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, for example, all relatively common in the South, were rarely seen in the Northeast.4 American

3 John Harley Warner, “The Idea of Southern Medical Distinctiveness: Medical Knowledge and Practice in the Old South,” in Science and Medicine in the Old South, ed. Ronald L. Numbers and Todd L. Savitt (Baton Rouge: Louisiana State University Press, 1989), 179-80; idem, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge, MA: Harvard University Press, 1986), 58-80. On sectionalist professional movements in the prewar South, see John McCardell, The Idea of a Southern Nation: Southern Nationalists and Southern Nationalism, 1830-1860 (New York: Norton, 1979). 4 Less common diseases considered particularly southern in an American context included filariasis, guinea worm, pterygium, tapeworm, trypanosomiasis, “typhomalarial fever,” and yaws. See Savitt, “Filariasis in the United States,” Journal of the History of Medicine and the Allied Sciences 32 (1977): 140-50; Gerald N. Grob, The 2 physicians took as a given the distinction between the climate, geography, and topography of the Old and New Worlds, and a further North–South division, endorsed since the colonial period, was only a natural extension of this idea.5

By emphasizing this connection with the principle of specificity, many historians have questioned the importance of macropolitics in stimulating southernist medical discourse. Warner, for example, diminishes the political aspects of the arguments for southern medical exceptionalism, claiming instead that calls for a distinctively southern medicine were merely one manifestation of a “response to problems felt in varying degrees by medical practitioners in all regions of America.” Less important for Warner than southern physicians' location in the South was their identity as physicians, and though southern medicine may have had a sectional hue, the discourse as a whole was tightly bound to accepted medical orthodoxy.6

Warner's account is a compelling analysis of southernist medicine. At the same time, his focus on the marginal position of the southern physician fails to explain cogently why, for instance, calls for southern medical distinctiveness were more urgent than calls for

Deadly Truth: A History of Disease in America (Cambridge, MA: Harvard University Press, 2002), 139-40; C. S. Fenner, “Pterygium,” NOMSJ 11 (1854-55): 634-41; Dale C. Smith, “The Rise and Fall of Typhomalarial Fever,” Journal of the History of Medicine and the Allied Sciences 37 (1982): 182-220, 287-321; and Jack Temple Kirby, Mockingbird Song: Ecological Landscapes of the South (Chapel Hill: University of North Carolina Press, 2006), 280. Even certain diseases of livestock, such as “Texas fever” (modern babesiosis and anaplasmosis) and equine glanders, were unique to the South in antebellum and post-Civil War America. Tamara Miner Haygood, “Cows, Ticks, and Disease: A Medical Interpretation of the Southern Cattle Industry,” Journal of Southern History 52 (1986): 551-64; Kirby, Mockingbird Song, 128. 5 Warner, The Therapeutic Perspective, 65-72; K. David Patterson, “Disease Environments of the Antebellum South,” in Science and Medicine, ed. Numbers and Savitt, 152-65.

On colonial views of Northern and Southern medicine and climate, see Gilbert Chinard, “Eighteenth Century Theories on America as a Human Habitat,” Proceedings of the American Philosophical Society 91 (1947): 27-57; Karen Ordahl Kupperman, “Fear of Hot Climates in the Anglo-American Colonial Experience,” William & Mary Quarterly 41 (1984): 213-40; H. Roy Merrens and George D. Terry, “Dying in Paradise: Malaria, Mortality, and the Perceptual Environment in Colonial South Carolina,” Journal of Southern History 50 (1984): 533-50; and Joseph I. Waring, “Colonial Medicine in Georgia and South Carolina,” Georgia Historical Quarterly 59 supp. (1975): 141-53. 6 Warner, “The Idea of Southern Medical Distinctiveness,” 205. 3 western medical distinctiveness, despite the similarly depressed state of the antebellum medical profession in the West and the acknowledged differences in disease environment between that region and the Northeast. Warner's conclusion that “the experience of the physician in the Old South, embodying in exaggerated form the anxieties of their professional counterparts in other regions, may best epitomize the experience of the antebellum American physician” may well be true, but his account does not provide an adequate explanation of what underlay the “exaggerated form” of southern medicine. In his emphasis on professional status, he at times loses sight of the macropolitics that shaped and provided the discourse for occupational grandstanding.7

Southernist medicine blurred the distinction between professional and sectional politics. Just as promotion of the South advantaged the southern medical profession, advancement of the southern physician increased regional pride throughout his section.

Warwick Anderson has analyzed the political uses of medicine in situations both more (the

Filipino resistance against American imperialism) and less (the Australian justification of separation from England) nationalistic than the sectional struggle in the United States.

Mastery of medicine, he writes, “[indicates] capacity for independence of mind and therefore of polity.” The uses of southernist medicine were similarly and simultaneously twofold: southern doctors demonstrated their individual independence of mind while illuminating the potential of an independent polity for the South as a whole. Defense of the medically exceptional South afforded southernist agitators, both political and medical, a

7 Ibid., 205. Physicians in western cities such as Chicago and Cincinnati also argued for the specificity of their region's medicine, but not with nearly the same fervor that southern doctors did. See John Duffy, From Humors to Medical Science: A History of American Medicine, 2nd ed. (Urbana: University of Illinois Press, 1993), 148. On the increasing similarities between the West and the Northeast in the decades prior to the Civil War, which explain in part the lack of sectional politics in Western medicine, see James M. McPherson, “Antebellum Southern Exceptionalism: A New Look at an Old Question,” Civil War History 29 (1983): 237. 4 domain in which to proclaim their region's and their own unassailable expertise. In their efforts to justify medical self-sufficiency, which provided professional authority, southern physicians suggested the potential for sectional self-reliance, validating the political aims of the restive, embattled, and ultimately besieged South.8

The Profession of a Section

This is a study of southernist medicine on three different levels and in three distinct periods within the late antebellum and Civil War eras. To introduce and analyze the ideology of southern medical distinctiveness, the first chapter examines the short-lived Southern

Medical Reports, an ambitious medical periodical published in 1849 and 1850 that sought, largely unsuccessfully, to promote regional medicine through the compilation of contributions from physicians in every southern state. Southern Medical Reports was the sectionalist journal par excellence, and a close focus on its contents and contributors reveals much about the intellectual roots of southernist medicine. Taken as a whole, all aspects of the publication—its structure, its articles, and the context within and for which it was produced—illustrate the falsity of any attempt to disaggregate the political from the medical in arguments for southern medical exceptionalism. To a large extent, what was political was medical, and vice versa.

Moving from ideology to institution, and from rhetoric to practice, the second chapter reviews the establishment of southern medical schools in the two decades preceding the Civil War. The founding of medical schools, along with the publication of journals, was the most significant professional and commercial activity for proponents of southernist medicine, and this was particularly true in New Orleans, the largest southern city and one of

8 Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines (Durham, NC: Duke University Press, 2006), 191. 5 the few that supported two antebellum medical colleges. Drawing on the New Orleans Medical and Surgical Journal and the New Orleans Medical News and Hospital Gazette, both of which began publication after 1840 and became allied with competing medical schools in the Crescent

City, this chapter demonstrates that economic incentives that often undermined appeals to the section as a whole, resulting in the lack of unity of the southernist medical enterprise.

Much like southerners on a larger scale, southern physicians considered themselves a unified group in opposition to the North. Competition within the South, however, revealed the factionalism inherent in the “movement,” and the difficulty of reconciling professional with political considerations.

The final chapter examines the forced implementation of southernist medicine that the outbreak of the Civil War precipitated. The presence of vast numbers of northerners in the South offered a test of the acclimation theory of southern diseases, which held that southerners were largely immune from diseases of their section, and the opportunity to contribute to the war effort actualized the previously discursive connection between the professional uplift of southern physicians and the sectional promotion of their region.

Though periodical publication largely halted during the war, the chapter analyzes the

Confederate States Medical and Surgical Journal, the official organ of the Confederate States' medical department, as well as a host of other primary sources focusing on the search for indigenous southern remedies. This effort suggested that the southern land was not, and need not be viewed as, persistently pestilential, but possessed health-giving properties as well.

In attempting to identify within the South substances to treat southern diseases, Confederate physicians offered the promise of medical and, implicitly, political independence for their region and its people who felt so closely tied to the soil.

Tracing the trajectory of southern medical distinctiveness sheds light on the 6 historical relationship between medicine and politics, and on the use of scientific discourse in the simultaneous service of profession and polity. A focus on medical journals, especially those of New Orleans, the epicenter of southernist medicine, allows elaboration of the medical, political, and professional aspects of southern regional medicine, and of the discourse's progression from ideas to ideals to implementation and assessment. The journals' contents, comprising together nearly 27,000 pages, testify to the myriad ways in which medicine and doctors contributed to and became intertwined with the South's cultural consciousness as the section moved toward secession and left the Union. As Drew Gilpin

Faust argues, “the moment when southerners explained themselves to themselves was the moment they came closest to explaining themselves to us.”9 In their professional efforts to define, defend, and develop a distinctively diseased South, southern physicians embodied and expressed the concerns of both nineteenth-century doctors and of their section. For southern and southernist practitioners, medicine was political, implicitly if not explicitly, and the politics of medicine offered a remedy for the particular ills against which the South as a whole struggled.

The Doctors in the South

As a historical subject, southern medical exceptionalism, though treated only sparingly in its own right, sits at the nexus of three vast fields of scholarship—nineteenth- century medicine, southern culture and politics, and the Civil War (and Civil War medicine specifically). As a result, literature on the topic is at once thorough and scarce, overwhelmingly abundant and frustratingly fragmentary. Mentioned in many places but seldom analyzed for itself, marginalized within broader discourses—perhaps as the prewar

9 Drew Gilpin Faust, The Creation of Confederate Nationalism: Ideology and Identity in the Civil War South (Baton Rouge: Louisiana State University Press, 1988), 84. 7 South felt itself to be—southern medical distinctiveness is a protean subject, and a review of the field, antebellum, bellum, and postbellum, is necessarily a review of fields in the plural.

Just as southernist medical discourse encompassed diverse threads (political, medical, economic, and ideological), and expressed itself in diverse ways to serve a multitude of goals, constructing a body of scholarship relevant to the subject combines areas of history that at first glance appear to have little in common.

This is not to say that scholars have not examined antebellum southern medicine directly. John Duffy and James Breeden have devoted a number of shorter articles to the topic, complementing John Warner's provocative if problematic analysis. Duffy's and

Breeden's contributions, though often lacking methodological complexity, nevertheless do the admirable and necessary service of summarizing, explaining, and partially complicating the “curious combination of science, self-interest, and sectionalism” that characterized the discourse.10 As reference tools (and as paperweights), few works surpass the early and mid- twentieth century heroic histories of medicine in southern states, which are valuable for their thoroughness but closer to encyclopedias than historical analyses. Wyndham Blanton's three-volume opus Medicine in Virginia, Joseph Waring's treatment of the medical history of

South Carolina, and, most usefully for this study, Duffy's Rudolph Matas History of Medicine in

Louisiana remain required starting points for the historian of medicine interested in the

South, but only as chronologies and direction toward primary sources.11

10 Breeden, “States-Rights Medicine,” 348; Duffy, “A Note on Ante Bellum Southern Medicine and Medical Practice,” Journal of Southern History 34 (1968): 266-76; idem, “Sectional Conflict and Medical Education in Louisiana,” Journal of Southern History 23 (1957): 289-306. 11 Wyndham Bolling Blanton, Medicine in the Virginia in the Nineteenth Century (Richmond: Garrett & Massie, 1933); Waring, A History of Medicine in South Carolina, 2 vols. (Columbia, SC: South Carolina Medical Association, 1964; Charleston, SC: South Carolina Medical Association, 1967); Duffy, The Rudolph Matas History of Medicine in Louisiana, 2 vols. (Baton Rouge: Louisiana State University Press, 1958); idem, The Tulane University Medical Center: One Hundred and Fifty Years of Medical Education (Baton Rouge: Louisiana State University Press, 1984). See also Lucie Robertson Bridgforth, “Medicine in Antebellum Mississippi,” Journal 8 Southernist medicine was a product not only of the South, but also of the particular position of the nineteenth-century American doctor. Charles Rosenberg and Steven Stowe depict Victorian-era medicine in the United States at the level of the individual physician, a practitioner who had an uncertain and negotiable status within the Jacksonian bent of

American society. Stowe focuses especially on the South, though he takes such pains to localize his narratives that he often ignores, willfully or not, broader themes.12 General studies of nineteenth-century American (and, to a lesser extent, European) medical history inform the trends from which the arguments for southernist medicine arose, and explain the institutions, primarily periodicals and medical schools, through which southern medical exceptionalism was expressed. Paul Starr and William Rothstein usefully address the social position of nineteenth-century physicians through a sociological, somewhat reductionist, and at times heavily quantitative analysis of institutions.13 Similarly, a wide array of studies of the public relations of physicians, the growth of the antebellum medical profession, and the demise of regulatory measures in the early nineteenth century frame the context within

of Mississippi History 46 (1984): 82-107; John H. Ellis, Medicine in Kentucky (Lexington: University Press of Kentucky, 1977); Evelyn W. Gay, The Medical Profession in Georgia (Fulton, MO: Ovid Bell Press, 1983); Howard L. Holley, A History of Medicine in Alabama (Birmingham, AL: University of Alabama Press, 1982); and Dorothy Long, ed., Medicine in North Carolina: Essays in the History of Medical Science and Medical Service, 1524-1960, 2 vols. (Raleigh, NC: North Carolina Medical Society, 1972). 12 Charles Rosenberg, “The American Medical Profession: Mid-Nineteenth Century,” Mid-America 44 (1962): 163-71; idem, The Cholera Years; The United States in 1832, 1849, and 1866 (Chicago: University of Chicago Press, 1962; repr., 1987); idem, “The Practice of Medicine in New York A Century Ago,” Bulletin of the History of Medicine 41 (1967): 223-53; idem, “The Therapeutic Revolution: Medicine, Meaning, and Social Change in 19th Century America,” in Sickness and Health: Readings in the History of Medicine and Public Health, ed. Judith Walzer Leavitt and Numbers (Madison: University of Wisconsin Press, 1978; 2nd ed., rev., 1985), 39-52; Steven M. Stowe, Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Chapel Hill: University of North Carolina Press, 2004); idem, “Seeing Themselves at Work: Physicians and the Case Narrative in the Mid-Nineteenth Century American South,” American Historical Review 101 (1996): 41-79. See also Duffy, “Medical Practice in the Ante Bellum South,” Journal of Southern History 25 (1959): 53-72. 13 Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982); William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (Baltimore: The Johns Hopkins University Press, 1972). 9 which southern physicians felt the need to undertake a program of professional uplift.14

From a medical standpoint, the notion of southern medical exceptionalism arose from a particularly American commitment to empiricism and observation. The orthodox medical profession of the nineteenth-century United States was profoundly self-conscious.

Buffeted by domestic sectarians and a feeling of scientific inferiority in the face of European medical science, American doctors emphasized the sui generis character of medicine in

America to assert their especial authority. They argued, as John Warner explains, that “not only did persons have their own characteristic temperaments, but so too did climates, places, and nations.” Just as southern physicians claimed that proper medical practice was the product only and irreplaceably of local experience, nineteenth-century American physicians of all regions considered doctrinal the principle of specificity, the dictates of which endorsed the primacy of local knowledge of illness. Treatment was not disease-specific, but instead carefully calibrated to fit patient and environment, both of which were considered malleable and only understandable with sustained exposure and practice.15 Conevery Bolton

14 On the public relations of the medical profession, see Duffy, “The Changing Image of the American Physician,” Journal of the American Medical Association 200 (1967): 30-34; Rosenberg, “The American Medical Profession”; Richard H. Shyrock, “Empiricism versus Rationalism in American Medicine, 1650-1950,” Proceedings of the American Antiquarian Society (new series) 65 (1969): 199-250; idem, Medicine and Society in America, 1660-1860 (New York: New York University Press); idem, “Public Relations of the Medical Profession in Great Britain and the United States,” Annals of Medical History (new series) 2 (1930): 308-39; and idem, The Development of Modern Medicine: An Interpretation of the Social and Scientific Factors Involved (Madison: University of Wisconsin Press, 1936; repr., 1974).

On the growth of the medical profession, see James H. Cassedy, American Medicine and Statistical Thinking, 1800-1860 (Cambridge, MA: Harvard University Press, 1984); idem, Medicine and American Growth, 1800-1860 (Madison: University of Wisconsin Press, 1986); idem, Medicine in America: A Short History (Baltimore: The Johns Hopkins University Press, 1991); John S. Haller, Jr., American Medicine in Transition, 1840-1910 (Urbana: University of Illinois Press, 1981); Lester S. King, Transformations in American Medicine: From Benjamin Rush to William Osler (Baltimore: The Johns Hopkins University Press, 1981); and James Harvey Young, “American Medical Quackery in the Age of the Common Man,” Mississippi Valley Historical Review 47 (1960-1): 579-93.

On medical licensing, see Joseph F. Kett, The Formation of the American Medical Profession, 1780-1860 (New Haven: Yale University Press, 1968); and Shyrock, Medical Licensing in America, 1650-1965 (Baltimore: The Johns Hopkins University Press, 1967). 15 Warner, The Therapeutic Perspective, 65; idem, Against the Spirit of System: The French Impulse in Nineteenth-Century 10 Valenčius describes American medicine of the pre-Civil War era as a “science of localities,”16 and physicians jealously guarded therapeutic ownership of their particular place. In the context of northern dominance in science and culture, southern physicians employed the accepted dictates of specificity to lay claim to medical dominion over the southern climate.

An Afflicted Environment

Against this backdrop, southern medical specificity rested largely on the assertion that certain diseases, notably malaria and yellow fever, were peculiarly southern.

Accordingly, works on the history of southern diseases (which often overlap with histories of southern public health) provide an indirect window into southern medical thinking in the nineteenth century. Jo Ann Carrigan has written extensively about yellow fever in New

Orleans, and her emphasis on the notion, sometimes termed the theory of acclimation, that yellow fever was a “strangers' disease” to which non-southerners were especially susceptible illustrates a less overtly ideological manifestation of southern exceptionalism that nevertheless acquired political heft during the Civil War.17 Likewise, Margaret Humphreys has examined both yellow fever and malaria in the southern context, with a focus on their

American Medicine (Princeton, NJ: Princeton University Press, 1998); idem, “From Specificity to Universalism in Medical Therapeutics: Transformation in the 19th-Century United States,” in Sickness and Health, ed. Leavitt and Numbers, 87-101; idem, “Medical Sectarianism, Therapeutic Conflict, and the Shaping of Orthodoxy in Antebellum American Medicine,” in Medical Fringe and Medical Orthodoxy, 1750-1850, ed. W. F. Bynum and Roy Porter (London: Croom Helm, 1987); idem, “Power, Conflict, and Identity in Mid- Nineteenth-Century American Medicine: Therapeutic Change at the Commercial Hospital in Cincinnati,” Journal of American History 73 (1986-7): 934-56; idem, “Science, Healing, and the Physician's Identity: A Problem of Professional Character in Nineteenth-Century America,” Clio Medica 22 (1991): 65-88; idem, “'The Nature-Trusting Heresy': American Physicians and the Concept of the Healing Power of Nature in the 1850's and 1860's,” Perspectives in American History 11 (1977-8): 291-324; Rosenberg, “The Therapeutic Revolution.” 16 Conevery Bolton Valenčius, The Health of the Country: How American Settlers Understood Themselves and Their Land (New York: Basic Books, 2002). 17 Carrigan, “Impact of Epidemic Yellow Fever on Life in Louisiana,” Louisiana History 4 (1963): 5-34; idem, “Privilege, Prejudice, and the Strangers' Disease in Nineteenth-Century New Orleans,” Journal of Southern History 36 (1970): 568-78; idem, The Saffron Scourge: A History of Yellow Fever in Louisiana, 1796-1905 (Lafayette, LA: Center for Louisiana Studies, University of Southwestern Louisiana, 1994); idem, “Yankee Versus Yellow Jack in New Orleans, 1862-1866,” Civil War History 9 (1963): 248-60; idem, “Yellow Fever in New Orleans, 1853: Abstractions and Realities,” Journal of Southern History 25 (1959): 339-55. 11 roles in the development of regional public health.18 These and other “disease histories” emphasize that southern medical distinctiveness did have an observable basis to support its oft-nationalistic overtones. Perception in this case drove reality: while the South's epidemiological profile was unique, more crucial for developing a southernist medicine were the ways in which antebellum Americans conceived of the region's uniqueness.19

Conceptions of a medically distinct South fueled the implementation of the southernist medical program through the promotion of local education and the founding of medical colleges throughout the section. As with many aspects of southern medical exceptionalism, the proliferation of medical schools in antebellum Dixie was part of a larger trend in American medicine as a whole that numerous scholars have chronicled.20 With the number of southern medical schools increasing more than tenfold between 1820 and 1860 without a corresponding increase in the pool of potential applicants, competition for students (or, more properly, students' fees) was cutthroat between North and South as well

18 Margaret Humphreys, Malaria: Poverty, Race, and Public Health in the United States, (Baltimore: The Johns Hopkins University Press, 2001); idem, Yellow Fever and the South, New Brunswick, NJ: Rutgers University Press, 1992; idem [as Margaret H. Warner], “Public Health in the Old South,” in Science and Medicine, ed. Numbers and Savitt, 226-55. Gerald Grob's The Deadly Truth (see n. 4 above) is the best general history of American disease, and contains extensive sections on supposedly southern afflictions. See also Erwin H. Ackerknecht, Malaria in the Upper Mississippi Valley, 1760-1900 (Baltimore: The Johns Hopkins University Press, 1945; repr., New York: Arno Press, 1977); Duffy, Epidemics in Colonial America (Baton Rouge: Louisiana State University Press, 1953); idem, “Yellow Fever in the Continental United States During the Nineteenth Century,” Bulletin of the New York Academy of Medicine 54 (1968): 687-701; Randall M. Packard, The Making of a Tropical Disease: A Short History of Malaria (Baltimore: The Johns Hopkins University Press, 2007); and Patterson, “Yellow Fever Epidemics and Mortality in the United States, 1693-1905,” Social Science and Medicine 34 (1992): 855-66. Keith Wailoo's Dying in the City of Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill: University of North Carolina Press, 2001) is an excellent study of sickle cell anemia in the South, though its focus is primarily the twentieth century. 19 See for example the essays in Savitt and Young, eds., Disease and Distinctiveness in the American South (Knoxville: University of Tennessee Press, 1988). 20 Rothstein, American Physicians; idem, American Medical Schools and the Practice of Medicine: A History (New York: Oxford University Press, 1987); Numbers, ed., The Education of American Physicians: Historical Essays (Berkeley: University of California Press, 1980); idem, “The Fall and Rise of the American Medical Profession,” in Sickness and Health, ed. Leavitt and Numbers, 225-36; Martin Kaufman, American Medical Education: The Formative Years (Westport, CT: Greenwood, 1976). The standard chronological history of antebellum American medical education is William Frederick Norwood, Medical Education in the United States Before the Civil War (Philadelphia: University of Pennsylvania Press, 1944). 12 as between individual southern schools. In this market, many southern medical colleges argued that the opportunities that they afforded aspiring southern physicians for study was, by virtue of their location in the South, preferable to those of more established and prestigious schools in the North.21

The South in the Doctors

While the discourse of southern medical exceptionalism was undeniably about medicine, it was no less about the South. Though it is a stretch to describe most mid- nineteenth-century American physicians, only one-quarter of whom in 1851 possessed a bachelor's degree,22 as intellectuals, medicine is by nature a learned (or taught) profession.

And, as Drew Faust, Michael O'Brien, and Eugene Genovese have explored and explained, the intellectual had a peculiar place in the Old South. Isolated from American centers of learning, which were in turn remote from the Western academy centered in Britain and

Continental Europe, southern men of letters embarked, as Faust describes, on a program of sectional uplift “founded in a reassuring cosmology” that asserted the worth of the South, and by extension that of themselves. Lacking established organs of intellectual discourse, with the cultural activity common to cities largely absent in the primarily rural South, southern thinkers linked projects of professional authority—which, for many southern physicians, involved the medical distinctiveness of their place of practice—to promotion of the section as a whole. Even if, as O'Brien emphasizes, the lack of southern intellectual institutions limited the actual audience of most learned discourse to a local level, southern thinkers often spoke of the region writ large while safeguarding most carefully their

21 Daniel Kilbride, “Southern Medical Students in Philadelphia, 1800-1861: Science and Sociability in the 'Republic of Medicine,'” Journal of Southern History 65 (1999): 697-732. 22 Ira M. Rutkow, Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine (New York: Random House, 2005), 51. 13 provincial interests.23 In the case of southern medical education, for example, physicians in southern municipalities asserted the propriety of their cities for medical instruction with reference to the entire South, and at the same time challenged the appropriateness of cities elsewhere in the South for medical education. Sectional discourse, then, often served various, diverse, and contradictory interests.

All these interests, however, coincided in the idea and the land of the South. The

South and its people, everyone agreed, were distinct. Though disputes certainly existed regarding the extent or character of that distinctiveness, few challenged the notion that the

South was a land apart. Indeed, on a readily observable level, the southern environment is singular in the United States even today. Several works in the burgeoning fields of environmental and borderlands history examine the relationship of illness and landscape in nineteenth-century America generally and in the South specifically. If, as two historians argue, “region may be seen as sculpting the essential conditions of disease and framing the social response,” examination of the literal Southland, not as a political unit but as a fact of topography, is crucial for analysis of the southernist medical enterprise.24 Conevery

Valenčius and Linda Nash emphasize the connection between topographical knowledge and

23 Faust, “A Southern Stewardship: The Intellectual and the Proslavery Argument,” American Quarterly 31 (1979): 63-80; Michael O'Brien, “'The Water Rose in the Graves': Discontinuity and Localism in Nineteenth-Century American Thought,” in The United States South: Regionalism and Identity, ed. Valeria Gennaro Lerda and Tjebbe Westendorp (Rome: Bulzoni Editore, 1991), 55-74. See also Faust, A Sacred Circle: The Dilemma of the Intellectual in the Old South, 1840-1860 (Baltimore: The Johns Hopkins University Press, 1977); idem, “The Rhetoric and Ritual of Agriculture in Antebellum South Carolina,” Journal of Southern History 45 (1979): 541-68; idem, The Creation of Confederate Nationalism; Eugene D. Genovese, The Southern Front: History and Politics in the Culture War (Columbia, MO: University of Missouri Press, 1995); O'Brien, Conjectures of Order: Intellectual Life and the American South, 1810-1860, 2 vols. (Chapel Hill: University of North Carolina Press, 2004); idem, “Finding the Outfield: Subregionalism and the American South,” Historical Journal 38 (1995): 1047-56; and idem and David Moltke-Hansen, eds., Intellectual Life in Antebellum Charleston (Knoxville: University of Tennessee Press, 1988). 24 Martha L. Hildreth and Bruce T. Moran, “Introduction,” in Diseases and Medical Care in the Mountain West: Essays on Region, History, and Practice, ed. Hildreth and Moran (Reno: University of Nevada Press, 1998), xiii- xix. In the same volume, Numbers's “The Significance of Regions in American Medical History” discusses the construction of regional identity with substantial reference to the South. 14 claims to possession of territory, a motivation that implicitly and explicitly underlay the efforts of southern physicians to assert their unique understanding of their environment.25

In the past two decades, several scholars have analyzed the South in terms of environmental history, situating the region in a medicogeographical context. Their conclusions—in Jack

Temple Kirby's words, that “the South is American to be sure, but different from other

American regions”—buttress the conception of the nineteenth-century South as a land, place, and polity separate from its northern counterparts in the Union.26

Given the assumed holistic relationship between health and environment and medicine and geography in the nineteenth century, the notion of the South as a land apart placed its people as a population apart. Impugning the South was impugning southerners, even if southerners themselves were doing the impugning. The ecological approach to disease carried a heavy moral weight. As Bennet Dowler, a prominent New Orleanian physician in the mid-nineteenth century, noted, southern society and culture were products of “Meteorological, as well as Political Economy.”27 The relationship of the southern people to the southern land was deeply felt.

The shock of the Civil War, which was fought almost entirely on that southern land, has cultural resonance in the region even today. For southern physicians, the war presented an opportunity. In addition to offering what George Adams describes as “a postgraduate

25 Valenčius, The Health of the Country; idem, “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; Linda Nash, Inescapable Ecologies: A History of Environment, Disease, and Knowledge (Berkeley: University of California Press, 2006). 26 Kirby, Mockingbird Song, xiv; idem, Poquosin: A Study of Rural Landscape & Society (Chapel Hill: University of North Carolina Press, 1995); Mart A. Stewart, “'Let Us Begin with the Weather': Climate, Race and Cultural Distinctiveness in the American South,” in Nature and Society in Historical Context, ed. Mikuláš Teich, Roy Porter, and Bo Gustafsson (New York: Cambridge University Press, 1997); idem, “What Nature Suffers to Groe”: Life, Labor, and Landscape on the Georgia Coast, 1680-1920 (Athens, GA: University of Georgia Press, 1996). 27 Bennet Dowler, “Researches on Meteorology,” NOMSJ 4 (1847-48): 412. 15 course in medicine and surgery,” the sectional conflict tested many of the assumptions upon which southernist medicine was founded.28 In wartime, southern physicians could treat southern patients in the South, while invading northern troops and their medical corps were forced to contend with putatively foreign southern diseases. The link between the practice of medicine and sectional promotion was no longer merely rhetorical, but instead a vital component of southern efforts to maintain independence.29

Ideology and practice dovetailed in the most distinctly southernist enterprise of the

Confederate Medical Corps. With the general Union blockade of the Confederacy hampering if not eliminating the ability of the South to import medical supplies, southern physicians, at the urging of Confederate Surgeon General Samuel Preston Moore, sought to identify and produce indigenous southern remedies for specifically southern diseases.30

Conditions of war thus necessitated a shift in southernist medical discourse. Not only was the South a unique environment with distinctive diseases, but it also, Confederate doctors hoped and promised, possessed its own unique remedies. The rhetoric of southern medical

28 George Worthington Adams, “Confederate Medicine,” Journal of Southern History 6 (1940): 151-66. 29 Certainly no shortage of material on Civil War medicine exists. Frank R. Freemon's Microbes and Minie Balls: An Annotated Bibliography of Civil War Medicine (Rutherford, NJ: Fairleigh Dickinson University Press, 1993) is an excellent survey of the field, though an updated version to include the past fifteen years of scholarship is desirable; Harris D. Riley, Jr.'s “Medical Activities” in The American Civil War: A Handbook of Literature and Research, ed. Steven E. Woodward (Westport, CT: Greenwood Press, 1996), 433-53, also deserves mention. Monographs of particular note include Adams, Doctors in Blue: The Medical History of the Union Army in the Civil War (New York: Henry Schuman, 1952); H. H. Cunningham, Doctors in Gray: The Confederate Medical Service (Baton Rouge: Louisiana State University Press, 1958; pbk. ed., 1993); Freemon, Gangrene and Glory: Medical Care During the American Civil War (Madison, NJ: Fairleigh Dickinson University Press, 1998); and Rutkow, Bleeding Blue and Gray. General histories of the Civil War are largely outside the scope of this study, but McPherson's Battle Cry of Freedom: The Civil War Era (New York: Oxford University Press, 1988) sets the standard with its combination of comprehensiveness, conciseness, and readability. 30 Many scholars mention the wartime effort to find indigenous southern antidotes, but few deal with it directly. Exceptions include Breeden, “Medical Shortages and Confederate Medicine: A Retrospective Evaluation,” Southern Medical Journal 86 (1993): 1040-48; Norman H. Franke, “Official and Industrial Aspects of Pharmacy in the Confederacy,” Georgia Historical Quarterly 37 (1953): 175-87; idem, “Pharmaceutical Conditions and Drug Supply in the Confederacy,” Georgia Historical Quarterly 37 (1953): 287-98; idem, “Pharmacy and Pharmacists in the Confederacy,” Georgia Historical Quarterly 38 (1954): 11-28; and Mary Elizabeth Massey, Ersatz in the Confederacy: Shortages and Substitutes on the Southern Homefront (Columbia, SC: University of South Carolina Press, 1952; repr., 1993). 16 journals and the founding of medical schools had entailed a fundamentally negative discourse, with practitioners aiming to disparage northern doctors as much as to promote southern physicians. In the development of a wartime southern medical botany, southernist medicine offered for the first time a truly southern-made medicine. Politically, the notion that the South could service itself medically—that it was less the Sickly South than the Self-

Reliant South—justified southern independence as it simultaneously enhanced the prestige of the southern medical profession.

This study seeks to draw together these threads of scholarship in the same way southern physicians drew from medical, political, and environmental sources in their construction and promulgation of arguments for southern medical distinctiveness. At the same time, this study demonstrates that though a “southernism” in medicine existed as a describable entity, it was not a united front. Many historians of the South, perhaps unintentionally internalizing the tenets of southern exceptionalism, remain so myopically focused on Dixie that the idea of the southerner ossifies as something more coherent than a geographic referent. Likewise, scholars too often treat medicine as an insular subject, finding in the common professional label of physician an explanation for the diverse individual behaviors of doctors. This study attempts to avoid such essentialization. Southern practitioners did not adopt a discourse of distinctiveness simply because they were southerners, nor because they were physicians. Rather, they adopted the discourse as individuals, who, because of profession and section, shared some of the same interests—but had divergent ones as well.

The language of medical journals was, as Drew Faust notes with regard to the perorations of southern agricultural societies, not “simply random pronouncements, but rather a group product,” and occupational publications were as much “a social form” as a 17 forum for personal expression. Analysis of medical periodicals therefore reveals the preoccupations and professional proclivities of doctors as individuals, and as a loosely associated social class, in the American South.31 In looking at what southern doctors actually said on a personal or municipal level, this study contributes to an understanding of what it means for discourse to be a group project if neither the group nor the project is the result of conscious or consonant organization. Southern physicians internalized broader discourses of their societal context in the service of specific professional and political goals.

The implications of this study are thus useful for assessing regional or professional

“movements” elsewhere, even those at a far geographical and chronological remove from the nineteenth-century United States.

31 Faust, “The Rhetoric and Ritual,” 567. 18

CHAPTER 1

WRITING SOUTHERN MEDICINE

Erasmus Darwin Fenner was satisfied. Surveying in 1850 the state of southern medical publishing, Fenner, a prominent New Orleanian physician and the founder of the first lasting medical journal south of Kentucky, contentedly observed that “when we look around us and witness the wonderful progress in southern medical literature that has been made since 1844, the time we commenced our editorial career, we feel highly gratified at the result.” As Fenner noted, “new medical journals” were “continually springing up in the

Southern states,” and Southern Medical Reports, his second periodical and current contribution to the southern medical scene, was foremost among them.1

Physicians in the South, like their counterparts elsewhere in nineteenth-century

America, produced a seemingly limitless array of professional publications, especially in the two decades preceding the Civil War. Antebellum doctors considered journals to be essential to their occupation. The periodical was the locus of medical professional discourse, with the profession's claim to status and legitimacy intertwined with the publication of scientific activity, despite the limited audience and frequent failure of most journals. As Fenner argued and most physicians believed, “the literature of a profession is the best index to its actual condition—it is, in fact the expression of its existing state.”2 Though filled with rhetorical bombast, southern medical journals nevertheless provide a window into the professional location of southernist medicine, revealing the diverse motivations behind physicians' creation of and support for the discourse.

