Female Patients in Early Modern Britain

Gender, Diagnosis, and Treatment

Wendy D. Churchill

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317135968
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

This investigation contributes to the existing scholarship on women and medicine in early modern Britain by examining the diagnosis and treatment of female patients by male professional medical practitioners from 1590 to 1740. In order to obtain a clearer understanding of female illness and medicine during this period, this study examines ailments that were specific and unique to female patients as well as illnesses and conditions that afflicted both female and male patients. Through a qualitative and quantitative analysis of practitioners' records and patients' writings - such as casebooks, diaries and letters - an emphasis is placed on medical practice. Despite the prevalence of females amongst many physicians' casebooks and the existence of sex-based differences in the consultations, diagnoses and treatments of patients, there is no evidence to indicate that either the health or the medical care of females was distinctly disadvantaged by the actions of male practitioners. Instead, the diagnoses and treatments of women were premised on a much deeper and more nuanced understanding of the female body than has previously been implied within the historiography. In turn, their awareness and appreciation of the unique features of female anatomy and physiology meant that male practitioners were sympathetic and accommodating to the needs of individual female patients during this pivotal period in British medicine.

Chapter 1
Male Medical Practitioners and Female Patients in Early Modern Britain: Gendered Clienteles, Illnesses, and Relationships

Traditionally, the historiography of early modern British medicine has tended to concentrate primarily on women in their roles as practitioners, especially lay healers and midwives.1 Much less attention has been afforded to females as patients within the medical marketplace; those works which have concentrated on the illness experiences of early modern women have done so primarily within the confines of gynaecological and obstetrical ailments.2 In addition, gendered morbidity for early modern British patients awaits examination through the lens of practitioner records. Underlying the scholarship on women’s health and medical treatment of this period has been the assumption that female patients fared worse than male patients.3 Such notions, however, have not been adequately evaluated through multiple manuscript sources pertaining to actual medical practice. Following in the wake of Barbara Duden’s 1991 study of the female patients of eighteenth-century German physician Johann Storch,4 a number of scholars have begun to approach the diagnosis and treatment of early modern British women from broader perspectives that encompass a range of issues pertinent to the relationships between female patients and male medical practitioners. These include: agency, privacy and confidentiality, consent, and trust.5 Nevertheless, many scholarly works that have examined such issues for early modern medicine have largely ignored the role of gender in the context of medical practice, or else have explored it only in a limited capacity through printed medical treatises.6 Scholars have long been interested in the degree of agency which groups (patients, lower social orders, women) exercised in early modern Britain; however, there is still much that is unknown in regard to how female patients acted as agents of their own health care (or in that of other women). To what extent were their actions limited by their sex, age, marital status, or socio-economic status? One particularly interesting aspect of agency is patient consent, a topic that has received little gendered analysis to date.7 Privacy and confidentiality have received cursory examination by several scholars of medicine who have rightly acknowledged that early modern notions of privacy were complex, often ambiguous, and vastly different from those of present day.8 Nevertheless, the manner in which, and the degree to which, privacy – or discretion – operated within early modern medical practice, particularly in regard to female patients, remains unclear. While the work of such scholars has inarguably opened new lines of investigation regarding the experiences of early modern female patients, there remains much more to be done.

By examining the records of early modern British professional medicine and its female clientele, this study aims to determine as much as information as possible about female patients, their illnesses, and their relationships with their male medical practitioners. In order to understand more fully the medical diagnosis and treatment of these women, this chapter will outline the demographics of the female patient clientele and the nature of their documented illnesses. Who were these female patients? To what extent do they represent the clientele of male medical practitioners? For what types of illnesses did women tend to be diagnosed and treated? Alongside such questions, this examination investigates whether there is any evidence that such diagnoses corresponded to variations in age, marital status, socio-economic background, geographical region or climate, and/or race. It considers the role of the identities and specialisms of the male practitioners in order to determine how gendered medical practices were conducted in early modern Britain and what this reveals about the treatment of female patients of various ages, marital status, socio-economic backgrounds, and races. Privacy, agency, consent, and trust are also vital components of this study; as such, it explores the extent to which privacy or discretion existed for female patients and the degree of agency they possessed – and, perhaps more crucially, were able to exercise – in the context of the patient-practitioner relationship.

Female patients in the period 1590 to 1740 were being diagnosed and treated for a wide range of somatic and psychological illnesses and conditions.9 This study focuses not only on illnesses and conditions of a female-specific nature (i.e. gynaecological and obstetrical issues, breast ailments, and hysteria, as outlined in Chapters 2 and 4) but also non-sex-specific illnesses which afflicted both sexes (i.e. venereal disease, smallpox, intermittent fevers, hypochondria, and melancholy, which are investigated in Chapters 3 and 4). The range of ailments treated (and thus deemed to be treatable) by practitioners was very wide and also included: rheums and catarrhs, sore eyes, migraines, whooping cough, measles, consumption, plague, dysentery, scrofula, leprosy, rickets, epilepsy, diabetes, gout, scurvy, apoplexy, hydrophobia, kidney stones, intestinal worms, poisonings, skin rashes, hernias, bruises, lacerations, fractures, burns, ulcers, and tumours. Due to the nature of the extant sources, it is not possible to determine whether the degree of attention devoted to particular ailments in the extant records is an accurate reflection of the manifestation of those diseases within various sectors (i.e. those based upon sex, age, marital status, socio-economics, and race) of the general population. Nevertheless, a number of conclusions regarding the illness patterns of early modern patients may be reached from the case evidence analyzed in this examination.

