Patients' Voices in Early 19th-Century Virginia (review)

For reasons known only to them, Drs. James and Edward Carmichael saved some seven hundred letters from their Fredericksburg, Virginia, patients between 1816 and 1832. This unusually extensive collection of such correspondence, along with a daybook logging their visits to patients in 1816–17, form the heart of a well-organized and attractively presented Web site that has much to reveal about early national Virginians' diseases and remedies, their relations with physicians, and their sense of body, affliction, and health.

The founder of the father-and-son practice, James Carmichael (1771–1831), migrated from Scotland to the United States not long after the country's own founding, went back to Edinburgh to study medicine, and then, still a young man, returned to establish his Fredericksburg practice. He was joined in his work by his son Edward in the 1830s; another son, George, also became a physician. Unlike many practitioners awash in a sea of competitors, mysterious and intractable ailments, and difficult access to medicines and new knowledge, the Carmichaels seem to have made a financial success of their calling, and the letters collected here (which include some correspondence from medical colleagues) show with striking clarity how doctors in this era acted as experienced craftsmen. What followed was that patients turned to them not only for answers and novel remedies, but also for affirmation of self-diagnosis, a supply of familiar medicines, and as ready interlocutors as well. So Robert Branaugh, on 29 February 1828, wrote mainly to complain of "something resem[b]ling the Itch only much worse"—and yet he turned his complaint into a brief, informative commentary on his own grasp of the matter, noting that the malady "is a previlent [sic] thing in this country[.] Some cure it by ointing with sulpher[.] I have tried that but since that have felt worse about the head." Some patients jotted only brief notes—urgent calls for help or specific medicines—while others went on at greater length with intricate descriptions of their affliction-altered bodies and disease-burdened days. White women and men are both represented among the correspondents, and although the considerable slave population of the region are themselves silent here, there is much evidence of how slave owners attempted to direct the health care of their human property.

The online presentation of these informative, sometimes moving, "patients' voices" (and caregivers' voices, too) is pleasing to the eye and easily navigated. Letters are searchable by name, date, subject, and keyword; each letter is displayed on the same screen both in its original manuscript form and as a typed (the medical daybook is viewable but has not been transcribed). Editorial practices by the archivists are carefully and clearly noted (the collection is housed in the Albert and Shirley Small Special Collections Library of the University of Virginia), and the site includes relevant photographs, newspaper articles, maps, and other contextual material. Alison White offers a thoughtful discussion of how to search the letters by using current medical terminology, a discussion that is appropriately careful not to assume that all past illnesses are best understood in twenty-first-century language. An essay "analysis" of the letters, written by Dr. Laura Shepherd in 2001 as a project undertaken during her medical residency, is also helpful, though perhaps too focused on retrospective diagnosis (what did they really have?) to be as broad or suggestive about the Carmichaels' medical world as such an overview might be. In all, though, this is an excellent site that will reward research into the historical experience of being sick and seeking care.