1 E. D. Fenner, “Preface,” SMR, 2: 9. 2 Ibid., 2: 10. 19 Examining this discourse, John Harley Warner, while acknowledging the sectionalist overtones of the rhetoric of southern physicians, argues that “implying that southern physicians promoted southern medical distinctiveness simply because they were southerners

… explains away more than it explains.”3 He instead attributes the strident defense of southern exceptionalism to an attempt to raise professional esteem among southern doctors, who, living in an anti-intellectual culture far from the country's centers of learning, had little status in their society. In Warner's view, southernist medicine was “driven by the anxieties and needs that pertained especially to the situation of the thinking physician in the South.”

The broader political aspects of the argument were thus only a means to an end, not a primary impetus behind the movement as a whole.4

An analysis of Southern Medical Reports, a short-lived regional journal that Fenner founded in 1849, complicates this picture. Though only one of many antebellum southern medical publications, Southern Medical Reports was an unusually ambitious enterprise that sought to “[give] a decided impulse to professional improvement in the South” by compiling contributions from physicians in every southern state, with varying success. Despite widespread praise from the medical communities of both the North and the South, the journal ceased publication in 1851 after only two volumes.5

The structure, contents, and context of Fenner's periodical illustrate both the professional and the regional concerns at the root of southernist medical discourse. Though

Fenner grounded the publication in the principle of specificity, which affirmed the primacy

3 John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1855 (Cambridge, MA: Harvard University Press, 1986), 78. 4 Idem, “The Idea of Southern Medical Distinctiveness: Medical Knowledge and Practice in the Old South,” in Science and Medicine in the Old South, ed. Ronald L. Numbers and Todd L. Savitt (Baton Rouge: Louisiana State University Press, 1989) 179-205. Warner also discusses these ideas in chapter 3 of The Therapeutic Perspective. 5 Fenner, “Introductory Address,” SMR, 1: 12. 20 of local and empirical knowledge for the practice of medicine, political considerations shaped the rhetoric and organization of the journal. Southern Medical Reports was at its core as much a political instrument as a medical document, as much a promotion of sectionalism as an endorsement of sectional medicine. Southern physicians employed political sectionalism as a conduit to professional improvement and promoted professional sectionalism as an additional argument for regional autonomy. Neither end was subservient to the other; rather, the goals were complementary.

Southernist medicine was certainly not only a political event. Substantial reference to the political conditions of the two decades preceding the Civil War, and not merely to the social status of southern doctors is, however, necessary for understanding the movement.

The arguments that proponents of southernist medicine expounded map so closely onto the prevailing political discourse of the period that diminishing in the medical realm the role of a broader southern sectionalism results in an impoverished analysis. Attempting to parse professional motives from those driven by macropolitics oversimplifies the picture.

Southern physicians were not merely adopting sectionalist language to swim with the prevailing current; they were, like other southern professionals, contributing substantially to the tide in the first place.

Fenner's First Journal

Erasmus Darwin Fenner was one of the most prominent southernist physicians, and his professional career typified the interaction between medicine and politics in the antebellum South. Fenner, the ninth of eleven children in a Scotch-Irish family, was born in

1807 near Louisbourg in central North Carolina. His father, Richard Fenner, was a

Revolutionary War veteran and physician. The Fenners were not southern gentry, but had deep roots in the colonial South: Richard's father had served as a councilor to the governor 21 of North Carolina, and Richard himself had accompanied George Washington on campaign.

Erasmus, who was exceedingly “delicate” physically in his youth, attended a secondary academy in Raleigh before his family in 1823 moved to Tennessee, where he continued his studies with a private tutor. Erasmus subsequently followed his father into medicine, first apprenticing under his older brother Robert, also a physician, and then graduating in 1830 from Transylvania Medical College. He subsequently practiced with Robert for three years in Jackson, Tennessee, before moving, first to Clinton, Mississippi, and then, after losing much of his personal wealth in the Panic of 1837, in 1840 to New Orleans, where, excepting a few temporary relocations during the Civil War, he would spend the remainder of his life.6

Fenner was by standards of the time highly learned—in addition to his professional degree, which was not required for medical practice, he had studied classical Greek and

Latin. Unlike many educated southerners, however, Fenner had not attended school in the

North. Transylvania Medical College, founded in Kentucky in 1799, was the first institution for medical instruction west of the Appalachians and the southernmost American medical school prior to the establishment of the Medical College of South Carolina in 1824.7 A large portion of Southern physicians that had formal medical education received it in

Philadelphia, primarily at Jefferson Medical College or the University of Pennsylvania.

Southern students were so numerous in the city that at the antebellum low point of southern enrollment at the Penn Medical School, 39 percent of the student body hailed from south of

6 For biographical treatments of Fenner, see D. Warren Brickell, “Biographical Sketch of Erasmus Darwin Fenner,” SJMS 1 (1866-67): 401-23; John Duffy, “Erasmus Darwin Fenner (1807-1866), Journalist, Educator, and Sanitarian,” Journal of Medical Education 35 (1960): 819-31; Joseph Jones, “American Medical Necrology: Fenner, Erasmus Darwin,” Transactions of the American Medical Association 29 (1878): 646-54; and William Dosité Postell, “Erasmus Darwin Fenner and the Beginnings of Medical Literature in Louisiana,” Annals of Medical History (3rd series) 3 (1941): 297-305. The three later accounts borrow heavily from Brickell's, though each contains some unique information about Fenner's life. 7 Steven M. Stowe, Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Chapel Hill: University of North Carolina Press, 2004), 21; Duffy, From Humors to Medical Science, 131. 22 the Mason–Dixon line.8 Fenner's educational background did not make him “more southern” than his medical contemporaries, but his lack of study in Philadelphia resulted in fewer ties to the northern medical establishment.

Fenner's first foray into periodical publishing came in May 1844, when he and Abner

Hester, a Tennessee native and Penn graduate, cofounded the New-Orleans Medical Journal, soon to become New Orleans Medical and Surgical Journal.9 As would be the case with Southern

Medical Reports, Fenner framed his purpose for the journal in distinctly sectional terms. He declared that “it is universally admitted that a Medical Journal is greatly wanted in this region,” as no American medical publication existed south of Louisville, and appealed to his own southern experience—“we have been raised in the South-West; our professional career has been chiefly in the South, and we can assert an experience of fifteen years in its peculiar maladies”—to explain his particular qualifications to chronicle the diseases of Dixie. In a common trope of southern medicine, Fenner emphasized the cruciality of specific personal experience for successful therapeutic medicine, going so far as to claim that a patient with a distinctly southern fever “would be much more safe under the management of some intelligent Planter or Overseer who had long resided in the region, and who was perfectly familiar with the disease, than he would be in the hands of the ablest Physician of London or Paris … who would be guided in his treatment solely by the general principles of medicine.”10 Focus on local clinical experience implicitly attested to the value of southern doctors: if a planter would be preferable to a northern doctor, then surely an actual

8 Daniel Kilbride, “Southern Medical Students in Philadelphia, 1800-1861: Science and Sociability in the 'Republic of Medicine,'” Journal of Southern History 65 (1999): 703-5. 9 For biographical information on Hester, see Fenner, “Death of Dr. Hester,” NOMSJ 10 (1853-54): 555-62. 10 “Introductory Address,” NOMSJ [as New-Orleans Medical Journal] 1 (1844-45): i, iii. Emphasis original. Following convention, I throughout this thesis omit authors from the citations of editorials and journal articles without bylines. 23 physician trained in the South would be superior to both. Simultaneously, Fenner rejected general medicine—which, given the prominence of northern schools, can be understood as northern medicine—in favor of familiarity, suggesting that locality was not merely an important component of medicine, but the most important component.

As Fenner urged a few sentences later, “it is in the South that we must study Southern diseases.” This was the essence of southernist medicine: the principle of medical specificity carried to extremes to assert an entire region's intellectual primacy. Even Fenner's putative eschewment of politics had a sectional edge, as he claimed that New Orleans Medical and

Surgical Journal “shall be liberal, independent, and impartial.”11 Liberalism for southern doctors was the acknowledgment of antagonism between northern and southern medicine, in opposition to what one southern physician called the “conservatism of the country,” which maintained that American medicine, though regional variations existed, was largely cut from a common cloth.12 Liberalism was also synonymous with the values of Jeffersonian democracy, which protected the right to property (construed by most southerners to include black slaves). Southern medical independence meant independence from domination by northern physicians; impartiality for Fenner was a return to medicine freed of the alleged northern bias of mainstream physic.13

New Orleans Medical and Surgical Journal, despite the local connotations of its name, exhibited the regional rhetoric and outreach that Fenner would perfect in Southern Medical

11 Ibid., iii, vi. Emphasis original. 12 John Gray Westmoreland, “Southern Medicine,” Atlanta Medical and Surgical Journal 5 (1859-60): 446. Westmoreland argued that this conservatism is “more properly speaking, Northern arrogance and Southern submissionism [sic].” Emphasis original. 13 On Jeffersonian liberalism in the South, see James M. McPherson, “Antebellum Southern Exceptionalism: A New Look at an Old Question,” Civil War History 29 (1983): 235; and David Potter, The South and the Sectional Conflict (Baton Rouge: Louisiana State University Press, 1968), 25. Potter notes that southern intellectuals (including modern southern historians) have long “found Dixie Jeffersonian, and Jeffersonianism liberal. Ergo Dixie [is] liberal.” 24 Reports. Of the forty articles in the first volume of Fenner's first journal, only eleven dealt directly with the Crescent City, while thirteen were selections from Mississippi and eight described events in Alabama. Fenner sought to “appeal to all practitioners of the

Southwest” and “to arouse from lethargy the genius and talent” of the medical profession in the southern states at large, rather than simply in his place of practice. New Orleans Medical and Surgical Journal became the most prominent periodical in the epicenter of the southernist medical movement. It was also by far Fenner's longest-lasting contribution to medical literature; now known as the Journal of the Louisiana State Medical Society, it has continued publishing, with some interruption and in various iterations, through the present day.14

The Topography of States' Rights

Fenner left New Orleans Medical and Surgical Journal in March 1848 due to financial problems with the journal, though the exact reasons for his departure remain obscure.15 He almost immediately set to work compiling Southern Medical Reports, the most ambitious of his publications. Much as New Orleans Medical and Surgical Journal had been, Southern Medical

Reports was at its core intended to foster improvement of the southern medical profession.

In the preface to the first issue, Fenner conceived of a work so vast in scope as to require supplementary publications, claiming that “the area of our observation is so extensive, diversified, and abundant in resources, that we shall probably find it difficult to compress our annual contributions within the compass of a single volume.” Despite his recognition of the South's diversity, Fenner's primary view of the region was holistic, at least inasmuch as

14 Duffy, The Rudolph Matas History of Medicine in Louisiana, 2 vols. (Baton Rouge: Louisiana State University Press, 1958), 2: 275; “Introductory Address,” NOMSJ [as New-Orleans Medical Journal] 1 (1844-45): i. 15 Duffy, The Rudolph Matas History of Medicine, 2: 278. Fenner would later claim that he made only $125 in his four years of work on New Orleans Medical and Surgical Journal, while Hester, who was briefly the journal's sole editor, maintained that his partnership with Fenner “was dissolved in the same friendly manner that it was originally formed, with every assurance of cordial support.” Duffy, “Erasmus Darwin Fenner,” 821; Abner Hester, “Health of the City &c.,” NOMSJ 5 (1848-49): 130; “Withdrawal of Dr. Fenner,” NOMSJ 4 (1847-48): 681-82. 25 the area was distinguished from the North. To emphasize the distinctiveness of the southern disease environment, Fenner entreated contributors to “take somewhat comprehensive views of Topography.” Likewise, he “[invited] special attention to the diseases of Negroes, and everything relating to their sanitary condition,” topics with which, it was correctly assumed, northern doctors were not familiar.16 Hester, Fenner's former colleague, eagerly promoted the publication, lauding the undertaking as “a new era in American

Medical History” even before the inaugural issue had appeared.17

The first volume of Southern Medical Reports, Consisting of General and Special Reports of the Medical Topography, Meteorology, and Prevalent Diseases in ten southern states was published in

1849. Fenner specified Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North and South Carolina, Tennessee, and Texas as the areas within the journal's purview; it was these same ten states, plus Virginia, that would secede from the Union in 1860 and 1861.

The first volume contained articles from seven of the targeted states (with Arkansas, Florida, and North Carolina excepted), as well as notices from non-northern medical colleges, an annotated list of American medical journals, and “Excerpta and Miscellanies” dealing with treatments for southern fevers. The title page included an intention to publish annually, along with a Latin quotation from Horace's Satires that translates in part: “the tiny ant … adds it to the heap which she piles up, by no means ignorant and not careless for the

16 Fenner, SMR, 1: v-vi. Emphasis original.

Much of the literature on antebellum southern medicine deals extensively (and often exclusively) with the diseases and medical treatment of black slaves. While little of this work is directly relevant to my analysis, some excellent examples include: James Denny Guillory, “The Pro-Slavery Arguments of Dr. Samuel A. Cartwright,” Louisiana History 9 (1968): 209-27; Margaret Humphreys, Malaria: Poverty, Race, and Public Health in the United States (Baltimore: The Johns Hopkins University Press, 2001); and Savitt, Medicine and Slavery: The Diseases and Healthcare of Blacks in Antebellum Virginia (Urbana: University of Illinois Press, 1979). Drew Gilpin Faust's “A Southern Stewardship: The Intellectual and the Proslavery Argument” is not concerned with medicine per se but is useful for examining the myriad intellectual arguments for slavery. American Quarterly 31 (1979): 63-80. 17 “Dr. Fenner's Southern Medical Reports,” NOMSJ 6 (1849-50): 556. 26 future.”18 As the epigraph suggested, Fenner's goals for the journal were lofty—to serve as a long-standing beacon of southern medicine, and of Southernism more broadly.

Fenner organized the periodical's contents by state, implicitly stressing both the medical commitment to specificity and the political endorsement of states' rights. Such a structure was not common in medical journals of the time, and even Fenner's own New

Orleans Medical and Surgical Journal had been arranged topically, not geographically. Fenner maintained a delicate dance between regional holism and deference to state sovereignty throughout the first volume. He congratulated the South that seven states had organized medical societies, but at the same time “[trusted] that State pride, if no other motive, [would] stimulate the members of these societies.” Despite the model of the nascent American

Medical Association, he made no appeal for the formation of a regional southern medical organization.19 Of the journals he reviewed at the volume's conclusion, four were southern, five western, and five northern, though he annotated only the southern publications extensively. His reviews praised the founders of periodicals jointly for professional and political accomplishments (including providing “a decided impetus to the cultivation of medical science in the South” and honoring one's “profession and [one's] State!”).20 The complex dualism between regional unity and state distinctiveness paralleled the concerns of southern sectionalism more broadly: Southern Medical Reports was, in a sense, a confederation

18 Original quotation: “sicut / Pavula (non exemplo est) magni formica laboris / Ore trahit quodcumque potest, atque addit acervo / Quem struit, haud ignara ac non incanta futuri.” Horace, Satires 1.1.33-35. Translation from: Christopher Smart, The Poetical Works of Christopher Smart: Volume V: The Works of Horace, Translated into Verse, ed. Karina Williamson (Oxford: Clarendon Press, 1996; orig. publ., 1767). 19 Ibid., 1: 255. Emphasis original. Fenner's silence in this regard is even more telling when one considers that in the first volume of New Orleans Medical and Surgical Journal he had declared “the period is not far distant, when the great body of the profession in this region [the South] will be united into a grand Medical Society.” “Editorial (New Orleans May 15th 1844),” NOMSJ [as New-Orleans Medical Journal] 1, no. 1 (1844- 1845): 66. (The issue number is included in this citation because the the first volume of the journal restarts its page-numbering beginning with the second issue.) 20 Fenner, SMR, 1: 465-68. Fenner applied the first statement to his former periodical, New Orleans Medical and Surgical Journal. On the antebellum movement advocating a united South, see Potter, The Impending Crisis, 1848-1861 (New York: Harper & Row, 1976), 83-86, 104-5. 27 (or Confederacy) of material from individual states, both united and divided by geography.

Nearly a third of the medical reports focused primarily on topography, environment, and climate, and reports on the meteorology of a specific location opened each state section excepting those of South Carolina and Tennessee. The overwhelming attention to climatic issues—those issues that most differentiated the South from the North—heightened the journal's sectional character. Yet Fenner's inclusion of topographical studies did not merely distinguish the South from the North; it also asserted southern intellectual ownership of the

Southland. Conevery Valenčius argues that “medical geography was a technique of

American colonization,” with detailed, scientific studies of regions representing “the intellectual dimension of a takeover at once political, military, cultural, and environmental.”

Within this context, the description of place in terms of health, environment, and the tangled relationship between the two was a claim to possession: an understanding of regional medical elements provided an authority that was as much political as scientific. Southern practitioners' preoccupation with local geography was a means by which the South, the geographic and intellectual periphery of the antebellum United States, could demonstrate its refusal to submit to the American medical and political metropole. If the narrative of settlement, medicine, and manifest destiny was, as Valenčius claims, “inextricably linked with the project of making American the lands” encountered, southern physicians' attention to medical geography emblematized the project of keeping southern the lands of the South.21

Also notable is what was not included in Fenner's journal. Despite significant attention to surgery and obstetrics in American medicine, only one article on these subjects

(a report from Mississippi on the “removal of one half of the interior maxilla”) appeared in

21 Valenčius, The Health of the Country, 165, 168. 28 the first volume. Unlike therapeutic practices, surgery did not privilege localized specificity, and surgical procedures were (ideally) identical across differing environments. There was thus nothing particularly southern—and, given that many southern doctors learned surgery in the North, much that was seen as northern—about medical operations. Accordingly,

Fenner paid them little attention in his determinedly southern journal.22

Similarly conspicuous by absence are Arkansas, Florida, and North Carolina, the only targeted states that did not contribute to the first volume. For a number of reasons, these states contained among the largest populations of Union sympathizers in the South. The independent people of mountainous western North Carolina had much in common with their northern neighbors who would during the Civil War secede from the Confederacy to form West Virginia; similarly rugged Arkansas would contribute significant numbers of troops to the North during the conflict. Florida's small population and relative isolation limited the effectiveness of southern sectionalists in promoting their cause. While politics alone cannot explain the absence of these states from the journal—their rurality also impeded organization of their medical professions—their lack of response to Fenner's solicitations suggests that southernist medicine did not have as large an appeal in areas where sectionalist politics were relatively unpopular.23

22 Warner, The Therapeutic Perspective, 59; idem, “The Idea of Southern Medical Distinctiveness,” 183. 23 On Unionism in Western North Carolina, see John C. Inscoe and Gordon B. McKinney, Confederate Appalachia: Western North Carolina in the Civil War (Chapel Hill: University of North Carolina Press, 2000), esp. chapter 4. On pro-Northern Arkansans, see Kenneth C. Barnes, “The Williams Clan's Civil War: How an Arkansas Farm Family Became a Guerrilla Band,” in Enemies of the Country: New Perspectives on Unionists in the Civil War South, ed. John C. Inscoe and Robert C. Kenzer (Athens, GA: University of Georgia Press, 2001), 188-207. Arkansas rejected its first ordinance of secession in 1861. McPherson, Battle Cry of Freedom: The Civil War Era (New York: Oxford University Press, 1988), 255.

Floridian Unionists and Secessionists alike would speculate in 1861 that the state's Ordinance of Secession, which was ratified by delegates to the Convention of the People of Florida, would not have passed if submitted to a popular vote. John E. Johns, Florida During the Civil War (Gainesville, FL: University of Florida Press, 1963), chapter 1.

29 The organization and contents of the first volume of Southern Medical Reports also reveal the beleaguered state of the antebellum southern medical profession. Despite the intended regional scope of the work, reports from Louisiana filled almost 60 percent of the space devoted to state articles. Of the thirteen Louisianan contributions, Fenner himself authored seven, attesting to the widespread lack of interest from southern physicians.

Similarly, of the three medical schools that submitted bulletins, one, Louisville Medical

Institute, was in Kentucky, which Fenner acknowledged was “beyond the [geographic] scope allotted to” the journal. His explanation, that “the large numbers of Southern students who annually attend” the school justified its inclusion, rings hollow in light of the number of southern pupils matriculating in Philadelphia's medical schools.24 Fenner appealed to

Kentucky most likely because, as a non-northern slave state, it had the greatest cultural affinity with his designated southern states. Even in the inaugural volume, the apathy of southern physicians forced Fenner to stretch his self-imposed geographic limit and contribute substantial work of his own. As uplifting the southern medical profession would prevent the need for inclusion of non-southern territories in his southern journal, Fenner's attempts to counteract his profession's ennui merged closely with his endorsement of southern exceptionalism.

Yellow Jack and Moral Medicine

Fenner's “Introductory Address” to the first volume of Southern Medical Reports

North Carolina's state medical society was formed in 1849. Dorothy Long, ed., Medicine in North Carolina: Essays in the History of Medicine and Medical Service, 1524-1960, 2 vols. (Raleigh, NC: North Carolina Medical Society, 1972), 1: 75. Arkansas and Florida did not have medical associations at the time of publication of Southern Medical Reports. Texas, however, also did not have a state medical society and is still represented in the first volume, so a lack of medical organization does not discredit political implications. For founding dates of antebellum American medical societies, see William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (Baltimore: The Johns Hopkins University Press, 1972), 70-71. 24 Fenner, SMR, 1: 458; Kilbride, “Southern Medical Students.” Fenner would in fact later in his career refer to Louisville Medical Institute as a “Northern school.” “Medical Department, University of Louisville,” NOMNHG 4 (1857-58): 357. 30 exhibited the blurring of occupational and sectional politics characteristic of southernist medicine. The address wove together several professional and political threads—history, unique diseases, and clinical empiricism—into a manifesto for southern medical distinctiveness, as well as Fenner's rationale for creating Southern Medical Reports. Fenner was thorough, logical, and calculating in his approach; he took pains to ground his arguments in the firm foundations of history and medicine, and to refrain from overt attacks on the

North and its doctors. The address was nevertheless a clarion call to medical arms for southern physicians, and a powerful endorsement of sectional medicine.25

Much of the address discussed the principle of medical specificity. Adopting a non- localized theoretical view, Fenner appealed to the notion that “even ordinary diseases … are often very much modified by the different climates and localities in which they appear.” In addition, he argued that “some diseases are indigenous to certain” areas and emphasized that southern doctors “have obtained [their] knowledge of diseases from personal observation.”26

Fenner carefully avoided rhetoric in an effort to sustain his analysis with accepted facts. The doctrine of specificity generated little doubt in the middle third of the nineteenth century.

Treatment was climate-specific, not disease-determined, and the environment, physicians believed, was liable to transmute familiar disease entities into unrecognizable forms or wholly distinct illnesses. As a result, many practitioners valued empirical observation more highly than formal instruction. Fenner's endorsement of this tradition placed him well within the bounds of mainstream medicine, regardless of sectional affiliation.27

At the same time, Fenner made no effort to excise references to uniquely southern

25 Brickell, “Biographical Sketch,” 407. 26 Fenner, “Introductory Address,” 10, 11. Emphasis original. 27 Warner, The Therapeutic Perspective, 58-80. Warner claims that between 1820 and 1860 “specificity endured virtually uncontested as a central dogma” in American medicine. 31 medical concerns. His chosen illustration of specificity is particularly telling: “yellow fever has been known to prevail from one extremity of the United States to the other—from

Quebec to Pensacola; but who does not know where its home is, or that it is seldom seen at the North?” Fenner could have made his point equally well with an ailment found more often in the North than in the South, or with one of the afflictions K. David Patterson has called “cosmopolitan” diseases, which afflicted both regions with similar prevalence but altered presentation. While perhaps appropriate for the introductory address to a southern medical journal, Fenner's reference to yellow fever, the most distinctly southern of diseases, called attention to southern exceptionalism.28

To the antebellum American in the North or the South, yellow fever connoted the uncontrollable insalubrity of the southern environment. Frequent trade with the West

Indies and the hot, wet southern climate that allowed the disease's mosquito vectors to thrive year-round and facilitated the spread of the virus in a way impossible in the colder North.29

Jo Ann Carrigan has suggested that the withdrawal of yellow fever from the North after

1820, coupled with its increased prevalence in the South, gave Dixie a second “peculiar institution.” Media scrutiny of epidemic yellow fever was often more extensive in the North than in the South, and as a result residents of both sections associated the disease with the

Southland.30 Midwesterners usually (and usually correctly) attributed its infrequent

28 Fenner, “Introductory Address,” 10; K. David Patterson, “Disease Environments of the Antebellum South,” in Science and Medicine, ed. Numbers and Savitt, 153. Patterson specifies respiratory and gastrointestinal infections, helminths, and cancer and heart disease as examples of diseases and afflictions typically found in both the North and South. John Duffy notes that tuberculosis is one example of a disease that many saw as primarily northern. The Rudolph Matas History of Medicine, 2: 25. 29 Humphreys, Yellow Fever and the South (New Brunswick, NJ: Rutgers University Press, 1992), 5-8. Humphreys explains that “a single case” could pose a severe public health threat in the South, while in the North only a critical mass of infected mosquitoes could create an epidemic. 30 Breeden, “Disease as a Factor in Southern Distinctiveness,” 11, and Jo Ann Carrigan, “Yellow Fever: Scourge of the South,” 55-78, both in Disease and Distinctiveness in the American South, ed. Savitt and James Harvey Young (Knoxville: University of Tennessee Press, 1988). 32 appearance on the upper Mississippi River to ships of southern origin. Between 1840 and

1860, at least one southern port a year had a major yellow fever epidemic, and worsening urban sanitation and climate conditions during the 1850s led to four of the most severe outbreaks in New Orleanian history: in an ironic twist of fate, the incidence of the South's regional disease increased as political sectionalism did.31

Yellow fever was the archetypal sectional affliction. It was a disease with which only the South had to contend; it was a disease that northern medicine (or, for that matter, southern medicine) could not treat effectively; and it was a disease to which non-southerners appeared especially susceptible.32 Yellow fever disrupted commerce and discouraged investment and immigration, creating a homogeneous South that contrasted with the melting pot of the North. The virus also profoundly shaped the southern public health movement.

As Margaret Humphreys observes, “it was yellow fever,” more than anything else, “that distinguished [the South] from the rest of the nation as a region where life and health were particularly endangered.” Regardless of its origins, everyone agreed, Yellow Jack (one of the disease's many monikers) was a southerner.33

In an era in which disease connected so strongly to place, illness was not value-free.

31 Erwin H. Ackerknecht, “Diseases in the Middle West,” in Essays in the History of Medicine, In Honor of David J. Davis, M.D., Ph.D., ed. University of Illinois Davis Lecture Committee (Chicago: University of Illinois Press, 1965), 180; Humphreys [as Margaret H. Warner], “Public Health in the Old South,” in Science and Medicine, ed. Numbers and Savitt, 229; Carrigan, “Yellow Fever: Scourge of the South,” 68. Yellow fever even conveniently mapped onto the most identifiable boundary of southern culture: Carrigan notes that physicians generally regarded the thirty-fifth parallel north as the upper boundary of epidemic yellow fever, which situates its northernmost limit very close to the 36º 30' north coordinate that the Missouri Compromise fixed as the northern boundary of slavery in the United States. 32 On the alleged vulnerability of non-southerners to yellow fever, see Carrigan, “Privilege, Prejudice, and the Strangers' Disease in Nineteenth-Century New Orleans,” Journal of Southern History 36 (1970): 568-78; and David R. Goldfield, “The Business of Health Planning: Disease Prevention in the Old South,” Journal of Southern History 42 (1976): 557-70. 33 Humphreys, Yellow Fever and the South, 45. On yellow fever's effects on commerce, investment, and immigration, see also Carrigan, “Impact of Epidemic Yellow Fever on Life in Louisiana,” Louisiana History 4 (1963): 5-34. On yellow fever, public health, and sectional arguments about proper treatment, see Humphreys, “Public Health.” 33 Both northerners and southerners cast epidemic yellow fever in a moral light. One northern newspaper suggested that the disease's presence in the South was punishment for slavery, particularly since the affliction had an apparent African genesis. Many Americans saw yellow fever as “an indictment of southern civilization,” or as “biological revenge” for trading in slaves. Defenders of the South claimed that the disease originated locally, that African resistance to the virus argued in favor of slavery (as slave labor sustained production in times of epidemic), and that the corruptions of abolitionism rendered northerners uniquely vulnerable to the ailment.34 Such arguments could not disguise the fact that yellow fever was both undeniably nocuous and undeniably southern. With illness arising from locality, medicine and health became a matter of regional pride for physicians and non-physicians alike. Southernist efforts to develop a medicine by and for the South thus carried an ideological weight far beyond caring for the sick.

A Heroic History

Fenner's introductory address also included an extended meditation on the recent history of medicine in the South. Acknowledging that southern “medical literature and science … have as yet been but slightly cultivated,” Fenner asserted that in the colonial period “the South could boast of distinguished physicians, who took the lead” in American medicine. In the seventy-five years past, however, the southern medical profession had fallen into a state of dependence and decrepitude, so much so that “seven years ago [prior to

Fenner's founding of New Orleans Medical and Surgical Journal] there was not a medical journal

34 Humphreys, “Public Health,” 230; Patterson, “Yellow Fever Epidemics and Mortality in the United States, 1693-1905,” Social Science and Medicine 34 (1992): 863. On northern and southern arguments about the moral meaning of yellow fever, see Carrigan, “Yellow Fever: Scourge of the South,” 61; and idem, The Saffron Scourge: A History of Yellow Fever in Louisiana, 1796-1905 (Lafayette, LA: Center for Louisiana Studies, University of Southwestern Louisiana, 1994), 67-69. K. David Patterson's fascinating “Disease Environments of the Antebellum South” argues that in a very real way the South created a “modified West African disease environment” through its unwitting importation of malaria, hookworm, and yellow fever via the slave trade. See n. 28 above. 34 published south of Kentucky, nor was there a medical book emanating from any respectable physician in the South.” Fenner explained that the South, once great medically, had lost its way, resulting in ignorance and apathy among its doctors.35

Fenner's allusion to the medical halcyon days of the South was a deliberate reference to the proposed heroic history of southernist medicine. Widely accepted by southern physicians, and asserted most vigorously by Samuel Adolphus Cartwright, a Mississippi doctor who contributed to the second volume of Southern Medical Reports, this history traced the origins of southern medicine to the father of Western medicine itself: Hippocrates.

Cartwright first expounded his view in an address, subsequently published in Fenner's New

Orleans Medical and Surgical Journal, before the Mississippi Medical Convention in 1846.

Lamenting the “sad deficiency of books and information on the diseases of [the southern] climate,” Cartwright claimed that he “[knew] of but one book that gives any thing like an accurate description of the diseases [that southerners] daily meet with in practice.” This book, Air, Waters, and Places, “was written by Hippocrates.”36

For Cartwright, northern medical knowledge was not merely insufficient for use in the South, but was as a shamelessly derivative distortion of Hippocrates's (southern) genius.

The inadequacy of antebellum medicine stemmed from northern failings. According to

Cartwright, “medicine originated or became a science, and advanced to a high state of maturity and perfection in a [place] very similar to” to the South; it was only “when civilization traveled north” that medicine became degraded and “imperfect.” As a result, northern medical education and practice was ineffectual in the South, and southern

35 Fenner, “Introductory Address,” 8-9. 36 Samuel A. Cartwright, “Address delivered before the Medical Convention, in the city of Jackson, January 13, 1846,” NOMSJ 2 (1845-46): 730. For a biographical sketch of Cartwright, see Mary Louise Marshall, “Samuel A. Cartwright and States' Rights Medicine,” NOMSJ 93 (1940-41): 74-78. 35 physicians ought to “[cut] across direct to Greece, and [drink] at the fountain head,” rather than imbibe the inaccuracies of general medicine. The medicine of the North was fine for its specific setting, but lost all utility when applied, as Cartwright later termed it, beyond

“that little hyperborean corner of the globe.”37

Cartwright's claims were not sui generis, but rather a southern variation on a broader argument. Like the employment of the principle of specificity for southernist ends, the adoption of Hippocrates as the founding figure of southern medicine was an effort by southernist physicians to situate their unique professional identity within the context of legitimate American medicine. Antebellum American practitioners of all regions used history generally and Hippocrates specifically to bolster their claims to professional legitimacy. For the American doctor, Hippocrates was the originator of the empirical medical tradition that orthodox physicians championed. Elisha Bartlett, a prominent

Massachusetts doctor, argued that Hippocrates was the direct intellectual progenitor of

American practitioners, and entreated his fellow physicians to believe that “the sun that shone upon Athens … [shone] still upon them.” With their Hippocratic antecedents, antebellum doctors, regardless of their uncertain professional status in their own time, were part of an ancient heritage that imbued them with authority.38 In line with Eric Hobsbawm's conception of an “invented tradition,” American physicians appealed to classical history to demonstrate corporate identity, professional legitimacy, and intellectual primacy.39 In a

37 Cartwright, “Address,” 731; idem, “Malum Egytiäcum, Cold Plague, Diphtheria, or Black Tongue,” NOMSJ 16 (1859): 380. 38 Warner, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton, NJ: Princeton University Press, 1998), 166-70, 180-82; idem, “Making History in American Culture: The Antebellum Competition for Hippocrates,” in Reinventing Hippocrates, ed. David Cantor (Burlington, VT: Ashgate, 2002), 200-36; Elisha Bartlett, A Discourse on the Times, Character and Writings of Hippocrates (New York: H. Bailliere, 1852), 72. See also Warner, “The Idea of Southern Medical Distinctiveness,” 199-204; and Valenčius, The Health of the Country, 182. 39 Eric Hobsbawm and Terence Ranger, ed., The Invention of Tradition (New York: Cambridge University Press, 36 southern society steeped in faux classical traditions—Valenčius notes that antebellum plantation owners often gave their slaves names from Greek and Roman history—the medical uses of Hippocrates held especial appeal.40

In response to criticism from John Bell, a Philadelphian who saw all politics and no history in what he termed “state-rights medicine,” Cartwright expanded his theory in a later piece in New Orleans Medical and Surgical Journal in which he explicitly connected Dixie to classical Greece: “more than twenty centuries after the fall of the Grecian [Republic] … the civilized white man proper again made his appearance in the South,” Cartwright claimed, where he settled “himself permanently in Virginia, the Carolinas, Georgia and Louisiana.”41 In this way, the supposed Greek origins of southern medicine underlay the more recent triumphal history of which Fenner's address spoke.

