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

In his superbly researched book on the practice of medicine by Southern physicians, Steven Stowe explores two deserving but often neglected subjects in the history of nineteenth-century American medicine. By looking at physicians well outside the orbit of the elite networks of northeastern cities like Philadelphia, New York, and Boston, Stowe hopes to excavate the humble "everyday" practice of medicine. What he finds are Southern physicians pulled by two opposing desires at this time. On the one hand, they "wished to be seen as innovative men of science" and to participate in an idealized, though emergent, cosmopolitan profession; on the other hand, they "embraced traditional, local ways of healing" and, in a very pragmatic way, catered to the market demands of the rural communities in which they practiced (11). Stowe argues persuasively that this fundamental tension shaped the very identity of Southern physicians and produced what he defines as the "country orthodox style" of medical practice (2).

In the first of three parts to the book, Stowe examines the education and early careers of Southern physicians. Inside the protective walls of medical schools, young physicians began their careers inspired by the quest for universal knowledge in medical practice. The practical demands of the first years of practice, however, challenged the idealism of young physicians, as they confronted illness in all its forms, fought to earn the trust of patients, and competed with other physicians and healers in the rural medical marketplace. As the second part of the book explains, physicians soon discovered that rural communities valued local health customs more than learned medical canons and that families respected a physician's moral courage as much as his medical savoir faire at the bedside. As Stowe argues, though, Southern physicians dared not abandon their training—to have done so would have undermined their distinctive authority and deprived them of the comforting sense of professional belonging they so desired, especially when practicing in isolated rural areas. In order to balance the cosmopolitan and the local, the orthodox and the vernacular, Southern physicians relied on the "hands-on experience" they gained in practice as a guide. The ennobling of individual experience, especially in writing, became the hallmark of the country version of orthodoxy (3). Part three of the book explores the ways in which Southern physicians marshaled individual experience in order to understand principles of health and illness in the South and to stay connected with other physicians.

Besides navigating uncharted historical waters and defining a country orthodox style of medical practice, Stowe's main contribution in this book is his masterful analysis of the rich sources he uncovers. Throughout their careers, Stowe argues, physicians "created a flood of written texts" because "their medicine was inseparable from their need to pronounce it" (3). In Doctoring the South, Stowe expands upon his familiar analysis of correspondence and case narratives by incorporating a new array of understudied genres of medical writing: student theses, physician daybooks, bedside notes, and medical topographies. Stowe first identifies the intended purpose of each genre. Some writing, particularly daybooks and bedside notes, chronicled the relatively unprocessed activities and experiences of physicians, and Stowe mines these sources for new evidence of the trials and tribulations of medical practice at this time. In student theses, case narratives, and topographies, however, physicians purposefully organized and reflected on the larger meaning of their individual experiences in practice. In all the genres of their writing, physicians told "stories" of their work—stories in which the physician-writer figured prominently in the plot. As Stowe has argued previously, through the interpretive act of "seeing themselves at work," nineteenth-century physicians used writing to construct a shared social, professional, and therapeutic identity. Doctoring the South develops this argument considerably by including new written genres and by identifying a coherent country orthodox style that emerged in the writing of Southern physicians in particular...