Folk Medicine in Southern Appalachia (review)

This new contribution to Appalachian studies is, in large part, a "historical construction of the folk medical beliefs and practices common in Southern Appalachia from the late nineteenth century to the Second World War" (p. xiv). The last two chapters, however, in covering recent decades, shift from historical construction to the theme of persistence and change in the folk-medical tradition. The book can be described as an overview in which Anthony Cavender is at pains to show that early "cultural preservationists, physicians, and other observers were naïve in their assertion that folk medicine would be vanquished by official medicine" (p. 183).

The book reads easily. Without question it can be recommended to anyone wanting a concise introduction to a large and unwieldy topic. Yet, some general questions should interest readers of the Bulletin. For instance, (1) Does the general reader take away from the book a sense that folk medicine has been an important social force, or that it was more a quaint practice that is currently on its last legs? (2) What is new in the book for the knowledgeable reader?

With regard to the first question, there are mixed messages. My sense is that Cavender has not done enough to shift stereotypical views of the quaintness of folk medicine, even while indicating its important place in Appalachian society. He does, for instance, separate it from the eclectic self-care common to all Americans at the time, but without giving reasons. Granted, the Southern Appalachian scene has had conspicuous features apart from its geography: besides an extraordinary abundance of medicinal plants in the area, Cavender recognizes that, until the 1940s or so, there were questionable standards and a scarcity of physicians. However, he adds: "had doctors been more available, it is doubtful that they could have done much to improve the health status of the people" (p. 24). He next states that medicine became effective only with the germ theory, and that there was little difference between physicians' and home medicines until well into the nineteenth century. Although this can be read as an indictment of both, it is, I suggest, easy for a reader to gather that folk medicine had no valid role after the twentieth-century successes of modern medicine. Moreover, despite Cavender's appropriate emphasis on people's experimentation with self-care, his discussion of many treatments is couched in terms that tend to reinforce the view of quaintness among those with little knowledge of the subject.

Cavender might have indicated more fully the social role of folk medicine (and the effectiveness or otherwise of pre-germ-theory medicine) by spending more time with the question: What constituted efficacy and "cure" in people's minds? Although he recognizes that "the efficacy question is critical" in assessing folk medicine (p. 81), when he does refer to it—mostly in a main chapter on treating numerous conditions from asthma to venereal disease—he relies, as he says, on a minimal number of sources. Even then his notes are few, without any consideration as to whether an intervention brought symptom relief if not cure. The knowledgeable reader may well regret not only the limited attention to the subject of efficacy, but also a lack of reference to much related regional literature that can provide context to and comparison with Appalachian studies. Such a reader may well wish, too, for a more sensitive understanding of the history of conventional medicine, and more exploration of such generalizations as the "bowels and blood system remained the major loci of concern among laypeople" (p. 42).

If, as I feel, some inherent attitudes have shaped the material, and the author should have exploited recent non-Appalachian scholarship, I do not want to detract from the value of the book as a review, especially the stress placed on the eclecticism of folk practices. Cavender states that the "dichotomous folk medicine versus biomedicine model of medical pluralism in...