Indeed, Cartwright viewed American southerners as the literal latter-day counterparts of the Dorian Greeks. Unlike Northern and European doctors, who appropriated the knowledge of others and “looked at every thing Southern through Edinburgh spectacles,”

Hippocrates's observations came from direct clinical experience of the same kind that the imperatives of medical specificity emphasized: the Greek's conclusions “were drawn from the millions of native-born Southern freemen in the Grecian Republican States, and aptly apply to the millions of like people at the present day inhabiting the Southern States of

America.” Cartwright considered the equivalent latitudinal positions of Kos and the

American South and likenesses in regional flora to “[prove] the identity of climate between

1983), 9-10. Lisa Marie Herschbach observes that antebellum medicine was “gripped by a commemorative impulse,” and Warner argues that for physicians the appeal to history “was medicine,” not a “culturally enhancing but detachable framework.” Lisa Marie Herschbach, “Fragmentation and Reunion: Medicine, Memory, and Body in the American Civil War,” (Ph.D. dissertation, Harvard University, 1997), 24; Warner, Against the Spirit of System, 166-67. Emphasis original. 40 Valenčius, The Health of the Country, 182. 41 John Bell, “Dr. Cartwright's Address – States-Rights Medicine,” Bulletin of Medical Science 4 (1846): 207-13; Cartwright, “Cartwright on Southern Medicine,” NOMSJ 3 (1846-47): 261. 37 Greece and the south-west portion of the United States, beyond all question and dispute.”

Furthermore, Cartwright saw societal links between the two regions, as in both areas “one portion of the people were free independent republicans” and the other “a different and inferior race, bred to servitude.” He used these natural and social correlations to support his conclusion: “similar people, similar government, similar climate, must, of necessity, produce a similarity in disease.”42

Rhetorical aspects aside, Cartwright's Hippocratic history and its cooption by Fenner was a potent expression of the blurring of professional and sectional politics in southernist medicine. The heroic history justified the downtrodden state of the southern medical profession by reference to northern corruption, and likened the South as a whole to the classical civilization of Greece that had inaugurated the Western cultural tradition. With their intellectual dependence on the North so galling, southern physicians concocted a mythology that was both apologetic for their present state and suggestive of the potential for a glorious future. In Cartwright's history, southerners were the rightful heirs of Western medicine, and the medical establishment over which the North lorded was a bastardized product of southern ingenuity.43 Southern medicine was decrepit not because of the faults

42 Cartwright, “Cartwright on Southern Medicine,” 269-71. Emphasis original. Cartwright cited the growth of cotton as a cash crop in Macedonia as further evidence that ancient Greece and the South were of a kind; other southerners, expanding the parallels further, referred to the Mississippi River or the Gulf of Mexico as “our Mediterranean.” Edward H. Barton, Introductory Lecture on the Climate and Salubrity of New Orleans and Its Suitability for a Medical School (New Orleans: E. H. Johns & Co., 1835), 21. Emphasis original.

Yellow fever also connected somewhat tenuously to the South's heroic medical history, as southern sectionalists saw the disease's epidemics as similar to plague strikes on ancient Greek cities. James Dugan, a post-Civil War author, would later term the disease the “Great Southern Plague” when recounting the particularly severe epidemic of 1878. Carrigan, “Impact of Epidemic Yellow Fever,” 29, 31. At the same time, the conspicuous absence of yellow fever from the Hippocratic corpus somewhat discredited attempts to use Hippocrates to bolster a distinctively southern medicine. David Arnold, “Introduction: Tropical Medicine before Manson,” in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500- 1900, ed. Arnold, (Amsterdam: Rodopi, 1996), 7. 43 In this respect, significant parallels exist between the southernist uses of Hippocrates and the later ideological casting of the Confederacy as the true heir of the American Revolution, with southerners 38 of southerners, but because medicine had been stolen from its original home. According to

Cartwright, if only southern physicians reasserted their agency, as Fenner constantly exhorted them to do, they would reclaim the lofty status of their past history, and the South would return to its proper place of prominence in the practice of medicine. Far from inventing a new authority, southernist practitioners stressed the deep and implicitly legitimate roots of their professional claims.44

The devising of a mythological origin for southern medicine also illustrates the insufficiency of attributing the discourse simply to belief in the principle of specificity, the widespread acceptance of which provided a medical justification for southernist medicine with no need for appeal to presumed Greek forebears. Medically, a Hippocratic myth was superfluous—no one doubted the difference of the southern disease environment.

Politically, however, the implication that aggressive Northerners had wrested medicine from the ancestors of the South aligned with southern grievances about the alleged theft of political power from the states by the federal government and the presumably impending deprivation of the right to own slaves. Medicine according to the principle of specificity was sectional; southern medicine, by contrast, was sectionalist.

Fenner concluded the introductory address with an appeal for support from the southern medical profession. He perfunctorily denounced “sectional feeling,” despite the implications of the address and the journal, and urged southern doctors to think “beyond the bounds of self-interest” and engage in “philanthropy [that] would prompt them to

rhetorically justifying opposition to the North as “continuity, not discontinuity.” See Faust, The Creation of Confederate Nationalism: Ideology and Identity in the Civil War South (Baton Rouge: Louisiana State University Press, 1988), 14-15. 44 As Alexander Means, a prominent southernist physician, bemoaned, for “too long, quite too long, has medical science in the South consented to lie in helpless dependence upon the bosom of the North, like a feeble foundling upon the breast of a foster mother, and to feed upon pap from the hands of strangers.” Means, “An Address, introductory to the Second Course of Lectures in the Atlanta Medical College,” Atlanta Medical and Surgical Journal 1 (1855-56): 709. 39 contribute what they can to relief of suffering humanity.” Fenner's “suffering humanity” referred of course to patients, but he could easily have been alluding to the tenuous state of southern medical publications. Of the 28 medical periodicals published south of the

Mason-Dixon line prior to 1850, the great majority survived less than two years. Fenner's own New Orleans and Medical Surgical Journal had had financial issues serious enough to compel its founder's resignation. As a regional journal, Southern Medical Reports required regional support from an area in which local publications often floundered.45

Grabbing the Golden State

Southern Medical Reports was well-received in both the North and the South, and

Fenner eagerly publicized his positive reviews. The journal's second volume began with several “Notices of [the] Work” from prominent periodicals. The Medical Examiner of

Philadelphia, which had historically attacked sectional medicine, likened Fenner to Daniel

Drake, the admired Western physician; the American Journal of the Medical Sciences, also of

Philadelphia, awarded similar plaudits. The Southern Medical and Surgical Journal, wary of the difficulty of publishing in the South, referred to the necessity of patronage for the

“continuance” of Southern Medical Reports. De Bow's Review, an oft-inflammatory southern intellectual magazine, noted that it was “always glad to see a southern book,” and the AMA endorsed the journal in its annual proceedings in both 1850 and 1851.46

The second volume of Southern Medical Reports had largely the same structure as the first. The contents remained focused on the aspects of medicine that most differentiated

45 Fenner, “Introductory Address,” 11; Myrl Ebert, “The Rise and Development of the American Medical Periodical, 1797-1850,” Bulletin of the Medical Library Association 40 (1952): 260-76. Emphasis original. 46 Fenner, SMR, 2: i-iii. Emphasis original. The American Journal of the Medical Sciences was the most respected antebellum American medical journal. Ebert, “The Rise and Development,” 255. For the Medical Examiner's more typical view on southernist medicine (and a southern response), see “The Medical Examiner on Sectional Medicine,” Southern Medical and Surgical Journal (new series) 5 (1849): 545-50. 40 the South from the North: twelve of the thirty-four state reports involved topography and environment, and none covered surgery. Cartwright contributed a paper on “the diseases and physical peculiarities of the Negro race,” and five articles examined dengue or “break- bone” fever outbreaks in southern cities.47 Reports from Louisiana once more comprised roughly 60 percent of the content, and Fenner wrote five articles, fewer than in the first volume but still substantially more than any other author. Florida was again not represented, though Arkansas and North Carolina did have brief reports. All of the states with articles in the first volume, excepting Tennessee, were present in some capacity in the second.48

The most notable shift between the first and second volumes was the inclusion of

California within the journal's geographic target area. Thomas Logan, a former New

Orleanian living in Sacramento, contributed three reports (on a cholera epidemic, “land scurvy,” and his adopted state's environment) to the second volume. Fenner acknowledged the apparent incongruity of the Golden State's presence, but explained it with reference to climate: California, “although north of our prescribed boundaries, isothermally considered is strictly a Southern State.” Logan similarly claimed that Sacramento's “climate and topography resemble very much that of New Orleans,” and that a proper “isothermal line” would connect Sacramento with Charleston despite the cities' six-degree difference in latitude.49 Regardless, other than with reference to the common unhealthiness of the two

47 Dengue, a painful and often fatal tropical disease, was like yellow fever virtually absent from the antebellum North. Albert E. Cowdrey, This Land, This South: An Environmental History (Lexington, KY: University Press of Kentucky, 1983; rev. ed. 1986), 38. 48 Fenner, SMR, 2: i-iii. As a historical aside, John Y. Basset, the subject of William Osler's famous essay on “An Alabama Student,” contributed to both volumes of Southern Medical Reports, the first with a report on the topography, climate and diseases of Madison County, Alabama, and the second with a similar article about Huntsville. Osler discovered Basset while reviewing Southern Medical Reports, and noted that Basset's two articles in Fenner's journal “are the only ones … credited to him [in medical literature].” Osler, An Alabama Student (Baltimore: The Friedenwald Company, 1896), 2, 12. 49 Fenner, SMR, 2: 7; Thomas M. Logan, “Reports from California,” in SMR, 2: 461-2. Logan also claimed that the existence of significant levee systems in both Sacramento and New Orleans testified to the 41 regions—Linda Nash notes that in the antebellum Central Valley, mortality from illness was close to that of the southern low country50—California did not medically or geographically fit with the South, and is strikingly out of place in Southern Medical Reports. As northern critics argued and Fenner admitted, the South itself does not have a uniform topography.

Expanding the region to include the Mediterranean climate of California violated the principle of specificity in which southernist physicians couched their claims.51

California's inclusion does make sense, however, in the context of the political debates raging in Congress and the nation at large as Fenner was compiling his second volume. The discovery of gold at Sutter's Mill in 1848 had launched the California Gold

Rush, and by 1850 the territory's population surpassed that of Florida. The prospect of

Californian statehood threatened the balance of senatorial power between the North and the

South, as a policy of self-determination would have led to California's admittance to the

Union as a free state, leaving the slave states a minority. The famously vitriolic exchanges over this issue eventually resulted in the Compromise of 1850, in which California entered the Union as a free state while the South was partially appeased with the passage of the

Fugitive Slave Law and other conciliatory measures.52

Against this backdrop, Fenner's incorporation of California into an avowedly southern journal carried weighty professional and political overtones. If California's topography shared enough with that of the South to produce a similar disease environment

(as appeals to “isothermal” aspects implied it did), then, according to the dictates of

similarity of their environments (p. 465). For a biographical sketch of Logan, who became an important figure in the development of the California medical establishment, see Linda Nash, Inescapable Ecologies: A History of Environment, Disease, and Knowledge (Berkeley: University of California Press, 2006), 45-47. 50 Nash, Inescapable Ecologies, 37. 51 On distinct disease regions within the South, see Patterson, “Disease Environments,” 163-65. 52 A full treatment of the Compromise of 1850 is outside the scope of this study. Two concise accounts are McPherson, Battle Cry of Freedom, 64-77; and Potter, The Impending Crisis, 90-120. 42 southernist medicine, California was medically separate from the North. When applied to

California's alleged southernness, Fenner's use of medical distinctiveness to support political sectionalism suggested that California was most properly sectionally aligned with the South, not the North—and therefore that northern (and, for that matter, Californian) conceptions of the territory as a free state were misguided. With southerners almost literally up in arms,

Fenner's inclusion of California in his journal promoted the cause of the South and simultaneously enhanced the visibility of the southern medical profession in an issue of great import to the region.53

Fenner's inclusion of the California reports could also have been less an appropriation of political discourse than an attempt to widen his subscriber base. Logan's

Louisianan roots make it likely that he knew Fenner prior to moving to Sacramento, and

Fenner may have seen his fellow physician's translocation as an opportunity to expand his journal's reach. Much of Fenner's own commentary in the second volume of Southern

Medical Reports was an appeal for financial support. His preface dwelled at length on the high publishing cost in New Orleans. He noted that a new postage law and a lack of reserve funds had made it “impossible” for the journal to be distributed without prepayment; he nevertheless expressed assurance, placing an imperative on his fellow doctors, that “after this statement of the difficulties we have encountered, the profession will be better prepared to appreciate our labours, and will extend us a liberal support, if they desire the work to be continued.” In lieu of the first volume's medical catalogue, Fenner included a lengthy section of advertisements. His notices of other journals referred both to their representation of the

53 Fenner's implication was something of a fairy tale. Aside from the obvious fallacy of lumping California's disease environment with that of the already-tenuously linked South, few mid-nineteenth-century Californians had any interest in southern institutions, particularly slavery. As Potter notes, “the admission of California to statehood on her terms as to slavery … meant [admission] as a free state.” The Impending Crisis, 99. 43 South and their financial solvency achieved after several years' struggle, a struggle that, as his other comments made clear, Southern Medical Reports was fiercely waging.54

Fenner ended the volume with a look to the future: “by the time the next volume comes out, it is hoped that the Work will have received such substantial support as to prevent us from being thus cramped in our efforts to serve the profession.” There would, however, not be a next volume. As a colleague later noted in an obituary of Fenner:

The pecuniary patronage of the Profession did not suffice to pay the expenses of this noble enterprize, and [the] two volumes, while they stand a monument to the memory of the Editor, are no less a silent, stern rebuke to the apathy of those whose pittances would have fostered an undertaking valuable and honorable to us all. The failure of this work, solely for want of pecuniary support, must always be a source of regret and shame to all real friends of our profession in the South.55

Proponents of southernist medicine viewed the journal's failure as a tragedy that undermined the project of a united southern medicine. Like so many of the southern journals before it, Southern Medical Reports, despite Fenner's lofty goals, remained provincial in construction and influence, failing to stimulate the interest or the pocketbooks of the southern medical profession as a whole.

A Dual Discourse

Fenner's professional career did not die with his journal. Having served as chairman of the Louisiana Physico-Medical Society in 1844, Fenner continued his involvement in professional organizations, holding a variety of positions in the Louisiana State Medical

Society before his 1853 election to the organization's presidency. In 1857 he assumed the editorship of another periodical, the New Orleans Medical News and Hospital Gazette, and held the position until the journal ceased publication at the outbreak of the Civil War. Under

54 Fenner, SMR, 2: 9, 10, 488-94, back cover. Emphasis added. 55 Brickell, “Biographical Sketch,” 408. 44 Fenner the Hospital Gazette became an increasingly strident advocate for southernist medicine. In one editorial, Fenner claimed “it is the 'manifest destiny' of the South to become more and more independent in” medicine. In another, he argued that northern- educated physicians often require three or four years “to unlearn” enough of their training to practice effectively in the South. The failure of Southern Medical Reports had little effect on

Fenner's penchant for rhetoric, or his enthusiasm for the southernist medical enterprise.56

Medical distinctiveness offered for antebellum southern physicians and citizens alike an opportunity for the formation of a regional identity not subservient to that of the North.

Jane and William Pease have written of the “quasi-colonial self-doubt” that southerners possessed in a country in which they were rapidly becoming disempowered.57 The depressed state of the southern medical profession exacerbated this self-doubt. The regional scope of

Southern Medical Reports and the journal's attendant focus on the few issues about which southerners were expert—local topography and subtropical epidemics in particular—offered the possibility of an independent medical realm not subject to northern superiority. Such independence both raised the status of southern doctors within their region and asserted their worth and that of the South on a national level. The construction of a heroic history, deference to states' rights, focus on southern diseases, and incorporation of non-medical issues such as Californian statehood into medical discourse were political acts, framed in the language of medicine and aimed at professional and regionalist ends. The principle of

56 Duffy, The Rudolph Matas History of Medicine, 2: 260-67, 281, 292; “Introductory Lecture,” NOMNHG 3 (1856-57): 486-87; “Medical Sectionalism,” NOMNHG 4 (1857-58): 158; Postell, “Erasmus Darwin Fenner and the Beginnings of Medical Literature in Louisiana,” Annals of Medical History (3rd series) 3 (1941): 298- 301. See also Duffy, “Sectional Conflict and Medical Education in Louisiana,” Journal of Southern History 23 (1957): 289-306; and idem, The Tulane University Medical Center: One Hundred and Fifty Years of Medical Education (Baton Rouge: Louisiana State University Press, 1984): 40. 57 Jane H. Pease and William H. Pease, “Intellectual Life in the 1830s: The Institutional Framework and the Charleston Style,” in Intellectual Life in Antebellum Charleston, ed. Michael O'Brien and David Moltke-Hansen (Knoxville: University of Tennessee Press, 1986), 235. 45 specificity provided a convenient medium for the incorporation of politics, but it was a medium, not a foundation.

The distinction between professional advancement and sectional ardor frequently dissolved in southernist medical discourse, and as a result both threads worked as means and ends. Endorsement of macropolitical considerations increased the visibility and relevance of southern physicians within their region, and the independence of the southern medical profession contributed to the intellectual independence of the South writ large. Political agitation by southern physicians certainly did not occur simply because they were southern; nor, however, was it a function simply of them being doctors. Their dual role as physicians in the South and southerners in medicine intertwined the prospects of their profession with those of their region.

The principle of specificity reinforced their claims on both counts. As Erasmus

Fenner once noted, “if this be sectional medicine, I cannot help it. It was not made so by me, but by Nature.”58 Observable differences between the North and the South allowed southernism to incorporate the naturalistic language of topographical medicine. At root, however, the movement was neither solely a justification for political regionalism nor for medical autonomy: it was agitation for both at the same time, with macropolitical and professional discourses woven together so closely as to be indistinguishable.

58 Fenner, “Introductory Lecture,” NOMNHG 3 (1856-57): 598. Emphasis original. 46

CHAPTER 2

TEACHING SOUTHERN MEDICINE

During a hiatus in his journalistic activities prior to his association with the New

Orleans Medical News and Hospital Gazette, Erasmus Darwin Fenner entered the field of medical education. Heeding the call of several Louisiana practitioners, who urged “the most radical reformer to establish a college of his own,” Fenner founded in 1856 the New

Orleans School of Medicine, which promoted itself on the opportunity it provided for aspiring southern doctors to gain clinical experience with southern diseases. New Orleanian physicians, excepting those associated with the city's already-extant Medical Department of the University of Louisiana, reacted enthusiastically to Fenner's endeavor, with one doctor describing the Crescent City as “the place of all others most fertile in the resources necessary to the acquirement of a complete medical education.” In extending his program from publication to education, Fenner further affirmed the necessity of a distinctively southern medical establishment.1

While regional journals were the mouthpieces of southern medical exceptionalism, it was in medical schools that rhetoric met practice. As the loci of urban southern physicians' professional activity, tangible declarations of professional legitimacy, and the institutions through which doctors could implement the program of their choosing, medical colleges, even more than periodicals, became the sites of concentrated southernism in antebellum

American medicine. John Harley Warner notes that schools “offered physicians a concrete

1 John Duffy, The Rudolph Matas History of Medicine in Louisiana, 2 vols. (Baton Rouge: Louisiana State University Press, 1958), 2: 259-67; idem, “Erasmus Darwin Fenner (1807-1866), Journalist, Educator, and Sanitarian,” Journal of Medical Education 35 (1960): 825; Bennet Dowler, “Historical Retrospection of the Principles and Polity of the American Medical Association,” NOMSJ 11 (1854-55): 487; “The New Orleans School of Medicine,” NOMNHG 3 (1856-57): 162. 47 context within which their commitment to southern medical distinctiveness could be objectified.”2 Accordingly, southern medical agitators framed appeals to study medicine in the South in terms of patriotism, economic prudence, and the principle of specificity.

The discourse of southern medical education was more pragmatic than that of southernist medicine as a whole. Rather than expounding on allusions to classical Greece

(though they were certainly present), educators focused on the necessity for medical students to learn in the place in which they intended to practice, and the corresponding advantages that the South offered for study. One frequent line of argument was the irrelevance of a northern medical education for southern practice, with Samuel Cartwright claiming that southern students educated in the North must “study Medicine twice; first, in studying hyperborean Medicine, in order to get a diploma, and secondly in studying the diseases of their own country in order to become successful practitioners.”3 Instead of a concern for the section as a whole, the imperatives of southern medical education, designed to attract students to new medical schools outside the Northeast, applied to the individual physician.

More than in any other field, it was with respect to medical education that, in the words of Conevery Valenčius, “the politics of being 'South' meshed with the concerns of medical geography.”4 Two overlapping but distinct geographical considerations shaped medical instruction in nineteenth-century America: the sectional placement of the school

(North, South, or West), and the specific location of the school within its section. Though the rhetoric of southern medical exceptionalism produced the requisite nods to the glory of

2 John Harley Warner, “A Southern Medical Reform: The Meaning of the Antebellum Argument for Southern Medical Education,” in Science and Medicine in the Old South, ed. Ronald L. Numbers and Todd L. Savitt (Baton Rouge: Louisiana State University Press, 1989), 207. 3 Samuel A. Cartwright, “Cartwright on Southern Medicine,” NOMSJ 3 (1846-47): 272. Emphasis original. 4 Conevery Bolton Valenčius, The Health of the Country: How American Settlers Understood Themselves and Their Land (New York: Basic Books, 2002), 179. 48 the South, medical education was a local endeavor, and southern physicians viewed other southern schools more as rivals than as collaborators in a larger project. The façade of sectional unity could only be carried so far in a highly competitive environment.

Within the region, southern schools directed their criticism especially toward New

Orleans, the South's largest metropolitan area and commercial center. The Crescent City's population increased dramatically in the prewar period, from fewer than 10,000 at the beginning of the century to 46,000 in 1830.5 By 1860, New Orleans was the fourth-largest urban area in the Union, and by far the most populous of the small number of southern cities. With abundant clinical resources, attractive recreational enticements, and perhaps the best-respected medical college in the South, New Orleans became the destination of many southern students wishing to study medicine in their home region. Medical schools elsewhere in Dixie, seeking to increase enrollment, vigorously contested the city's status as the South's medical metropole.

In some sense, why and how New Orleans was the target of southern practitioners' criticism is less important than the fact that intrasouthern medical criticism occurred at all.

Neither the existence of such polemic nor the New Orleanian reaction, which included an impassioned defense of the city's salubrity and its appropriateness for medical instruction, is consistent with notions of a united southern medical profession. Fenner predicated the reforms of his New Orleans School of Medicine on the recommendations of the distinctly unsouthern American Medical Association, and then rhetorically cast his school in opposition not only to the institutions of the North, but also to those elsewhere in the

5 James H. Cassedy, Medicine and American Growth: 1800-1860 (Madison: University of Wisconsin Press, 1986), 108; Gerald N. Grob, The Deadly Truth: A History of Disease in America (Cambridge, MA: Harvard University Press, 20002), 102; Michael O'Brien, Conjectures of Order: Intellectual Life and the American South, 1810-1860, 2 vols. (Chapel Hill: University of North Carolina Press, 2004), 1: 119-20. 49 South. Fenner may have promoted the potential for southern students to study diseases in

Dixie, but he was more concerned that southern students study in New Orleans and at his school specifically, not in the South in general.

In the transition from journals to schools, from rhetoric to practice, and from instructing to instruction, the supposed medical and political unity of the South disintegrated. Far from a unified cultural program, calls for southern medical distinctiveness were more particularly calls for the commercial and professional gain of individual practitioners in individual cities and institutions. If the structure and content of Southern

Medical Reports demonstrate the difficulty of disaggregating political from medical concerns in the antebellum South, the southernist uses of medical education suggest that underlying both political medicine and medical politics were economic motives. Enrichment of sectional knowledge was fine, but only to the extent it fostered personal enrichment as well.

As a professional class southern physicians may have sounded alike, especially in contrast to their northern counterparts, but arguments for southern medical exceptionalism did not indicate the existence of a united front.

Educational Increases

In 1855, the Medical Department of the University of Louisiana completed its second decade as the New Orleans's only institution of medical instruction. Founded in

1834, with the first course of lectures beginning the following January, the Medical College of Louisiana (which was incorporated, with a concurrent name change, into the newly minted University of Louisiana in 1847) was the antebellum United States' fifteenth medical school, and one of only five chartered south of the Mason–Dixon line prior to 1850. The school's prospectus emphasized a dozen advantages that New Orleans offered as a location for a medical college; chief among them was the opportunity the city afforded the 50 southerner “to study diseases and their treatment in the climate in which he intends to practice.”6 Along much the same lines, Edward H. Barton, one of the college's founding professors, expressed his belief that the establishment of a medical school in Louisiana would aid “to throw off the thraldom [sic] imposed upon us [southerners] by our elder sisters of the Union,” and would appropriately “adapt our education to our peculiar position.”

Growing steadily in size, with a faculty that never exceeded ten members, the Medical

Department had remained for twenty years the sole option for aspiring physicians wishing to study in the South's largest city.7

The existence of only one medical college in New Orleans was something of an anomaly. In a society stricken with what Ronald Numbers has called “medical school mania,” the founding of local medical colleges was almost a hobby—and a potentially lucrative one at that—for nineteenth-century American physicians.8 Ostensibly to provide opportunities for medical education to those unwilling or unable to travel to the Northeast, but more often to make their founders a profit, 26 new medical schools opened in the three decades between 1810 and 1840, with another 47 to be inaugurated in the following thirty- five years.9 Between 1800 and 1820 alone, the number of American medical schools more than tripled, and would do so again before 1850. The vast majority of the new colleges were

6 As cited in Harold Cummins, “Formal Medical Education in New Orleans, 1834-,” Bulletin of the Medical Library Association 30 (1942): 303. On the incorporation of the Medical College of Louisiana into the new state university, see “University of Louisiana,” NOMSJ 4 (1847-48): 147-48. 7 Edward H. Barton, Introduction Lecture on the Climate and Salubrity of New Orleans and Its Suitability for a Medical School (New Orleans: E. Johns & Co., 1835), 3. Emphasis original. On the history of the Medical Department of the University of Louisiana, see Cummins, “Formal Medical Education in New Orleans,” 300-8; and J. M. Mason, “Early Medical Education in the Far South,” Annals of Medical History (new series) 4 (1932): 64-79. 8 Numbers, “The Fall and Rise of the American Medical Profession,” in Sickness and Health: Readings in the History of Medicine and Public Health, ed. Judith Walzer Leavitt and Numbers (Madison: University of Wisconsin Press, 1978; 3rd ed., rev., 1997), 226. 9 Richard Harrison Shyrock, Medical Licensing in America, 1650-1965 (Baltimore: The Johns Hopkins University Press, 1967), 28. Martin Kaufman gives a slightly different year range (extending to 1877) for the opening of an additional 47 medical schools after 1840. Kaufman, “American Medical Education,” in The Education of American Physicians: Historical Essays, ed. Numbers (Berkeley: University of California Press, 1980), 11. 51 located west of the Appalachians. Though New England, New York, and Philadelphia, the traditional hubs of American medical education, saw an increase of only 6 schools between

1820 and 1860, the far less populous remainder of the country gained 34 medical colleges during the same period. Nearly one-third of medical-school-educated doctors in the prewar period attended a rural college. The United States in 1850 had 42 operating medical schools;

France, reputed to have the best medical education system in the world, had 3.10

The expansion of medical education in the South was if anything disproportionate to that elsewhere in the Union. Nearly twenty medical schools were founded south of the

Mason–Dixon line in the four decades prior to the Civil War, with existing schools expanding in size as rapidly as (and often more rapidly than) their facilities would allow.

Southerners claimed Erasmus Fenner's alma mater, Kentucky's Transylvania Medical College, which opened in 1799, as their own, though the first medical school in a future Confederate state, the Medical College of South Carolina, did not commence operation until 1824. The

1834 founding of the Medical College of Louisiana marked the fourth establishment of a medical school on southern soil.11 By 1860, four of the nation's nine largest institutions of medical instruction, including both the Medical Department of the University of Louisiana and Fenner's New Orleans School of Medicine, were located in states that would secede

10 William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (Baltimore: The Johns Hopkins University Press), 92-93, 98; Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 42. In 1834, the United States had one medical school for every 750,000 people. This was actually a smaller ratio than that for medical journals, for which one existed for every 715,000 Americans. Cassedy, Medicine and American Growth, 67-68. 11 James O. Breeden, “States-Rights Medicine in the Old South,” Bulletin of the New York Academy of Medicine 52 (1976): 364-65; Steven M. Stowe, Doctoring the South: Southern Physicians and Everyday Medicine in the Mid- Nineteenth Century (Chapel Hill: University of North Carolina Press, 2004), 21. On the founding of the Medical College of South Carolina, see Joseph Ioor Waring, A History of Medicine in South Carolina, 2 vols. (Columbia, SC: South Carolina Medical Association, 1964; Charleston, SC: South Carolina Medical Association, 1967), 1: 166-70. The Medical College of Georgia, which opened in Augusta in 1832, was the second southern medical school; the Medical College of the State of South Carolina, organized in Charleston in 1833, was the third. Howard L. Holley, A History of Medicine in Alabama (Birmingham, AL: University of Alabama Press, 1982), 75; Waring, A History of Medicine in South Carolina, 2: 71-84. 52 within the next year.12

The rapid increase in the number of medical schools resulted, of course, in a corresponding surge in the number of medical school graduates. American medical colleges awarded 343 M.D. degrees, combined, in the first decade of the nineteenth century. Fifty years later, between 1850 and 1859, more than 17,000 Americans were granted doctorates of medicine. As Fenner's colleague Abner Hester noted, though “schools alone cannot make good Physicians,” they were clearly able to “manufacture Doctors without limit.” In 1860, physicians of some sort comprised 49 percent of all southern professionals.13

The explosion of schools and practitioners did not signal an increased professionalism in medicine. Nearly all antebellum medical colleges were proprietary institutions, with low or nonexistent standards for matriculation and graduation. Lack of rigor was primarily a function of economics: professors received student fees directly, and therefore had a powerful incentive to draw as many students as possible, especially since the proliferation of institutions gave students who were unable to gain admission or felt a course of study too taxing ample alternative options. The profit motive was not the only impetus for the founding of medical colleges, but the almost complete absence of public financing meant that even those professors with primarily pedagogical rather than pecuniary objectives needed to attract large numbers of students or bear the cost of school operations as a financial burden. As a result, terms of study were shortened from 7 to 9 months to 12 to 14 weeks, entrance requirements were eliminated in practice if not in theory, and student fees were decreased, which in turn made the cycle self-perpetuating, as physicians needed to

12 “Medical School Statistics for 1859–60,” NOMNHG 7 (1860-61): 132. 13 Rothstein, American Medical Schools and the Practice of Medicine: A History (New York: Oxford University Press, 1987), 48; “Our Medical Schools,” NOMSJ 9 (1852-53): 282; Stowe, Doctoring the South, 9. 53 admit more students to maximize revenue.14

Faculty resorted to extraordinary means to increase attendance figures. Several antebellum physicians frequented prisons to recruit inmates.15 Admissions requirements were minimal—only 26 percent of medical students in 1851 possessed a bachelor's degree— and graduation standards equally so: as one scholar has written, “neither literary nor prior academic achievements nor good moral standing was of consequence” for medical school admission, and since all schools charged a substantial diploma fee, professors had a financial incentive to ensure that all their students passed. Joseph Kett summarizes it bluntly:

“historians have found little to say in defense of medical standards in the 1820 to 1860 period. Medical schools were bad, sometimes incredibly bad.”16

The spike in the supply of physicians, qualified and not, intensified rivalries between institutions and individual doctors for patients and locations of practice. No one was more conscious of the problem than the practitioners themselves, who frequently bemoaned the damage that the chaos was inflicting on the public esteem of medicine. “The medical education system in this country … is outrageous from first to last,” declared Samuel

Choppin, a Louisiana physician and founder of the New Orleans Medical News and Hospital

Gazette.17 The failings of medical colleges left the reputation of the American medical

14 Shyrock, Medical Licensing, 28; Rothstein, American Physicians, 18; Starr, The Social Transformation, 43-44; Henry Burnell Shafer, The American Medical Profession, 1783 to 1850 (New York: Columbia University Press, 1936), 51; Kaufman, “American Medical Education,” 10-11; idem, American Medical Education: The Formative Years, 1765-1910 (Westport, CT: Greenwood Press, 1976), 40. 15 Ira M. Rutkow, Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine (New York: Random House, 2005), 51. 16 Kaufman, American Medical Education, 51; Numbers, “The Fall and Rise,” 225; Rutkow, Bleeding Blue and Gray, 50; Joseph F. Kett, The Formation of the American Medical Profession: The Role of Institutions, 1780-1860 (New Haven, Yale University Press, 1968), vii. 17 Kaufman, American Medical Education, 42, 45; Warner, “The Selective Transport of Medical Knowledge: Antebellum American Physicians and Parisian Medical Therapeutics,” Bulletin of the History of Medicine 59 (1985): 225; Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: University of Chicago Press, 1962; repr., 1987), 154; “Editorial [untitled, 1 September 1854],” NOMNHG 1 (1854-55): 291-92. 54 profession in tatters, leading to situations in which city officials, arguing that it could endanger the public, warned against including too many physicians on newly formed municipal boards of health.18

Southernism and Medical Education

With the increase in competition, medical schools sought ways to differentiate themselves not only from their nearby counterparts, but also their rivals in other states, or, increasingly, in other sections of the country. All medical education was local in nineteenth- century America; as Steven Stowe observes, medical schools North, South, East, and West taught “men that medical practice always was practice somewhere.”19 With recourse to the principle of specificity and to civic pride, regional medical men, particularly in the South, argued for the necessity of studying medicine where one wished to practice. Like other aspects of the southernist medical enterprise, promotion of a southern medical education wove together medical and sectional threads into a broad admonishment that aspiring southern doctors stay home for training.

Samuel Crawford, a Tennessee doctor, expressed the sentiment plainly in 1860:

“northern books are not adapted to southern diseases … the same is true of northern colleges.” Though admitting that general practice was similar everywhere, Crawford asserted that “medicine, like disease, must spring from the very elements, soil, sunshine, moisture, etc., that produce disease,” and accordingly that “the study and cure of diseases in one locality does not necessarily give the information requisite to success in another locality.” J.

E. Thompson of Roseville, Arkansas, posited that the young doctor educated in the North

18 Duffy, “The Changing Image of the American Physicians,” Journal of the American Medical Association 200 (1967): 32. See also Shyrock, “Public Relations of the Medical Profession in Great Britain and the United States, 1600-1870,” Annals of Medical History (new series) 2 (1930): 308-39. 19 Stowe, Doctoring the South, 21. Emphasis original. 55 should “not think himself competent to treat Southern diseases until he has attended a course of clinical instruction” in the South.20 In line with the antebellum localization of medicine and medical practice, regionalization of medical education seemed not just plausible but almost intuitive.

Even when implicitly recognizing the superior quality of the instruction in northern schools, southerners maintained that the experience of a southern medical education provided far better preparation for southern practice than could be obtained elsewhere. William

Carpenter, speaking at the Medical College of Louisiana in 1844, acknowledged that the

North's colleges “have descriptions and plates of diseases” which southern schools may not, yet southerners have “the living tableaux, the diseases themselves.” In other words, he contended, the North has “fine anatomical preparations”; the South, however, has “the anatomical works of the Creator which can be but meanly imitated.”21 Such arguments were partial attempts to minimize the importance of northern schools' better-funded and better- furbished facilities for medical instruction. If the best a northern school could offer was only a facsimile of the clinical material found in vivo in the South, southern schools' superior, true-to-nature disease presentation more than compensated for what the colleges may have lacked in accoutrements.

