Women and healthcare in early modern E uropeстатья из журнала
Аннотация: Over the past two decades, our understanding of women's engagement in early modern medicine and healthcare has changed dramatically. Informed by a renewed interest in women's history, scholars working in the 1980s and 90s began to recover the activities of early modern midwives, sages-femmes and assorted female healers. Much of this scholarship was influenced by second-wave feminism that emphasized the exclusion of women from public and professional life. In her important overview of women and gender in early modern Europe, for instance, Merry Wiesner argued that, between 1500 and 1800, female medical practitioners were increasingly marginalized by the rising tide of professionalization, which emphasized formal training, occupational titles and various licensing mechanisms.1 Indeed, there is evidence that the number of licensed female medical practitioners declined in some major urban areas in the sixteenth century.2 Similarly, the valuable study by Laurence Brockliss and Colin Jones situated female practitioners within the ‘medical penumbra’ of early modern France, along with charlatans and empirics whose qualifications were frequently questioned. According to these authors, skilled medical women were relegated to the ‘sphere of compassionate and charitable activity’ by the end of the seventeenth century. Within this arena, women could nevertheless serve in traditional nursing and caring roles or occasionally move beyond them.3 Crucial to the marginalization of women as healers was the denigration of their empirical knowledge and know-how by university-trained physicians and guildsmen eager to establish superior professional competencies. Learned medical practitioners were known to scoff at the kind of practical knowledge women healers possessed, since it was not grounded in text-based, academic medical theory. As academic medicine became increasingly consolidated as a body of knowledge from the sixteenth century on, university-trained physicians often excoriated ‘silly’ women, ‘old wyves’ and ‘toothless, wrinkled, chattery, superstitious taper-bearing old women’ who dared to meddle in medicine.4 The result, according to this narrative, was that female practitioners were pushed to the margins by medical professionalization and their expertise devalued within a more highly differentiated marketplace. In the past fifteen years or so, numerous studies have both challenged and complicated this account. Central to this reappraisal is the identification of early modern medical practitioners beyond those holding formal occupational titles. Monica Green, Margaret Pelling, Mary Fissell and Montserrat Cabré have persuasively argued that a narrow focus on official work identities has led us to both undercount and undervalue the healthcare services women provided to household and community.5 In making this argument, Cabré has explored the rich semantic associations linking late medieval women and healing, while Green has coined the terms ‘medical agents’ and ‘agents of health’ to capture the wide range of medical providers who were active in settings where formal medical titles were not used.6 Similarly, Fissell has introduced the concept of ‘bodywork’ as a way to dismantle ‘hierarchies of value’ first created in the early modern period and reproduced by later generations.7 These new interpretive frameworks have enabled scholars to reclaim areas of health promotion and illness management in which early modern women figured prominently, ranging from pharmacy and ‘physic’ to various forms of care.8 As medical agents drawn from all walks of life, early modern women worked as paid nurses, unremunerated caregivers and live-in hospital administrators; they made and marketed medicines as commercial pharmacists or small-scale purveyors; managed the reproductive process as skilled midwives and as wet-nurses in charitable institutions; carried out minor surgeries; ran health-related establishments, sometimes with their husbands or other practitioners; wrote and published collections of medical recipes and alchemical compounds; served as expert witnesses and diagnosticians of the parish dead. Some female practitioners distinguished themselves as adepts within a burgeoning medical and scientific culture.9 By redefining what constitutes medical work, scholars have mapped a more complex terrain for early modern healthcare and women's place in it. This recuperation has profound implications for our view of the medical resources available in early modern society and highlights the value contemporaries placed on various types of services. Since the medical landscape of early modern Europe remained highly localized, at times the legitimacy of these endeavours was contested or viewed unfavourably by local authorities, but this resistance was neither uniform nor universal.10 Many of these recent scholarly developments can also be traced to the explosive interest in domestic medicine over the past decade. Some years ago, Margaret Pelling termed medical care offered in the home, primarily by mothers, wives, sisters and daughters, as ‘the first port of call’ when illness struck.11 Indeed, there is widespread consensus that the household remained the primary locus of care in late medieval and early modern Europe, despite the proliferation of hospitals and other charitable institutions. It was expected that women would develop the necessary know-how to manage illness and administer remedies within a domestic setting, thereby providing a critical resource within a more complex hierarchy of resort. Importantly, household medicine remained fully integrated with, rather than separate from, the wider medical economy.12 Well into the eighteenth century, when medical licensing and university-based educational programmes had firmly taken root in many parts of Europe, home-based healing was used alongside other measures, as an alternative to them, and as a last recourse when all else failed, even among affluent Europeans.13 The