Medicine and Distinctiveness in the American South, 1840-1870

MINISTERING TO DIXIE: MEDICINE AND DISTINCTIVENESS IN THE AMERICAN SOUTH, 1840-1870 A thesis presented by Jesse Meeker Kaplan to the Department of the History of Science in partial fulfillment of the requirements for an honors degree in History and Science Harvard University Cambridge, Massachusetts March 2009 MINISTERING TO DIXE: MEDICINE AND DISTINCTIVENESS IN THE AMERICAN SOUTH, 1840-1870 by Jesse Meeker Kaplan ABSTRACT During the antebellum period, many physicians in the southern United States argued that their region's climatic conditions and unique disease profile made medical practice in the South fundamentally different from that in the North. Doctors asserted southern medical distinctiveness most stridently in medical periodicals, the contents of which blurred medical and macropolitical considerations., and in the founding of medical schools, though economic incentives often undermined appeals to southern unity. During the Civil War, the shortage of Confederate medical supplies necessitated a search for indigenous southern medicines, actualizing the discursive link between medical regionalism and southern sectionalism. This thesis argues that southernist medicine constituted a claim to authority that was both professional and sectional, asserting the legitimacy of southern physicians while medically justifying broader southern political aspirations. At the same time, southernist doctors were not a united front, and examination of the discourse illustrates the tensions inherent in common professional language. Keywords: American Civil War, medical education, nineteenth-century medicine, physicians, sectionalism, southern United States TABLE OF CONTENTS Acknowledgements iii Abbreviations Used in the Notes v Introduction: Medical Politics 1 The Profession of a Section 5 The Doctors in the South 7 An Afflicted Environment 11 The South in the Doctors 13 Chapter 1: Writing Southern Medicine 19 Fenner's First Journal 21 The Topography of States' Rights 25 Yellow Jack and Moral Medicine 31 A Heroic History 34 Grabbing the Golden State 40 A Dual Discourse 44 Chapter 2: Teaching Southern Medicine 47 Educational Increases 50 Southernism and Medical Education 55 Metropolis and Morgue 60 The New Orleans School of Medicine 66 The Location of Education 72 Chapter 3: Making Southern Medicine 76 Disease and Acclimation 81 The Surgeon General and the Blockade 87 A Journal for the Confederacy 91 Finding Drugs in Dixie 95 An Independent Medicine 101 Conclusion: Political Medicine 108 The Profession Speaks 114 Bibliography 117 i ACKNOWLEDGEMENTS Few student-scholars need reminding that a thesis entails labor; and while a project such as this is necessarily a labor of love, all too often it is forgotten that it is a labor of many. During the writing of this thesis, I have benefited immeasurably from the advice, guidance, and encouragement of numerous individuals, and I would be remiss if I did not acknowledge their role in this project's successes. Any flaws, of course, are entirely my own. This thesis began with a footnote. Beginning research on what I intended to be a paper about academic geography, I happened across an essay on medical topography, which noted offhand that in antebellum America medicogeographical ideas were employed to justify the sectional rift between North and South. Accompanying this brief reference was an even briefer note with citations for further reading, and my project had begun. Conevery Bolton Valenčius, the author of that essay and footnote, graciously offered suggestions for direction and sources early in my research.1 Anne Harrington led the tutorial in which I wrote parts of what became the introduction and the first chapter, and she has remained an invaluable sounding board and guide throughout the project. She has offered patience, erudition, and a sympathetic ear. I decided three years ago to study the history of science because of a lecture course she taught, and my debt to her is enormous. I can only hope that this project reflects a fraction of the passion that she brings to her teaching and research. Charles Rosenberg read drafts of the introduction and the first two chapters. His comments, criticisms, and insights aided everything from my methodology to my prose style. For him, I will remember in future projects “not to oversalt the cod.” Sarah Jansen offered monthly advice as the leader of my senior tutorial, and Allie Belser shepherded me through the logistics of the process. Marco Viniegra proposed several fruitful areas of research, and this study is richer because of his input. Morgan Mallory read and edited every word of this thesis, and her discerning eye was vital in the revision process. Dave Unger, who advised this project, has an uncanny knack for offering helpful and needed suggestions on issues large and small, and it was rare that a problem arose for which he did not have at least a partial solution. His willingness to give rein generally but push when necessary, to supply humor and insight, and to critique and force rethinking of my ideas and arguments have left an indelible impression on this thesis. That he was so attentive while engaged in his own project was more than could be asked. For my final thanks, to my parents and brother, paper is inadequate. Suffice to say that this project, or anything else that I do or have done, would not have been possible without their unconditional support, limitless understanding, and infinite patience. 