Many southern doctors had been educated in the North, and they cited their own experiences when dismissing the relevance of northern training for southern medical practice. Josiah Nott, the noted Mobile physician, flatly declared that he had “never seen a

20 S. P. Crawford, “Southern Medical Literature,” Nashville Journal of Medicine and Surgery 18 (1860): 197-98 ; J. E. Thompson, “Medical Notes and Reflections,” NOMNHG 4 (1857-58): 738. Duffy notes that physicians in the western medical centers of Chicago, Cincinnati, and Lexington similarly questioned the utility of medical education in the Northeast for practice in the Midwest. Duffy, From Humors to Medical Science: A History of American Medicine (Urbana: University of Illinois Press, 1976 [as The Healers]; 2nd ed., 1993), 148. 21 W. M. Carpenter, “Introductory Lecture delivered before the medical class of the Louisiana Medical College,” NOMSJ [as New-Orleans Medical Journal] 1 (1844-45): 367-68. 56 lecture or essay from the pen of a northern lecturer on remittent or yellow fever that [he] could read half through,” and that “it is absurd to say, other things being equal, that there is not an advantage in a southern over a northern education, to those who are to practise in malarial districts.” Fenner's colleague D. Warren Brickell, while disavowing charges of sectionalism, protested that he had received a fine education in the North, “yet [was] neither blind to, nor ashamed to confess the error [he] committed in thus entirely eschewing the inducements that were offered at home.”22 With the proliferation of medical schools throughout the South and the resulting increases in competition, claims of the importance of sectional education increased in volume and stridency.

Southern practitioners occasionally resorted to alarmist language in a bid to keep southern students in the South. Edward Barton warned of an inevitable “severe experience” awaiting in the early years of practice for a southern physician educated in the North, from which the student would be “saved” had he been educated in the Southland. Barton also claimed that study in the South was crucial not only to students' professional well-being but also their personal health, arguing that no northern student “would think of [spending] a summer” in New Orleans simply to attend medical school, and “yet the danger of a

[southerner] spending a winter or two winters [in the North], is at least equal.” Northern medical education was thus (somewhat hopefully) cast not just as professionally useless, but personally injurious as well.23

In addition to demonstrable differences in diseases between North and South, which gave credence to calls for regional medical education, the founding of southern medical schools dovetailed with a broader movement among southern men of letters. Through

22 J. C. Nott, “Medical Schools,” NOMSJ 14 (1857): 356; “Medical Schools, No. 1,” NOMNHG 3 (1856-57): 678. Emphasis original. 23 Barton, An Introductory Lecture on Climate, 21-22. 57 much of the antebellum period, the social elite of the South traditionally sent their sons out of the region for higher education. Not that all northern colleges were popular among the southern upper class. Bastions of “Yankee” culture, especially in New England, were anathema to southern gentry, and Harvard Medical School, for example, graduated only one southern student in its history to 1850. By contrast, conservative, cosmopolitan Philadelphia was a favored destination for scions of southern gentry, and at the city's Jefferson Medical

School, the nation's largest, Virginians outnumbered students from Pennsylvania for much of the antebellum period. A full 68 percent of pre-Civil War medical graduates of Jefferson and the more prestigious University of Pennsylvania were southerners.24 To paraphrase

David Moltke-Hansen's analysis of antebellum Charleston, rather than import students, the

South exported them.25

Concerned about their section's educational dependence on the North, Dixie's intelligentsia sought to reduce the export of future southern leaders and doctors. As early as the colonial period, Thomas Jefferson had admonished southerners to remain wary of the undermining of the southern lifestyle by northern educators, and this discourse sharpened as the antebellum period progressed. J. D. B. DeBow, a professor at the University of

Louisiana and editor of a prominent southern periodical, claimed that a southern man “must resolve to do with his children, as he is striving … to do with his cotton, manufacture the

24 Joseph Lyon Miller, “The Physicians of the Old South, Their Character and Education,” Bulletin of the Medical College of Virginia 25 (1929): 14; Breeden, Joseph Jones, M. D.: Scientist of the Old South (Lexington, KY: University Press of Kentucky, 1975), 17, 22; Daniel Kilbride, “Southern Medical Students in Philadelphia, 1800-1861: Science and Sociability in the 'Republic of Medicine,'” Journal of Southern History 65 (1999): 702- 5; Wyndham Bolling Blanton, Medicine in Virginia in the Nineteenth Century (Richmond: Garrett & Massie, 1933), 9-10. One author refers to Philadelphia as the “medical capital of the [Old] South.” Thomas W. Murrell, “The Exodus of Medical Students from Philadelphia, December 1859,” Bulletin of the Medical College of Virginia 51 (1954): 3. 25 David Moltke-Hansen, “The Expansion of Intellectual Life: A Prospectus,” in Intellectual Life in Antebellum Charleston, ed. O'Brien and Moltke-Hansen (Knoxville: University of Tennessee Press, 1986), 17. 58 material when [or where] it grows.”26 Southernist educational policy provided at least part of the impetus for the chartering of the University of Louisiana in 1847, and the movement championing the production of properly southern school books for the education of southrons had its correlate in efforts to write medical manuals for instruction in the South.27

Writers connected the South “[teaching] her own students” to the region “[doing] her own thinking” and the assertion of southern culture as equal to that of the North.28 Efforts for home education were, however, largely unsuccessful, and the annual exodus north, which many southerners viewed as a “tacit confession” of inferiority, continued with little change until the Civil War. During the 1850s, more than 50 percent of southern medical students received their education in the North, and nearly one quarter of the doctors who would comprise the Confederate Medical Corps were graduates of Penn Medical School. For most young doctors, the promise of professional advancement through better education proved more compelling than appeals to southern unity.29

Metropolis and Morgue

As with the proliferation of American medical schools in general, economic

26 “Southern School-Books,” De Bow's Southern and Western Review 13 (1852): 264. Redaction added. The South was dependent on the North for textbooks both intellectually (because few southern writers produced them) and technologically (because the South's lack of a competitive printing industry meant that the few books that southerners did write had to be published either in the North or in Europe). Drew Gilpin Faust, The Creation of Confederate Nationalism: Ideology and Identity in the Civil War (Baton Rouge: Louisiana State University Press, 1988), 17. 27 For one prominent example of a “southernist” medical textbook, see Thompson McGown, A Practical Treatise on the Most Common Diseases of the South (Philadelphia: Grigg, Elliot, & Co., 1849). Daniel Drake's classic Systematic Treatise, Historical, Etiological, and Practical, on the Principal Diseases of the Interior Valley of North America, ed. S. Hanbury Smith and Francis G. Smith (Philadelphia: Lippincott, Grambo, & Co., 1854), despite its own localized geographic focus, provides a useful apolitical comparison to McGown's work. 28 Thompson, “Medical Notes and Reflections,” 738. See also “Future Revolutions in Southern School Books,” De Bow's Review 30 (1861): 606-14. 29 Breeden, “States-Rights Medicine,” 364; Dowler, “Types of Diseases and Types of Therapies,” NOMSJ 15 (1858): 601; Duffy, The Rudolph Matas History of Medicine, 2: 259-60; John S. Ezell, “A Southern Education for Southrons,” Journal of Southern History 17 (1951): 303, 309, 327; John McCardell, The Idea of a Southern Nation: Southern Nationalists and Southern Nationalism, 1830-1860 (New York: Norton, 1979), 203-6; Warner, “A Southern Medical Reform,” 214; Frank R. Freemon, “Administration of the Medical Department of the Confederate States Army,” Southern Medical Journal 80 (1987): 632. 59 incentives as much as sectional pride drove the southern emphasis on home institutions.

With the industrial North and West eclipsing the agrarian South in economic vitality, southerners connected a patronage of local institutions to the retention of southern dollars in southern places. Alexander Means, an outspoken southernist physician, exhorted southerners to remain at home for their education and end the immiseration of their region:

“break the spell which has so long paralyzed [the South's] own powers, and turn upon the thirsty bosoms of her own Institutions the educational money-tide which has flowed for half a century into the bloated coffers of Northern schools.” DeBow noted bluntly that the use of northern publications “carries out of the South a very large amount of money.” On a more pragmatic level, southern physicians claimed that despite the superficially higher cost of living in New Orleans as compared to Philadelphia or New York, the relative affordability of travel within the South made attendance of a southern medical school cheaper than enrolling “abroad” at a northern college.30

Yet the idea of the “southern” medical school was a shibboleth. Medical schools south of the Mason–Dixon line differed as much (or as little) from each other as they did from schools elsewhere in the Union.31 Despite the rhetorical homage to the South as a whole, commercial considerations and local interests undermined the efforts of the profession to present a unified southern medicine in opposition to the putatively monolithic northern medicine against which physicians protested. Michael O'Brien has observed that

“localism [was] a great fact of antebellum Southern culture.” If politics and periodicals, as

30 Alexander Means, “An Address, introductory to the second course lectures in the Atlanta Medical College,” Atlanta Medical and Surgical Journal 1 (1855-56): 710; “Southern School-Books,” 263; “The Comparative Cost of Attending Medical Lectures North and South,” NOMNHG 5 (1858-59): 551-52. James Breeden estimates that by the 1850s southern medical students spent nearly $500,000 annually in the North. Breeden, “States-Rights Medicine,” 364. 31 Warner, “A Southern Medical Reform,” 216. 60 O'Brien maintains, were two of the few southern entities that aspired to a more regional position—a contention that the case of Southern Medical Reports buttresses—medical colleges remained rooted in the distinctly local discourse more typical of southern thought.32

New Orleans, despite or because of its claims to be the South's medical metropole, was a constant target of charges of insalubrity, not just from northerners, but from other southerners as well. Yellow fever, the South's sectional affliction, appeared so frequently in the Crescent City that the annual epidemics were considered almost endemic.33 Yellow Jack was responsible for between one-third and one-half of deaths in New Orleans during the two decades preceding the War Between the States. Between 1846 and 1855, New

Orleanians died at an annual rate of nearly seventy per one thousand people, a mortality three and a half times more severe than that for the rest of the country.34 One antebellum

New Orleans physician summarized the city's reputation as “'the Wet Grave-Yard,' the aceldama of the South, and little more than a vast Necropolis”; another described yellow fever as Louisiana's “stone of Sisyphus.” Such publicity was not good for business, and drastically diminished the potential for the city's economic growth.35

32 O'Brien, “'The Water Rose in the Graves': Discontinuity and Localism in Nineteenth-Century Southern Thought,” in The United States South: Regionalism and Identity, ed. Valeria Gennaro Lerda and Tjebbe Westendorp (Rome: Bulzoni Editore, 1991), 61-62. Drew Faust further observes that professional portraits of “southern society as united and self-conscious was a rhetorical gesture, more prescriptive than descriptive.” Faust, “The Rhetoric and Ritual of Agriculture in Antebellum South Carolina,” Journal of Southern History 45 (1979): 556. 33 Samuel Forry, an American army physician, referred in a comprehensive medicogeographical study of the United States to yellow fever as an “endemico-epidemic” of the South. Forry, The Climate of the United States and Its Endemic Influences: Based chiefly on the records of the Medical Department and Adjutant General's Office, United States Army (New York: J. H. & G. Langley, 1842; repr., AMS Press, 1978), 290. Emphasis original. 34 John H. Ellis, Yellow Fever and Public Health in the New South (New Brunswick, NJ: Rutgers University Press, 1992), 32-33. Ellis cites the annual rate for the country as a whole as 21-23 per one thousand. 35 Rothstein, American Physicians, 59-60; Jack Temple Kirby, Mockingbird Song: Ecological Landscapes of the South (Chapel Hill: University of North Carolina Press, 2006), 285-86; Bennet Dowler, “Researches upon the Necropolis of New Orleans, with brief allusions to its vital Arithmatic [sic],” NOMSJ 7 (1850-51): 277; M. Morton Dowler, “Letter on Yellow Fever,” NOMSJ 11 (1854-55): 494; Duffy, “Social Impact of Disease in the Late 19th Century,” in Sickness and Health, ed. Leavitt and Numbers, 424. New Orleans accounted for close to 58 percent of the recorded deaths from yellow fever in the United States between 1800 and 1860. Grob, The Deadly Truth, 103. 61 Physicians from elsewhere in the South, competing with the schools of New Orleans for students and prestige, were quick to seize on the city's reputation for unhealthiness. An

Alabama practitioner cited the Crescent City's regular yellow fever epidemics as one reason that Mobile would be a more appropriate site for a medical college than the Mississippi

Delta. Not only, he argued, did the epidemics make the practice of medicine in Louisiana too dangerous for young doctors, but the pervasiveness of yellow fever also colored all other disease presentation in New Orleans, resulting in the misleading distortion of clinical specimens. Among a populace that insisted upon “the immediate relevance of speculation,” the suggestion that New Orleanian instruction lacked utility was a serious charge.36 Likewise, physicians promoting Richmond or Nashville as the proper locality for the “great medical centre of the South” based their claims partially on the fact that these cities, while sufficiently southern to provide clinical exposure to southern ills, were “not so far South as to endanger the Northern constitution,” implying that the cities of the Deep South, of which New Orleans was the most prominent, were too disease-ridden to function as medical emporia.37 An appeal to the consideration of northern well-being would have been incongruous in a unified southernist medical movement, as the needs of northerners would have been irrelevant to the construction of a college by and for southerners. As such passages illustrate, the true manifestation of “states' rights” in antebellum southern medicine, more than sectionalist polemics directed at the North, was the discourse's aggressively local focus. Far from the promotion of a Southland-wide movement,

36 W. H. Taylor, “Annual Oration,” in Transactions of the Medical Association of the State of Alabama at Its Eighth Annual Session, Begun and Held in the City of Mobile, February 5, —6 , —7 , 1855 (Mobile: Middleton, Harris & Co., 1855), 118; Faust, A Sacred Circle: The Dilemma of the Intellectual in the Old South, 1840-1860 (Baltimore: The Johns Hopkins University Press, 1977), 146. 37 P. Claiborne Gooch, “The Great Medical Centre of the South,” Stethoscope and Virginia Medical Gazette 3 (1853): 468-76. Warner summarizes the contemporary arguments for and against each of the would-be southern medical centers in “A Southern Medical Reform,” 216-18. 62 southernist physicians concerned themselves first and foremost with the interests of their city or state, not their section.

Predictably, most New Orleanian doctors rejected the uncharitable characterization of their city, often appealing to the emerging science of statistics to rebut the charge of death and disease.38 Abner Hester claimed that New Orleans was, excepting yellow fever epidemics, one of the more salutary cities in the United States, and argued only partly in jest that the Crescent City was so healthy that “one half of its physicians ought to seek places where they can do better.” Samuel Cartwright called the charges of insalubrity “the popular delusion of the day,” blaming “unacclimated” immigrants for the high death rate. According to Bennet Dowler, the federal census suggested that frequent relocations of consumptives to

Louisiana (an attempt to use the heat to counter tuberculosis) skewed death rates in New

Orleans.39 Both prominent New Orleans medical journals in the 1840s and 1850s included as part of their editorial matter sections entitled “Health of the City,” which served as periodic strident assurances of the healthfulness of New Orleans. According to the journals' editors, New Orleans was “more blessed” in health than any other city; “more exempt from disease” (“with the exception of yellow fever”) than any other locality; and

“[occupied] a pre-eminently healthy location” in “a healthy state.” Even in the midst of yellow fever epidemics, New Orleans doctors insisted that “rumors which go abroad

38 On the role of statistics and demography in antebellum American medicine, see Cassedy, American Medicine and Statistical Thinking, 1800-1860 (Cambridge, MA: Harvard University Press, 1984). 39 “Health of the City,” NOMSJ 8 (1851-52): 135; “Health of the City,” NOMSJ [as New-Orleans Medical Journal] 1 (1844-45): 371; Cartwright, review of Report on the Meteorology, Vital Statistics, and Hygiene of the State of Louisiana, by E. H. Barton, M. D., NOMSJ 8 (1851-52): 240, 251; Bennet Dowler, “Statistical Researches on the mortality from Pulmonary Consumption in the Northern and Southern States, as proved by the Mortality Statistics of the Seventh Census of United States, etc. (1850),” NOMSJ 14 (1857): 312-23. Cartwright justified his conclusion by nothing that “the mortality among that class of people [immigrants] is great everywhere” (p. 246). 63 respecting the amount of sickness are greatly exaggerated.”40 Public relations as much as healing or sectionalism motivated the southernist medical enterprise.

New Orleanians were committed to the appropriateness of their city as a locus of medical learning. Just as New Orleans was the commercial center of the antebellum South, they argued, so would—and so should—it become the section's medical center. New

Orleans had four hospitals, including the Charity, which cared for close to 16,000 patients annually and was termed “the great Clinical Alma Mater of the South.”41 Francophone New

Orleans retained cultural ties with Paris, the Western medical capital of the antebellum period, where many educated Americans from all regions went for formal or informal medical training.42 And, as John Duffy wryly observes, New Orleans had a “universal reputation as a plague spot,” which “was not without its advantages from a medical standpoint.”43 As the 1857 circular of the New Orleans School of Medicine claimed: “New

40 “Health of New Orleans,” NOMSJ 2 (1845-46): 262; “Health of the City,” NOMSJ 2 (1845-46): 397; Cartwright, “The Yellow Fever at Natchez in all its bearings on the Quarantine question and Yellow Fever at New Orleans,” NOMNHG 2 (1855-56): 16; “Health of the City,” NOMSJ 4 (1847-48): 272. 41 Edward C. Atwater, “Internal Medicine,” in The Education of American Physicians, ed. Numbers, 166; Thompson, “Medical Notes and Reflections,” 738. The other three hospitals were the Franklin Infirmary, the Maison de Santé, and the Marine Hospital. William Dosité Postell, “Erasmus Darwin Fenner and the Beginnings of Medical Literature in Louisiana,” Annals of Medical History (3rd series) 3 (1941): 297. Charity had opened in 1736, only eighteen years after the founding of New Orleans, and had expanded to a larger building in 1833. Cummins, “Formal Medical Education,” 302. 42 19 of the 21 American students who studied for a diploma at the Faculté de Médecine in Paris in 1830s were from Louisiana. O'Brien, Conjectures of Order, 1: 119.

On the influence of the Paris Clinical School on antebellum American medicine, see Erwin H. Ackerknecht, Medicine at the Paris Hospital, 1794-1848 (Baltimore: The Johns Hopkins University Press, 1967); Warner, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton, NJ: Princeton University Press, 1998); idem, “Remembering Paris: Memory and the American Disciples of French Medicine in the Nineteenth Century,” Bulletin of the History of Medicine 65 (1991): 301-25; and idem, “The Selective Transport of Medical Knowledge,” Bulletin of the History of Medicine 59 (1985): 213-31. 43 Duffy, “Sectional Conflict and Medical Education in Louisiana,” Journal of Southern History 23 (1957): 289- 306. Duffy notes elsewhere that many antebellum medical schools depended on grave robbers for the procurement of cadavers. Atwater adds that Louisiana's “liberal autopsy laws” aided the collection of medical specimens. Duffy, The Tulane University Medical Center: One Hundred and Fifty Years of Medical Education (Baton Rouge, Louisiana State University Press, 1984), 38; Atwater, “Internal Medicine,” 166. 64 Orleans stands unrivalled [sic] in her supply of dissecting material.”44 New Orleans physicians thus both contested the perception of their city's insalubrity while promoting that same insalubrity as one of the city's greatest medical assets.

In both uses of the argument, doctors of the Crescent City consciously set themselves as far apart from their southern counterparts as from the northern physicians whose medicine allegedly threatened Dixie, placing New Orleans in opposition not only to the North but also to other southern cities. Barton, in an 1837 speech at the Medical

College of Louisiana, claimed that “the sunny clime and mild temperature of Louisiana … has been proved to have been more favorable, especially to the extremes of human life, than any other portion” of the United States, including, presumably, other areas of the South.

Likewise, Brickell, delivering an introductory lecture in 1857 at the second session of the

New Orleans School of Medicine, revealed that one impetus for the founding of the school a year earlier had been that New Orleans was previously “fast-becoming [sic] a fifth-rate point” in medical education, behind not New York or Philadelphia, or even Edinburgh and

Paris, but Louisville, Charleston, Augusta, and Nashville—behind, in short, southern cities with which New Orleans rhetorically had affinity as part of a common southern medicine.45

The heated discourse over the proper location of the South's medical center reveals the divergent local interests that dominated southernist medicine, and the resulting lack of unity in the “movement.”

The New Orleans School of Medicine

44 ARC, 1: 7. Even doctors from elsewhere in the South acknowledged the Crescent City's superior endowments for medical education. For example, John Gray Westmoreland, a Georgian, argued that no southern medical student should ever study in the North because “what can not [sic] be furnished by Charleston, Richmond, Augusta, Savannah, Atlanta, Mobile, or Nashville, can surely be found in New Orleans.” Westmoreland, Atlanta Medical and Surgical Journal 5 (1859-60): 446-47. 45 Barton, Introductory Lecture on Acclimation, delivered at the opening of the third session of the Medical College of Louisiana (New Orleans: Commercial Bulletin Print, 1837), 16; Brickell, “Introductory Lecture,” NOMNHG 4 (1857-58): 595. Emphasis original. 65 It was more a belief in New Orleans as a medical center than a commitment to the

South that led to the establishment of Louisiana's second medical college. Determining that

New Orleans could support a new school, an enterprise for which he had argued for nearly a decade,46 Erasmus Fenner, aided by eight of his colleagues in the city's medical establishment, organized a faculty, purchased a lot opposite the Charity Hospital, and built a campus, which one contemporary described as “one of the most imposing edifices” in the

Crescent City. The New Orleans School of Medicine was chartered in May 1856, and opened in November the same year. New Orleanians waxed poetic about the new school's facilities: the lecture halls were “large, well lighted, and well ventilated”; the dissecting room the “finest … in the country”; even the “obstetric cabinet of wet preparations” was “not equalled” among comparable medical institutions. Seventy-six students, representing nine southern states along with Cuba and Nicaragua, enrolled in the first course of lectures; 23 students who had already completed a year of medical school elsewhere were granted degrees following the first lecture sequence. In the antebellum period, the school would have only two students from states that would remain in the Union during the Civil War.47

Fenner's introductory lecture,48 delivered at the school's opening on November 17,

46 Fenner had declared in the first volume of New Orleans Medical and Surgical Journal that “at a day not distant, New-Orleans must become the seat of a great medical school,” even if “the present Professors of the Louisiana Medical College should not be destined to establish it.” “The Louisiana Medical College,” NOMSJ [as New-Orleans Medical Journal] 1 (1844-45): 372. 47 “New Orleans School of Medicine,” NOMNHG 3 (1856-57): 620-21; “New Orleans School of Medicine,” NOMNHG 3 (1856-57): 489-90; ARC, 1: 2. Students from Louisiana (25), Mississippi (17), and Alabama and Texas (11 each) comprised the bulk of the first class. Of the eleven states that would secede in 1861, only Virginia and Florida had no members in the the school's initial lectures. California (one student in 1858) and New York (one in 1859) accounted for the only two non-southern and non-foreign antebellum students in the School of Medicine. ARC, 2: 14 and 3:1. 48 The introductory address was a staple of antebellum medical school convocations. Generally delivered by a member of the faculty, introductory lectures frequently contained personal or professional advice for students, served as ad hoc eulogies for deceased colleagues, or were an opportunity for the speaker to expound on medical issues of particular interest to himself. The nascent American Medical Association disliked the lectures, claiming that they were merely “turgid and extravagant attempts at eloquence.” The introductory address, however, could also have a more pragmatic function. As Genevieve Miller notes, if a 66 1856, was a characteristically grandiloquent expression of the southernist (and peculiarly

New Orleanian) medical program. Beginning with the heroic history of southern medicine, which he traced from Hippocratic Greece through Alexandria, Pergamum, Rome, and into the colonial South, Fenner argued for the localization of medical education and the propriety of his city and school as a place of instruction. Sectional tension, he declared, was not his intent. Instead, he wished “to awaken among the physicians of the South a spirit of generous and honorable rivalry with their talented and accomplished brethren in the North.”

In logic familiar to any capitalist, Fenner painted competition as the fuel of his profession.49

Fenner's language of rivalry strikingly echoed that which he and his colleagues used to justify their opening of a new medical college in a city in which a well-established, well- functioning, and well-respected school already existed. Brickell declared upon the founding of the New Orleans School of Medicine that “competition is truly said to be the life of trade, yet it is no more so of trades than of professions,” and referred, like Fenner, to the

“honorable rivalry” that would develop between the new school and the Medical

Department of the University of Louisiana. Fenner contended that the presence in New

Orleans of two medical schools was “as it should be” for the advancement of medical education. Fenner and Brickell would in subsequent years dub the competition between the

Crescent City's two schools “la rivalité honorable.”50 In the use of the same rhetoric to contrast his school and its primary competitor as he employed to oppose South to North,

school was newly founded or changed locations, the opening lecture would often justify the change. See American Medical Association, “Report of the Committee on Medical Literature,” Transactions of the American Medical Association 1 (1848): 285; Miller, “Medical Education One Hundred Years Ago: The Introductory Lecture,” Ohio State Medical Journal 54 (1958): 1580. See also idem, “Medical History,” in Numbers, ed., The Education of American Physicians, 290-308; and Warner, Against the Spirit of System, 14. 49 Fenner, “Introductory Lecture,” NOMNHG 3 (1856-57): 587. 50 “The New Orleans School of Medicine,” NOMNHG 3 (1856-57): 162-63; “North Carolina Journal of Medicine and Surgery,” NOMNHG 3 (1856-57): 623; “Medicine in New Orleans,” NOMNHG 5 (1858- 59): 748. Emphasis original. 67 Fenner implied that the gaps separating the two pairs were of a kind: far from a common southern medicine, the University Medical Department and the New Orleans School of

Medicine were as adversarial as were broader regions in the medical sectionalism of the period.51

Fenner's address was precise in the promotion of New Orleans as a site of medical learning. Drawing on accepted medical precepts, Fenner emphasized the “paramount importance of a natural talent for the profession and a proper place for the study of it.” This proper place, however, was not the South as a whole. Rather, it was “in this last particular, that [Fenner claimed] for New Orleans, advantages superior to those presented by any place in America.” Likewise, he highlighted clinical opportunities provided by New Orleans and the School of Medicine specifically, noting the school's agreement with the Charity Hospital for students' full access to the wards and the new campus, “complete … for all the practical purposes of medical teaching.”52 Though referring frequently to the South writ large, the thrust of Fenner's lecture focused on Louisiana alone. The New Orleans School of

Medicine was not a beacon of southern medicine but of Louisianan medicine, and though

Fenner's language echoed that of doctors elsewhere in the South, the School of Medicine was no more an endorsement of their programs than of those of northern physicians.

The New Orleans School of Medicine had a ten-member faculty, with professors of the traditional fields of surgery, the theory and practice of medicine (a position that Fenner held), physiology, materia medica and therapeutics, medical chemistry, medical jurisprudence,

51 Fenner outlined in his remarks a direct challenge to the University, claiming that “no medical institution possessed of real merit … has ever been injured by fair and honorable competition.” Fenner, “Introductory Lecture,” 594. Emphasis original. In actuality, rivalry between the schools and their student bodies was mild but real: Duffy notes that the the students of each school would march in choreographed formation to and from the Charity Hospital, and that they “occasionally tossed tomatoes and potatoes at each other.” Duffy, The Tulane University Medical Center, 28. 52 Ibid., 596. Emphasis original. 68 anatomy, and obstetrics, along with chairs of “Clinical Medicine and Auscultation and

Percussion” and “Diseases of Women and Children.”53 The latter position was the first of its kind in the United States, and eagerly promoted by the school's advocates as evidence of the institution's innovativeness. Fenner lengthened the school's annual term to five months, and correspondingly reduced the number of days of lectures per week from the typical five to three. With the reduced density of classroom instruction, each professor was expected to provide at least one hour daily for clinical instruction at the Charity Hospital. The school's circular reiterated the focus on continual experiential instruction, noting that students “have daily bedside observation of all the diseases which appear amongst us.” In an era in which only nine American medical colleges required hospital attendance of their students, the

School of Medicine's program was notable.54

The school's innovations were not Fenner's alone. The New Orleans School was one of the first institutions to implement, if tentatively and incompletely, the reforms that the

American Medical Association had adopted soon after its founding in 1847, in a meeting in which Fenner had participated. The AMA mandated clinical instruction and hospital practice as the foundation of medical education, and emphasized an arrangement of professors much like that of the School of Medicine. Though the Association desired a half-year term, Fenner's five-month semester was significantly longer than the standard twelve-week cycle, and Fenner and Brickell declared their readiness “to extend [the term] to

53 ARC, 1: 5. Fenner claimed that his school would teach according to the process “found so eminently successful in the hospitals of Paris,” and he would in 1859 tour hospitals in Europe with the express purpose of gleaning techniques “to emulate at” the New Orleans School. “Medical Schools, No. 4—The American Medical Association and the question of education—How nearly has the New Orleans School of Medicine conformed to the proposed standard?” NOMNHG 4 (1857-58): 297-99; Warner, Against the Spirit of System, 65-66; “Dr. E. D. Fenner,” NOMNHG 6 (1859-60): 307-10. 54 ARC, 1: 1, 3-4; Shafer, The American Medical Profession, 89. Emphasis original. Warner argues that the New Orleans School of Medicine “made regular instruction at the bedside of hospital patients more central to its curriculum than any other medical school in America.” Warner, Against the Spirit of System, 221. 69 six months, if supported by those who should be their patrons.”55 Fenner's other innovations were similarly indebted to the AMA.56

Fenner's adoption of the AMA's recommendations was certainly not an endorsement of “northern” medicine. A number of southern physicians occupied posts in the antebellum AMA, and the organization was in its early years almost wholly ineffective in promoting reform in medical education in either the North or the South. As several

Louisiana doctors observed, the young Association faced “the combined resistance of medical schools,” and the organization's influence was limited to issuing recommendations that medical colleges were free to ignore, and generally did.57 Yet if not a declaration of allegiance to northern medicine, Fenner's implementation of the AMA's reforms, and his promotion of his school's resulting difference from its competitors in the South, undermines the conception of a unified southernist medicine.

Fenner and his collaborators actively cultivated their position as reformers to the extent that the School of Medicine's southernness became secondary to its mission to improve medical education in New Orleans, and, through its improved reputation, draw students to its city. Several members of the faculty declared that “the institution to which we belong has done more than all other schools put together, in the way of real practical effort to improve medical education in this country.” What is more, they added, their fight for

55 “Medical Schools, No. 4,” 299. Emphasis original. 56 For a secondary account of the Association's recommendations, see Kaufman, American Medical Education, 94. On the AMA's views of antebellum American medical education, see American Medical Association, “Report of the Committee on Education,” Transactions of the American Medical Association 1 (1848): 235-48. On southern physicians in the antebellum AMA, see Martha Carolyn Mitchell, “Health and the Medical Profession in the Lower South, 1845-1860,” Journal of Southern History 10 (1944): 445. On Fenner and the AMA, see Cassedy, American Medicine and Statistical Thinking, 216; Duffy, “Erasmus Darwin Fenner,” 824; Fenner, “Brief Notes on a Medical Tour in the United States,” NOMSJ 3 (1846-47): 195-96; and Postell, “Erasmus Darwin Fenner,” 299-300. 57 “American Medical Association,” NOMNHG 2 (1855-56): 231. 70 reform came “in the face of most violent local opposition.”58 Rather than placing himself and his school at the head of the southernist movement, Fenner conceived of his project and that of his school on a distinctly individual level. Local (and therefore southern) forces were as troublesome to reform, and thereby to the New Orleans School of Medicine, as were northern physicians.

Fenner's lack of appeal to sectionalism did not represent a shift in attitude from his journalistic career, but rather reflected a change in medium. Fenner's rhetorical endorsement of the South in his journals established sectionalist medicine as a serious intellectual pursuit among southern physicians as a vehicle to uplift the southern medical profession and the

South as a whole. Sectional unity was not, however, ideal for distinguishing Fenner's medical college from its closest competitors. Professional promotion was a worthy cause, but economic concerns, as for American physicians in all areas, trumped appeals for regional unity. In many ways, the rhetoric of southern medical exceptionalism was a victim of its own success: with a need to differentiate one southern school from another, reference to the now-commonplace argument for sectional medicine was ineffective in recruiting students.

As the School of Medicine developed, Fenner increasingly framed the institution's importance primarily with reference to New Orleans—arguing that the city “will ere long rival Philadelphia” as a medical center—rather than to the South as a whole. He portrayed the New Orleans School as “of benefit to our city, of benefit to our State, and of benefit to all surrounding States favoring [the school] with their patronage.” He credited the School of

Medicine with leaving New Orleans “unrivalled [sic]” as a site of medical instruction, even if

“to the eyes and ears of some no doubt this [appeared] altogether 'provincial.'” Estimating

58 “Next Meeting of the American Medical Association—Medical Education,” NOMNHG 6 (1859-60): 153- 54. 71 the monetary boon from the school's students to the Crescent City to be nearly $300,000 per annum, he asked whether “any man [can] longer doubt that the new School has done good” for its city and state. Only insofar as the prosperity of New Orleans benefited the greater

South did Fenner endorse his school as a sectional windfall.59 The School of Medicine was a specifically New Orleanian, not southern, enterprise, and arguments for southern medical education were correspondingly claims for locality, not section. Though southernist medical educators shared the same rhetorical means, their goals differed in particulars which often made them wholly opposed to each other.

