change over time? We know that the incidence and virulence of particular diseases have varied from one period to another, as has their medical treatment. But what was it like for the individuals who suffered and died from those illnesses, for the health practitioners and institutions that attended to them, and for the families who buried and mourned them? In Shadows in the Valley, Alan Swedlund addresses these questions by closely examining the history of mortality in several small communities in western Massachusetts from the mid-nineteenth to the early twentieth century―from just before the acceptance of the germ theory of disease through the early days of public health reform in the United States. This was a time when most Americans lived in rural areas or small towns rather than large cities. It was also a time when a wide range of healing practices was available to the American public, and when the modern form of Western medicine was striving for dominance and authority. As Swedlund shows, this juncture of competing practices and ideologies provides a rich opportunity for exploring the rise of modern medicine and its impact on the everyday lives of ordinary Americans. To indicate how individuals in different stages of their lives were exposed to varying assaults on their health, the book is structured in a way that superimposes what the author calls “life-course time” onto chronological time. Thus the early chapters look at issues of infancy and childhood in the 1840s and 1850s and the last chapters at the problems of old age after 1900. The reader becomes familiar with specific individuals and families as they cope with the recurrent loss of children, struggle to understand the causes of new contagions, and seek to find meaning in untimely death. By using a broad time frame and a narrow geographical lens, Swedlund is able to engage with both the particularities and generalities of evolving medical knowledge and changing practice, and to highlight the differences in personal as well as collective responses to illness and loss.