Overview
For students and teachers, this section provides examples of the secondary literature on this topic. In general, this essay serves as an overview of some of the issues relevant to this subject.
The Place of Women:
Midwives and Domestic Medicine in the 18th Century
This section is meant to introduce you to some of the methodological approaches that historians have employed in writing on the subject of midwifery and domestic medicine. In this essay, we focus on two of the books that have had the most impact on our understanding of the role of women in this history. These include Paul Starr’s The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (Starr), and Laurel Ulrich’s A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812 (Ulrich). Each of these books offers a different perspective and each offers insight into how historians can approach the question: “How do we tell a history of medicine in America that does justice to the role of women?”
Starr
Paul Starr’s book is a good place to start our discussion. The Social Transformation of American Medicine is an example of a very broad history. Starr sets out to explain how the American medical profession became the powerful, authoritative profession that it has. In doing so, Starr begins at the “beginning.” He starts his readers off in 18th-century America, when the first rumblings of medical professionalization were visible in physicians’ efforts to distinguish themselves from lay healers and "quacks" through education and licensing. It is during this time, argues Starr, that doctors in colonial America first attempted to reproduce the prestige and institutional authority held by their British counterparts. (Starr, 30) According to Starr, however, Americans’ distinct democratic culture resisted social hierarchy. Early Americans maintained a stubborn attachment to the idea that every man was born with the common sense necessary to take care of himself, particularly when it came to healing. This did not necessarily mean that everyone relied solely on their own knowledge to cure their ills, but it did create an environment in which Americans believed in their own judgment when it came to choosing where to go for help when they became ill. Starr claims that it was this unique American sensibility, the belief that “men had free and equal rights to judgment,” which allowed practices like midwifery, domestic medicine, and lay medicine to flourish into the 19th century. (Starr, 31)
In the midst of this chaotic landscape of competing bodies of knowledge, physicians also struggled with the effectiveness of their own remedies. For most of the 18th century and part of the 19th century, many people, including many physicians, believed that “nature” was the most effective healer. It was the health practitioner’s job simply to assist nature. It was under these conditions that women fulfilled an important role as the default healer among their circles of friends and family. He writes, “Care of the sick was part of the domestic economy for which the wife assumed responsibility.” (Starr, 32)
In keeping with his earlier claim that physicians began attempts to organize and gain profession legitimacy in the mid-18th century, Starr points out the emergence of medical guides published by physicians around this time. These guides served both the American public and elite doctors by catering to the needs and professional agendas of each. These home medicine manuals catered to Americans’ democratic sensibilities by providing them with knowledge that allowed them to make informed decisions about their health. However, they also introduced the general public on a mass scale to the language and advice of physicians. According to Starr, this latter point was crucial because women’s acceptance of physicians’ advice via the medical guides helped lay the groundwork for their acceptance of physicians’ physical presence within the home, an environment that would otherwise have fallen almost exclusively under the jurisdiction of women.
It is noteworthy that Starr gives attention to domestic medicine as a sphere of knowledge that is separate from his other categories of 18th-century healing — lay medicine and professional medicine. Although he places housewives in the category of domestic medicine, Starr also discusses women in his section on lay medicine — a sphere he distinguishes from domestic medicine simply as “an occupation…but without any standardized training or group organization.” (Starr, 48) Starr places midwives within this category of lay healer. In his discussion of the eventual decline of female midwifery, Starr simply recapitulates the arguments of several other historians who have pointed to the use of forceps to shorten women’s labor, the growth of licensing for doctors, the overall increase in the number of male physicians practicing obstetrics, and the general shift to more rigid social roles for women as explanations for this gradual shift form female to male midwives.
While Starr’s work provides an excellent framework for understanding the changing relationships between domestic, lay, and professional medicine which characterized healing during the 18th century, his approach does have limitations. A book as broad in scope as Starr’s is often limited in its analytical depth into any single area. For this reason, Starr’s book is an excellent place to start when embarking on a research project of this kind because it lays a foundation for understanding the history of medicine within American history more generally. One of the most important ideas that emerges from Starr’s broad treatment is the realization that the medicine we recognize today has not developed because it was the “best” or even the most effective at treating people’s illnesses. The history which Starr asks us to consider is that different bodies of health knowledge have coexisted. He argues that in the 18th century, these coexisting bodies of knowledge consisted of domestic, lay, and professional medicine. According to Starr, if we wish to understand our medical system today we must understand how it arose, and in order to do that we must understand the systems with which it has competed in the past. It is in this way that Starr gives us a glimpse of the ways in which women can be reinserted into the history of medicine.
Ulrich
While Starr offers us a general overview of the history of medicine, Laurel Ulrich provides us with a specific historical account based on the life of an 18th-century midwife. In A Midwife’s Tale, Ulrich introduces us to Martha Ballard, a dedicated mother, wife, neighbor and midwife in 18th-century rural Maine. Through a detailed exploration of Martha’s diary, Ulrich reconstructs her life in marvelous detail. It is Ulrich’s creative use of primary sources that makes A Midwife’s Tale so much more than just an interesting story. Ulrich has painstakingly combed Martha’s diary, matching her entries with local court records, newspapers, and the diary of a prominent educated physician who lived nearby. More than simply telling Martha’s life story, Ulrich’s impeccable scholarship allows her to place Martha within the larger history of midwifery and medicine in America, specifically the northeastern portion of the country.
While Ulrich’s book reads smoothly and easily, the complex and difficult process behind such a product is worth mentioning. As we pointed out, the success of A Midwife’s Tale stems in part from Ulrich’s ability to link Martha’s life to a larger historical narrative like that in Paul Starr’s book. This connection between macro- and micro-history involves an incredible amount of archival research. In perusing Ulrich’s footnotes, one finds hundreds of references to 18th- and early 19th-century documents, not just Martha’s diary. This in-depth research gives Ulrich the ability to first link Martha’s personal accounts with a local history, then a regional and national history, and finally, using secondary sources, she is able to link into the larger literature on the history of medicine. (Ulrich, 25)
In connecting Martha to a larger history, Ulrich dismisses earlier terms for healing practiced by women. Domestic medicine, she argues, cannot be applied to women like Martha who traveled all over her area treating neighbors in exchange for goods and services. Similarly, lay medicine, she argues, “connotes the lack of formal organization in female practice, but fails to suggest its complexity.” Ulrich finally settles on the term social medicine. Social healers, she argues, “were so closely identified with their public that we can hardly find them.” (Ulrich, 61) Through the writings of Martha Ballard, Ulrich tells us a history not so dissimilar from that told by Starr. What differs most in their accounts is the specificity, richness, depth, and, as Ulrich writes, an understanding of “what was lost, as well as what was gained, in the political, economic, and social transformations of the eighteenth and early nineteenth centuries.” (Ulrich, 32)
Ulrich’s work reminds us of why history is so interesting — it is the story of the people who came before us, who helped create the world we live in today. By bringing voices such as Martha Ballard’s back from the past, works like A Midwife’s Tale provide the details that can support, inform, or challenge the larger historical narratives like Starr’s The Social Transformation of American Medicine. At the same time, works like Starr’s help historians like Ulrich make sense of and find meaning in the scattered remnants of the past.
The accounts of both Starr and Ulrich provide historians interested in studying the place of women in the history of medicine with incredible resources for beginning such an investigation. We hope you have come to understand a little about the different ways historians have approached these issues in the past and have learned to see what the benefits can be in having such different scholarly perspectives. As you continue to explore the Web of Healing, we hope that these ideas will help you think about how to do a social history of medicine in America.