The Location of Education

Aided by a $20,000 grant from the Louisiana State Legislature, the New Orleans

School of Medicine grew rapidly. Its second class, consisting of 126 matriculates, was two- thirds larger than its first had been, and by its third course of lectures it boasted 164 students, ranking ninth among the medical schools of the country, “in spite of,” claimed

Fenner, “opposition, rivalry, a late yellow fever epidemic, and other obstacles.” The following year, in 1859, its 218-student class was the seventh-largest in the United States, leading its founders to pronounce it “the best medical school in the land.” The faculty likewise continued to grow, with the professorship of surgery divided in two in 1859.60 The

School of Medicine's success did not adversely affect its older competitor, the Medical

Department of the University of Louisiana, the enrollment of which increased through the

1850s. By 1860, New Orleans was the country's largest medical center after New York and

59 “The Medical Schools of New Orleans,” NOMNHG 6 (1859-60): 845; “A Chat with Our Patrons,” NOMNHG 6 (1859-60): 594; “Medicine in New Orleans,” 747. 60 ARC, 1: 2, 2: 1, and 3: 1; “Medical School Statistics for 1858—9 [sic],” NOMNHG 6 (1859-60): 230-32; “Medical School Statistics for 1859-60,” 132; “The New Orleans School of Medicine,” NOMNHG 7 (1860-61): 205-6. 72 Philadelphia.61 Fenner, assessing the school's first four years in existence, saw his college as a trailblazer which had “raised the torch and showed the path of Progress,” in the course of which the institution had “been the first to leave the old narrow path.” With the continued growth of the school, Fenner felt confident that “four more [years] will find [New Orleans] the medical center of the Union.”62

Four more years, of course, saw New Orleans no longer part of the Union. The

New Orleans School of Medicine closed with the outbreak of hostilities in 1861,63 and though Fenner briefly reorganized the school after the war, it remained in operation for only four years following his death in 1866. Devoted to the college to the end of his life, he fell ill immediately after teaching a course of lectures, and died soon after.64

In many ways, the establishment of southern and southernist medical schools was the high water mark of the movement for southern medical exceptionalism. The southern medical journal was restricted in readership and as a result in societal impact; it was in the operation of medical schools, not periodical publication, that the southern practitioner could, as Drew Faust notes, most forcefully “imbue his work with a direct social relevance.”65

Medical schools garnered professional prestige and local visibility, and through the founding of a school a physician could tangibly contribute to the communal esteem. In an era in which doctors struggled to assert their worth, the establishment of a school provided a rare

61 James Denny Guillory, “Southern Nationalism and the Louisiana Medical Profession, 1840-1860,” (M.A. thesis, Louisiana State University, 1965), 29. The Medical Department of the University of Louisiana consistently ranked fourth or fifth in ranking by enrollment of American medical colleges in the 1850s. “Medical School Statistics for 1858—9 [sic],” 230-31; “Medical School Statistics for 1859-60,” 132. 62 “The Progress of Medicine in New Orleans,” NOMNHG 7 (1860-61): 546; “Health of Our City and Its Prospects,” NOMNHG 7 (1860-61): 620. 63 The Medical Department of the University of Louisiana would close in 1862. Of the nearly twenty southern medical schools, only the Medical College of Virginia remained open for the duration of the war. H. H. Cunningham, Doctors in Gray: The Confederate Medical Service (Baton Rouge: Louisiana State University Press, 1958; pbk. ed., 1993), 35. 64 “Obituary: Prof. E. D. Fenner,” Medical Record 1 (1866): 222. 65 Faust, A Sacred Circle, x. 73 opportunity for physicians to accrue positive publicity. The founding of medical colleges also exerted a lasting impact on the southern social landscape, with many modern medical schools in the South tracing their origins to antebellum antecedents. To cite but one of many examples, the Medical Department of the University of Louisiana operates today as the Tulane University School of Medicine.66

Ironically then, it was in the establishment of medical schools, the practical thrust of southernist medicine, that the movement became less a promotion of the South than a factional, profit-driven enterprise (as “northern” medicine became as well). Ronald

Numbers and John Warner, examining the discourse by which doctors argued for a distinctly

American medicine to end their intellectual dependence on Europe, note that “at the same time American physicians acquired their own institutions for clinical researches, they also freed themselves from their commitment to a distinctive 'American' practice.”67 The pattern was much the same for antebellum southernist medicine. Southern doctors shared common interests when questioning the North's hegemony, but anti-northern rhetoric was useful only to a point. As southerners founded their own medical colleges and arguments for southern medical exceptionalism began to produce tangible results, southern physicians discarded regional concerns in favor of more local, parochial, and personal goals. Antebellum southernism could not sustain the uneasy balance between sectional uplift and avowed localism that characterized the movement in all its manifestations, medicine included.

Unable to present a unified project except in opposition to the North, antebellum southernist medicine was a fundamentally reactionary movement. While it is not incorrect to consider it, as Warner does, “as one among the variety of projects American physicians

66 See Duffy, The Tulane University Medical Center. 67 Numbers and Warner, “The Maturation of American Medical Science,” in Sickness and Health, ed. Leavitt and Numbers, 139. 74 engaged in to improve the standing of the profession in the mid-nineteenth century,” such a characterization overlooks the defensiveness inherent in the southern rejection of northern medicine. More than practicing a truly southern medicine, antebellum advocates for southern medical distinctiveness merely decried “northern” medicine while offering little in the way of unique medical methodology. Though a group product, southernist medicine was not an organizing force. What united southernists was an understanding that their commercial livelihoods would be best served through the discrediting of the dominant northern medical establishment. With this accomplished, the southernist program lost any unity it had possessed. Concurring politically and in agreement medically, antebellum southern physicians nevertheless proved unable to overcome their individual economic interests in the service of their region as a whole.

75

CHAPTER 3

MAKING SOUTHERN MEDICINE

When war came, southern physicians joined the vanguard. The Daily Delta of New

Orleans crowed that in political debates “the leading members [were] of the faculty” at the

Crescent City's two medical schools. Voices of medical men joined those of politicians, priests, and other professionals in the growing chorus for secession and the call to arms in defense of Dixie. Anthony Peniston, a professor of anatomy at the New Orleans School of

Medicine, exulted that “no portion of the [southern] people have rushed to their country's standard with more alacrity than the medical profession.” The School of Medicine's students, claimed Peniston, were “found in almost every regiment from the neighboring

States,” and the professor “[predicted] that in the death-struggle around the young Banner of Freedom, none will be found more faithful and brave” than southern doctors. So supportive of the war effort were southern physicians that the Confederacy initially had difficulty developing a medical department, as nearly all able southern doctors chose to serve in the army, not the medical corps.1

It is tempting to regard the sectional conflict as a historical breakpoint, particularly with respect to the southern states. The Civil War did provide an undeniable caesura in southern history. Southern regionalism irrupted into full-throated nationalism, and in the

1 “Political Doctors,” Daily Delta (New Orleans), June 9, 1860; James O. Breeden, “Rehearsal for Secession? The Return Home of Southern Medical Students from Philadelphia in 1859,” in His Soul Goes Marching On: Responses to John Brown and the Harpers Ferry Raid, ed. Paul Finkelman (Charlottesville, VA: University of Virginia Press, 1995), 204; idem, Joseph Jones, M.D.: Scientist of the Old South (Lexington, KY: University Press of Kentucky, 1975), 88, 97; “The Revolution,” NOMT 1 (1861): 238; Breeden, “The 'Forgotten Man' of the Civil War: The Southern Experience,” Bulletin of the New York Academy of Medicine 55 (1979): 654. On southern physicians' decisions to join the army rather than the medical corps, see Paul E. Steiner, Physician- Generals in the Civil War: A Study in Nineteenth Mid-Century American Medicine (Springfield, IL: C. C. Thomas, 1968). 76 four short years between Fort Sumter and Appomattox, southern independence progressed from birth-pangs to death-throes. With Reconstruction, history did at least partially begin anew, with the North triumphant and Dixie devastated. The conventional conception of

Old and New Souths separated by the war is perhaps overly simplistic, but not a gross misrepresentation of events as southerners lived and experienced them.

Yet while cleaving history at its joints produces clean narratives, history is rarely so clean. The Civil War was of course a catalytic and, at least in the short term, a cataclysmic event. Secession did not, however, resolve or dissolve the discourses of southern sectionalism, including that of southern medical exceptionalism. On one level, the outbreak of the Civil War further validated the southernist medical enterprise. Southern physicians argued that a rejection of northern medicine was not just necessary for health, but a patriotic duty. “It is time,” declared one Georgia practitioner, “that we should cease to look to nationality in medicine, any more than we should look to a nationality in politics.”2 The war afforded the opportunity for every southern physician to practice on southerners in the

Confederacy, in the process producing an experientially educated cadre of practitioners who cut their professional teeth exclusively in the South.

In addition, the Civil War, largely as a result of the Union blockade, fostered the insularity of southern professional classes, especially within medicine. Sudden and prolonged isolation from intellectual activity beyond the borders of the Confederacy fueled intense attention to the South and its character. As Michael O'Brien has observed, “if you only hear your own voice, it is not hard to believe in your own persuasiveness,” and in the absence of any intellectual exchange, imbued with a national fervor, educated southerners

2 John Gray Westmoreland, “Southern Medicine,” Atlanta Medical and Surgical Journal 5 (1859-60): 446. Emphasis original. 77 upheld the cause, interests, and justifications of all things southern.3

Yet at the same time that the war added an overtly political imperative to southern medical distinctiveness, the demands and realities of the conflict vitiated the institutions through which antebellum southernist physicians had espoused their region's exceptionalism.

In the spring of 1861, the New Orleans School of Medicine and the Medical Department of the University of Louisiana completed the most successful term in the history of New

Orleanian medical education, awarding a combined 210 degrees, with Fenner's school in particular enjoying a banner year. By the fall, with the rush of sectional fervor and desire to serve the cause among professors and prospective students alike, enrollment in the colleges had decreased by more than three-quarters, with further drops to come as the academic year progressed. Union forces occupied New Orleans in April 1862, and neither school would reopen for the remainder of the war.4

New Orleanian periodicals were in much the same situation. Fenner's and D. Warren

Brickell's New Orleans Medical News and Hospital Gazette ceased publication early in 1861, and the New Orleans Medical and Surgical Journal lasted only through May of the same year.

Anthony Peniston briefly assumed Fenner's and Brickell's mantle through the March 1861 inauguration of a new journal, the New Orleans Medical Times, that consciously “[laid] claim to all the prestige and honor of” the Hospital Gazette. As Peniston noted, however, “amid these tronblous [sic] times, the sorrows and causes of a poor editor grow apace,” and, lacking

3 George W. Adams, “Confederate Medicine,” Journal of Southern History 6 (1940): 151; Michael O'Brien, “'The Water Rose in the Graves': Discontinuity and Localism in Nineteenth-Century Southern Thought,” in The United States South: Regionalism and Identity, ed. Valeria Gennaro Lerda and Tjebbe Westendorp (Rome: Bulzoni Editore, 1991), 74. 4 “Medical Class of the New Orleans School of Medicine,” NOMNHG 7 (1860-61): 859; “The New Orleans School of Medicine,” NOMT 1 (1861): 155-56; John Duffy, The Rudolph Matas History of Medicine in Louisiana, 2 vols. (Baton Rouge: Louisiana State University Press, 1958), 2: 302; idem, The Tulane University Medical Center: One Hundred and Fifty Years of Medical Education (Baton Rouge: Louisiana State University Press, 1984), 40-41. 78 money and subscribers, the publication produced only three issues, folding a month after the war began. In the South outside New Orleans, no antebellum medical journal was published beyond 1863. The organs and institutions of sectional medicine did not far outlive the coming of the sectional conflict.5

The absence of antebellum rhetoric and locations of practice did not signal the death knell of an avowedly southern medicine. Instead, the crisis of the conflict induced a shift in the southernist medical enterprise. Prior to the war, the discourse of southern distinctiveness had focused on the insufficiency of all things northern—publications, doctors, medical colleges, and above all experiences—for use in the South. With the emergence of the Confederacy, a theoretically unified South replacing the antebellum pockets of activity that had sniped with each other as much as with the North, the southern medical profession emphasized not the impropriety of northern practice in southern places, but the ability of the South to provide for itself medically. While antebellum southern medical exceptionalism had entailed an essentially negative discourse, disparaging the North rather than detailing the advantages of Dixie, wartime southernist medicine was primarily positive, founded on the belief or at least the hope that, with exposure to “northern” medicine no longer possible, the South could supply its medical profession with the experience, the (informal) education, and most importantly the remedies on which successful medical practice depended.

Along with the shift in emphasis, the discourse shifted locations as well. Medical southernism during the Civil War did not emanate from New Orleans. Most Louisiana physicians, including Erasmus Fenner, served the Confederacy in some way, but their

5 “To Our Readers,” NOMT 1 (1861): 75; “To Our Subscribers,” NOMT 1 (1861): 238; Adams, “Confederate Medicine,” 153. 79 contributions were primarily practical, not ideological or professional. With New Orleans far from the Confederate capital at Richmond and isolated by Union occupation from 1862 through the end of the war, the antebellum New Orleanian medical establishment was geographically scattered and rhetorically isolated.6 Rather, the epicenter of medicine of the

Confederate States was the official medical department, based in Virginia and led by a South

Carolinian, Surgeon General Samuel Preston Moore.

In the absence of medical professional activity in the South, Moore founded a periodical, the Confederate States Medical and Surgical Journal, which stressed the viability of indigenous remedies springing from land that was entirely and irrevocably southern.

Whereas the South's sickliness had been paramount for antebellum Americans, southernist doctors of the Civil War sought to demonstrate that the same South that created disease could also cure as well. In their efforts to find distinctively southern pharmaceuticals,

Confederate physicians attempted to make southern not only the theory but also the practice of medicine, providing the basis and justification for an independent profession to accompany the independent southern polity. In wartime southernist medicine, conceptions of southern salubrity replaced, or at least superseded, antebellum assumptions of southern sickness. Depicting the South as the location of medicine as much as of disease—and in the process validating the southern population, who closely associated themselves and their

6 Fenner was something of an itinerant during the Civil War. After voting against secession—not out of political objections, but because he believed the South had little chance of lasting success in the conflict— Fenner traveled to Richmond, where he founded the Louisiana Soldiers' Relief Association and operated the Louisiana Hospital, which, in perhaps the truest manifestation of “states' rights medicine,” was devoted exclusively to the care and relief of Confederate soldiers from Fenner's home state. Returning to New Orleans just prior to the Union capture of the city, Fenner was expelled from the Crescent City in May 1863 for refusing to take an oath of loyalty to the Union. He fled to Mobile, where, excepting a brief stay in Canton, Mississippi, he would remain for two years before returning to New Orleans at war's end. Duffy, “Erasmus Darwin Fenner (1807-1866), Journalist, Educator, Sanitarian,” Journal of Medical Education 35 (1960): 823; William Dosité Postell, “Erasmus Darwin Fenner and the Beginnings of Medical Literature in Louisiana,” Annals of Medical History (3rd series) 3 (1941): 302. On the Louisiana Hospital, see Duffy, The Rudolph Matas History of Medicine, 2: 303. 80 culture with their land—southern medicine in the Civil War affirmed simultaneously the legitimacy of the Confederate enterprise and the existence of a unique and important place, ideologically and professionally, for physicians in the new southern nation.

Disease and Acclimation

The American Civil War was the last major military conflict fought before the advent of germ theory, and the toll that illness exacted on both armies far exceeded battlefield casualties. While the lack of Confederate records, which burned in a fire in Richmond in

April 1865,7 hinders direct comparisons between the two armies, illness-related mortality was unquestionably bad. In the 2.2-million strong Union Army, 275,000 soldiers died from disease; estimates suggest that nearly 22 percent of the Confederate force of 750,000 perished due to illness. During one 19-month period spanning most of 1862 and 1863, close to 17 percent of the Confederate Army was at any one time stricken with pneumonia.

The ratio of two (for the Union) or three (for the Confederates) deaths from disease to every combat fatality was better than in previous wars: in the Mexican-American War fifteen years earlier, the ratio was ten illness-related casualties to one death in battle. Still, the number of deaths from disease in the Civil War was greater than the total number of deaths from all causes in all American military conflicts combined from the American Revolution through the Vietnam War, excepting World War II. Disease accounted for roughly 58 percent of Union wartime deaths, and 64 percent of fatalities on the Confederate side.8

7 Adams, “Confederate Medicine,” 152; H. H. Cunningham, Doctors in Gray: The Confederate Medical Service (Baton Rouge: Louisiana State University Press, 1956; pbk. ed., 1993), vii; Jack D. Welsh, Two Confederate Hospitals and Their Patients: Atlanta to Opelika (Macon, GA: Mercer University Press, 2005), 1. 8 Jeffrey S. Sartin, “Infectious Disease during the Civil War: The Triumph of the 'Third Army,'” Clinical Infectious Diseases 16 (1993): 580; Adams, “Confederate Medicine,” 159; idem, Doctors in Blue: The Medical History of the Union Army in the Civil War (New York: Henry Schuman, 1952), 3; A. J. Bollet, “To Care for Him That Has Borne the Battle—A Medical History of the Civil War,” Medical Times 117 (April 1989): 121; Breeden, “Confederate Medicine: The View from Virginia,” Virginia Medical Quarterly 117, no. 4 (1991): 223; Michael R. Gilchrist, “Disease & Infection in the American Civil War,” American Biology Teacher 60 (1998): 81 The specific afflictions of the Civil War were myriad, and rarely occurred in isolation.

Pneumonia, measles, malaria, tuberculosis, the vaguely defined catch-all of “camp fevers,” and hookworm (“chronic malarial poisoning” to contemporaries) were endemic in the camps of both armies. It was generally understood that whatever else a soldier had, he suffered from an intestinal ailment, usually diarrhea or dysentery, as well. The Union Army reported more than 1.7 million cases of diarrhea and 1.3 million cases of malaria in five years of war. In Robert E. Lee's Army of Northern Virginia, each soldier was diagnosed with an average of three illnesses between July 1861 and March 1862.9 The deadly cocktail of diseases wreaked havoc on both sides, forcing military commanders to pay as much or more attention to the health of the forces than to the combat strength of the two armies. In a war in which disease was omnipresent, health was combat strength.

Through its pervasive influence on specific campaigns, disease influenced the course of the war. At the siege of Vicksburg, for example, close to half of all Confederate troops, as compared to roughly one-quarter of the Union force, became ill, leading to the fall of the fortress and the severing of the Confederacy in two.10 In the Trans-Mississippi Department, as Frank Freemon observes, the obstacles for Union forces were “primarily medical rather than military.” Disease in the area prevented Union troops from subduing smaller contingents of Confederates, with over 40 percent of Union soldiers in the region becoming

258; Judith Lee Hallock, “'Lethal and Debilitating': The Southern Disease Environment as a Factor in Confederate Defeat,” Journal of Confederate History 7 (1991): 51-61. 9 Adams, “Confederate Medicine,” 159-61; Harris D. Riley, Jr., “Medicine in the Confederacy,” Military Medicine 118 (1956): 145; Gerald N. Grob, The Deadly Truth: A History of Disease in America (Cambridge, MA: Harvard University Press, 2002), 147; Courtney R. Hall, “The Lessons of the War between the States,” International Record of Medicine 171 (1958): 425. 10 Frank R. Freemon, “Medical Care at the Siege of Vicksburg, 1863,” Bulletin of the New York Academy of Medicine 67 (1991): 434. During the Vicksburg campaign, the number of able Confederate troops declined from 41,000 in January 1863 to 30,000 in June, shortly before the surrender of the fort. The number of Union forces, thanks to reinforcements and marginally better medical care, increased from 48,000 to 65,000 during the same period. 82 ill in the summer and early fall. Endemic malaria repeatedly stymied Robert E. Lee's efforts to retake for the Confederacy the newly formed state of West Virginia, and thereby allowed

Union troops another secure avenue into the Piedmont.11

While the quality of care varied widely within and between the two armies, all advantages that “good” medical treatment offered was relative, and the proportion of the ill who eventually succumbed was largely the same for both sides.12 When the condition of one army was much better than that of the other, the sheer number of casualties from illness had the potential to incapacitate a fighting force. During William Sherman's 1864 advance into Georgia, the Confederate Army of Tennessee lost more than 45 percent of its troops to disease in July, and another half of the remaining soldiers in August. In Sherman's force, by contrast, disease afflicted “only” 31 percent of soldiers in July, and then a third of the remaining troops in August.13

The Civil War was fought almost entirely in the Confederacy, and the South's reputation for unhealthiness worried Union forces especially. Many physicians in the Union camps claimed that disease was so pervasive in the South that the practice of medicine was fruitless. One Massachusetts physician in a Baton Rouge hospital resorted to sending as many of his malaria patients as far north as he could, as he felt that climatic considerations trumped any ministrations, pharmaceutical or otherwise, that he could supply. Along the

Atlantic seaboard, malaria, meningitis, and ever-dreaded yellow fever devastated advancing

Union forces. Yellow Jack, of which most Union troops knew only from frequently

11 Idem, “The Medical Challenge of Military Operations in the Mississippi Valley during the American Civil War,” Military Medicine 157 (1992): 494-96; Bollet, “To Care for Him,” 124. 12 Freemon, “Medical Care at the Siege of Vicksburg,” 430. 13 Breeden, “A Medical History of the Later Stages of the Atlanta Campaign,” Journal of Southern History 35 (1969): 58. 83 embellished hearsay, terrified the advancing northerners.14

Much as antebellum New Orleanians had embraced their city's reputation for unhealthiness to justify its propriety as a medical center, southerners, civilian and military, actively fueled fear of Dixie's disease environment among Union troops. Some congregations in New Orleans regularly concluded services with a prayer for a yellow fever epidemic, which would presumably devastate the unprepared and occupying northerners while sparing the city's native population. New Orleanians loudly described the terrors of past epidemics within hearing of wary Union officers, and on one occasion two particularly puckish residents of the Crescent City measured Union troops, offering as an explanation that the two Louisianans were contracted to supply the 10,000 coffins that would be needed to bury the Union soldiers upon the inevitable attack of Yellow Jack.15

These southerners were not solely making mischief; rather, they based their claims on accepted medical doctrine. A long tradition in Dixie, and in New Orleans in particular, held that natives of the South, who had constant exposure to the climatic conditions thought to cause yellow fever, were immune from the disease. John Harrison, a founder of the future

Medical Department of the University of Louisiana, argued in 1845 that yellow fever

“attacks only strangers, those born in [New Orleans] being perfectly exempt from the disease.” Erasmus Fenner's colleague Bennet Dowler claimed that northerners did not

“acquire nor inherit any immunity from yellow fever by nativity,” in contrast to the resistance with which every New Orleanian was equipped by virtue of birth and residence. Stanford

Chaillé, who would after the war lead the University Medical Department, went so far as to

14 Freemon, “The Medical Challenge,” 495; idem, Gangrene and Glory: Medical Care During the American Civil War (Madison, NJ: Fairleigh Dickinson University Press, 1998), 138. 15 Freemon, Gangrene and Glory, 141; Jo Ann Carrigan, The Saffron Scourge: A History of Yellow Fever in Louisiana, 1796-1905 (Lafayette, LA: Center for Louisiana Studies, University of Southwest Louisiana, 1994), 84-85. 84 promote the “[removal] of the unacclimated” en masse to prevent recurrence of yellow fever in

New Orleans.16 The South's sectional disease, it was believed, did not trouble southerners.17

In some instances, acclimation theory appeared to hold true during the conflict.

Though malaria occurred, as did nearly all ailments, more frequently among Confederate troops than among Union soldiers,18 mortality from the disease was higher among Union forces due to the acquired immunity many southerners possessed. Pierre G. T. Beauregard, the prominent Confederate general, reportedly told Confederate president Jefferson Davis that any Union offensives from the Carolina coast into the interior would fail because of northerners' unfamiliarity with southern fevers. At one point in 1862, Union troops in

North Carolina delayed an attack on Wilmington because of a yellow fever epidemic in the city. Following the fall of Vicksburg, Confederate Secretary of War James Alexander

Seddon claimed in an official memorandum that the insalubrity of the Mississippi Valley would become a boon to the Confederate war effort. He appeared correct when, in the two months following the citadel's surrender, the percentage of Union troops disabled by malaria

16 John Harrison, “Remarks on Yellow Fever,” NOMSJ 2 (1845-46): 130; Bennet Dowler, “Yellow Fever Epidemics of Norfolk and New Orleans in 1855; with General Remarks and Reflections,” NOMSJ 12 (1855-56): 331; Stanford Chaillé, “Yellow Fever of 1858 in New Orleans,” NOMSJ 15 (1858): 812. Emphasis original. A belief in acclimation, in addition to challenging conventional depictions of the South as uncontrollably unhealthy, justified regional medical loyalty, deeply felt or not: as Harrison observed, “young men born in [New Orleans] but sent to Europe or our Northern Colleges,” often lost their immunity and were “attacked [by disease] on their return to the South,” offering a (slightly threatening) medical incentive to stay in Louisiana for schooling. 17 For an overview of acclimation theory and yellow fever in New Orleans, see Carrigan, “Privilege, Prejudice, and the Strangers' Disease in Nineteenth-Century New Orleans,” Journal of Southern History 36 (1970): 568-78. 18 This advantage should not be overstated, and malaria could prove as debilitating for Union forces as for Confederate soldiers. In one contingent of Union troops in South Carolina, for example, the annual incidence rate for malaria was over 100 percent because many Union troops had multiple episodes of the disease. Similarly, in North Carolina in 1863 and 1864, a force of 1000 Union soldiers reported 2,353 cases of malaria. Freemon, Gangrene and Glory, 140; Mark F. Boyd, “An Historical Sketch of the Prevalence of Malaria in North America,” American Journal of Tropical Medicine 21 (1941): 234. Bollet speculates that the apparently higher incidence of malaria in southern troops may have resulted from southern soldiers joining the Confederate Army when already ill with the disease, as malaria was endemic throughout the antebellum South. Civil War Medicine: Challenges and Triumphs (Tucson, AZ: Galen, 2002), 290, 298. 85 promptly skyrocketed to nearly 17 percent. Sickliness, it seemed, could save the South.19

On the whole, however, southern acclimation did not neutralize wartime diseases. A far higher proportion of Union than Confederate troops hailed from cities, in which previous exposure to diseases of proximity such as measles and mumps was more likely. As a result, rural southern soldiers, despite fighting in their geographic and medical homeland, had less experience with the war's prevalent infections than did their northern counterparts.

Since the demands of camp life mimicked those of antebellum urban living—poor sanitation, overcrowding, and abundant opportunities for the transmission of pathogens— northerners, a large percentage of whom hailed from metropolitan areas, needed less medical adjustment to the military lifestyle than did country-bred southern troops. More often than not, the troops acclimating were not “strangers” to the South, but instead its permanent population.20

Perhaps most frustrating for southern physicians was the absence of epidemic yellow fever in occupied New Orleans. During the three full years of Union occupation, New

Orleans suffered a total of nine deaths from yellow fever, a far cry from the four serious epidemics and numerous smaller outbreaks that had plagued the city during the decade prior to the war. The strict quarantine and sanitation measures that Benjamin Butler, the Union commandant of the occupied city, imposed and enforced left New Orleans almost hermetically sealed, limiting opportunities for the importation of the disease. In addition,

19 Freemon, Gangrene and Glory, 140; Riley, Jr., “Medicine in the Confederacy,” 57; Bollet, Civil War Medicine, 301; Freemon, “The Medical Challenge,” 495. See also Richard M. McMurry, “Marse Robert and the Fevers: A Note on the General as Strategist and Medical Ideas as a Factor in Civil War Decision Making,” Civil War History 35 (1989): 197-207. 20 Duffy, From Humors to Medical Science: A History of American Medicine (Urbana: University of Illinois Press, 1976 [as The Healers]; 2nd ed., 1993), 160; Jack Temple Kirby, Mockingbird Song: Ecological Landscapes of the South (Chapel Hill: University of North Carolina Press, 2006), 128, 287. Kirby notes that only in 1940 would the South achieve a level of urbanization comparable to that of the Northeast in 1860. On the medical disadvantages of the Confederates in the southern environment, see Hallock, “'Lethal and Debilitating.'” 86 much as yellow fever had retreated from the North after 1820, in the process becoming the

South's sectional affliction, the disease, as would be clear decades later, had begun similarly withdrawing from the Mississippi Delta after its peak incidence in the 1850s.21

The absence of epidemic yellow fever at a time when New Orleanians would have welcomed it—and during which southernist physicians confidently predicted that it would arrive—was a humiliating blow to the southern medical profession. Not even a northern physician, but a northern general had managed the disease more effectively than had native southern practitioners. That a surge in yellow fever deaths arrived almost simultaneously with the return of home rule in 1866 made the southernist failures all the more galling. In the decade following its occupation, New Orleans would suffer four more epidemics, discrediting if not entirely eliminating the acclimation theory. Ironically, Bennet Dowler, a

New Orleanian and one of the most prominent acclimationists, was a victim of the 1878 epidemic, the worst in the city's history.22

The Surgeon General and the Blockade

At the outbreak of the Civil War, the South had been thoroughly dependent on the

North for medical supplies for at least three decades, if not since American independence.

Lacking any manufacturing facilities significant in comparison to those of the North, the

South obtained nearly all its medicine elsewhere, and, with few exceptions, movements for distinctively southern medical periodicals and medical schools called for a distinctively southern materia medica as well. Physicians North and South employed the same

21 Carrigan, The Saffron Scourge, 82-95. See also idem, “Yankee versus Yellow Jack in New Orleans, 1862- 1866,” Civil War History 9 (1963): 248-60. 22 Carrigan, The Saffron Scourge, 96-113; Duffy, The Rudolph Matas History of Medicine, 2: 386. Carrigan notes that there were nearly 200 deaths from yellow fever in 1866 (the year of return to home rule), as compared to 1 in 1865. 87 pharmaceutical remedies (though in different quantities and dosages23), and even in terms of the patent medicines of apothecaries, pharmacists, and sectarians such as homeopaths, northern products predominated in the antebellum southern medical establishment.24

The general blockade that the Union Navy imposed on the South, coupled with the sudden cessation of the hitherto internal trade with the North, thus had the potential to effect a medical emergency in the Confederate States. The Union government declared medical supplies contraband almost as soon as the war commenced in early 1861 (an order that the Confederate government considered “atrocious”), and prices of drugs, fueled by scarcity, spiked throughout the South. Quinine, thought to be the sine qua non of malaria treatment, sold for between $400 and $600 per ounce after 1863. Some northern doctors considered the medical ban too cruel for the sectional conflict to justify, and at an 1864 meeting of the American Medical Association, a New York physician proposed lifting the prohibition on the trade in medical supplies, noting that Union prisoners of war suffered alongside their Confederate captors. Such sympathies with the South were apparently not widespread in the organization: according to a southern report of the incident, the doctor was “hissed from the hall,” and the ban remained in place.25

23 One regional variation about which nearly all orthodox American physicians agreed was the need to adjust dosages and uses of drugs depending on climate and temperature. Physicians viewed the constant heat of the South, for example, as a depletive force, reducing the propriety of venesection but increasing the utility of purgatives and stimulants. John Harley Warner, “From Specificity to Universalism in Medical Therapeutics: Transformation in the 19th-Century United States,” in Sickness and Health: Readings in the History of Medicine and Public Health, ed. Judith Walzer Leavitt and Ronald L. Numbers (Madison: University of Wisconsin Press, 1978; 3rd ed., rev., 1997), 90. See also idem, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge, MA: Harvard University Press, 1986), 71-72. 24 Richard Harrison Shyrock, “Medical Practice in the Old South,” in Medicine in America: Historical Essays (Baltimore: The Johns Hopkins University Press, 1966), 57; James Harvey Young, “Patent Medicines: An Element in Southern Distinctiveness,” in Disease and Distinctiveness in the American South, ed. Todd L. Savitt and Young (Knoxville: University of Tennessee Press), 154-93. 25 Robert E. Denney, Civil War Medicine: Care & Comfort of the Wounded (New York: Sterling, 1994), 11; Mary Louise Marshall, “Medicine in the Confederacy,” Bulletin of the Medical Library Association 30 (1942): 288; Bollet, Civil War Medicine, 301; Adams, “Confederate Medicine,” 155; “Indigenous Remedies of the South,” CSMSJ 1 (1864): 106n. 88 With enforcement of the blockade increasingly effective, southerners' efforts to secure reliable medical supplies (and the profit resulting from the sale of such precious goods) took myriad forms. The Confederate government organized a special agency at

Nassau in the Bahamas to oversee the smuggling of medical supplies into the South, and officially prioritized medicines as third (behind ordnance and clothing) in importance of items to be brought through the blockade. Irregular commerce between southerners and northerners, often with the tacit acceptance or participation of local Union officials, continued apace with the flourishing regular trade that had existed prior to the war.

Southerners swapped cotton for textiles, medicines, and military supplies, and between $20 and $30 million worth of goods passed through Memphis, the hub of the border trade, to various places in Dixie. Despite the relative boom of unofficial commerce, however, the

Confederacy nevertheless wanted for nearly every supply, medicinal and otherwise, necessary for a functional medical department. While some southern physicians saw the shortages as an opportunity—Anthony Peniston declared that “we can do just as well without

[northerners] as they can without us”—the situation quickly became desperate.26

The organization and administration of the beleaguered Confederate Medical

Department fell to Samuel Preston Moore, a native Charlestonian and career military physician. Moore was born in 1813, the scion of a distinguished family of doctors, one of whom had served as Lord Baltimore's surgeon. After graduating from the Medical College

26 Adams, “Confederate Medicine,” 155; Stewart M. Brooks, Civil War Medicine (Springfield, IL: Charles C. Thomas, 1966), 68; Breeden, “Medical Shortages,” 1041-42; Hall, “The Lessons of the War between the States,” 423; “The Revolution,” 236. David Courtwright questions the validity of the general scholarly view of Confederate medicine, claiming that “at least until the last year of the war, Confederate doctors were reasonably well-supplied with basic drugs.” Courtwright's work focuses on opiates, and while the South was able to produce indigenously grown narcotics (see below), Courtwright marshals no evidence to support his contention that southern physicians had ready access to quinine, calomel, chloroform, or other necessary drugs throughout the course of the war. Courtwright, “Opiate Addiction as a Consequence of the Civil War,” Civil War History 24 (1978): 107. 89 of South Carolina in 1834, Moore practiced in Arkansas for one year before receiving an appointment in the Medical Corps of the United States Army. Over the next decade, he was based at various times in Iowa, Kansas, Oklahoma, and Florida, and he served in the

Mexican-American War, during the course of which he met Jefferson Davis for the first time. After the war, Moore lived in Texas and briefly taught at West Point, before moving to

New Orleans to work as a purveyor shortly before the secession of his home state.

