Reconsidering the History of Domestic Medicine

By Jennifer W. Reiss

The history of American medicine often follows a declension/ascension narrative: it’s a teleology of medical progress dominated by professionalised and scientifically-minded male physicians of the nineteenth century bringing the light of modernity to backward-looking, female-dominated folk practice of earlier periods. Even comparable British scholarship on early modern medical history follows a top-down story of professionalising medics ineffectively controlling a diverse ‘medical marketplace’ – a position which appreciates the place of vernacular practice generally, but underplays non-commercial, domestic medicine. Lay, and especially female practitioners were an essential alternative source of medical knowledge, particularly for poor and rural populations with limited access to other forms of health care, as well as a complement to the professional medicine available to urban and elite populations.

My dissertation, “By My Own Experience:” Women, Medicine and Knowledge in the Eighteenth Century Anglo-Atlantic World, which I recently completed for the American History subject group at Cambridge University, focused on complicating these traditional narratives through analysis of two female-penned manuscript medical recipe books, one American and one British.

While not a faith minister like some Quaker women, shopkeeper Elizabeth Paschall (1702-1767) medically ministered to her family, friends and neighbours along Philadelphia’s Market Street. Her ‘receipt’ book from the 1740s to 1760s records who, what and how she healed, often with a flair for detail and imagery.[1] The manuscript is valuable not only as a rare surviving life record of an early American woman, but also because it opens a window into public health in Philadelphia at a key time of flux. Scottish and continentally-trained physicians established North America’s first general purpose hospital and medical school in Philadelphia in 1751 and 1765, respectively. At the beginning of the century, settlers on mid-Atlantic seaboard appealed to whatever medical knowledge a neighbour or family member could proffer. By mid-century, however, dozens of male doctors brandishing diplomas were jostling to serve the Delaware River valley’s ill and infirm.

Elizabeth Jennens Hanmer (1705-1777), akin to Paschall, was of middling gentry status, educated and well-connected, but not aristocratic, and ministered to her local community in Flintshire, Wales and in London, at nearly the exact same time as Paschall was working in Philadelphia.[2] Just like Paschall, Hanmer was interacting with a new breed of formally educated male physicians, while still engaging with the older image of the ‘Lady Bountiful’ caring for the poor in lieu of established institutional medicine. Hanmer’s text is longer, but she is much more perfunctory in her entries. For their stylistic differences, however, their concerns were much the same – each book is dominated by similar ailments and similar treatments, from remedies for sore breasts and sore eyes to recommendations for purchaseable patent nostrums like Daffy’s Elixir and herbal cures like savin and chamomile. A comparison shows a remarkable consistency of British domestic medical culture across the Empire.

Specifically, my dissertation contrasted the medical practices of these Elizabeths on three dynamics – their level of engagement in their Atlantic World context, the nature of the communities they served, and what the recipes suggest they may have thought about their own medical skill. Gender was an important element in my analysis. Socially defined primarily as caregivers, but barred from active participation in these new medical institutions, eighteenth-century women were suddenly excluded from obtaining the style of medical expertise society was beginning to value. A significant element of an early modern woman’s worth – her knowledge of bodily care and intimate experience with illness – was increasingly usurped by the gentleman doctor. Overall, the goal of my dissertation was to understand how, constrained by gender, these otherwise unremarkable, unknown women interacted on a day-to-day level with larger historical changes taking place in the eighteenth century: globalisation, Enlightenment learning and ultimately the politics of authority.

While only a set of case studies, the Hanmer and Paschall books reveal the continued expertise and confidence of female healers as they abutted male practice, but also how the nature of that skill was influenced by their Atlantic basin context. They are evidence of a thriving Anglo-American female medical culture for longer than traditional narratives imply.[3]


[1] Elizabeth Coates Paschall, Receipt Book, Library of the College of Physicians of Philadelphia, MS10a352.

[2] For reasons I get into in the thesis, the Wellcome misattributes the manuscript to Elizabeth’s aunt. It is filed as Esther Hanmer (née Jennens) and others, Recipe Book, Wellcome Library, London, MS2767, accessed February 9, 2019,

[3] For further reading see: Laurel Thatcher Ulrich, A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812 (New York: Alfred A. Knopf, 1990, paperback ed. New York: Vintage, 1991), Rebecca J. Tannenbaum, The Healer’s Calling: Women and Medicine in Early New England (Ithaca: Cornell University Press, 2002) and Elaine Leong, Recipes and Everyday Knowledge: Medicine, Science and the Household in Early Modern England (Chicago: University of Chicago Press, 2018). The “traditional” medical marketplace story is embodied by Roy Porter’s work, a good example of which is Roy Porter and Dorothy Porter, Patient’s Progress: Doctors and Doctoring in Eighteenth-Century England (Cambridge: Polity Press, 1989).

Image: Page from Elizabeth Hanmer’s Recipe Book, Wellcome Library, London, MS2767,

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