1 Appropriately then, this study will also begin with a footnote: the essay in question is Conevery Bolton Valenčius, “Histories of Medical Geography,” in Medical Geography in Historical Perspective, ed. Nicolaas A. Rupke (London: The Wellcome Trust Centre for the History of Medicine, 2000), 3-28 iii ABBREVIATIONS USED IN THE NOTES ARC Annual Report and Circular of the New Orleans School of Medicine CSMSJ Confederate States Medical and Surgical Journal NOMNHG New Orleans Medical News and Hospital Gazette NOMSJ New Orleans Medical and Surgical Journal NOMT New Orleans Medical Times SJMS Southern Journal of the Medical Sciences SMR Southern Medical Reports v INTRODUCTION MEDICAL POLITICS Writing in 1856 in the New Orleans Medical and Surgical Journal, the flagship publication of the South's largest metropolitan and medical center, James C. Billingslea, an Alabama physician, implored his primarily southern readers to pay greater heed to regional sources of medical authority: “I desire to call the attention of southern physicians to the necessity of patronizing our southern [medical] institutions, and our southern medical journals. The necessity of this patronage is demanded, not only by the political aspects, which are now presented in these United States, but also by humanity.”1 Billingslea's opinions were not atypical in the antebellum South. Derisively termed “states' rights medicine” by northern commentators, arguments for southern medical distinctiveness were wide-ranging and led to the establishment of local medical schools, journals, and methods of practice. The use of medical discourse in pre-Civil War southern nationalism heightened regional notions of peculiarity, and, in the eyes of many southerners, testified to the incommensurability of the northern and southern ways of life. As the South increasingly felt itself becoming a junior partner within the Union, medicine adopted a “Southernist” discourse founded on the three institutions on which southerners particularly feared northern encroachment—states' rights, slavery, and agrarianism.2 The “political aspects” to which Billingslea referred are somewhat obvious. Billingslea's exhortation, however, also claimed that “humanity” required southernist 1 James C. Billingslea, “An Appeal on Behalf of Southern Medical Colleges and Southern Medical Literature,” NOMSJ 13 (1856-57): 214. Emphasis original. 2 James O. Breeden, “States-Rights Medicine in the Old South,” Bulletin of the New York Academy of Medicine 52 (1976): 348. 1 medicine, extending his argument beyond political rhetoric into the professional duty of healing. Medicine was far from the only profession to adopt a sectionalist stance in the Old South, yet it presents a unique case to the historian. Unlike fields such as education and literature, in which regional variation had a clear political genesis, orthodox American medicine of the mid-nineteenth century endorsed an idea of sectional peculiarity. Though sciences like anatomy and chemistry and practices such as surgery and obstetrics differed little from place to place, the antebellum physician, North and South, privileged an understanding of location and cast therapeutics in a distinctly regional light. From a medical standpoint, “there was,” as John Harley Warner notes, “nothing inherently distinctive about the argument for southern medical distinctiveness.” Physicians saw climate and geography in all areas of the United States as contributing to unique disease expression. Embodied as the principle of specificity, this view distinguished rural from urban, wet from dry, and hot from cold, and promoted the use of individual clinical experience to shape treatments.3 Nearly all applications of specificity suggested basic differences between the disease environments of the North and South. The rapidly urbanizing North contrasted demographically with the agrarian South, and the temperate climes north of the Mason– Dixon line shared little with the subtropical environment of the heart of Dixie. Even individual diseases differentiated the sections—malaria, hookworm, and yellow fever,

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