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

More than thirty years ago, Ackerknecht called upon his colleagues in the history of medicine to shift their emphasis from the published accounts of the medical elite to the more intimate records of daily practice found in diaries, daybooks, case records, correspondence, and physicians' ledgers—in other words, to close the gap "between the medicine preached and the medicine actually practiced." ¹ This he called a "behaviorist" approach to medical history. Fulfilling this worthy suggestion imposed a daunting task for historians. To follow this behaviorist model the readily available journal, proceedings, and textbook literature could no longer serve the purpose; rather, archives containing elusive scraps of personal memorabilia squirreled away in out-of-the-way places would become the prize of the historical prospector. Given the magnitude of the behaviorist project, few have been willing to embark upon this difficult and time-consuming mining expedition.

Stowe, however, has accepted the Ackerknecht challenge. Through his meticulous digging in archival collections throughout the South, he has shown himself adept in ferreting out the gems of everyday practice as it really was in the nineteenth century. This prodigious research is augmented by a well-written narrative that takes readers to southern medical-school classrooms, to doctors' offices, and to the bedsides of the neighbors that they sought to mend and heal. "The achievement of country orthodoxy," writes Stowe, "was to affirm that all the experience a man needed to be a good doctor was available to him in his community" (270). Indeed this is a book about the bonds and boundaries of country medicine delivered in a caring environment that placed emphasis less on science than on the strong attachments of region and religion. One rather surprising conclusion drawn from Stowe's book is that, except for race, the practices of doctors in the South probably varied little from those of their northern colleagues; in both cases, the close relationship of physicians with their community shaped and molded their everyday professional affairs. In a nation that was predominantly rural, the seasonal rhythms of agrarian life above and below the Mason-Dixon Line conferred continuity and commonality on physicians' practices, distinguished only by the sharp realities of the South's herrenvolk social order. Stowe's book is a tale written large upon the American landscape.

Two relatively minor points need clarification. First, Stowe asserts that by mid-century, clinical work and experience with the sick was "widespread and taken seriously" (52). Although he may be correct, he needs to marshal more evidence than mere assertion and a few sketchy examples. Countering Stowe is the South Carolinian J. Marion Sims who received his medical degree in 1835 after attending colleges in Charleston and Philadelphia. Sims insisted that he embarked upon his medical career with "no clinical advantages, no hospital experience, and had seen nothing at all of sickness." ² Similarly, when Simon Baruch earned his degree from the Medical College of Virginia in 1862 he did so without "ever treating a sick person or even having lanced a boil." ³

The second point of contention is Stowe's persistent casting of the southern physician in terms of orthodoxy. "As with other contexts of orthodox practice we have seen," writes Stowe, "the fact that each man's personal style enlarged rather than transgressed orthodoxy is the key to understanding how orthodoxy retained is powerful continuity on the rural, domestic scene" (176). But mid-nineteenth century also saw a smaller but nonetheless widespread and important assortment of alternative practitioners on the American scene, North and South. Surely the connections between botanics and homeopaths—all of whom sported degrees from sectarian colleges throughout the young nation—and the communities that they served mirrored in numerous ways...