Following the brief tenure of David DeLeon, Moore was appointed Surgeon General on

July 30, 1861, and would remain in the office until the war's conclusion.27

Whereas DeLeon, though a career army doctor like Moore, was avowedly southernist in medical orientation—he firmly believed in acclimation and the uniqueness of the southern constitution, and had complained in a U.S. Army report that many army physicians at postings in the South were ineffective because they had attended northern medical schools28—Moore was less ideological, with little patience for theorizing, and focused instead on the direness of the situation that confronted him. Moore's subordinates universally regarded him as overly exacting, with his reserved demeanor leading to charges of unfriendliness. His defenders responded that organizational skills, not pleasant manners, were vital to performance as surgeon general.29

Moore viewed as one of his primary tasks continuing the education of the southern medical profession, in spite of the social disruption caused by the war and the lack of formal

27 Carrington Williams, “Samuel Preston Moore: Surgeon General of the Confederate States Army,” Virginia Medical Monthly 88 (1961): 573-55; Cunningham, Doctors in Gray, 27-28; Freemon, Gangrene and Glory, 29; George N. Malpass, “Medicine in the Confederate Army,” American Journal of Pharmacy 115 (1943): 176. The literature is regrettably devoid of a full-length study of Moore. For other biographical sketches, see Riley, Jr., “Moore, Samuel P.,” in Encyclopedia of Southern Culture, ed. Charles Reagan Wilson and William Ferris (Chapel Hill: University of North Carolina Press, 1989), 1374-75; and E. R. Weiss, “Life and Times of Samuel Preston Moore, Surgeon General of the Confederate States of America,” Southern Medical Journal 23 (1930): 916-22. 28 Freemon, Gangrene and Glory, 19-20. 29 Cunningham, Doctors in Gray, 249; Malpass, “Medicine in the Confederate Army,” 177. 90 medical institutions in the Confederacy excepting the Medical College of Virginia. To supply updated professional literature to a profession severed from contact with the medical world outside of the Confederacy, he produced pamphlets and commissioned the publication of several medical books. Responding to the disbanding of local medical societies, he founded the Association of Army and Navy Surgeons of the Confederate

States, an organization based in Richmond whose members met regularly for the presentation of scientific papers. Moore also organized “refresher” courses at the Medical

College of Virginia for local and military physicians and promoted the creation of ad hoc medical societies in each Confederate encampment, where surgeons would dissect cadavers from the battlefield and discuss medical practice. Committed to the notion of a vigorous southern medical profession, Moore strove to foster the continued intellectual development of southern physicians during the trying times of the conflict.30

A Journal for the Confederacy

Moore's most ambitious and for a time most successful endeavor was the creation of a wartime southern medical journal to fill the vacuum resulting from the cessation of nearly all southern publications. Along with James Brown McCaw, director of the Confederacy's largest hospital and editor of the prewar Virginia Medical and Surgical Journal, and William

Middle Michel, like Moore a Charlestonian, Moore edited and produced the Confederate States

Medical and Surgical Journal, first published in January 1864.31 The journal's first issue contained four sections—Original Communications, Confederate States Hospital Reports, a

Chronicle of Medical Science, and Editorial and Miscellaneous—that would remain the core components of the publication. Printed in Richmond, the journal published monthly

30 Freemon, Gangrene and Glory, 129-30; Adams, “Confederate Medicine,” 153-54. 31 Freemon, Gangrene and Glory, 129-30; Carol Cranmer Green, Chimborazo: The Confederacy's Largest Hospital (Knoxville: University of Tennessee Press, 2004), 111; Williams, “Samuel Preston Moore,” 624. 91 through February 1865, at which point it ceased production with no editorial notice. Several historians maintain that the March 1865 issue was ready for press when it was lost in the

April fire that also destroyed the official Confederate medical records.32

Confederate States Medical and Surgical Journal was the only substantial medical periodical begun by either side during the war, and exhibited the shortage of supplies characteristic of

Confederate medicine and the Confederacy more broadly. An editorial in the fifth issue noted that the periodical's “great difficulty, not yet overcome, is to be found in … the want of paper.” The journal's typeface was smaller than that of most prewar medical periodicals, and each page contained two columns of text to maximize the amount of information that could be squeezed into a single issue. The journal's length was also paltry, at least in comparison to antebellum medical publications: the first eight installments were only 16 pages apiece, with the final six issues increased in size to 24. The first volume's total page count of 224 was a far cry from the typical volume of New Orleans Medical and Surgical Journal, which averaged over 800 pages annually between its 1844 founding and the Civil War. With physical form reflecting want of material, the journal was clearly a southern product.33

The only non-essential item that regularly garnered space in the journal was an ornate masthead that firmly situated the publication in the southernist medical tradition.

Depicting Hippocrates, the proclaimed founder of southern medicine, the half-page graphic contained a seal with the phrase experientia docet (“experience teaches”), alluding to the

32 Freemon, Microbes and Minie Balls: An Annotated Bibliography of Civil War Medicine (Rutherford, NJ: Fairleigh Dickinson University Press, 1998), 45; Bollet, Civil War Medicine, 47. For a general overview of the history, structure, and contents of the CSMSJ, see William D. Sharpe, introduction to The Confederate States Medical and Surgical Journal, in History of Medicine Series, issued under the auspices of the Library of the New York Academy of Medicine, no. 47 (Metuchen, NJ: Scarecrow Press, 1976), v-xii; and idem, “The Confederate States Medical and Surgical Journal, 1864-1865,” Bulletin of the New York Academy of Medicine 52 (1978): 373- 418. 33 Ira M. Rutkow, Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine (New York: Random House, 2005), xiv; “The Prospect before Us,” CSMSJ 1 (1864): 78. 92 emphasis on empiricism in orthodox American medicine and to southern physicians' belief in the necessity of practice in the South in the training of a doctor. With its echoes of

Samuel Cartwright's heroic history of southern medicine, the masthead appropriated the figure of Hippocrates for an avowedly southern purpose. The presence of the graphic placed the father of medicine in the Confederacy, lending an ideological weight to the eminently practical medical enterprise that Samuel Preston Moore intended the periodical to be, and appropriating for the South a crucial symbol of the legitimacy of antebellum

American physicians. That the large masthead was included repeatedly in a publication in which space was at a premium illustrates the continuing importance of southernist concerns in wartime southern medicine.34 Much like antebellum southernist periodicals, then,

Confederate States Medical and Surgical Journal promoted both the southern medical profession and the South as a whole.

The journal's editors made clear from the first issue their belief in the importance of their publication. In addition to providing contact with foreign medical literature and serving as the official mouthpiece of the Confederate Medical Department, the periodical was to be “the representative of the [southern medical] profession, the exponent of its view,” and above all “the record of its experience.”35 In the absence of any other southern medical publications, and with the imprimatur of the Confederate States government,

Moore's journal was to ensure the continuation of the southern voice—and a determinedly

34 Though numerous historians argue that the figure in the masthead was Hippocrates, William Sharpe raises the possibility that the graphic may have been Asclepius, the Greek god of medicine. Evidence suggests that Hippocrates was a more likely candidate—in addition to the high position of the father of medicine in the nineteenth-century American medical tradition, the figure's aged depiction supports the notion that it was intended to portray Hippocrates rather than Asclepius, who is often depicted as a vigorous figure. Sharpe also acknowledges that Hippocrates was a possibility for the figure. Bollet, Civil War Medicine, 47; Sharpe, “The Confederate States Medical and Surgical Journal,” 373. The masthead was discontinued after eight issues, presumably to save paper. 35 “Salutatory,” CSMSJ 1 (1864): 13. 93 experiential one at that—in the medical tradition of the time. As the publication's prospectus noted, “no effort [would] be spared … to lay the foundation of a Southern

Medical Literature on a firm and enduring basis.”36 While wartime practicality dictated less attention to ideological grandstanding in the journal than in its predecessor periodicals in the

South, the mere existence of Confederate States Medical and Surgical Journal affirmed that southern participation in medical discourse was a desideratum.

In the view of its editors, Confederate States Medical and Surgical Journal was as successful as could be expected given the circumstances. By the May issue, five months after the first publication, Moore, McCaw, and Michel trumpeted that the journal had “already attained a larger circulation than was ever reached before by any Southern medical periodical,” with subscriptions (originally $10 per annum) continuing to “flow in rapidly.” The editors, while admitting problems procuring paper, nevertheless vowed to double the periodical's size as soon as was prudent. In the ninth issue, the first which was enlarged to 24 pages, the subscription fee was increased to justify the new costs in material. In November 1864, the editors again cited their unprecedented numbers of subscribers, and announced the intention to continue the journal in 1865, if southern practitioners would continue to support the periodical “with purse and pen.”37

Though the lack of Confederate records makes calculation of the journal's domestic circulation difficult, the periodical did secure mention in one foreign publication. London's

Lancet, in an editorial on April 16, 1864, referred to the “Confederate Medical and Surgical

Journal,” and lamented that “our medical brethren in the South are suffering extreme hardship and privation.” Given the circumstances, the Lancet's editors declared, “the

36 [Circular], CSMSJ 1 (1864): 32. 37 “The Prospect before Us,” 78; “To the Reader,” CSMSJ 1 (1864): 140; “Prospectus,” CSMSJ 1 (1864): 187. 94 publication … deserves our cordial welcome,” and clearly indicated southern physicians'

“truest feeling of professional zeal and unquenchable love of their art.” The Lancet likewise admonished Union doctors for “[resenting] our professional feeling of amity with Southern as with Northern brethren.” The journal's appearance in a highly respected medical publications was a coup for Moore, who claimed that his “communications with the literature of other countries has been singularly successful,” even though the Lancet article was apparently the journal's only formal exposure outside of the South.38

Confederate States Medical and Surgical Journal was a testament to the belief that the southern medical profession could support—and deserved—its own unique professional voice. With medical literature the accepted index of professional status, the persistence of distinct periodicals indicated the viability of an independent medical profession, and the very presence of Moore's journal suggested if only implicitly that the South was in a meaningful way different than the North. Despite the periodical's focus on the practical needs of an underfunded and ill-equipped wartime profession, the journal fostered a medical discourse that by virtue of the circumstances was uniquely and unquestionably southern.

Finding Drugs in Dixie

In addition to topics of military medical importance, articles and editorial matter in

Confederate States Medical and Surgical Journal focused on the potential development of indigenous southern remedies for disease. With the reduced availability of medicine due to the blockade, the Confederate Medical Department embarked on an ambitious program of identifying and manufacturing specifically southern surrogates for therapeutic substances. In

38 “Medicine in the Confederate States,” Lancet 1 (1864): 445-46; “The Prospect before Us,” 78. Sharpe suggests that, given the existence of only a few references to the journal in medical publications in the Union (all of which, like the Lancet editorial, omit the “States” from the periodical's name), the Lancet article was the only indisputable evidence that any northern journal editors had that Confederate States Medical and Surgical Journal existed. Sharpe, “Introduction,” xii. 95 this effort, necessitated by the conditions of the war but eagerly endorsed by southern physicians, the Confederacy embraced the dictates of southernist medicine. With southern medical publication and education halted, wartime arguments for southern medical distinctiveness focused not on southern physicians but on southern land, and not on southern methods of treatment but instead on the treatments themselves. In attempting to find southern antidotes in southern flora—in effect, using the South to cure the South—the

Confederacy unwittingly engineered a shift in southernist discourse from place of practice to methods and material. With the object of agitation different, but the overarching focus on southern medical self-reliance the same, an implicit assumption of southern exceptionalism colored the Confederate medical war effort.

In the search for southern remedies, the Confederate Medical Department situated itself in a long folk tradition of medicine. “There is,” one American practitioner declared in

1848, “an opinion extensively entertained by the mass of mankind, that there exist in the vegetable kingdom of every country appropriate and effectual remedies for the diseases of that country.” Far from exclusive to the American South, the belief that every region contains plants able to cure all the diseases in the area has antecedents throughout history.39

Local environments were not always pernicious, but could be beneficial and harmful in equal doses, with the dangers of allegedly unhealthful areas such as the South counterbalanced, at least in theory, by the potential the same area provided for the restoration of health. As southern physicians argued, “medicine, like disease, must spring from the very elements, soil, sunshine, moisture, etc., that produce disease … the very circumstances that develop the

39 N. S. Davis, “Report of the Committee on Indigenous Medical Botany,” Transactions of the American Medical Association 1 (1848): 342; Patricia Spain Ward, Rebel in the Ranks of Medicine, 1840-1921 (Tuscaloosa: University of Alabama Press, 1994), 29; Adams, “Confederate Medicine,” 155; Breeden, “Medical Shortages,” 1043. 96 one, contains, and suggest also, the antidote.” Place did not only give illness, but also could, when exploited by a skilled practitioner, offer relief from affliction.40

In the context of antebellum American medicine, a doctrine of local remedies reinforced the importance of linking treatment not to disease but to environment.

Nineteenth-century physicians took as a given that “the earth is divided into many natural botanical zoölogical provinces, each possessing their own peculiar fauna and flora,” and the holistic approach of medical geography privileged variations in indigenous plant life as a crucial component of place that could produce or reduce illness. Acknowledging the medicinal utility of regional flora further organicized the assumed connection between place and person, with an individual's territorial location holding the key to personal health or lack thereof. Local knowledge was not only knowledge of an area's unique diseases, but also of the potential cures literally present in the landscape. When the flora of two different localities differed, a similar ailment might require entirely opposite treatments in the different areas, a hallmark of the principle of specificity.41

The most ardent Confederate champion of indigenous medical botany was Francis

Peyre Porcher, a Charlestonian like Moore and Professor of Materia Medica and

Therapeutics at the Medical College of South Carolina prior to the war.42 Even before the secession of the South, Porcher had been an active proponent of the development of

40 Linda Nash, Inescapable Ecologies: A History of Environment, Disease, and Knowledge (Berkeley: University of California Press, 2006), 48; Martha L. Hildreth and Bruce T. Moran, “Introduction,” in Diseases and Medical Care in the Mountain West: Essays on Region, History, and Practice, ed. Hildreth and Moran (Reno: University of Nevada Press, 1998), xv; S. P. Crawford, “Southern Medical Literature,” Nashville Journal of Medicine and Surgery 18 (1860): 198. 41 Warner, “From Specificity to Universalism,” 90; idem, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton, NJ: Princeton University Press, 1998), 254-5; Crawford, “Southern Medical Literature,” 195; Mart A. Stewart, “'Let Us Begin with the Weather': Climate, Race and Cultural Distinctiveness in the American South,” in Nature and Society in Historical Context, ed. Mikuláš Teich, Roy Porter, and Bo Gustafsson (New York: Cambridge University Press, 1997), 242. 42 Breeden, “Medical Shortages,” 1043. Additional biographical information about Porcher—he received his medical degree from a South Carolinian school, and subsequently studied in New York and Paris before returning to the South—can be gleaned from Warner, Against the Spirit of System, 40, 78, 101, 109, 256. 97 remedies from southern flora, offering a nearly two-hundred-page report on the subject to the American Medical Association in 1849.43 In August 1861, De Bow's Review, which was produced jointly in Charleston and New Orleans, published a lengthy report of Porcher's detailing 121 potentially valuable southern plants. Porcher exhorted southerners to “look within [their] own limits for everything which may contribute to supplying [their] industrial wants,” arguing that “much may be supplied by the Southern States.”44 The report caught

Moore's attention. In 1862, the Surgeon General, after sending a directive throughout the

South asking the citizenry to report any indigenous plants with possible medicinal uses, released Porcher from his duties at a military hospital and commissioned him to expand his report into a comprehensive overview of the potential of southern flora to cure disease.45

Porcher's Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural, was published in 1863. Containing entries on over 35,000 species of southern plants (not all medicinal), the work was, as Porcher noted, intended equally for “the Regimental Surgeon in the field, the Physician in his private practice, or the Planter on his estate.” The focus on versatile utility was a staple of the southernist tradition; Erasmus Fenner, for example, had declared that Southern Medical Reports was “designed to be useful to the planter, merchant, lawyer, politician, and heads of families generally.”46 Stridently defending the ability of the

43 Francis P. Porcher, “Report on the Indigenous Medicinal Plants of South Carolina,” Transactions of the American Medical Association 2 (1849): 677-862. The AMA had launched a committee on indigenous medical botany at its inaugural meeting, with the committee chairman proclaiming that thorough knowledge of local remedies would eliminate “many of the so-called uncertainties of medicine.” Davis, “Report of the Committee on Indigenous Medical Botany,” Transactions of the American Medical Association 2 (1849): 664. 44 Porcher, “Resources of the Southern Fields and Forests: Trees and Plants Valuable in the Arts, for Manufacturing Purposes and in Domestic Economy, Growing in South Carolina and Georgia, and Common to Many of the Southern States,” De Bow's Review (new series) 6 (1861): 105-6. 45 Mary Elizabeth Massey, Ersatz in the Confederacy: Shortages and Substitutes on the Southern Homefront (Columbia, SC: University of South Carolina Press, 1952; repr., 1953), 119; Porcher, Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural: being also a Medical Botany of the Confederate States: with practical information on the useful properties of the trees, plants, and shrubs (Charleston: Steam-Power Press of Evans and Cogswell, 1863), iii. 46 Breeden, “Medical Shortages,” 1043; Porcher, Resources, iii; E. D. Fenner, “Preface,” SMR, 2: 11. 98 South to produce its own medicine, Porcher declared that remedies described in his treatise were “quite as valuable as others obtained from abroad,” though he did acknowledge that foreign medicine was at the moment “either impossible to be procured or scarce and costly.”

The botanical resources of the South, were, in Porcher's eyes, “extraordinarily rich,” and in the Confederacy's “wonderful exuberance of vegetation” lay its deliverance from the ravages of the sectional diseases that the devastation of war had intensified.47

From the standpoint of southernist medicine, Resources of the Southern Fields was notable in three respects. First, Porcher rejected localism within the South. Though identifying the specific habitat of each plant, Porcher emphasized that the vegetation he described was “the teeming product of every variety of soil and climate, from Maryland to

Florida, and from Tennessee to Texas,” and was thus the common possession of the

Confederacy and the southern people as a whole. Wartime southernist medicine displayed little of the provincialism, intended or otherwise, that had characterized southern medical colleges and periodicals prior to the war. The common cause of the South under siege trumped local triumphalism, and the desperation of war eliminated the economic incentives that had driven factionalism in antebellum southern medical education. If only because the war effectively ended medical professional activity in much of the South, it was during the

47 Breeden, “Medical Shortages,” 1043; Porcher, Resources, iii, vii.

Modern scholars' evaluations of Porcher's recommendations are mixed. Freemon characterizes the sum total of Resources on the Southern Fields as “the substitution of one inactive preparation for another.” Breeden demurs, arguing instead that southern indigenous remedies “were usually less dangerous” than were the “heroic” therapies of northern (and prewar southern) physicians. Freemon, “Administration of the Medical Department of the Confederate States Army,” Southern Medical Journal 80 (1987): 633; Breeden, “Medical Shortages,” 1046. On nineteenth-century American physicians' views of nature as a healer, and the implications of heroic therapy for their professional standing, see Warner, “'The Nature-Trusting Heresy': American Physicians and the Concept of the Healing Power of Nature in the 1850's and 1860's,” Perspectives in American History 11 (1977-78): 291-324. 99 conflict that southernist medicine became something of a united and unanimous discourse.48

Second, echoing Fenner's “isothermally” justified inclusion of California in Southern

Medical Reports a decade earlier, Porcher's reference in his preface to Maryland, a slave state that had remained in the Union, suggested that, political situation aside, Maryland was a natural member of the South. If Maryland's soil and vegetation was southern, and its people the product of their place, then the state as a whole was properly a part of Dixie as well. Medical appropriation was political appropriation. Writing immediately following

Robert E. Lee's 1862 advance into Maryland, Porcher may have been justifying the incorporation of the invaded territory into the Confederate States. Just as prewar southernist periodicals had done, wartime southern medical publications espoused a medicine that was as sectionalist as it was sectional.

Finally, like Fenner, who intended that his journals and the New Orleans School of

Medicine would endure as permanent beacons of an enriched southernist medicine, Porcher believed his work would “supply a present as well as a future want.”49 For southernist physicians, indigenous medicines were not merely a desperate stopgap for the superior foreign medicine that the conditions of the conflict rendered unavailable. Rather, wartime shortages provided a further impetus to the development of a distinctively southern medicine, with doctors not only educated in the South but also using the South to cure its own diseases. In this ideological framework, southern medical botany did not substitute for conventional (northern) remedies, but superannuated them. The Civil War had, in the view of Porcher and other southern practitioners, unshackled southern practice from its humiliating dependence on the North. Indigenous pharmaceuticals provided an opportunity

48 Porcher, Resources, vii. Emphasis added. 49 Ibid., iii. 100 for demonstrating the medical self-reliance of the South alongside its political independence, and Porcher's Resources of the Southern Fields was a concrete testament to the potential for the

South to succor its medical and political needs itself.

An Independent Medicine

Porcher's pharmacopoeia was not the only Confederate effort to develop local remedies. Moore distributed numerous circulars asking for recommendations on the medical uses of indigenous plants, and editorials in Confederate States Medical and Surgical Journal frequently appealed for contributions on southern flora. Moore encouraged in particular the planting of poppies in southern states, as the narcotic products of the plant were valuable and effective anesthetics. This initiative was met with enthusiasm, especially in rural and fertile North Carolina and Florida. As a result, painkillers were one of the few medicinal substances that the Confederacy did not lack during the sectional conflict, but wartime cultivation, combined with the devastating poverty of the postbellum South, led to a surge in opiate addiction in the region following the war.50 In addition, the medical department, under the auspices of the Confederate government, operated commercial laboratories, factories, and distilleries dedicated to research on and production of potentially useful southern botany. In Louisiana, for example, two facilities in 1864 produced turpentine, castor oil, and several other medicinal substances.51

50 On opiate addiction in the South, see Courtwright, Dark Paradise: A History of Opiate Addiction in America (Cambridge, MA: Harvard University Press, 1982 [as Dark Paradise: Opiate Addiction in America before 1940]; enl. ed., 2001), 38, 45; idem, “Opiate Addiction”; and idem, “The Hidden Disease: Opiate Addiction and Cocaine Use in the South, 1860-1920,” Journal of Southern History 49 (1983): 57-72. For a divergent view, see Mark A. Quinone, “Drug Abuse during the Civil War (1861-1865),” International Journal of the Addictions 10 (1975): 1007-20. 51 “Indigenous Remedies of the South,” 107; Riley, Jr., “Medicine in the Confederacy,” 57; Breeden, “Medical Shortages,” 1043; Duffy, From Humors to Medical Science, 165; Hall, “Confederate Medicine: Caring for the Confederate Soldier: An Introduction to the History of the Medical Corps of the Confederate Army in the War between the States,” Medical Life 42 (1935): 459; Howard L. Holley, A History of Medicine in Alabama (Birmingham, AL: University of Alabama Press, 1982), 139. In addition to the two facilities in Louisiana, 101 With the development of indigenous southern remedies, Confederate physicians attempted to fulfill not only a medical imperative, but also a psychological component of treatment. As Charles Rosenberg has observed, “people seemed to want medicines.” More than counsel, patients wanted prescriptions, and deployment of the therapeutic arsenal was as much or more a central component of the role of the doctor than was diagnosis of the ailment. The very fact of drugs provided, if not relief, then at least a modicum of formality that maintained the public's already-limited faith in physicians. With the blockade limiting the ability of physicians to supply pharmaceuticals, employment of native flora prevented a complete dissolution of the occupational prestige and exclusivity through which practitioners acquired their authority.52

That the medicinal flora was southern, however, carried particular resonance.

Conceptions of the South as unhealthy pervaded nineteenth-century American culture.

Everything southern—weather and aliment, and by extension society and culture—was tainted with an implicit but ever-present assumption of insalubrity. The romantic image of the southern swamp, dark, gothic, harboring creatures and criminals, and productive of disease-causing miasma, firmly ensconced the region in the American psyche as a baneful, noxious area. Ronald Numbers notes that the South's “very identity has sometimes centered on disease.” With the presence of illness carrying a moral weight, southern insalubrity resulted in the region's ideological degradation. As much as slavery, the perceived unhealthiness of the South defined Dixie, in the minds of both northerners and

Confederate botanical laboratories were found throughout the South, with factories in Richmond, Charlotte, Lincolnton (North Carolina), Columbia (Georgia), Augusta, Macon, Atlanta, Milledgeville (Georgia), Knoxville, Tyler (Texas), Arkadelphia (Arkansas), Montgomery, and Mobile. Bollet, Civil War Medicine, 247; Massey, Ersatz in the Confederacy, 119. 52 Charles E. Rosenberg, “The Practice of Medicine in New York A Century Ago,” Bulletin of the History of Medicine 41 (1967): 245. On professional authority in the nineteenth-century United States, see Daniel H. Calhoun, Professional Lives in America: Structure and Aspiration, 1750-1850 (Cambridge, MA: Harvard University Press, 1965). 102 southerners, as a region apart from the rest of the United States.53

More than other Americans of the nineteenth century, perhaps as a result of the increasing marginalization they felt within the Union, southerners identified strongly with their section—with its culture, with its mythology, and with the land resting beneath the two.

Southerners believed, as John Harley Warner terms it, that “the singular natural resources of the South went largely unexplored” in the northern-dominated discourse of antebellum

America. The primarily agrarian lifestyle of the region, by virtue of which southerners were in literal, visceral, and continuous contact with the southern earth, reinforced the sense that a southerner did not merely live in the South, but was from the South in the most fundamental way. Southerners frequently argued that the southern lifestyle sprung from and was dictated by the land of the South—in the words of one South Carolina planter, all of southern society was “an affair of geography.” Plantations, slavery, and agriculture; the landed aristocracy, sharecroppers, and backwoodsmen; distinctive art, architecture, and social convention: all were, according to many southerners, consequences of the southern environment, and so were the southern people. The South was unique, claimed southerners, because its climate and vegetation were different; and southerners passionately defended this difference because they, like the region's flora, were products of the southern soil.54

53 Steven M. Stowe, Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Chapel Hill: University of North Carolina Press, 2006), 4; Carrigan, “Yellow Fever: Scourge of the South,” in Disease and Distinctiveness, 70; David C. Miller, Dark Eden: The Swamp in Nineteenth-Century American Culture (New York: Cambridge University Press, 1989), 8, 13; Kirby, Poquosin: A Study of Rural Landscape & Society (Chapel Hill: University of North Carolina Press, 1995), 163; Numbers, “The Significance of Regions in American Medical History,” in Diseases and Medical Care in the Mountain West, ed. Hildreth and Moran, 7. 54 Stewart, “What Nature Suffers to Groe”: Life, Labor, and Landscape on the Georgia Coast, 1680-1920 (Athens, GA: University of Georgia Press, 1996), 243-45; idem, “'Let Us Begin with the Weather,'” 243; Warner, “A Southern Medical Reform: The Meaning of the Antebellum Argument for Southern Medical Education,” in Science and Medicine in the Old South, ed. Numbers and Todd L. Savitt (Baton Rouge: Louisiana State University Press, 1999), 213; William Elliott, The Anniversary Address of the State Agricultural Society of South Carolina, delivered in the hall of the House of Representatives, November 30, 1848 (Columbia, SC: South Carolina Agricultural Society, 1848), 43; Drew Gilpin Faust, “The Rhetoric and Ritual of Agriculture in Antebellum South Carolina,” Journal of Southern History 45 (1979): 556; O'Brien, Conjectures of Order: Intellectual Life and the 103 The notion that this same southern soil was not pestilential but was instead, in

Porcher's terms, “a bounteous Providence,” was a powerful validation of southern sectionalism. The ability to maintain health in the South with southern plants offered the promise of a self-reliance that southerners, including and especially southern physicians, had found elusive in the antebellum United States. Finding health in the land of the South was symbolically finding health in the southern population, and, by extension, the southern polity. Dixie was, as one southern medical student declared, “the land that gave

[southerners] birth.” The war and the blockade made the search for indigenous remedies a humanitarian imperative, but the ideological uplift that the prospect of success promised drove the movement as much as did considerations of wartime health. Like the overlapping of professional promotion and sectional prestige in antebellum arguments for southern medical distinctiveness, the wartime search for southern medical botany could legitimize both southern physicians and their country, née region, writ large.55

The search for indigenous medicines likewise offered for physicians the potential for a truly singular southern enterprise. The prewar rhetoric of southern medical distinctiveness and the emphasis on southern medical education had implicitly accepted (even if it explicitly

American South, 1810-1860, 2 vols. (Chapel Hill: University of North Carolina Press, 2004), 1: 145.

Early twentieth-century historians of the South trained in the school of environmental determinism would apply much the same logic to their analyses of the region. For examples of this approach to southern history and society, see W. J. Cash, The Mind of the South (New York: A. A. Knopf, 1941; repr., New York: Vintage Books, 1991); Clarence Cason, 90º in the Shade (Chapel Hill: University of North Carolina Press, 1935; repr., Tuscaloosa: University of Alabama Press, 2001); and Ulrich Bonnell Phillips, Life and Labor in the Old South (Boston: Little, Brown, & Co., 1929; pbk. ed., Columbia, SC: University of South Carolina Press, 2007). Phillips's work opens with the famous line “let us begin by discussing the weather, for that has been the chief agency in making the South distinctive” (p. 3). For more recent and nuanced examinations of the relationship between southern climate and southern culture, see Raymond Arsenault, “The End of the Long Hot Summer: The Air Conditioner and Southern Culture,” Journal of Southern History 50 (1984): 597- 628; and A. Cash Koeniger, “Climate and Southern Distinctiveness,” Journal of Southern History 59 (1988): 21-44. 55 Porcher, Resources, vii; William W. Cozart, “The Place where Southern Students Should Acquire their Medical Knowledge” (M. D. thesis, Medical College of the State of South Carolina, 1856), 15. 104 opposed) the conception of the Sickly South. The value of practical experience in the

South, in the eyes and words of antebellum southernists, was a knowledge of and exposure to southern disease, not southern antidotes. The faculty of southern medical schools had mainly received their education in the North, and while they often used their own experience to validate their promotion of southern training, even the most strident southernists admitted that in point of fact difference in instruction between the sections was almost nonexistent. Instead, they claimed, it was the potential for practical experience with southern illness that should compel southern students to stay in Dixie. The almost obsessive preoccupation of antebellum southern physicians with yellow fever, the most visible and most harmful distinctly southern disease, illustrates the assumption of insalubrity in the discourse of southern medical exceptionalism. Southern medical practice mattered, southernists argued, because the South was uniquely unhealthy. The distinctively southern medicine of antebellum America was more about place than practice, and depended on the fundamental identity of the South as an especially afflicted area. Though claims to specialized knowledge of southern physicians may have benefited the antebellum South as a whole, they reinforced rather than challenged American conceptions of diseased Dixie.

Using southern flora to treat southern diseases shifted this calculus. The Civil War destroyed the professional institutions of southernist medicine and effectively disproved the acclimation theory that southern physicians considered a central tenet of practice, but the conflict at the same time provided the possibility for the development of a medical care that was determinedly southern in both location and material. Physicians connected the potential for southern pharmaceuticals with the viability, and even the propriety, of the South as a political entity. As Moore proclaimed, “the bountiful Providence has spread over the broad surface of our Southern land, all the elements of an independent nationality.” Southern- 105 made medicine allowed the shedding of the implicitly moral taint that attended American conceptions of the pestilential South. Rather than as a degraded area, the salutary South could stand aside the North as a righteous place of political independence. Sectional drugs supported sectional aspirations; medical autonomy signified political autonomy.56

So too, the search for native remedies implied, did the South, no longer sickly, possess all the elements of an independent medical profession. Southern pharmacology testified to the value of local southern knowledge, validating the prewar focus of Southern

Medical Reports and other publications on specifically southern topography.

Medicogeographical essays had for antebellum practitioners demonstrated their unique claims to possession of the South, and Confederate physicians extended these claims further: knowledge of medical geography indicated not merely possession of territory, but the ability to implement a region's resources to practical ends. Southern medical botany suggested that doctors could not only know but also use the South, and that attendant with the recognition of southern ailments was the creation of a determinedly southern health.

Medicinals situated in the land of the South promised the development of a medicine and a medical profession independent of those of the North.

