Lecture Four: Cultures of Disease and Care

Women, Illness, Home, and Community

Premises of social/domestic medicine and modern medicine

Social and domestic

1. Doctors are incidental
2. Many are sick much of the time
3. Health-care is community cement
   • A community is a social unit of mutual support
4. Neighborly female services: "the offices of friendship"
   • Nutrition: food is medicine (household books)
   • Housework
   • Child care
   • Nursing
   • Watching
   • "Assistance" at childbirth
   • Laying out: "the last office of friendship"

Modern

1. Doctors are central
2. Most are well most of the time
3. Health care is individual, threatens to divide community
4. Professional Services
   • Legal legitimation of diagnosis
   • Treatment plan and drug access for healing and self-fulfillment
   • Protection of privacy
   • High-tech birthing
   • Invisible deathing

Women as healers and ill

1. Martha Ballard, healer: Community
   • Epidemic disease, accident, midwifery, infant care, herbal medicines, physician's assistant, mortuary work (though mainly Pollard)
2. Emily and Sarah Gillespie, healers and invalids: Family and Geography
   • Accidents, diseases of ageing (dropsy, stroke?), watching, minor surgery, nursing
3. Deborah Viner Fiske, invalid: Class
   • Moral support, self-taught medical student and self-healer

Martha Ballard

1. Hallowell, one generation post pioneering
2. Unlicensed, flexible, skilled professional
   • Class structure: professionals, neighbors, servants
3. Training and theory
   • Learned medicine?
   • "Empiric"
   • Nature healer? - "doing more than assuaging pain...confirming the essential order of the universe." (Ulrich, p. 53): Sympathetic cures
4. Women's and children's health: secondary medical services?
5. Is Martha Ballard part of the medical marketplace?
6. Fees: Potlatch? Custom? For time or skill?

Emily and Sarah Gillespie

1. Agricultural isolation
2. Economic competition
3. Emotional entrapment
4. Limitations on women's careers
5. Local doctors and the magnetic healer
6. Disease as human relations
   • "Just as Emily attributed her illness to James's violence and indifference, she insisted that Sarah's attentive care alleviated emotional stress and thus facilitated healing" (595)

Deborah Viner Fiske

1. Rothman's problem: Why do doctors give men and women different advice for the same disease?
   • Men: travel, ocean voyages
   • Women: quiet, confidence, ...and pregnancy
2. Consumption as a lifestyle
   • A disease of young adults
3. Disease as self-fashioning; active invalidism; heightened sensitivity
4. Negotiations with Drs. Warren and Jackson
   • Diagnosis by letter
   • Deborah as medical autodidact
   • What game is Dr. Warren playing?
5. Class: the luxury of suffering
6. Religion and status: the license for authoritative heaven talk

Relations of lay healers with doctors

1. Overlapping pharmacopeia, but avoidance of strong medicine, theoretical advice
2. Competition
   • Male midwifery
3. Cooperation and complementary practice
   • Attendance at autopsy: courtesy, recognition, legitimation, enactment of status, consultation
4. Why must doctors be gentlemen?
   • Gentleman = man of property

Deadly disease and religion

1. Acceptance of child mortality
2. "What an excellent thing is the grace of submission!" - Henry Sweall on death of firstborn baby (Ulrich, 42)
3. Disease as ambivalent divine gift
4. "Oh most merciful God, let not the disease which they wisdom has brought upon her be suffered to fix its seat upon her vitals.  In thy hands are the springs of life.  Bless the means for her recovery and graciously spare her to me and this family, to her lonely father and her friends." - Nathan Fiske, on Deborah (Rothman, 103)

Contemporary Implications

1. Home: the hospital of last resort
2. The aged between medicare and medicaid
3. But...where has the community gone?
   • Who works in the home?
4. But...do we thrive in each other's illnesses?