Women and healthcare in early modern Europe

This is the authors' abstract. We don't add key points for this paper.

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 Sandra Cavallo and have emphasized the of a in with the of health and the of households as a of and female in the sixteenth and seventeenth it to be this could the social rather than on of the by and with an between and of these to a on domestic and everyday for which women primary the of a wide range of the of the domestic as a of by the century. health promotion with domestic medicine provided the by which women of the social developed important practical skills and of health studies of domestic medicine have also new on the household as a of knowledge outside traditional frameworks of and modern women created new medical along with a of their by of everyday household of these on the of both and in to a in As a a often of and for making medicines and for or and other for domestic management or recipes was terrain for and the of many female practitioners the of their in that could be and by later collections could be or by over some of their female also and which the in the sixteenth century. 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The first of the the range of public medical activities women performed in early modern for which they were in or As in sixteenth-century London, local the use of practical knowledge beyond ‘the of the domestic of midwives, and other women holding medical which In female medical physicians and working in the public and the of healthcare in were members of hospital in these were so which than a of hospitals ranging from a and a to hospitals and two providing and other is about women's hospital work in was – a conditioned by and in hospital nursing and sick and to and hospital and to and administering and providing other of and to of many of these activities had their in the medieval these became more as hospitals themselves became more highly differentiated in the early modern in sixteenth-century and for instance, on which the of the care of social as well as medical As and for healthcare services in sixteenth-century female hospital from were to work in with health their in By women at the hospitals in and who from administrative with their In some these and were on both the practical and importance of the in care by of these roles a of medical and know-how and new female the of active in France, formal programmes for hospital In the of the the by the between and This new on the medical of and evidence for everyday healthcare all social for what it can us about medical within early modern households and women's expertise within that the of household medicine and professional in of and By the of and in practice – medicines in – the of early modern medical this rich to between the and other female practitioners who the of for their expertise by some of their remedies and later in scientific on these two of evidence – the other – that there was of female practitioners in early modern within and beyond the The widespread of their medical some of the by medical and eager to their professional these articles our understanding of the of women's healthcare activities in the early modern period. than female practitioners at the margins of medical the issue at the of household medicine, of public and the of medical and of the articles the hospital and parish as important of knowledge and The collection us the to which of medical charity and public health on the knowledge and skills in domestic medicine when to for services. 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