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

ONE. Men, Schools, and Careers

15 n u Chapter One u men, schools, and careers N Becoming an M.D. in the mid-nineteenth-century United States was not an outlandish choice for a young man; it was not like running away to sea. But medicine, straddling the line between trade and profession, filled with economic and therapeutic uncertainties, was anything but the main chance. In the South, before and after the Civil War, the ideal of manly success was to master a flourishing plantation, the traditional seat of a man’s economic power, political influence, and social esteem. Nonetheless, thousands of southern men made orthodox medicine their choice during the mid-nineteenth century, and increasing numbers of them (including some men already in practice) decided that formal medical schools were the best place to pursue it.∞ This chapter focuses on southern men making this choice, viewing it as an encounter between their ambitions—framed by family, gender, and the local context of medicine—and an orthodox profession itself in the throes of change. Indeed, the fact that students were defining their personal goals at just the time physicians were rethinking education makes schools a particularly good place to analyze the tensions shaping medicine in this period. What follows builds on the well-known picture of medical innovators using schools as the means of reforming orthodoxy into a more intellectually unified and therapeutically sound medicine. The main focus here is on schools as the local institutions they were, sites for a distinct, ground-level orthodoxy in the making. Socially speaking, this means looking at schools as strikingly visible, urban institutions built on—and helping to define—a fraternity of physicians. From an intellectual point of view, it means understanding how the new medical education was caught in the friction between two goals that, as we will see, influenced physicians’ view of their medicine throughout their careers. On the one hand, faculty and students 16 u choosing medicine imagined the school, and therefore orthodoxy, to be a cosmopolitan world apart from the surrounding vernacular culture of healing. On the other hand, they discovered that the outside world constantly impinged on the school in ways both useful and troubling. Thus, even though most faculty and students after 1830 eagerly embraced the idea of an institutional world of their own, they were unable—and in many instances unwilling—to isolate themselves from a surrounding social matrix of ideas and influences on doctoring. In this respect, this chapter reexamines the fierce competition among schools during the nineteenth century as being about more than money, professional standards, and gatekeeping. On a deeper level, the struggle over schooling reveals that even the largest institutions, notwithstanding their genuine e√ort to make education more universal and abstract, actually privileged a local context for learning that encouraged physicians to focus on issues of self and locale. In particular, by fostering fraternal bonds among men, schools helped create a fluid, personal context for the very essence of medical knowledge. This chapter considers, first, some of the moral and material realities that men—mostly young men—pondered as they made their decision to become doctors. This is followed by a look at the significance of medical schools’ struggle to shape a unique world after 1830. A struggle over academic requirements , it also was a struggle over the question of physicians’ identity: were they to be the harbingers of a cosmopolitan medical science or should they be content to be the repositories of familiar, local practice. Finally, this chapter considers how the issues raised by schools’ academic tensions also were shaped by their continuing commitment to apprenticeships and to an urban setting. In all of these contexts, schools embraced elements of a vernacular world that they also wished to hold at bay. family, intellect, and the manly choice Family as the cradle of young men’s prospects and character profoundly shaped how men imagined becoming physicians. Throughout the mid-nineteenth century , no clear professional career ‘‘path’’ in medicine existed to help men make their decision. Most men more or less backed into medicine. In the 1830s, for instance, J. Marion Sims thought that medicine was interesting mostly because it seemed more inclusive and less rigid than either law or the ministry. Another young South Carolinian, Lafayette Strait, after attempting ‘‘to go through the Citadel and fail[ing],’’ chose medicine in the 1850s for the simple reason that ‘‘I Men, Schools, and...