very pervasiveness of domestic medicine, however, raises important questions about the relationship between charitable care and commercialized practice in pre-modern Europe. Since the early modern household was conceived as an open, flexible space with permeable boundaries, the medical expertise women developed there was often put to use among neighbours and other community members as well. Many activities associated with home-based healing were so highly naturalized as ‘women's work’ that it was unclear whether they required formal compensation when performed outside one's immediate household. Was skilled medical care provided by female neighbours best considered an act of charity freely given, or was it a commercial service provided within an evolving medical marketplace? As several articles in this collection demonstrate, the issue of payment for everyday healthcare services – administering remedies, tending the sick – became a flashpoint in the early modern period. Responses to this question were hammered out in highly localized settings, giving rise to different administrative and social solutions. Indeed, Sandra Cavallo and David Gentilcore have stressed ‘the importance of the local cultural context in differentiating the opportunities and choices’ consumers could make among active medical agents.14 Yet the frequency with which the question of remuneration surfaced, whether in fifteenth-century Valencia or in sixteenth-century London, points to an important moment of transition for Europe as a whole. Commercialization increasingly conditioned the public recognition of women's medical skills and their perceived identities as healthcare practitioners. Other studies have shown that early modern households played a crucial role in health promotion as well as therapeutic care. Sandra Cavallo and Tessa Storey have emphasized the revival of a preventive paradigm after 1500, in tandem with the growing circulation of printed vernacular health manuals and the avid compilation of handwritten recipe books.15 Fostering healthy households emerged as a key concern of middling and elite female householders in the sixteenth and seventeenth centuries, although it remains to be seen how deeply this concern could penetrate the lower social orders. Health regimens emphasizing prevention rather than cure drew extensively on Galenic principles of the six non-naturals: avoiding bad air by inhaling sweet smells; regulating diet and consuming foods with health-giving properties; striking an appropriate balance between sleep and exercise. Successful implementation of these regimens hinged to a considerable degree on manipulating domestic interiors and monitoring everyday routines, for which well-to-do women bore primary responsibility. Although the culture of prevention encompassed a wide range of practices, the quality of the domestic environment emerged as a key ingredient of healthy living by the mid-sixteenth century. Blending health promotion with curative responsibilities, domestic medicine provided the means by which women across broad swatches of the social spectrum developed important practical skills and gained varying degrees of health literacy. Recent studies of domestic medicine have also generated new perspectives on the household as a site of knowledge production operating outside traditional frameworks of guild and university. Early modern women created new medical knowledge, along with a heightened sense of their own authority, by means of everyday household practice.16 A fundamental part of these inquiries rests on the analysis of both printed and manuscript recipe collections, particularly in England and, to a lesser extent, in Italy. As a genre, recipe books assembled a rich, often jumbled mix of ingredients and information. They collected directions for making medicines and cosmetics, techniques for preserving food or removing stains, and other instructions useful for domestic management or tradecraft.17 Concocting recipes was prime terrain for experimentation and the development of proprietary knowledge; many avid female practitioners recorded the results of their efforts in manuscript books that could be passed down and supplemented by later generations. Consequently, recipe collections could be single-authored works or collectively generated by householders over time. To fulfill some of their principal duties, female householders also consulted printed herbals and recipe collections, which flooded the cheap print market in the sixteenth century. These ‘useful books’ provided important sources of advice and information; like vernacular health regimens, they could be read in different ways for different purposes.18 Further extending the reach of household medical knowledge were the lively epistolary exchanges between and among literate women and men that also served to consolidate social relationships.19 To date, most studies of household medicine have focused on women's expertise. The complex ways in which domestic medicine was gendered merit further investigation. Given the porous nature of early modern households and their work-sharing arrangements, however, it is not always possible to know ‘which person was doing exactly what work’.20 Lisa Smith and Elaine Leong have argued that early modern fathers, husbands, uncles and sons were indeed interested, active participants in home-based medicine. Their studies show that respectable male householders in England and France engaged in certain types of domestic medical activities, such as gathering remedies, and played an instrumental role in medical decision-making when family members fell ill. This is an area ripe for further investigation. In assessing how household medicine was gendered, the issue of change over time warrants particular attention. Since the studies mentioned above focus on the late seventeenth and eighteenth centuries, it may be that changing views of masculinity and new family ideals emerging in the early modern period help to explain a more vigorous emphasis on men's domestic healthcare