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This work sets out to determine why home care, despite its potential as a preferred, rational, and cost-effective alternative to institutional care, remains a marginalized experiment in care giving. Nurse-historian Karen Buhler-Wilkerson traces the history of home care from its 19th-century origins in organized visiting nurses' associations, through a time when professional home care nearly disappeared, on to the 1960s, when a new wave of home care gathered force as physicians, hospital managers, and policy makers responded to economic mandates. Focusing on sickrooms of the rich, middle class and poor, this historical account examines how race, ethnicity, income, gender, type of illness, local conditions and patterns of practice influenced access to and quality of care. Buhler-Wilkerson links local ideas about the formation and function of home-based services to national events and health care agendas, and she gives special attention to care of the "dangerous" sick, particularly poor immigrants with infectious diseases, and the "uninteresting" sick - those with chronic illnesses. The book also evaluates the impact of social attitudes, medical advances, demographic change, and economic factors in shifting care from the home to the hospital and back home again.