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Cultures of Disease and Care

Cultures of Disease and Care. Women, illness, home, community. Where the action was… . at home. S& D Doctors are incidental Many are sick much of the time Health-care is community cement A community is a social unit of mutual support

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Cultures of Disease and Care

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  1. Cultures of Disease and Care

  2. Women, illness, home, community

  3. Where the action was… at home

  4. S& D Doctors are incidental Many are sick much of the time Health-care is community cement A community is a social unit of mutual support Neighborly female services (“the offices of friendship”) Nutrition: food is medicine Household books House work Child care Nursing Watching “assistance” at child birth Laying out: “the last office of friendship” Modern Doctors are central Most are well most of the time Health care is individual, threatens to divide community Professional Services Legal legitimation of diagnosis Treatment plan and drug access for healing and self-fulfillment Protection of privacy High tech birthing Invisible deathing Premises of social/domestic medicine and modern med

  5. Women as healers and ill • Martha Ballard, healer: community • Epidemic disease, accident, midwifery, infant care, herbal medicines, physician’s assistant, mortuary work (though mainly Pollard) • Emily and Sarah Gillespie, healers and invalids: family, geography • Accidents, diseases of ageing (dropsy, stroke?), watching, minor surgery, nursing • Deborah Viner Fiske, invalid: Class • Moral support, self taught medical student and self healer

  6. Martha Ballard • Hallowell, one generation post pioneering • Unlicensed, flexible, skilled professional • Class structure: professionals, neighbors, servants • Training and theory: • Learned medicine? • “Empiric” • Nature healer? “doing more than assuaging pain… confirming the essential order of the universe.” (Ulrich, 53): sympathetic cures • Women’s and children’s health -- secondary medical services? • Is MB part of the medical marketplace? • Fees -- potlatch? Custom? For time or skill?

  7. Emily and Sarah • Agricultural isolation • Economic competition • Emotional entrapment • Limitations on women’s careers • Local doctors and the magnetic healer • 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)

  8. Deborah Viner Fiske • 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 • Consumption as life style • A disease of young adults • Disease as self-fashioning; active invalidism; heightened sensitivity • Negotiations with Drs. Warren & Jackson • Diagnosis by letter • DVF as medical autodidact • What game is Warren playing? • Class: the luxury of suffering • Religion and status: the license for authoritative heaven talk

  9. Relations of lay healers with doctors • Overlapping pharmacopeia, but avoidance of strong medicines, theoretical advance • Competition • Male midwifery • Cooperation and complementary practice • Attendance at autopsy • Courtesy, recognition, legitimation, enactment of status, consultation • Why must doctors be gentlemen? • Gentleman = man of property

  10. Deadly disease and religion • Acceptance of child mortality • “What an excellent thing is the grace of submission!” • Henry Sewall on death of firstborn baby (Ulrich, 42) • Disease as ambivalent divine gift • “Oh most merciful God, let not the disease which thy wisdom has brought upon her be suffered to fix its seat upon her vitals. In thy hands are all 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 DVF (Rothman 103)

  11. Neurasthenia: doctors take back the serious self • What makes a great diagnosis • A long list of variable symptoms • The concept of energy, from humor to solid and back to humor again • Beard and Mitchell: neurologists for the Main Line • Making hysteria attractive, providing a womb equivalent for men; reclaiming hypochondriacal territory • An all class disease: students can see it too, treat and diagnose • A disease for the serious youth, not fun but a grown up response • Consider: DVF meets Drs Beard and Mitchell

  12. Contemporary implications • Home: the hospital of last resort • The aged between medicare and medicaid • The de-institutionalized • But… where has the community gone? • Who works in the home? • But… do we thrive in each other’s illnesses?

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