responsibilities compared to earlier centuries.21 Animated by these new lines of inquiry, this collection of six articles by an international team of scholars advances our understanding of how healthcare was organized, practiced and gendered in early modern Europe. Spanning England and the continent from the fifteenth to the eighteenth centuries, the studies presented here put forward new findings based on original archival research that illuminate local contexts as well as larger patterns of provisioning. All of the articles put female practitioners squarely at the centre of analysis, while taking into account the diverse legal, social and economic settings in which they worked. Attending to both particular circumstances and their broader implications, the issue paints a rich and varied portrait of women's medical skills, both paid and unpaid, that were deployed in the home and marketplace during a major watershed in European history. Although the issue touches on diverse questions – perceptions of illness; the diffusion of intimate bodily knowledge – it makes three main contributions to the ongoing reappraisal of women's role in early modern healthcare arrangements. First, the issue deepens our understanding of how household medicine was actually practiced by positioning it in relation to broader networks of community, charity and commerce. Several of the articles offer new and detailed insights into the domestic environments in which female practitioners operated; they throw the scale of women's household healing activities and their appropriation of medical texts into sharper relief. Other contributions explore the intersection of home-based healing with the overall medical economy, highlighting the social and legal tensions resulting from this overlap. Whether spotlighting female experts who worked without pay or practitioners who purveyed their skills in the marketplace, the issue casts new light on women's claims to medical expertise and their self-perception as healers. Second, the issue stresses the significance of women's medical skills to emerging structures of public health. Part of the untold story of women's engagement with health-related activities in the early modern period concerns their integration into new social welfare initiatives, the provision of poor relief, and other measures aimed at fighting disease at the population level. This story is especially resonant for sixteenth-century urban areas. Although the European population began to recover numerically after 1500, it remained vulnerable to disease threats from plague, syphilis and other epidemics. Growing population density in urban centres put added pressures on the existing sanitation infrastructure and preventative measures such as quarantine that had been developed in the late medieval period. Economic hard times and religious warfare heightened demand for urban poor relief and prompted the establishment of new charitable institutions such as orphanages, women's shelters and specialized hospitals.22 As several articles in this issue indicate, female medical practitioners found important new openings in these settings. In sixteenth-century London, poor almswomen worked in dual roles within the post-Reformation scheme of charitable care: as ‘keepers’ paid to tend the parish sick and as ‘searchers’ who diagnosed cause of death and relayed crucial epidemiological information to civic authorities. In Renaissance Venice, women from artisan families purveyed plague remedies aimed at treating or preventing outbreaks of this dread disease; in the process, they not only served the common good but also promoted private family fortunes. In German towns and cities, certified midwives and other trained female practitioners held civic office and worked as specialized hospital administrators. Throughout early modern Europe, women's ‘unofficial’ medical skills were put to a number of innovative ‘official’ uses. Yet at the same time, this public medical work was often obscured in early modern administrative records. Even though the expansion of poor relief and public health measures undoubtedly increased women's employment in the healthcare sector, their visibility diminished in bureaucratic sources. By problematizing the disjuncture between historical activities and their documentation, the issue throws the gendered nature of early modern record keeping into sharper relief. Finally, the articles in this issue shed new light on early modern female practitioners as both producers and consumers of medical knowledge. That knowledge was primarily experiential in nature, based on seeing and doing, but it could be deeply informed by reading practices and medical theory.23 Important sites for knowledge production considered here run the gamut from the domestic spaces of English and German households to Catalan law courts, London parishes and Venetian city streets. Most obviously, expert noblewomen generated new knowledge by experimenting with medical remedies in their laboratories. But knowledge could be produced in the household in less obvious fashion. English gentlewomen appropriated herbals and health manuals in highly individualized ways by developing personalized reading strategies, note-taking and compilation practices. By selecting and reorganizing existing medical information to suit their own needs, elite women expressed their subjectivity as consumers. Law courts provided another avenue through which medical expertise could be acquired and adjudicated; vivid testimonies presented in court by both male and female ‘experts’ highlight the interplay of lay and learned understandings of how the body functioned. Considered as a whole, these six articles showcase a pluralistic medical culture in which many historical actors claimed extensive medical competencies, despite the new valuation attached to formal academic training. The articles are organized thematically into two clusters, each of which follows a rough chronological arrangement. The first group of articles, by Blumenthal, Rankin and