Slavery, Disease, and Suffering in the Southern Lowcountry (review)

Peter McCandless, whose previous work placed mental illness in South Carolina in a nuanced historical context, has turned his attention to disease in the Carolina lowcountry from the colonial period to the Civil War. Focusing on the relationship between disease and the plantation economy, he uncovers in fascinating detail how human choices affected the demographic and epidemiological trends in the coastal regions that were dominated by powerful slaveholding interests. Organizing his material topically rather than chronologically, McCandless illuminates the impact of diseases such as malaria, yellow fever, and smallpox on the regional population and connects that history with the shifting assumptions of the lowcountry medical establishment.

The book opens with the “huge credibility gap” (p. 14) between colonial boosters’ rhetoric of regional healthfulness and the reality of the disease environment that resulted from the importation of African slaves who were forced to work in “an especially welcoming environment for diseases transmitted by mosquitoes and water-borne parasites” (p. 8). An outbreak of epidemic disease in the 1680s merely foreshadowed the “tempest of mortality” (p. 26) that overtook the region at the turn of the eighteenth century. Still, over the next century and a half, colonial boosters and their antebellum successors downplayed the risk that disease posed to lowcountry residents.

McCandless’s command of the historical sources as well as the relevant scientific issues allows him to chronicle the human dimension of the medical tragedy caused by malaria and yellow fever in the eighteenth century. He conveys the mechanisms by which these illnesses were spread, and he charts the political and economic forces that influenced medical authorities to doctor their accounts of what was transpiring to mitigate additional damage to the region’s reputation and fortunes. McCandless offers poignant evidence of the suffering experienced by groups such as the French Acadians who were resettled in South Carolina in 1755 and the Anglican missionaries who conveyed in their correspondence their anguish over being surrounded by so much disease. The terrible plight of the African and African American slave population is a central theme in McCandless’s analysis. As one case in point, McCandless conveys the horror of African corpses being dumped into waterways after they expired on their disease-ridden ships. On the eve of the slave trade’s closure in 1808, a traveler reported that almost a third of the imported slaves “had died at the wharf in less than three months from dysentery and other contagious diseases” (p. 50).

McCandless makes a significant contribution to the scholarship on lowcountry slavery and disease by connecting variable contemporary medical theories with political and cultural concerns that shifted from year to year. He demonstrates, for example, the long historical trajectory of the notion that lowcountry residents were protected from yellow fever because they “were assimilated to the ‘specific gaseous poison’ that caused the fever” (p. 110), but he also conveys how such theories gave way to the contrary reality when disease surfaced in the supposedly immune local population. In particular, the ways in which racial assumptions informed disease theory shifted depending on the concerns of those in power. Early colonial boosters denied that whites were at risk laboring on the coast; antebellum medical theorists emphasized “the idea that the African or black ‘race’ possessed immunities to malaria and yellow fever” (p. 131); and postbellum authorities then reversed that logic to argue that whites rather than blacks were more likely to survive in the lowcountry—an argument that conveniently dovetailed with the economic need to attract a new labor force to the region following the violent demise of the old plantation system.

Throughout the work, McCandless examines the multiple regional, religious, and racial perspectives informing debates over theories of disease transmission and treatment. He demonstrates how these debates affected the lowcountry not just in terms of demographics and economics but also on the level of a regional culture that conceptualized prudent conduct as a matter of life and death. He demonstrates...