Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (review)

The dramatic rise of modern biomedicine powerfully shaped a teleological narrative of the profession in which nineteenth-century medical practice was perceived primarily as a transition zone to the later era. The resulting scholarship has often highlighted the colorful professional debates between orthodox physicians and their opponents. In this volume Steven Stowe looks at nineteenth-century American medicine through a fresh lens that resists "the story of linear change" (p. 20) and shifts the focus from professional battles to medicine as practice. This important study vividly illustrates how the everyday work of doctoring in local communities between 1830 and 1880 shaped the identities of southern physicians.

Doctoring the South builds on the contributions of other historians, such as John Harley Warner, who have analyzed the complexities of nineteenth-century medical orthodoxy. At the same time, Stowe breaks new ground in illuminating the close connections between southern physicians and their local communities. His exhaustive research considers the long arc of doctors' careers from medical school to established practice. Numerous genres of medical literature serve as the backbone of the book's three sections on medical training, medical practice, and physicians' broader reflections on the nature of their profession. Stowe marshals fascinating evidence from medical school theses, personal journals, physicians' daybooks, medical topographies, and case narratives to make a set of interlocking arguments about the imaginative worlds, professional identities, and social relationships of nineteenth-century medical doctors.

According to Stowe, nineteenth-century southern physicians fashioned a distinctive "country orthodoxy" (p. 2) that blended two visions of professional activity. While the pursuit of medical science set physicians apart from the community, vernacular sick-care immersed practitioners in the lives of their patients. Southern physicians resolved this tension by blending abstract medical knowledge with an emphasis on individual practice, moral leadership, and local reputation. Country orthodoxy both bound physicians to their home communities and defined an individualized professional identity that "resisted amendment" (p. 104) as medical training began to change later in the century. Even the upheaval of the Civil War, Stowe suggests, had little influence on the ethos of country orthodoxy.

At the same time, Stowe is quick to defend southern physicians against charges of "unthinking resistance to the 'modern'"(p. 145). Southern practitioners instead embraced a different variety of modernism, rooted in the "Romantic individualism" (p. 243) of a practitioner's emotional and moral quest for identity. The literary context and implications of this secondary argument about modernity are not as fully developed as the discussion of country orthodoxy. Stowe's discussion of Romanticism does, however, open important interpretive passages between medical writing and other streams of nineteenth-century American culture.

Not surprisingly, the country orthodoxy that emphasized the local context of white physicians also tied them closely to "the racial order of southern communities" (p. 105). Race fundamentally structured the "clinical vision" (p. 107) of white physicians—as seen, for example, when they noted a summons to treat an enslaved patient as a "Negro call" (p. 140). Stowe concurs with historians such as Todd Savitt (Medicine and Slavery, 1978) that antebellum racial theories did not necessarily result in white doctors' use of differential therapeutics for black and white bodies. Instead, Stowe asserts, the social relations of slavery profoundly shaped other crucial dimensions of medical care, such as physicians' silence on the trauma of whipping and sexual abuse, and their impersonal representation of many enslaved patients. Stowe's exploration of race, gender, and slavery in almost every chapter of the book skillfully conveys the way in which the power disparities of a slave society infused the imaginative and moral worlds of southern orthodox practice.

In short, Doctoring the South is an exhaustively researched and carefully analyzed consideration of medicine, not as scientific theory or professional institution, but as lived practice. With its multidimensional portrayal of southern white doctors, this book enriches an existing literature...