Leong, takes issues of domestic medicine in new directions by exploring their relation to late medieval slavery, Renaissance material culture and early modern reading practices. By contrast, the second group of articles, by Munkhoff, Stevens Crawshaw and Kinzelbach, focuses more explicitly on the uses to which domestic medical expertise was put in public and professional settings, such as parishes, hospitals and physicians' practices between the sixteenth and eighteenth centuries. Running throughout the collection as a unifying thread is the concern with the production and transmission of knowledge sketched out above. The opening article by Debra Blumenthal, ‘Domestic medicine: slaves, servants and female medical expertise in late medieval Valencia’, capitalizes on the rich body of judicial records from fifteenth-century Valencia, a booming commercial hub and a centre of the medieval Mediterranean slave trade. Blumenthal tackles the question of how female medical expertise acquired in the home was both utilized and contested in one of the most dynamic urban communities on the Iberian peninsula. At the core of her study are five court cases concerning ‘defective’ female slaves and servants considered unfit for service owing to illness or other physical imperfections. The civil courts of late medieval Valencia heard a wide range of voices in their deliberations: university-trained physicians, surgeons, pharmacists, fishmongers, merchants, bakers' wives, neighbours, female servants. It was not uncommon for midwives and other women holding civic medical appointments to appear as ‘expert witnesses’ in court, but Blumenthal notes that even laywomen lacking such titles were judged to be particularly competent at assessing the health status of slaves.24 Plaintiffs seeking financial restitution or legal protections in these disputes devised powerful strategies that combined learned medical opinions with lay medical expertise. In their attempts to win the day in court, plaintiffs obviously saw real probative value in the evaluations of experienced women healers, despite their lack of occupational titles. Blumenthal argues that, by inviting testimony from female lay experts as well as university-trained physicians, the courts of late medieval Valencia not only applied current medical knowledge but actively produced it. One of the most striking features of these cases is the widespread diffusion of medical literacy among the lay populace, evidenced in the presumed ability to ‘read’ bodily conditions. Female neighbours who testified in local courts possessed a surprisingly intimate knowledge of other women's bodies, as well as the vocabulary to describe a range of physical conditions.25 This kind of empirical knowledge coupled the diagnostic tools of the senses, especially keen visual observation, with hands-on expertise gained from day-to-day practice. The authority wielded by some female practitioners can be seen in the final case under discussion, in which the diagnosis proposed by a baker's wife in the 1440s forced court-appointed physicians to reconsider whether a Circassian slave woman suffered from leprosy. The lively testimonies presented here challenge the established view that medical professionalization in the Crown of Aragon was largely complete by the mid-fourteenth century. Yet these cases nevertheless highlight important frictions between female practitioners, their clients, and the interests represented by magistrates and learned physicians. Blumenthal argues that women who had a reputation for being effective healers in their own households were called upon by neighbours to treat them during their illnesses, especially if those persons lacked relatives or other household members who could provide care. However, lack of professional standing often made it difficult for women to be compensated for services rendered. Nursing provides a good case in point. Driven by patient demand, home-based nursing offered skilled urban women a supplementary, albeit irregular source of income. Given the urgent, often unpredictable nature of illness, however, nurses generally made informal agreements with their patients rather than drawing up notarized contracts. Caring for sick neighbours at home, even if it meant ignoring one's own domestic responsibilities, blurred the lines between friendship, charitable social obligation and paid work. This ambiguity came back to haunt women like Ysabel, a tailor's wife who nursed the merchant Matheu de Celi, his wife Maria and other household members through multiple illnesses for more than twenty-five years. The couple had promised to compensate Ysabel for her longstanding service by leaving her a legacy in their last wills; when they failed to deliver on that promise, Ysabel filed suit in 1475. Although the outcome of this case is unknown, it demonstrates how the naturalization of certain healing activities exposed irregular female practitioners to legal battles over the commercial value of their skills. The diffusion of medical expertise among lay women – this time in the realm of pharmacy – is examined by Alisha Rankin in ‘Exotic materials and treasured knowledge: the valuable legacy of noblewomen's remedies in early modern Germany’. Although early modern women from all walks of life practiced the art of pharmacy, noblewomen were renowned for providing home-based remedies to local communities as a form of charity and estate management. Some German aristocratic women with a scientific bent gained a local or regional reputation as highly skilled apothecaries, tapping their widespread exchange networks to procure both familiar ingredients and exotic materia medica. Rankin has argued elsewhere that confecting medicinal remedies was viewed as such an integral part of noblewomen's normal household duties that these women ‘became fêted as healers not in spite of their gender, but because of it’.26 The medicines and health-giving confections made by these elite women were not meant to be sold, but instead were given as gifts to other aristocrats