In efforts to development indigenous remedies, southern medical exceptionalism became for the first time fully southern in application as well as rhetoric. Erasmus Fenner's

Southern Medical Reports had provided a legitimating impetus to the professional production of southernist discourse, but championed essentially “northern” medicine practiced in the

South, and the establishment of southern medical colleges was at its core an economic, not sectional, endeavor. In contrast, the search for southern medicinal botany was an effort— even if one determined largely by northern imposition—to find in the South a regional

56 “Indigenous Remedies of the South,” 106. 106 medicine. As one Alabama physician argued, a proper “southern medicine like southern plants can only flourish in a southern climate.” Rooted in the southern soil, as southerners felt themselves to be, indigenous southern remedies afforded a symbolic affirmation of the potential for self-reliance of the South and its medical profession.57

57 W. T. Taylor, “Annual Oration,” in Transactions of the Medical Society of the State of Alabama at Its Eighth Annual Session, Begun and Held in the City of Mobile, February 5, —6, —7, 1855 (Mobile: Middleton, Harris, & Co., 1855), 120. 107 CONCLUSION

POLITICAL MEDICINE

The coming of the Civil War had not eliminated the discourse of southernist medicine, and the end of the war did not either. Though the opportunity for the South's political independence had passed, southern sectionalism did not end at Appomattox; and though all professional groups in the postbellum South had suffered severe losses of members, morale, and a populace to support their endeavors, southern physicians remained a class seeking occupational prestige. Samuel Preston Moore retired from medical work to live in Richmond and work with the Virginia Agricultural Society, but many of the principal antebellum advocates for southern medical distinctiveness attempted to reconstitute the institutions that southern medical exceptionalism had inspired, and within which it had, rhetorically at least, thrived.1

The devastation of the postwar South greatly distressed Erasmus Darwin Fenner; an obituarist of the New Orleanian would later attribute Fenner's development of diabetes to his despair over the condition of his section. Fenner nevertheless sought to revivify his school and his periodical activity with the same determinedly southernist and expressly New

Orleanian bent as prior to the conflict. The New Orleans School of Medicine reopened on

November 13, 1865, with the Medical Department of the University of Louisiana reconstituting itself the same year. In a bid attract enough students to remain financially solvent, both schools offered supplemental spring and summer programs in addition to their regular terms of study. For the next several years, the School of Medicine's class ranged in number between 60 and 108 students, at its largest less than half the size it had reached prior

1 Carrington Williams, “Samuel Preston Moore: Surgeon General of the Confederate States Army,” Virginia Medical Monthly 88 (1961): 573-55. 108 to the war. Fenner remained fully involved in the school's operations, exacerbating his declining health in his refusal to cease teaching.2

The New Orleans Medical and Surgical Journal resumed publication in July 1866, following closely on the heels of the founding of the Southern Journal of the Medical Sciences, which the editorial staff of the prewar New Orleans Medical News and Hospital Gazette, highlighted by Fenner and D. Warren Brickell, had inaugurated on May 4, 1866. Fenner, as fate would have it, died the same day; his last journal's most cited article today is its founder's obituary. Fenner was committed to his southernist institutions to the end, and witnesses to his passing noted that while semi-conscious he “was muttering of the School of Medicine,” and several times asked Brickell about the prospects of success for their new journal.3 The

“honorable rivalry” between the schools, and the proxy war of words between the journals, lingered even past Fenner's death. An obituary published in New Orleans Medical and Surgical

Journal, the periodical Fenner had founded over two decades earlier, was singularly muted in its praise, claiming that Fenner had “struggled to attain an enviable distinction” among his fellow doctors and the citizens of New Orleans. Brickell, Fenner's professional colleague and close friend, angrily declared in response that “never was a greater error conceived” than the diminishing of Fenner's stature in the Louisiana medical community.4

2 Joseph Jones, “American Medical Necrology: Fenner, Erasmus Darwin,” Transactions of the American Medical Association 29 (1878): 653-54; “Obituary: Prof E. D. Fenner,” Medical Record 1 (1866): 222-23; John Duffy, The Rudolph Matas History of Medicine in Louisiana, 2 vols. (Baton Rouge: Louisiana State University Press, 1958), 2: 386; “[Untitled Editorial],” NOMSJ [as New Orleans Journal of Medicine] 22 (1869): 191-92; “List of Matriculates New Orleans School of Medicine.—Session 1866-67,” SJMS 1 (1866-67): 798. Jones claims that Fenner's “last illness was greatly aggravated, if not absolutely induced, by his incessant labors, and by his refusal to intermit work even after several serious paroxysms of fever.” 3 Duffy, “Erasmus Darwin Fenner (1807-1866), Journalist, Educator, and Sanitarian,” Journal of Medical Education 35 (1960): 823; idem, The Rudolph Matas History of Medicine, 2: 530; “Obituary: Prof E. D. Fenner,” 222; Jones, “American Medical Necrology,” 654. 4 “Necrological Notices,” NOMSJ 19 (1866-67): 139; D. Warren Brickell, “Biographical Sketch of Erasmus Darwin Fenner, M.D., late Professor of the Theory and Practice of Medicine in the New Orleans School of Medicine, Senior Editor of the Southern Journal of the Medical Sciences, etc., etc.,” SJMS 1 (1866-67): 422. When the two journals merged in 1867, one of the first declarations of the editors of the joint 109 Neither his school nor his last periodical long outlived Fenner. The Southern Journal of the Medical Sciences published only two volumes, reluctantly merging in 1867 with the New

Orleans Medical and Surgical Journal. The consolidated periodical was rechristened the New

Orleans Journal of Medicine, under which name it would publish until monetary issues forced a hiatus in production between 1870 and 1873. The School of Medicine, lacking students and students' fees, a youthful faculty, and the energy and dedication of its founder, suspended operations in April 1870. Brickell founded a successor school, the Charity Hospital Medical

College, in 1873, but the institution folded four years later. The Medical Department of the

University of Louisiana would endure without serious challenge as the premier medical school in the Crescent City until the 1931 chartering of the Louisiana State University

School of Medicine. With the deaths of Bennet Dowler in 1878 and Brickell in 1881, the

Louisiana medical profession had lost nearly all of its antebellum southernist agitators within two decades of the Civil War.5

For most of Reconstruction, however, southern medical exceptionalism endured as a tangible idea. S. M. Bemiss, one of the editors of the New Orleans Journal of Medicine, deliberately “[appealed] most directly and most earnestly to the whole Profession of the

South,” declaring that not only was “there … propriety in the universality with which

Southern practitioners look to the medical periodicals of their own section,” but also that

“such literature and information is to them a necessity.” Similarly, the New Orleans Journal of

Medicine claimed for the Crescent City “local advantages” for medical instruction that “more

publication was that the new “Journal is pledged not to become the organ of either School.” “Medical Teaching in New Orleans,” NOMSJ [as New Orleans Journal of Medicine] 22 (1869): 386; Stanford Chaillé, “To the Subscribers and all Patrons of the New Orleans Med. and Surg. Journal,” NOMSJ 20 (1867): 421-23. 5 “Consolidation of the two Medical Journals,” SJMS 2 (1867): 595; S. M. Bemiss, “Salutatory,” NOMSJ [as New Orleans Journal of Medicine] 21 (1868): 193; William Dosité Postell, “Erasmus Darwin Fenner and the Beginnings of Medical Literature in Louisiana,” Annals of Medical History (3rd series) 3 (1941): 297-305; Duffy, The Rudolph Matas History of Medicine, 2: 529-30. 110 than counterbalance” the superior facilities of medical schools elsewhere. Northern colleges may have had better-known faculty and more modern equipment, but, Bemiss argued, these

“alone can no more qualify one for the practice of medicine than for swimming.” Foremost among the advantages of New Orleans for medical training was potential experience with southern diseases: New Orleans, the editors asserted, was “not only … the best place in the world to have yellow fever” because of the superiority of southern physicians, but also “the best place to study” Yellow Jack and a host of other sectional afflictions. Such sentiment echoed, of course, the prewar language used to justify southern and New Orleanian medicine. Emphasis on empiricism and experience did not fall with the Confederacy.6

Southernist medicine was perhaps less prominent in the postbellum South than it had been before the war, but the difference was one of magnitude, not of presence and absence. The sectional conflict had so devastated the southern land, population, and economy that few postwar outlets existed for the expression of professional rhetoric, and the southern medical profession as a whole, like nearly all segments of southern society, emerged from the war battered, demoralized, and greatly reduced in number. Many of those physicians who had lost their lives in the war or left the South seeking better professional or economic prospects were among the most vocal and learned doctors in Dixie, and their departures partially muzzled the southernist viewpoint.7

Though the Civil War had discredited (though not eliminated belief in) the acclimation theory of southern illness, in other ways the conflict and its aftermath reinforced many of the observations upon which arguments for a distinctively southern medicine

6 Bemiss, “Salutatory,” 193; “Medical Teaching in New Orleans,” 386-87; Steven M. Stowe, Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Chapel Hill: University of North Carolina Press, 2004), 264. 7 Joseph Ioor Waring, A History of Medicine in South Carolina 2 vols. (Columbia, SC: South Carolina Medical Association, 1964; Charleston, SC: South Carolina Medical Association, 1967), 143. 111 rested. The destruction of southern infrastructure and the poverty of Reconstruction exacerbated health problems in the South, increasing the incidence of malaria and leading to the entrenchment of hookworm and pellagra (which appeared in the North only in isolated cases) throughout Dixie. Though yellow fever appeared less frequently than in the antebellum period, when Yellow Jack did come, as in 1878, the epidemics were even more devastating than they had been prior to the war, with the disease running rampant in the unsanitary conditions of devastated southern cities. The same war that squelched the political impetus for southernist medicine intensified the movement's medical rationale.8

Southern physicians did not ignore the war, but neither did they defiantly celebrate the romance of the lost southern cause. Though topographies continued to be popular

(claims to possession of southern land could never entirely fall by the wayside), accounts of surgical operations and military medical matters appeared much more frequently in postwar periodicals than they had prior to 1861. Contrary to the firebrand editorials of the antebellum period, postwar articles defending sectional medicine were almost apologetic in tone, with one editorial in the New Orleans Journal of Medicine stressing that the authors

“would be distinctly understood as deprecating any appeal to sectional pride or preference.”

Whether tempered, chastened, or simply wary of offending the Reconstruction authorities, southern practitioners promoted southern medicine less stridently following their section's surrender of arms. Lack of stridency did not, however, imply a lack of conviction.9

What ultimately ended the southernist medical enterprise had little to do with the

8 Duffy, “The Impact of Malaria on the South,” 29-54, Alan I. Marcus, “The South's Native Foreigners: Hookworm as a Factor in Southern Distinctiveness,” 79-99, and Elizabeth W. Etheridge, “Pellagra: An Unappreciated Reminder of Southern Distinctiveness,” 100-119, all in Disease and Distinctiveness in the American South, ed. Todd L. Savitt and James Harvey Young; Jo Ann Carrigan, The Saffron Scourge: A History of Yellow Fever in Louisiana, 1796-1905 (Lafayette, LA: Center for Louisiana Studies, University of Southwestern Louisiana, 1994), 113. 9 “Medical Teaching in New Orleans,” 387; Stowe, Doctoring the South, 269. 112 South, but much to do with medicine. An emphasis on empirical observation did not disappear as medical science advanced, but the location of observation shifted gradually but inexorably from landscape to laboratory. While it is, as John Harley Warner notes, too simplistic to argue that medicine became “more scientific” postbellum, the proper place of science was no longer largely local, and the proper methods no longer particularly personal.

Science was not yet industrial or global, but it had expanded, if only haltingly, beyond a regional context. Many of the founding events of what is today considered “modern” medicine occurred in the two decades following the American Civil War. Joseph Lister began promoting aseptic surgery in 1867; Robert Koch isolated Bacillus anthracis in 1877; and

Louis Pasteur famously demonstrated the rabies vaccine on Joseph Meister in 1885.

Microbes supplanted if did not entirely replace miasma as a putative cause of disease.

Medical knowledge, especially about the diseases of the global South, accumulated so quickly that definitive works on tropical and subtropical illness were rendered obsolete in the time between their completion and publication.10

Within the context of the principle of specificity, which enshrined local knowledge as central to successful practice, it had been more than plausible for southern physicians to argue that “Southern medicine must widely differ both as a science and an art, from

Northern medicine.”11 Yet in experimental investigation, southern medicine did not and could not differ as a science from that of the North. Divergence between northern and southern practice was incommensurable, or at least illogical, within the putatively objective gaze of laboratory science. Regional medicine became a distinction without a difference.

10 John Harley Warner, “Science in Medicine,” in Historical Writing on American Science: Perspectives and Prospects, ed. Sally Gregory Kohlstedt and Margaret W. Rossiter (Baltimore: The Johns Hopkins University Press, 1985), 50; François Delaporte, The History of Yellow Fever: An Essay on the Birth of Tropical Medicine, trans. Arthur Goldhammer (Cambridge, MA: MIT Press, 1991), 11. 11 Bemiss, “Salutatory,” 193. 113 Knowledge was not yet fully universal, but the pendulum had swung away from recognition of localized knowledge in context.

No longer differing as a science, the art of southern medicine could no longer differ from that of the North either. By 1892, when a group of southern educators formed the

Southern Medical College Association with the express purpose of effecting the adherence of southern medical schools to the practices of their northern counterparts, southern medical exceptionalism had become a discourse for practitioners of low status in the South, not self-styled intellectuals. Southern medical distinctiveness still carried social resonance; southern public officials would, for example, oppose a federal health agency by claiming that northern officials had no experience with yellow fever, and therefore could not effectively regulate the South. By and large, however, sectional medicine was no longer a badge of authority, but instead a mark of backwardness.12

The Profession Speaks

This study began with a quote. James Billingslea's claim that not only politics but also “humanity” demanded a recognition of and attention to a distinctively southern medicine was a powerful expression of the dualism of the southernist medical program. Southernist doctors attempted to reconcile the uneasy and at times incompatible tension between serving medicine and serving the South, promoting local interests and promoting sectional unity, and, during the Civil War, fighting the North and fighting disease. At each step of the development of southern medical exceptionalism—from the rhetoric of periodicals to the practice of medical instruction, and further to the crisis and ultimate transformation of the discourse in the cauldron of the war—physicians' claims to professional legitimacy validated

12 Warner, “Education, Medical,” in Encyclopedia of Southern Culture, ed. Charles Reagan Wilson and William Ferris (Chapel Hill: University of North Carolina Press, 1989), 1349-50; Margaret Humphreys, Yellow Fever and the South (New Brunswick, NJ: Rutgers University Press, 1992), 13-14. 114 their region's sectional and secessionist proclivities.

For much of the nineteenth century, as Warwick Anderson argues, medicine was a

“fundamentally moral understanding of how to inhabit a place with propriety.”13 Medicine and disease came from place; the holism of health involved not merely the body in toto, but the relationship between body, landscape, atmosphere, and a host of other diverse and vaguely defined natural elements. For inhabitants of the South—many of whom worked the land, defended the land, and attributed their circumstances to the land more causally than did their contemporaries in other regions—the connection between disease and place yoked southern diseases to the southern people. In viewing in the South the potential for new publications, unique education, and particularly and peculiarly southern medicines, with the same southern soil that was productive of disease simultaneously productive of cures, southern physicians found in the South the potential for an independent entity that was as much political as medical. In attempting to vitiate the notion of the diseased South, southernists sought to cast off the implicit taint of immorality that colored conceptions of

Dixie in the nineteenth century. The southern polity did not rest on medical precepts, but the appropriation of a unique medicine for the South constituted a claim to knowledge and authority that was equally and inextricably sectional and professional.

Southernist medicine was not one entity. Yet the expression of the several strands of discourse—regional affinity, local medical education, acclimation, and indigenous medicinal botany—demonstrates the distinction between a united movement and a mass movement, between professional language and the common language of a profession. If only because it is individuals who speak, works of history (this study included) must focus

13 Warwick Anderson, The Cultivation of Whiteness: Science, Health and Racial Destiny in Australia (Melbourne: Melbourne University Press, 2002), 4. 115 on individuals to exemplify abstractions; but in the case of southern medical exceptionalism, it may be proper to say that no single doctor was a southernist. Rather, the enterprise of southern physicians as a diverse, factional, individualized, and sectional group constituted in aggregate the essence of a distinctively southern medicine. Arguing for and against their section and themselves, nineteenth-century southern physicians, sharing a set of assumptions about their world and the practice of medicine, unintentionally created a movement in which people did not always or often move the same way. And, as laboratory medicine ultimately suggested about the South, southern doctors were far from unique. A marginalized social class in a marginalized region, southern physicians found in their marginalization the potential for their uplift. Understanding the doctors of the American

South thus provides a lens for understanding the dovetailing of regional or national differences and professional interests elsewhere in time and place. Distinctively medical and distinctly political, the dual discourse of southern physicians of the mid-nineteenth century was determinedly local in expression, but exemplified and shaped trends—of medicine, of regionalism, and of social relations— larger than itself.

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BIBLIOGRAPHY

In the interest of maintaining brevity without sacrificing thoroughness, I have limited my discussions of each source; in general, the longer the annotation, the more relevant or important the work to my subject. Secondary sources are arranged thematically, roughly in the order that the themes appear in the thesis, though of course divisions between categories are fluid. For the New Orleans journals, I have included a few key sources (and no editorials) as separate entries, but the footnotes in the main text are more useful for locating individual articles.

Primary Sources

Journals and Official Records New-Orleans Medical Journal (1844-45); New Orleans Medical and Surgical Journal (1845-67); New Orleans Journal of Medicine (1868-70) New Orleans Medical News and Hospital Gazette (1854-61) New Orleans Medical Times (1861) Southern Journal of Medical Sciences (1866-67) Erasmus Fenner cofounded the New Orleans Medical and Surgical Journal in 1844, and remained on the editorial staff until 1848, when he left to found Southern Medical Reports. Through the 1850s, New Orleans Medical and Surgical Journal became something of a mouthpiece for the Medical Department of the University of Louisiana. Fenner assumed the editorship of the New Orleans Medical News and Hospital Gazette in 1857, and the journal subsequently affiliated itself closely with Fenner's New Orleans School of Medicine. The Hospital Gazette ceased publication in 1861, and the New Orleans Medical Times briefly succeeded Fenner's periodical. The Southern Journal of the Medical Sciences, Fenner's short-lived last journal, published its first issue on the day of its founder's death, and soon merged with New Orleans Medical and Surgical Journal, with the combined periodical publishing as the New Orleans Journal of Medicine for three volumes.

Fenner, E. D., ed. Southern Medical Reports. 2 vols. New York: B. M. Norman, 1850; Samuel S. & William Wood, 1851. Fenner founded this journal in 1850 to much fanfare, intending it to serve as a flagship journal for southernist medicine. Though it ceased publication after two years due to lack of funding, it is one of the best examples of actual movement toward an independent southern medical profession, and Fenner's introductory address to the first issue is something of a manifesto for southern medical exceptionalism.

Confederate States Medical and Surgical Journal (1864-65) This short-lived journal represents close to the sum total of southern medical literature produced during the Civil War. With the active support of Confederate Surgeon General Samuel Preston Moore, Confederate States Medical and Surgical published original contributions from southern physicians, as well as extensive extracts from foreign journals. Much of the journal's content focused on military surgery and indigenous substitutes for unavailable medical supplies.

Atlanta Medical and Surgical Journal Charleston Medical Register Nashville Journal of Medicine and Surgery Savannah Journal of Medicine Southern Medical and Surgical Journal 117 Stethoscope and Virginia Medical Gazette This is a sampling of medical journals from various areas in the antebellum South. The editors of the Savannah Journal once claimed that “this is a Southern journal and one devoted to Southern literature and diseases of the Southern country” (italics original).

The War of the Rebellion, A Compilation of the Official Records of the Union and Confederate Armies. 4 series, 70 volumes. Washington, DC: Government Printing Office, 1880-1901; repr., Harrisburg, PA: Historical Times, 1985; Wilmington, NC: distributed by Broadfoot Publishing Co., 1985. The fourth series of the Official Records contains numerous circulars that the Confederate Medical Department issued regarding indigenous medical botany. The Official Records as a whole contains a comprehensive index directing researchers to individual volumes within the four series, and each volume contains contains an index by page.

United States Surgeon-General's Office. Medical and Surgical History of the War of the Rebellion. 12 vols. Washington, DC: Government Printing Office, 1870-1878; repr., Wilmington, NC: Broadfoot Publishing Co., 1990-1992. The government's official Medical and Surgical History is an excellent reference tool and primary resource for much work on Civil War medicine.

Articles, Texts, and Miscellaneous Sources American Medical Association. “Report of the Committee on Education.” Transactions of the American Medical Association 1 (1848): 235-48. The AMA Committee on Education laments the state of medical instruction in the United States and urges an expansion of experiential education.

———. “Report of the Committee on Medical Literature.” Transactions of the American Medical Association 1 (1848): 249-88. The inaugural AMA Committee on Medical Literature declaims that the intent of medical study in the United States should be to observe “what nature has done with her American elements, and teach us what disease is here,” as opposed to in Europe.

Annual Report and Circular of the New Orleans School of Medicine. 3 vols. New Orleans: Bulletin Book and Job Office, 1857, 1858, 1859. The annual reports of Fenner's medical school offer a window into the practical implementation, couched in southernist and empirical discourse, of his ideas of medical reform.

Bartlett, Elisha. A Discourse on the Times, Character and Writings of Hippocrates. New York: H. Bailliere, 1852. Bartlett's ode to Hippocrates is a demonstration par excellence of the high esteem that antebellum American physicians held for the father of medicine.

———. The History, Diagnosis, and Treatment of the Fevers of the United States. Revised by Alonzo Clark. Philadelphia: Lea & Blanchard, 1847, 4th ed., rev., 1856. Bartlett's encyclopedic treatise contains a lengthy section on yellow fever's general confinement to warm and humid (and therefore southern) regions.

Barton, E. H. Introductory Lecture on Acclimation, delivered at the opening of the third session of the Medical College of Louisiana. New Orleans: Commercial Bulletin Print., 1837. Barton discusses the putatively misunderstood role of acclimation to the southern environment. 118

———. Introductory Lecture on the Climate and Salubrity of New Orleans and Its Suitability for a Medical School. New Orleans: E. Johns & Co., 1835. Barton's lecture at the opening of the Medical College of Louisiana grandiloquently expounds upon several tropes of southernist medicine, including the peculiarity of southern diseases and the need for southern medical students to study in the South.

Bowling, W. K. “Seceding Students.” Nashville Journal of Medicine and Surgery 18 (1860): 169- 75. In the winter of 1859, many southern medical students withdrew from Philadelphia's medical schools, alleging that the abolitionist climate of the city in the wake of John Brown's execution had been life in the North intolerable for them. Bowling defends their claims. A number of secondary sources also address this topic; see the “Medical Education” section below.

Brickell, D. Warren. “Biographical Sketch of Erasmus Darwin Fenner, M.D., late Professor of the Theory and Practice of Medicine in the New Orleans School of Medicine, Senior Editor of the Southern Journal of the Medical Sciences, etc., etc..” Southern Journal of the Medical Sciences 1 (1866-67): 401-23. Brickell's obituary is a lengthy celebratory ode to Fenner.

Brieger, Gert H., ed. Medical America in the Nineteenth Century. Baltimore: The Johns Hopkins University Press, 1972. This sourcebook contains several nineteenth-century essays on different aspects of medicine. Brieger provides short but valuable introductions to each section of the book.

Cartwright, Samuel A. “Address delivered before the Medical Convention, in the city of Jackson, January 13, 1846.” New Orleans Medical and Surgical Journal 2 (1845-46): 724- 33. Bell, John. “Dr. Cartwright's Address – State-Rights Medicine.” Bulletin of Medical Science 4 (1846): 207-13. Cartwright's address was one of the earliest articulations of southern medicine's heroic history, and Bell, a prominent Philadelphia physician, gave a spirited and satirical northern reaction to the call for southern medical distinctiveness.

———. “Cartwright on Southern Medicine.” New Orleans Medical and Surgical Journal 3 (1846-47): 259-72. Cartwright argues, with appeal to climate, government, and parallels of latitude, that Hippocrates was a southern doctor, and that southerners ought to read Greek works directly, rather than relying on distorted “northern” medicine taught in Edinburgh and Philadelphia.

———. “Statistical Medicine or Numerical Analysis Applied to the Investigation of Morbid Actions: A Lecture, delivered by request, to the Medical Class of the University of Louisville, January 17th, 1848.” Western Journal of Medicine and Surgery (3rd series) 1 (1848): 185-206. Cartwright discusses statistics and the alleged unhealthiness of the Mississippi Valley.

Cochran, Jerome. “Rationalism and Empiricism : The Laws and Limitations of Scientific Investigation.” Nashville Journal of Medicine and Surgery 18 (1860): 119-28, 206-15. Cochran's essay exemplifies the mid-nineteenth-century commitment to empiricism with which proponents of southernist medicine justified their arguments. 119

Cozart, William W. “The Place where Southern Students should acquire their Medical Knowledge.” M.D. thesis, Medical College of the State of South Carolina, 1856. Cozart argues for southern students to study medicine in the South, and in the process equates the North's “monopolies in science” to those “in political economy.”

Crawford, S. P. “Southern Medical Literature.” Nashville Journal of Medicine and Surgery 18 (1860): 195-98. Appealing to naturalistic conceptions of illness modified by geography, Crawford laments the absence of robust southern medical literature and southern medical colleges.

Davis, N. S. “Report of the Committee on Indigenous Medical Botany.” Transactions of the American Medical Association 1 (1848): 341-57. This report notes the belief “that there exist in the vegetable kingdom of every country appropriate and effectual remedies for the diseases of that country,” which helped fuel the Confederate effort to find indigenous substitutes for medicinal substances in short supply.

———. “Report of the Committee on Indigenous Medical Botany.” Transactions of the American Medical Association 2 (1849): 663-75. The AMA commissioned Francis Porcher to compile a report on the medicinal plants of South Carolina that later proved instrumental to his Civil War catalogue of southern flora.

Drake, Daniel. A Systematic Treatise, Historical, Etiological, and Practical, on the Principal Diseases of the Interior Valley of North America as they appear in the Caucasian, African, Indian, and Esquimax Varieties of the Population. Edited by S. Hanbury Smith and Francis G. Smith. Philadelphia: Lippincott, Grambo, & Co., 1854. Drake's classic study of the diseases of the Mississippi Valley is an exemplar of antebellum understandings of the relationship between disease and environment.

Elliott, William. The Anniversary Address of the State Agricultural Society of South Carolina, delivered in the hall of the House of Representatives, November 30, 1848. Columbia, SC: State Agricultural Society of South Carolina, 1848. Elliott, treating the insalubrity of the South as an incontestable fact, argues that the existence of slavery in the South is “an affair of geography, rather than of choice.”

Fenner, E. D. History of the Epidemic Yellow Fever at New Orleans, La., in 1853. New York: Hall, Clayton, 1854. Fenner gives a contemporary's account of New Orleans's worst pre-Civil War epidemic.

Forry, Samuel. The Climate of the United States and Its Endemic Influences: Based chiefly on the records of the Medical Department and Adjutant General's Office, United States Army. New York: J. & H. G. Langley, 1842; repr., AMS Press, 1978. Forry, a former United States Army doctor, based this treatise on mortality and morbidity statistics gathered from military posts around the country in the 1830s. The study was for a long period the most complete medical topography of the United States.

Fulton, John. Memoirs of Frederick A. P. Barnard. New York: Macmillan, 1896. Barnard, a northerner who taught in the South, deals with southernist discourse at length.

Gooch, P. Claiborne. “The Great Medical Centre of the South.” Stethoscope and Virginia 120 Medical Gazette 3 (1853): 468-476. Gooch, quoting extensively from an introductory address given by a colleague at the University of Nashville, argues for “a great Southern medical institution,” which Gooch claims should, for financial, climatic, and accessibility reasons, be located in Richmond.

Hentz, Charles A. A Southern Practice: The Diary and Autobiography of Charles A. Hentz, M.D. Edited by Steven M. Stowe. Charlottesville, VA: University Press of Virginia, 2000. The diary of Hentz, an Alabaman physician practicing from the 1850s until 1894, provides a window into attitudes dominant among southern doctors in the nineteenth century.

Jones, Joseph. “American Medical Necrology: Fenner, Erasmus Darwin.” Transactions of the American Medical Association 29 (1878): 646-54. This obituary relies heavily on Brickell's “Biographical Sketch.”

LeCont[e], Joseph. “On the Science of Medicine and the causes which have retarded its practice.” Southern Medical and Surgical Journal (new series) 6 (1850): 456-74. LeConte bemoans the depressed state of antebellum medicine.

Logan, Thomas M. “Reports From California.” In Southern Medical Reports, Vol. 2, edited by E. D. Fenner, 460-80. New York: Samuel S. & William Wood, 1851. Logan contributed three articles to the second volume of Southern Medical Reports, justifying their inclusion by appealing to the “isothermal” similarity between the southern and Californian climates.

Massie, J. Cam. A Treatise on the Eclectic Southern Practice of Medicine. Philadelphia: Thomas, Cowperthwait & Co., 1854. Massie wrote this text in part to rectify the perceived anti-southern bias of medical textbooks and in part to advocate a sectarian view of medicine generally.

McGown, Thompson. A Practical Treatise on the Most Common Diseases of the South: Exhibiting Their Peculiar Nature and The Corresponding Adaptation of Treatment. To Which is Added an Appendix, Containing Some Miscellaneous Matter. Also a Glossary, Explaining the Meanings of the Technicalities, or Medical Phrases, Used in this Work. Philadelphia: Grigg, Elliot and Co., 1849. McGown attempted to promote a separate southern medicine by publishing this textbook, which was well-received in the South but repudiated in both the North and the West.

McGuire, Hunter. “'Progress of Medicine in the South': Address of the President before the Southern Surgical and Gynecological Association, at the Meeting held in Nashville, Tenn., November 13, 1889.” Southern Historical Society Papers (1876-1905) 17 (1889): [10 pages]. McGuire was one of the instigators of the southern medical student secession from Philadelphia in 1859, and this address sounds a clarion call for southernist medicine.

McPheeters, William M. I Acted from Principle: The Civil War Diary of Dr. William M. McPheeters, Confederate Surgeon in the Trans-Mississippi. Edited by Cynthia DeHaven Pitcock and Bill J. Gurley. Fayetteville: University of Arkansas Press, 2002. McPheeters's diary gives the perspective of a well-educated rural doctor during the Civil War.

———. “Sectional Medicine.” Saint Louis Medical and Surgical Journal 5 (1847-48): 363-65. 121 McPheeters, though a Westerner, dismisses sectional medicine as “shallow sophistry.”

Means, Alexander. “An Address, introductory to the Second Course of lectures in the Atlanta Medical College.” Atlanta Medical and Surgical Journal 1 (1855-56): 705-23. Means eloquently invokes the heroic history of southern medicine.

“Medicine in the Confederate States.” Lancet 1 (1864): 445-46. This article was the sole means by which most physicians outside of the South knew of the existence of the Confederate States Medical and Surgical Journal.

Mitchell, B. Rush. “Southern versus Northern Practice.” Medical Examiner (new series) 4 (1848): 591-95. “The Medical Examiner on 'Sectional Medicine.'” Southern Medical and Surgical Journal (new series) 4 (1848): 699-704. Mitchell decries the arguments for southern medical distinctiveness, claiming that medical “principles recognize no degrees of latitude.” The editors of Southern Medical and Surgical Journal respond in kind.

“Obituary: Prof. E. D. Fenner, M. D.” Medical Record 1 (1866): 222-23. This brief, anonymous obituary is a good summation of Fenner's life.

Osler, William. An Alabama Student. Baltimore: The Friedenwald Company, 1896. Osler discovered John Y. Basset, the subject of this famous essay, when reviewing Southern Medical Reports, both volumes of which contain contributions from Basset.

Pickford, James H. Hygiene; or Health as Depending Upon the Conditions of the Atmosphere, Foods and Drinks, Motion and Rest, Sleep and Wakefulness, Secretions, Excretions, and Retentions, Mental Emotions, Clothing, Bathing, &c. London: John Churchill, 1857. Pickford's work exemplifies antebellum Anglo-American climatic theories of disease.

Porcher, Francis P. “Report on the Indigenous Medicinal Plants of South Carolina.” Transactions of the American Medical Association 2 (1849): 677-862. Porcher's wartime Resources of the Southern Fields and Forests drew heavily from this earlier work, completed as a report for the AMA Committee on Indigenous Medical Botany.

———. Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural: being also a Medical Botany of the Confederate States: with practical information on the useful properties of the trees, plants, and shrubs. Charleston: Steam-Power Press of Evans & Cogswell, 1863. Commissioned directly by Samuel Preston Moore, Porcher produced this 600-page index and description of the uses of plants indigenous and introduced to the South. Porcher's work was the most tangible product of the Confederate emphasis on promoting by necessity a determinedly and literally southern approach to medicine during the Civil War.

———. “Resources of the Southern Fields and Forests: Trees and Plants Valuable in the Arts, for Manufacturing Purposes and in Domestic Economy, Growing in South Carolina and Georgia, and Common to Many of the Southern States.” De Bow's Review (new series) 6 (1861): 105-31. This earlier, abridged version of Porcher's later treatise with nearly the same title argues that southerners must learn to develop the resources of their land fully.

122 Rosenkrantz, Barbara Gutmann, advisory ed. Health in the Southern United States. New York: Arno Press, 1977. The primary sources in this collection are emblematic of the approach to the southern disease environment in both the pre- and post-Civil War eras.

———, advisory ed. Yellow Fever Studies. New York: Arno Press, 1977. This volume contains sources on various aspects of yellow fever in the United States.

“Southern School-Books.” De Bow's Southern and Western Review 13 (1852): 258-66. “Future Revolution in Southern School Books.” De Bow's Review 30 (1861): 606-14. J. D. B. DeBow's Review was a prominent antebellum southernist periodical based in New Orleans. These articles argue for the manufacture of textbooks by and for southerners.

[Southerner]. “Southern Typhoid Fever, Quinine, Dr. Fenner, Typhus, &c.” Boston Medical and Surgical Journal 47 (1852-53): 405-6. Fenner, E. D. “The Abortive Treatment of Continued Fever.” New Orleans Medical and Surgical Journal 10 (1853-54): 42-73. [Southerner]. “Southern Typhoid Fever—Dr. Fenner.” Boston Medical and Surgical Journal 49 (1853-54): 38-41. These two letters to the editor cast doubt on the ability of southern physicians to identify the diseases of their region correctly. Fenner responds briefly in his article.

Stahl, Daniel. “The Sectional Teachings of Medicine.” Southern Medical and Surgical Journal (new series) 5 (1849): 545-50. Stahl, an Illinois physician, defends the value of the “sectional teaching” of medicine with regard to the unique diseases of the South and Midwest.

Taylor, W. T. “Annual Oration.” In Transactions of the Medical Association of the State of Alabama at Its Eighth Annual Session, Begun and Held in the City of Mobile, February 5, — 6, —7, 1855, 117-29. Mobile: Middleton, Harris & Co., 1855. Taylor cites the medical importance of locality, the putative Hippocratic origins of southern medicine, and states' pride to argue for the establishment of a medical school in Mobile.

Warren, Jonathan Mason. The Parisian Education of an American Surgeon: Letters of Jonathan Mason Warren, 1832-1835. Edited by Russell M. Jones. Philadelphia: American Philosophical Society, 1978. Warren was one of many antebellum American doctors who studied in Paris, and his letters (along with Jones's excellent introduction) shed light on the concerns of American physicians in France.

Westmoreland, John Gray. “Southern Medicine.” Atlanta Medical and Surgical Journal 5 (1859- 60): 445-47. Occasioned by the medical student secession from Philadelphia in 1859, Westmoreland's editorial is an impassioned polemic that justifies southernist medicine almost wholly by reference to politics.

Secondary Sources

Studies of Southern Science and Medicine Breeden, James O. “States-Rights Medicine in the Old South.” Bulletin of the New York Academy of Medicine 52 (1976): 348-72. 123 Breeden gives an extended overview of southernist medicine in the pre-Civil War era. His account is notable for its lack of provincialism: he quotes widely from local medical journals of the period from several different states, and chronicles the reaction in the North and West to southern medical sectionalism.

Duffy, John. “A Note on Ante-Bellum Southern Nationalism and Medical Practice.” Journal of Southern History 34 (1968): 266-76. Duffy's article is one of the most cited treatments of southern medical distinctiveness.

———. “Erasmus Darwin Fenner (1807-1866), Journalist, Educator, and Sanitarian.” Journal of Medical Education 35 (1960): 819-31. Though this biography is essentially a retread of D. Warren Brickell's “Biographical Sketch” (see Primary Sources above), it is one of the only modern accounts of Fenner's life.

———. “Medicine, States' Rights.” In Encyclopedia of Southern Culture, edited by Charles Reagan Wilson and William Ferris, 1355-6. Chapel Hill: University of North Carolina Press, 1989. This is a concise overview of arguments for southern medical exceptionalism.

Guillory, James Denny. “Southern Nationalism and the Louisiana Medical Profession, 1840- 1860.” M.A. thesis, Louisiana State University, 1965. Guillory's master's thesis focuses on sectional(ist) medicine in Louisiana.

———. “The Pro-Slavery Arguments of Dr. Samuel A. Cartwright.” Louisiana History 9 (1968): 209-27. Guillory's article analyzes in part the sectional rift in American medicine.

Johnson, Thomas Cary. Scientific Interests in the Old South. New York: Appleton-Century, 1936. Johnson's work was for a long period the classic in the field, although he analyzes southern science without comparison to other regions, limiting the generalizability of his conclusions.

Jordan, Weymouth T. “Plantation Medicine in the Old South.” Alabama Review 3 (April 1950): 83-107. Jordan describes the notion that the ideal plantation doctor would be raised in a southern setting.

Marshall, Mary Louise. “Samuel A. Cartwright and States' Rights Medicine.” New Orleans Medical and Surgical Journal 93 (1940-1): 74-78. Samuel Cartwright was a vocal proponent of southern regional medicine, and Marshall's account is one of the only biographical treatments of the man specifically.

Miller, Joseph Lyon. “The Physicians of the Old South, Their Character and Education.” Bulletin of the Medical College of Virginia 25 (1929): 9-23. Miller's celebratory account quotes extensively from primary sources.

Numbers, Ronald L., and Savitt, Todd L., eds. Science and Medicine in the Old South. Baton Rouge: Louisiana State University Press, 1989. This collection of essays is the sine qua non for scholars of southern science and medicine. The contributions cover many related but separate topics; of particular pertinence to southern medical specificity are K. David Patterson's work on disease environments, John Harley Warner's discussions of “distinctiveness” and southern medical reform, and Margaret Warner's “Public Health in the Old South.” 124

Postell, William Dosité. “Erasmus Darwin Fenner and the Beginnings of Medical Literature in Louisiana.” Annals of Medical History (3rd series) 3 (1941): 297-305. Postell assesses Fenner's career, noting that “after his arrival in New Orleans, Dr. Fenner's personal history and the history of medical journalism in Louisiana are largely the same story.”

Shyrock, Richard H. “Medical Practice in the Old South.” In Medicine in America: Historical Essays, 49-70. Baltimore: The Johns Hopkins University Press, 1966. Shyrock's essay on antebellum southern medicine is wide-ranging, cogent, and analytical.