While a wide range of diseases were present amongst all demographic groups – men and women, children and adults, poor and wealthy, white and black – certain diagnoses appear to have strongly corresponded to constitutional and social variables such as sex, age, socio-economic status, and race. For instance, sex played an important role in disease manifestation and identification. Women were afflicted with a host of reproductive-related disorders and conditions that were unique to the anatomy and physiology of the female body, including sore and abscessed breasts, abnormal vaginal discharges such as fluor albus (also known as ‘the whites’), and uterine haemorrhages and prolapses.10 Meanwhile, men were frequently treated for afflictions such as hernias, as well as external injuries resulting from manual occupations and acts of violence.11 Rickets was denoted and diagnosed solely as a disease of childhood,12 although its effects could, perhaps, be felt most acutely in childbearing women throughout a lifetime.13 Gout is notable for its appearance amongst mostly older (middle-aged men and post-menopausal-aged women), well-to-do patients,14 while certain types of domestic accidents such as scalds and burns can often be located (although not exclusively) amongst patients from the lower social orders.15 The limited evidence pertaining to patients of differing locales and races in the context of overseas British medical practice examined in this study suggests that, at least in practice, climate and race had far less impact upon the diagnosis and treatment of illness than sex, age, and socio-economic status. The complex, interconnected relationship that existed between illness and these variables will be explored in subsequent sections of this investigation, especially in Chapter 3.

Gendered Clienteles and Medical Practices

Female patients are well represented amongst the extant records. In many manuscript and printed physician casebooks, they outnumbered male patients, frequently comprising well over half of the practitioner’s recorded clientele. For instance, George Bate’s casebook for his London practice during 1654–60 includes 200 patients: 107 females, 87 males, and 6 unspecified patients. His female patients therefore represent 53.5 per cent of his recorded clientele, and 55.2 per cent of those patients whose sex is specified.16 Female cases represent approximately 59.8 per cent of all the patient cases recorded in an early seventeenth-century, anonymous medical casebook; they comprise approximately 65.7 per cent of those cases where the patient’s sex can be determined; these calculations are based on approximately 113 female cases, 59 male cases, and at least 17 cases for which the sex cannot be definitively determined.17 Dr Barker of Shrewsbury’s casebook for the late sixteenth and early seventeenth centuries reveals that 51.7 per cent of the patients were female, while 48.3 per cent were male.18 The 1676–96 casebook of Sir Edmund King is comprised of 481 patients; 277 of these are female (57.6 per cent of his recorded clientele; 61.6 per cent of those patients whose sex is specified), 173 male, and 31 unspecified.19 Of the 182 cases selected for inclusion in John Hall’s posthumously published casebook, nearly 60 per cent (109) pertained to females.20 Other scholars have uncovered similarly high rates of females amongst patient clienteles. Based on a four-year sample, Michael MacDonald established the average sex ratio of Sir Richard Napier’s astrological medical practice as 78.8 males per 100 females.21 Ronald C. Sawyer confirmed MacDonald’s findings regarding Napier’s female-dominated practice, calculating that 55.3 per cent of Napier’s recorded clientele was female and 44.7 per cent was male.22

Two additional London examples that differ in regard to time period, practitioner specialism, and health care setting are worthy of consideration: the physician casebooks of the private London practice of Thomas Wharton (1614–73)23 and the Westminster Infirmary (a voluntary hospital in London which, with the exception of emergency cases, admitted patients based on subscription and nomination).24 Between the years of 1660 and 1667, more than three-quarters (78.8 per cent) of Wharton’s patient case entries were female. His notes and prescriptions consist of 208 patient entries: 164 females, 40 males, and 4 whose sex is indecipherable or indeterminable.25 The Westminster Infirmary casebook for 1723–24 reveals that physicians William Wasey (1691–1757) and Alexander Stuart (1673?–1742) jointly treated patients in some 170 recorded cases, approximately 56.5 per cent of whom were female. Of the 170 patient cases included in the infirmary casebook, 96 were female and 74 were male.26

In some respects, the prevalence of women amongst the hospital patients is not altogether surprising since women comprised the majority of poor in early modern Britain.27 Nevertheless, the predominance of females amongst the patient demographics of this institution is not consistent with the findings regarding other eighteenth-century voluntary hospitals. Kevin Siena has concluded that patients treated at royal and voluntary hospitals (regardless of their diagnoses) were typically male, while workhouse infirmary patients were overwhelmingly female.28 Attempting to account for such differences, Siena hypothesized that hospitals may have ‘privileged men’s health, [or] … more men could afford the fees.’29 He also perceptively pointed out that women would have experienced more difficulty in accessing voluntary hospitals due to ‘the networking resources needed to contact the elite men controlling such hospitals’.30 Yet, if so, why (and how) did women outnumber men in t...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• About the Book
• Acknowledgements
• Note on Spelling, Names, and Dates
• List of Abbreviations
• List of Symbols and Measurements
• Introduction: Investigating the Records of British Medical Practice, circa 1590–1740
• 1 Male Medical Practitioners and Female Patients in Early Modern Britain: Gendered Clienteles, Illnesses, and Relationships
• 2 The Treatment of Female-Specific Complaints by Male Hands
• 3 Prescribing for the Sexed Body: Women, Men, and Disease in Early Modern British Medical Practice
• 4 Feminizing the ‘Diseases of the Head, Nerves or Spirits’: Medical Diagnosis of Women’s Minds, Bodies, and Emotions
• Conclusion
• Bibliography
• Index