or distributed gratis to the local poor. This kind of charitable healing paradoxically contrasts with the more explicit commercial motives of Italian religious women, who marketed a wide array of medicines to the lay public in the sixteenth and seventeenth centuries.27 Like other small-scale vendors in Italian Renaissance cities, nuns developed a booming business by producing remedies for consumers who could not manufacture them in their own kitchens.28 The extent to which female healers sold their wares to other consumers hinged on the structure of local markets, pointing once again to the importance of local settings in the ways that healthcare was both provisioned and commercialized. Here Rankin focuses on the relationship between the materiality of German noblewomen's pharmacy and the immaterial medical knowledge it embodied. Through a close study of two extensive apothecary inventories – one made for Electress Anna of Saxony (1532–85), the other for Duchess Sibylla of Württemberg (1564–1614) – Rankin gives us a rare glimpse into the details of their working environment and the impressive scale of their pharmaceutical operations. Even though the exact recipients of their medicaments are not always clear from surviving records, the sheer range of medical items they possessed in their storerooms and distilleries attests to a vibrant pharmaceutical practice. At the same time, these sources highlight an important disjuncture between the material worth of medical ingredients and equipment, on one hand, and their value as a family legacy on the other. Rankin argues that the perceived value of this pharmaceutical legacy lay in the eye of the beholder. Post-mortem inventories drawn up by notaries were concerned above all with establishing the economic value of the distilling apparatus, expensive drugs, containers, furnishings, and hundreds of books left behind. By contrast, what noblewomen and their daughters treasured most highly were efficacious remedies and the knowledge they represented. Notaries privileged the market value of drugs and equipment; noblewomen emphasized instead the medical value of proprietary recipes, which were handed down through the generations as heirlooms. It was the immaterial value of noblewomen's medical knowledge embodied in their recipes that was seen as a true family treasure – a Schatz. This analysis has wider implications for both medical history and material culture in the ways it challenges purely economic definitions of value. The next article by Elaine Leong, ‘“Herbals she peruseth”: reading medicine in early modern England’, turns from questions of hands-on practice to the ways early modern women produced and consumed medical information as readers of vernacular medical texts. Household advice manuals made clear that the ideal gentlewoman in seventeenth-century England could not fulfill her household duties without knowing ‘physic’ and the operations of herbs. Such knowledge was to be gained in part through books and reading. Leong contends that ‘reading about medicine, and about nature more generally’, needs to be considered alongside more explicit medical activities such as nursing, dressing wounds, making and administering remedies. Focusing on three financially comfortable gentlewomen – Anne Clifford (1590–1676), Elizabeth Freke (1642–1714) and Margaret Boscawen (d. 1688) – Leong tracks the printed medical books appearing in their collections. These included pharmacopeias, contemporary medical recipe collections, general medical guides and various herbals, reflecting the growing availability of medical print wares produced for the mass market.29 Of even greater interest here, however, is how these books were read. Leong characterizes the common approach these gentlewomen took to medical books as ‘a slow process of repeated readings, conversations and digestion’ that fuelled their minds. They read and re-read texts, studied entries one by one, made meticulous notes, and conferred with other trusted knowers. In short, their usage of medical texts was geared toward practice, rather than toward leisure. But this kind of reading was neither a passive process nor a simple, linear transfer of knowledge. Each woman appropriated the same texts in different ways, marking a subjective variation from reader to reader that reflected individual interests and circumstances. Anne Clifford, for example, carefully selected material from John Gerard's massive, popular herbal: she took extensive notes, summarized and extracted entries, and at times reorganized the information to create her own ‘epitome’ in manuscript form. Elizabeth Freke also read steadily through Gerard's herbal – a process that took almost two months – in order to create a ‘customized abstract’ that functioned as a new, stand-alone text in which she interpolated other observations. Similarly, Margaret Boscawen created her own treasury of knowledge by reordering material from Nicholas Culpepper's popular herbal into a handwritten ‘plant book’ that combined seasonal to-do lists with her own system of categorization. Leong shows us how these gentlewomen not only consumed medical knowledge but actively produced it; in the process, she undermines received notions about cultural consumption that emphasize collective, codified patterns of reading. The second cluster of articles investigates women's involvement in institutional healthcare settings, especially innovative forms of medical charity and public health, which often capitalized on home-based healing skills. Despite differences in local markets and political arrangements, towns and cities across Europe strengthened their hand at plague management, met increased demands for poor relief, and fostered specialized hospital care in the sixte
Год издания: 2014
Авторы: Sharon T. Strocchia
Издательство: Wiley
Источник: Renaissance Studies
Ключевые слова: Historical Economic and Social Studies, Historical Studies on Reproduction, Gender, Health, and Societal Changes
Открытый доступ: bronze
Том: 28
Выпуск: 4
Страницы: 496–514