Slavery, South Carolina, Health, Disease
Throughout the eighteenth and nineteenth centuries South Carolina was known to be particularly unhealthy, certainly the least healthful area on the Atlantic coast and surpassed only by New Orleans on the Gulf coast. Peter McCandless’s book is a thorough and detailed study of how South Carolina came to be so unhealthy and how contemporaries reacted to the disease environment. Previous scholarship on southern medical history has tended to focus either on the health of slaves on plantations, or on the impact of specific diseases such as yellow fever. This very timely volume is the first modern study of medical history in one state over an extended period. McCandless argues that South Carolina’s high mortality was entirely due to human factors, particularly human migration and human exploitation. There is nothing inherently terrible about South Carolina’s climate; rather it was the importation of slaves and the extensive commerce with Africa and the West Indies that introduced virulent diseases such as malaria and yellow fever that took such a heavy toll on the population. The human impact on the environment, such as the clearing of forests and the creation of rice fields, allowed the mosquito population to flourish and disseminate viruses effectively. Newly arrived Europeans brought smallpox that killed large numbers, while the harsh [End Page 168] conditions prevalent on rice plantations exposed enslaved Africans to dysentery, pneumonia, and worms.
McCandless generally relies on qualitative sources such as the letters of residents and publications of medical professionals in preference to the extant quantitative materials. Mortality records exist only for Charleston, and then for only a portion of nineteenth century, and McCandless’s skepticism about their usefulness given the vagaries of diagnostic medicine is probably justified. One novel use that McCandless might have made of this data would be to look at black urban mortality in contrast to that of plantation slaves. Much of the mortality of rural blacks was due to their environment, so this was perhaps a missed opportunity to illustrate how the urban environment impacted on the health of the enslaved.
One of the many strengths of this book is how it chronicles how whites responded to their disease environment and how theories of health waxed and waned in public consciousness. Yellow fever, for example, was widely understood to be imported in the eighteenth century, necessitating quarantine measures to prevent it. After 1800 physicians agreed that yellow fever was locally generated, and therefore quarantine was pointless. After c.1850 the importation theory once again became accepted. No treatment for yellow fever was found to be effective, but there were some significant medical advances made during the eighteenth and nineteenth centuries. Tincture of bark emerged as a treatment for malaria, while inoculation and later vaccination became effective preventative treatments for smallpox. Advances in public health were less obvious: Clean water remained unavailable to large segments of the population, for instance, and many medical treatments were to be dreaded just as much as the disease they were meant to cure.
McCandless establishes how the behavior patterns of the low country elite were influenced by their perceptions of health. Initially plantations were considered healthier in the summer than Charleston, but by the 1770s Charleston had emerged as the place where the elite spent their summers. After 1800, first inland villages, then island summer homes, and finally distant refuges attracted an elite in constant search of places that were healthiest in the torrid summer months. To a significant extent, however, the elite were their own worst enemy. South Carolina’s principal allure was the opportunity to make vast sums of money. Therefore the elite moulded their landscape with profit in mind, not health, and suffered the consequences. The chance to make money also attracted [End Page 169] new migrants from Europe whose vulnerable immune systems were assaulted by mosquito-borne diseases as soon as they arrived.
The most interesting argument of this book is that the political, social, economic, and religious development of South Carolina was shaped by disease. McCandless...