Studies of Medicine in Individual Southern States Blanton, Wyndham Bolling. Medicine in Virginia in the Nineteenth Century. Richmond: Garrett & Massie, 1933. Bridgforth, Lucie Robertson. “Medicine in Antebellum Mississippi.” Journal of Mississippi History 46 (1984): 82-107. Duffy, John. The Rudolph Matas History of Medicine in Louisiana. 2 vols. Baton Rouge: Louisiana State University Press, 1958. Ellis, John H. Medicine in Kentucky. Lexington: University Press of Kentucky, 1977. Gay, Evelyn W. The Medical Profession in Georgia. Fulton, MO: Ovid Bell Press, 1983. Holley, Howard L. A History of Medicine in Alabama. Birmingham, AL: University of Alabama Press, 1982. Long, Dorothy, ed. Medicine in North Carolina: Essays in the History of Medical Science and Medical Service, 1524-1960. 2 vols. Raleigh, NC: North Carolina Medical Society, 1972. Waring, Joseph I. “Colonial Medicine in Georgia and South Carolina.” Georgia Historical Quarterly 59 supplement (1975): 141-53. ———. A History of Medicine in South Carolina. 2 vols. Columbia, SC: South Carolina Medical Association, 1964; Charleston, SC: South Carolina Medical Association, 1967. These state medical histories can largely be taken together. All are valuable references that present anecdotal, occasionally hagiographic, and bland but chronological surveys of developments in medicine in their respective purviews. Duffy's work is slightly more analytical than most; Holley's account of Alabama distinguishes itself by depth of insight and synthesis (rather than renarration) of primary sources.

Works on Southern Physicians Breeden, James O. Joseph Jones, M.D.: Scientist of the Old South. Lexington, KY: University Press of Kentucky, 1975. Breeden's biography of Jones's career through the Civil War is a fine study of one of the Confederacy's most learned and important physicians.

Duffy, John. “Medical Practice in the Ante Bellum South.” Journal of Southern History 25 (1959): 53-72. This article explains the considerations shaping medical treatment in the prewar South.

Horsman, Reginald. Josiah Nott of Mobile: Southerner, Physician, and Racial Theorist. Baton Rouge: Louisiana State University Press, 1987. Horsman's biography of one of the antebellum South's most prominent public intellectuals is comprehensive, though largely uncritical.

Jordan, Weymouth T. Ante-Bellum Alabama Town and Country. Florida State University 125 Studies, no. 27. Tallahassee: The Florida State University, 1957. Jordan examines life in nineteenth-century Alabama, including home remedies and family doctors.

Mitchell, Martha Carolyn. “Health and the Medical Profession in the Lower South, 1845- 1860.” Journal of Southern History 10 (1944): 424-46. Mitchell's account of antebellum southern medicine is serviceable, although it contains some factual inaccuracies (such as an incorrect date for the founding of the New Orleans School of Medicine).

Postell, William Dosité. “A Review of Louisiana Medical Literature, 1796-1843, The Formative Years.” Annals of Medical History (3rd Series) 4 (1942): 207-18. Postell illustrates the dearth of professional medical activity in early antebellum Louisiana.

———. “The Doctor in the Old South.” South Atlantic Quarterly 51 (1952): 393-400. Postell's is an adequate if not analytical depiction of the antebellum southern physician.

———. “The Medical Societies of Louisiana Prior to the War Between the States.” New Orleans Medical and Surgical Journal 93 (1940-1): 65-74, 150-59. Postell catalogues the development of state medical associations in Louisiana.

Stowe, Steven M. Doctoring the South: Southern Physicians and Everyday Medicine in the Mid- Nineteenth Century. Chapel Hill: University of North Carolina Press, 2004. Stowe focuses on social conditions and the daily experience of physicians rather than the larger political discourse surrounding southern medicine. He takes pains to situate his narrative and emphasize the importance of location, but his attention to individuals often obscures societal trends.

———. “Obstetrics and the Work of Doctoring in the Mid-Nineteenth-Century American South.” Bulletin of the History of Medicine 64 (1990): 540-66. Much of this article was adapted into sections of Doctoring the South.

———. “Seeing Themselves at Work: Physicians and the Case Narrative in the Mid- Nineteenth-Century American South.” American Historical Review 101 (1996): 41-79. Like Stowe's other works, this article is excellent in describing daily practice but only hints in a few places at the ideology and medical assumptions informing this practice.

Ward, Patricia Spain. Simon Baruch: Rebel in the Ranks of Medicine, 1840-1921. Tuscaloosa: University of Alabama Press, 1994. Ward's study of a European physician who adopted Charleston as a home touches on the issues of medical training and education and the life of a physician during the nineteenth century.

General Studies of Nineteenth-Century Medicine Ackerknecht, Erwin H. A Short History of Medicine. New York: Ronald Press Company, 1955; rev. ed., Baltimore: The Johns Hopkins University Press, 1982. Ackerknecht's brief history is a good referent for the global history of medicine.

———. “Anticontagionism between 1821 and 1867.” Bulletin of the History of Medicine 22 (1948): 562-93. Ackerknecht's survey of the mid-nineteenth-century contagion debate focuses on yellow fever.

———. Medicine at the Paris Hospital, 1794-1848. Baltimore: The Johns Hopkins University 126 Press, 1967. Ackerknecht's is the definitive study of the Paris School, though it concentrates almost exclusively on the school itself and not on its influence on American medicine.

Brieger, Gert H. “Therapeutic Conflicts and the American Medical Profession in the 1860s.” Bulletin of the History of Medicine 41 (1967): 215-22. Brieger notes that in the mid-nineteenth century “the medical profession began more and more to examine its position in society.”

Cassedy, James H. American Medicine and Statistical Thinking, 1800-1860. Cambridge, MA: Harvard University Press, 1984. Cassedy examines the use of quantitative methods in antebellum American medicine.

———. Medicine and American Growth, 1800-1860. Madison: University of Wisconsin Press, 1986. This wide-ranging study surveys the applications of demography and statistics in American medicine in the antebellum period and includes sections on medical regionalism in both the South and the West.

———. Medicine in America: A Short History. Baltimore: The John Hopkins University Press, 1991. Cassedy's book is an excellent concise reference.

Courtwright, David T. Dark Paradise: A History of Opiate Addiction in America. Cambridge, MA: Harvard University Press, 1982 (as Dark Paradise: Opiate Addiction in America before 1940); enl. ed., 2001. Courtwright deals mainly with the twentieth century, but does note the high incidence of opiate addiction in the antebellum South relative to that in the North in the same period.

Duffy, John. From Humors to Medical Science: A History of American Medicine. Urbana: University of Illinois Press, 1976 (as The Healers); 2nd ed., 1993. Duffy's account is thorough, and he exhibits his predilection toward southern medicine in a longer treatment of the subject than is typical in American medical histories.

———. “The Changing Image of the American Physician.” Journal of the American Medical Association 200 (1967): 30-34. This is a useful overview of historical public attitudes toward the medical profession.

Ebert, Myrl. “The Rise and Development of the American Medical Periodical, 1797-1850.” Bulletin of the Medical Library Association 40 (1952): 243-76. Ebert's article contains an astounding amount of raw data, including a list, with publication dates and places, of every American medical periodical published in the first half of the nineteenth century.

Haller, John S., Jr. American Medicine in Transition, 1840-1910. Urbana: University of Illinois Press, 1981. Haller concentrates on medicine in the second half of the nineteenth century, though several of his chapters deal extensively with antebellum physicians.

King, Lester S. Transformations in American Medicine: From Benjamin Rush to William Osler. Baltimore: The Johns Hopkins University Press, 1991. King traces the history of nineteenth-century medicine with only the briefest references to the social 127 and political factors that shaped the medical profession.

Leavitt, Judith Walzer, and Numbers, Ronald L., eds. Sickness and Health in America: Readings in the History of Medicine and Public Health. Madison: University of Wisconsin Press, 1978; 3rd ed., rev., 1997. Sickness and Health is an invaluable resource for analysis of American public health and medical practice. Ronald Numbers's and John Harley Warner's essay on the maturation of the American medical profession, Warner's “From Specificity to Universalism in Medical Therapeutics,” and John Duffy's “The Social Impact of Disease in the Late 19th Century” are of especial relevance to the context of southernist medicine, but the volume as a whole is excellent.

Pernick, Martin S. A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth- Century America. New York: Columbia University Press, 1985. Though the focus on surgery precludes an interest in explicitly regional medicine, A Calculus of Suffering treats extensively the uncertain professional place of the physician in antebellum American society.

Rosenberg, Charles E. “Erwin H. Ackerknecht, Social Medicine, and the History of Medicine.” Bulletin of the History of Medicine 81 (2007): 511-32. Rosenberg's discussion of Ackerknecht's career and works emphasizes the importance of considering the role of societal forces in studying the history of medicine.

———. “The American Medical Profession: Mid-Nineteenth Century.” Mid-America 44 (1962): 163-71. Rosenberg sketches the dispiriting and dispirited state of the nineteenth-century American doctor.

———. The Cholera Years: The United States in 1832, 1849, and 1866. Chicago: University of Chicago Press, 1962; repr., 1987. Rosenberg's study is an excellent, nuanced portrait of American society and the medical profession at three points in the mid-nineteenth century.

———. “The Practice of Medicine in New York A Century Ago.” Bulletin of the History of Medicine 41 (1967): 223-53. Rosenberg's cross-sectional portrait of New York medical practice in 1866 limns the professional, social, and medical factors influencing nineteenth-century physicians. The article's methodology is one that more historians of science should employ.

———. “The Therapeutic Revolution: Medicine, Meaning, and Social Change in 19th Century America.” In Sickness and Health in America: Readings in the History of Medicine and Public Health, edited by Judith Walzer Leavitt and Ronald L. Numbers, 39-52. Madison: University of Wisconsin Press, 1978, 2nd ed., rev., 1985. Rosenberg's article serves as a thorough overview of a topic with which John Harley Warner's Therapeutic Perspective deals at length.

Rosenkrantz, Barbara Gutmann. “The Search for Professional Order in 19th Century American Medicine.” In Sickness and Health in America: Readings in the History of Medicine and Public Health, edited by Judith Walzer Leavitt and Ronald L. Numbers, 219-32. Madison: University of Wisconsin Press, 1978, 2nd ed., rev., 1985. Rosenkrantz notes the role specificity played in nineteenth-century medical practice.

Rothstein, William G. American Physicians in the Nineteenth Century: From Sects to Science. 128 Baltimore: The Johns Hopkins University Press, 1972. Rothstein employs a sociological approach to assess the institutional and professional challenges and changes in nineteenth-century American medicine. Rothstein credits medical sectarianism with a longer-lasting and more profound influence on regular practitioners than do many other historians.

Shafer, Henry Burnell. The American Medical Profession, 1783 to 1850. New York: Columbia University Press, 1936. Shafer surveys the professional activity and development of nineteenth-century doctors.

Shyrock, Richard H. “Empiricism versus Rationalism in American Medicine, 1650-1950.” Proceedings of the American Antiquarian Society (new series) 65 (1969): 99-150. This is an unfocused overview of empirical and rationalist trends in early American medicine.

———. Medicine and Society in America, 1660-1860. New York: New York University Press, 1960. Shyrock presents a useful, concise depiction of American medical history.

———. “Public Relations of the Medical Profession in Great Britain and the United States, 1600-1870.” Annals of Medical History (new series) 2 (1930): 308-39. Shyrock analyzes the public standing of the medical profession in the United Kingdom and the United States with a particular focus on the early nineteenth century.

——— The Development of Modern Medicine: An Interpretation of the Social and Scientific Factors Involved. Madison: University of Wisconsin Press, 1936; repr., 1974. Shyrock's survey of the development of European and American medicine between 1600 and 1850 includes discussions of social and historical influences on the medical profession.

Starr, Paul. The Social Transformation of American Medicine. New York: Basic Books, 1982. Starr's landmark study of the evolution of the American medical profession remains one of the best treatments of physicians and professionalism in the United States. Starr's sociological approach omits much that normally animates medical history, but The Social Transformation is an invaluable (though not unproblematic) resource for tracing changes in the professional status of the American physician.

Warner, John Harley. Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine. Princeton, NJ: Princeton University Press, 1998. Warner's analysis of the influence and appropriation of the Paris Clinical School in antebellum America provides excellent grounding in nineteenth-century American medical concerns. The work incorporates threads relating to southernist medicine and the role of narratives for American physicians.

———. “Making History in American Medical Culture: The Antebellum Competition for Hippocrates.” In Reinventing Hippocrates, edited by David Cantor, 200-36. Burlington, VT: Ashgate, 2002. Warner's article is a wide-ranging and cogent examination of the myriad mid-nineteenth-century uses of Hippocrates in crafting an American medical tradition.

———. “Medical Sectarianism, Therapeutic Conflict, and the Shaping of Orthodox Professional Identity in Antebellum American Medicine.” In Medical Fringe and Medical Orthodoxy, 1750-1850, edited by W. F. Bynum and Roy Porter, 234-60. London: Croom Helm, 1987. This essay touches on issues of professionalism and identity that profoundly shaped the occupational 129 landscape of nineteenth-century American physicians.

———. “Power, Conflict, and Identity in Mid-Nineteenth-Century American Medicine: Therapeutic Change at the Commercial Hospital in Cincinnati.” Journal of American History 73 (1986-7): 934-56. Warner uses the case of an Ohio hospital to illustrate the importance that the antebellum regular medical profession placed on orthodox therapeutic methods.

———. “Remembering Paris: Memory and the American Disciples of French Medicine in the Nineteenth Century.” Bulletin of the History of Medicine 65 (1991): 301-25. This article assesses the the ways in which American doctors who studied in Paris applied their experiences to medicine in the United States.

———. “Science, Healing, and the Physician's Identity: A Problem of Professional Character in Nineteenth-Century America.” Clio Medica 22 (1991): 65-88. Warner examines the importance that the antebellum American medical profession placed on healing, which lent credence to the southernist imperative to study diseases in their natural contexts.

———. “'The Nature-Trusting Heresy': American Physicians and the Concept of the Healing Power of Nature in the 1850's and 1860's.” Perspectives in American History 11 (1977-78): 291-324. Warner analyzes the emergence of belief in nature-driven healing in the mid-nineteenth century, dealing at length with the influence of the Paris Clinical School on American medicine.

———. “The Selective Transport of Medical Knowledge: Antebellum American Physicians and Parisian Medical Therapeutics.” Bulletin of the History of Medicine 59 (1985): 213- 31. This article employs the principle of specificity and antebellum American physicians' view of their profession to argue that the transfer of medical knowledge is an inherently selective process.

———. The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885. Cambridge, MA: Harvard University Press, 1986. Despite the wide focus of the work, The Therapeutic Perspective treats southern medicine extensively, particularly in the third chapter. Warner's analysis is characteristically penetrating.

Young, James Harvey. “American Medical Quackery in the Age of the Common Man.” Mississippi Valley Historical Review 47 (1960-1): 579-93. Young chronicles the rise of nostrums and irregular medicine in the nineteenth century.

Histories of Southern Diseases and Public Health Ackerknecht, Erwin H. Malaria in the Upper Mississippi Valley, 1760-1900. Baltimore: The Johns Hopkins University Press, 1945; repr., New York: Arno Press, 1977. Ackerknecht's work touches briefly on the prevalence of malaria in the South.

Boyd, Mark F. “An Historical Sketch of the Prevalence of Malaria in North America.” American Journal of Tropical Medicine 21 (1941): 223-44. This article analyzes malaria in the United States through the early twentieth century.

Carrigan, Jo Ann. “Impact of Epidemic Yellow Fever on Life in Louisiana.” Louisiana 130 History 4 (1963): 5-34. Carrigan persuasively argues that yellow fever, though wholly absent in the North, was “an integral aspect of life (and death) in Louisiana,” illustrating one reason why southerners believed northerners did not adequately understand the health problems of the South.

———. “Privilege, Prejudice, and the Strangers' Disease in Nineteenth-Century New Orleans.” Journal of Southern History 36 (1970): 568-78. Carrigan links attitudes about the putatively unique susceptibility of non-southerners to yellow fever to both disease theory and social class in the antebellum Crescent City.

———. The Saffron Scourge: A History of Yellow Fever in Louisiana, 1796-1905. Lafayette, LA: Center for Louisiana Studies, University of Southwestern Louisiana, 1994. The Saffron Scourge synthesizes many of Carrigan's shorter articles into a single, coherent narrative about yellow fever and the South.

———. “Yankee Versus Yellow Jack in New Orleans, 1862-1866.” Civil War History 9 (1963): 248-60. This article explains the ironic fact (given the supposed ignorance of northerners about yellow fever) that Union troops occupying New Orleans prevented the outbreak of epidemic yellow fever.

———. “Yellow Fever in New Orleans, 1853: Abstractions and Realities.” Journal of Southern History 25 (1959): 339-55. Carrigan examines Louisianan perceptions of the yellow fever epidemic of 1853.

Delaporte, François. The History of Yellow Fever: An Essay on the Birth of Tropical Medicine. Translated by Arthur Goldhammer. Cambridge, MA: MIT Press, 1991. Delaporte's account notes the contributions of earlier understandings of yellow fever as a climactic disease to the eventual identification of actual mode of transmission.

Dubisch, Jill. “Low Country Fevers: Cultural Adaptations to Malaria in Antebellum South Carolina.” Social Science and Medicine 21 (1985): 641-49. Dubisch assesses the conditions that made malaria particularly prevalent in the Carolina low country and the symbolic social value of the disease in the antebellum South.

Duffy, John. Epidemics in Colonial America. Baton Rouge: Louisiana State University Press, 1953. Duffy devotes long sections to yellow fever and malaria, and addresses a number of other common diseases. This work is largely a rehashing and reprinting of primary sources, with little secondary analysis.

———. “Nineteenth Century Public Health in New York and New Orleans: A Comparison.” Louisiana History 15 (1974): 325-37. Duffy's article usefully contrasts differing northern and southern responses to epidemics.

———. Sword of Pestilence: The New Orleans Yellow Fever Epidemic of 1853. Baton Rouge: Louisiana State University Press, 1966. This study chronicles an event that Duffy claims “helped to crystallize the southern health movement,” which developed originally as a response to the need to control distinctively southern diseases.

———. “Yellow Fever in the Continental United States During the Nineteenth Century.” Bulletin of the New York Academy of Medicine 54 (1968): 687-701. 131 Duffy's article is a good introduction to the history of yellow fever in the 1800s.

Ellis, John H. “Businessmen and Public Health in the Urban South During the Nineteenth Century: New Orleans, Memphis, and Atlanta.” Bulletin of the History of Medicine 44 (1970): 197-212. Ellis traces the role of epidemic disease in spurring southern public health movements.

———. Yellow Fever and Public Health in the New South. New Brunswick, NJ: Rutgers University Press, 1992. This book focuses on the postbellum era, but contains some analysis of antebellum southern cities.

Fossier, A. E. “Yellow Fever and Its Influence on the Development of New Orleans.” Bulletin of the Medical Library Association 30 (1942): 316-26. Though the writing is overwrought, this article contains interesting statistics and is a decent survey of yellow fever's history in New Orleans.

Goldfield, David R. “The Business of Health Planning: Disease Prevention in the Old South.” Journal of Southern History 42 (1976): 557-70. Goldfield touches on public health and the acclimation theory of yellow fever.

Grob, Gerald N. The Deadly Truth: A History of Disease in America. Cambridge, MA: Harvard University Press, 2002. Grob's dry but encyclopedic account of American diseases traces the impact of both endemic and epidemic illnesses through different periods in the history of the United States. Grob treats regional differences in medicine extensively, particularly in sections on the colonial and antebellum eras.

Haygood, Tamara Miner. “Cows, Ticks, and Disease: A Medical Interpretation of the Southern Cattle Industry.” Journal of Southern History 52 (1986): 551-64. Haygood's article discusses babesiosis and anaplasmosis, two cattle diseases nicknamed “Texas fever” that were not natively present in the North or Midwest during the antebellum period.

Humphreys, Margaret. Malaria: Poverty, Race, and Public Health in the United States. Baltimore: The Johns Hopkins University Press, 2001. Humphreys's section on colonial and antebellum medicine notes that the prevalence of malaria in the South was seen as demeaning to the region.

———. Yellow Fever and the South. New Brunswick, NJ: Rutgers University Press, 1992. Humphreys's work is the best comprehensive analysis of the role of yellow fever in American medicine. She makes the provocative claim that it was primarily yellow fever “that distinguished the South from the rest of the nation as a region where life and health were particularly endangered” (p. 45).

Jordan, Philip D. “Milksickness in Kentucky and the Western Country.” Filson Club Historical Quarterly 16 (1992): 29-40. Milksickness, a disease resulting from the ingestion of white snakeroot, was prevalent in frontier regions of the South and Midwest throughout the nineteenth century. Jordan's account is folksy but useful.

Meade, Melinda S. “The Rise and Demise of Malaria: Some Reflections on Southern Settlement and Landscape.” Southeastern Geographer 20 (1980): 77-99. Meade approaches malaria from a quasi-environmental historical perspective, focusing on the physical changes in landscape that affected the endemicity of malaria in the South. 132

Merrens, H. Roy, and Terry, George D. “Dying in Paradise: Malaria, Mortality, and the Perceptual Environment in Colonial South Carolina.” Journal of Southern History 50 (1984): 533-50. This article, though concerned with the colonial era, examines early southern attitudes toward an affliction that southerners would claim as their own during the pre-Civil War period.

Packard, Randall M. The Making of a Tropical Disease: A Short History of Malaria. Baltimore: The Johns Hopkins University Press, 2007. Packard's synthetic history includes case studies of colonial South Carolina and the Reconstruction South, though it treats the antebellum period only in passing.

Patterson, K. David. “Yellow Fever Epidemics and Mortality in the United States, 1693- 1905.” Social Science and Medicine 34 (1992): 855-65. Patterson gives a comprehensive if dry overview of yellow fever in the United States.

Savitt, Todd L. “Filariasis in the United States.” Journal of the History of Medicine and Allied Sciences 32 (1977): 140-50. Savitt examines the New World history of the elephantiasis-causing parasite, which is endemic to Africa but was entrenched in Charleston (and nowhere else in the United States) for over a century.

———. Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia. Urbana: University of Illinois Press, 1978. Though it deals mostly with race, Savitt's excellent analysis touches on some themes relating to general ideas of a unique southern disease environment.

Savitt, Todd L., and Young, James Harvey, eds. Disease and Distinctiveness in the American South. Knoxville: University of Tennessee Press, 1988. This collection is essential for any study of southernist medicine. James Breeden's introduction, John Duffy's essay on malaria, and Jo Ann Carrigan's chapter on yellow fever are all standouts.

Sigerist, Henry E. “The Cost of Illness to the City of New Orleans in 1850.” Bulletin of the History of Medicine 15 (1944): 498-507. Sigerist chronicles the insalubrity of the Crescent City in 1850.

Smith, Dale C. “The Rise and Fall of Typhomalarial Fever.” Journal of the History of Medicine and Allied Sciences 37 (1982): 182-220, 287-321. Smith's article treats at length the arguments for southernist medicine, and attributes the very definition of “typhomalarial fever” in part to the push for southern medical distinctiveness.

Wailoo, Keith. Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health. Chapel Hill: University of North Carolina Press, 2001. Wailoo's excellent study of sickle cell anemia in Memphis focuses on the twentieth century and is useful for assessing the persistence of unique disease narratives in the New South.

Studies of Antebellum Medical Education and Licensing Abrahams, Harold J. “Secession from Northern Medical Schools.” Transactions and Studies of the College and Physicians of Philadelphia (4th series) 36 (1968-69): 29-45. This is a account of the 1859 southern student “secession” from Philadelphia's medical schools.

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Barlow, William, and Powell, David O. “A Dedicated Medical Student: Solomon Mordecai, 1819-1822.” Journal of the Early Republic 7 (1987): 377-97. This article focuses so closely on Mordecai that it neglects issues of societal importance.

Breeden, James O. “Rehearsal for Secession? The Return Home of Southern Medical Students from Philadelphia in 1859.” In His Soul Goes Marching On: Responses to John Brown and the Harpers Ferry Raid, 174-210. Edited by Paul Finkelman. Charlottesville, VA: University Press of Virginia, 1995. Breeden's article is one of the few studies that attempts to separate and analyze the interwoven medical and political threads of this event.

Calhoun, Daniel H. Professional Lives in America: Structure and Aspiration, 1750-1850. Cambridge, MA: Harvard University Press, 1965. Calhoun examines the antebellum “retreat toward mediocrity” of law, medicine, and the clergy.

Cummins, Harold. “Formal Medical Education in New Orleans, 1834-.” Bulletin of the Medical Library Association 30 (1942): 300-8. Cummins gives the barest of sketches of the antebellum medical schools of the Crescent City.

Derbyshire, Robert C. Medical Licensure and Discipline in the United States. Baltimore: The Johns Hopkins University Press, 1969; repr., Westport, CT: Greenwood Press, 1969. This book is a brief history of American medical licensing.

Duffy, John. “Sectional Conflict and Medical Education in Louisiana.” Journal of Southern History 23 (1957): 289-306. Duffy, focusing particularly on the history of the New Orleans School of Medicine, traces the links between sectionalism and medical instruction in New Orleans.

———. The Tulane University Medical Center: One Hundred and Fifty Years of Medical Education. Baton Rouge: Louisiana State University Press, 1984. This work is celebratory, but still useful given the importance of the Tulane Medical Center (originally the Medical Department of the University of Louisiana) in southern medicine.

Ezell, John S. “A Southern Education for Southrons.” Journal of Southern History 17 (1951): 303-27. Ezell's account illustrates the sectionalist discourses driving the establishment and overhaul of southern post-secondary institutions generally.

Fossier, Albert E. “History of the Medical Education of New Orleans From Its Birth to the Civil War.” Annals of Medical History (new series) 6 (1934): 320-52, 427-47. Fossier quotes extensively from popular and medical periodicals and gives a detailed overview of the establishment of and progress in medical education in antebellum New Orleans.

Kaufman, Martin. American Medical Education: The Formative Years, 1765-1910. Westport, CT: Greenwood, 1976. Kaufman's monograph is an excellent survey of nineteenth-century American medical education, and very useful for tracing the evolution of medical institutions through the period.

134 Kett, Joseph F. The Formation of the American Medical Profession: The Role of Institutions, 1780- 1860. New Haven: Yale University Press, 1968. Kett assesses the causes and effects of the repealing of medical licensing laws and the proliferation of medical schools in the antebellum United States.

———. “Regulation of the Medical Profession in America, 1780-1860.” Ph.D. thesis, Harvard University, 1964. Kett's dissertation covers largely the same ground in manuscript as in book form (see the previous entry), but is included here separately because the thesis contains significant material on medical licensing and societies in Louisiana that is not present in the published version.

Kilbride, Daniel. “Southern Medical Students in Philadelphia, 1800-1861: Science and Sociability in the 'Republic of Medicine.'” Journal of Southern History 65 (1999): 697- 732. This article, one of the most recent treatments of antebellum southern medical education, does a better job demonstrating the southernist tendencies of Philadelphian gentry than proving the alleged “cosmopolitanism” (Kilbride's term) of the southern elite.

Mason, J. M. “Early Medical Education in the Far South.” Annals of Medical History (new series) 4 (1932): 64-79. This is a celebratory yet informative account of the founding of the Medical College of Louisiana.

Miller, Genevieve. “Medical Education One Hundred Years Ago: The Introductory Lecture.” Ohio State Medical Journal 54 (1958): 1578-82; 55 (1959): 40-1, 44. Miller analyzes a small sampling of introductory lectures from antebellum American medical schools to glean (few) insights about the nineteenth-century medical profession.

Murrell, Thomas W. “The Exodus of Medical Students from Philadelphia, December 1859.” Bulletin of the Medical College of Virginia 51 (1954): 2-15. Murrell's article is a rambling account of the 1859 Philadelphia medical school secession.

Norwood, William Frederick. Medical Education in the United States Before the Civil War. Philadelphia: University of Pennsylvania Press, 1944. Norwood is still cited because of the breadth of his research.

Numbers, Ronald L, ed. The Education of American Physicians: Historical Essays. Berkeley: University of California Press, 1980. This collection surveys the history of medical education from the colonial period through the mid- twentieth century. Martin Kaufman's overview, Genevieve Miller's “Medical History,” and Edward Atwater's “Internal Medicine,” which analyzes the New Orleans School of Medicine, are worth consulting.

Rothstein, William G. American Medical Schools and the Practice of Medicine: A History. New York: Oxford University Press, 1987. Rothstein borrows heavily from his earlier and better American Physicians (see above).

Shyrock, Richard Harrison. Medical Licensing in American, 1650-1965. Baltimore: The Johns Hopkins University Press, 1967. Shyrock traces the history of medical licensure in the United States.

Spalding, Phinizy. The History of the Medical College of Georgia. Athens, GA: University of 135 Georgia Press, 1987. Spalding gives a concise summary of an important antebellum southern medical school.

Warner, John Harley. “Education, Medical.” In Encyclopedia of Southern Culture, edited by Charles Reagan Wilson and William Ferris, 1349-50. Chapel Hill: University of North Carolina Press, 1989. This is an excellent introduction to the rise and fall of arguments for southern medical education.

Studies of Cultural Exceptionalism and Intellectual Life in the South Billington, Monroe L., ed. The South: A Central Theme? Huntington, NY: Krieger, 1976. The essays in this volume treat several threads in the notion of southern distinctiveness.

Carpenter, Jesse T. The South as a Conscious Minority, 1789-1861: A Study in Political Thought. New York: New York University Press, 1930. Carpenter's study deals mostly with constitutional considerations, but does contain a section on the evolution of a collective “Southern mind.”

Cash, W. J. The Mind of the South. New York: A. A. Knopf, 1941; repr., New York: Vintage Books, 1991. Cash's classic study of the putative psychological characteristics of southerners is flawed, geographically deterministic, and full of sweeping assumptive generalizations. It is also provocative, well- written, and still relevant, if only for its obvious shortcomings, more than sixty years after its publication.

Cason, Clarence. 90º in the Shade. Chapel Hill: University of North Carolina Press, 1935; repr., Tuscaloosa: University of Alabama Press, 2001. In this “psychograph,” Cason argues that climate was fundamental in shaping southern culture.

Eaton, Clement. The Mind of the Old South. Baton Rouge: Louisiana State University Press 1967; rev. ed., 1976. Eaton makes interesting observations about social life in the antebellum South, but has a tendency to essentialize characteristics in the construction of the titular southern “mind.”

Faust, Drew Gilpin. A Sacred Circle: The Dilemma of the Intellectual in the Old South, 1840-1860. Baltimore: The Johns Hopkins University Press, 1977. Faust's superb depiction of the southern intellectual revolves around five case studies, though none are physicians. John Harley Warner's essay on southern distinctiveness in Science and Medicine in the Old South draws heavily, with varying success, from Faust's work.

———. “A Southern Stewardship: The Intellectual and the Proslavery Argument.” American Quarterly 31 (1979): 63-80. Faust chronicles the demoralized state of antebellum southern intellectual life, bringing the argument of A Sacred Circle to bear on justifications for slavery.

———. The Creation of Confederate Nationalism: Ideology and Identity in the Civil War South. Baton Rouge: Louisiana State University Press, 1988. Faust describes the religious, political, and social threads that leaders of the Confederacy strove to employ for the development of a unique identity.

———. “The Rhetoric and Ritual of Agriculture in Antebellum South Carolina.” Journal of Southern History 45 (1979): 541-68. 136 The portrait Faust draws of the use of rhetoric by antebellum planters is strikingly similar and highly applicable to southernist physicians' employment of professional discourse.

Ford, Jr., Lacy K. Origins of Southern Radicalism: The South Carolina Upcountry, 1800-1860. New York: Oxford University Press, 1988. Ford attempts to explain the attraction of secession to poor white antebellum southerners.

Franklin, John Hope. The Militant South, 1800-1861. Cambridge, MA: Belknap Press of Harvard University Press, 1956; 2nd ed., 1970. Franklin analyzes the development of the martial culture of the antebellum South.

Genovese, Eugene D. The Southern Front: History and Politics in the Culture War. Columbia, MO: University of Missouri Press, 1995. Genovese's essay on “The Culture of the Old South” is particularly relevant for southernist medicine.

Inscoe, John C., and Kenzer, Robert C., eds. Enemies of the Country: New Perspectives on Unionism in the Civil War South. Athens, GA: University of Georgia Press, 2001. This volume is useful for gauging the relative strength of sectionalist ideology in different areas of the South, which helps to explain differential contributions to southernist medicine.

McCardell, John. The Idea of a Southern Nation: Southern Nationalists and Southern Nationalism, 1830-1860. New York: Norton, 1979. McCardell examines aspects of antebellum southernist ideology in several areas, including education, literature, and geographical expansion. His book is a good introduction to the subject.

McPherson, James M. “Antebellum Southern Exceptionalism: A New Look at an Old Question.” Civil War History 29 (1983): 230-44. McPherson's characteristically well-written and provocative article analyzes in detail the differences between the antebellum North and South.

———. Battle Cry of Freedom: The Civil War Era. New York: Oxford University Press, 1988. McPherson's opus is the best relatively concise treatment of the broader political and sectional threads leading to the Civil War, and of the war itself.

O'Brien, Michael. Conjectures of Order: Intellectual Life and the American South, 1810-1860. 2 vols. Chapel Hill: University of North Carolina Press, 2004. O'Brien's magisterial study of intellectuals and culture in the antebellum South is a nonpareil in the field. Its scope can be overwhelming, but it is an invaluable resource for any scholar of the Old South.

———. “Finding the Outfield: Subregionalism and the American South.” Historical Journal 38 (1995): 1047-56. O'Brien examines southern localism and regionalism in the course of this book review.

———. “'The Water Rose in the Graves': Discontinuity and Localism in Nineteenth- Century Southern Thought.” In The United States South: Regionalism and Identity, edited by Valeria Gennaro Lerda and Tjebbe Westendorp, 55-74. Rome: Bulzoni Editore, 1991. O'Brien argues that individual localism, not southern regionalism, was the dominant mode of intellectual thought in the antebellum South.

137 O'Brien, Michael, and Moltke-Hansen, David, eds. Intellectual Life in Antebellum Charleston. Knoxville: University of Tennessee Press, 1986. The essays in this volume depict the seemingly contradictory cosmopolitanism and parochial insularity of the intellectual and ideological center of pre-Civil War southern culture.

Phillips, Ulrich Bonnell. Life and Labor in the Old South. Boston: Little, Brown, & Co., 1929; pbk. ed., Columbia, SC: University of South Carolina Press, 2007. Life and Labor is a classic and frequently criticized portrait of the society and economy of the antebellum South. Phillips famously begins his study with “let us begin by discussing the weather, for that has been the chief agency in making the South distinctive.”

Potter, David M. The Impending Crisis, 1848-1861. New York: Harper & Row, 1976. Potter examines the political and societal sectional trends of the late antebellum period.

———. The South and the Sectional Conflict. Baton Rouge: Louisiana State University Press, 1968. A collection of essays from various points in Potter's career, The South and the Sectional Conflict gives several provocative takes on different aspects of alleged southern distinctiveness.

Rozbicki, Michal J. “The Curse of Provincialism: Negative Perceptions of Colonial American Plantation Gentry.” Journal of Southern History 63 (1997): 727-52. Rozbicki surveys British attitudes toward the colonial planter class, many of which Northerners later adopted wholesale as criticisms against the antebellum South.

Schlesinger, Arthur Meier. “The State Rights Fetish.” In New Viewpoints in American History, 220-44. New York: Macmillan, 1922. Schlesinger's classic essay analyzes the states' rights doctrine that became anathema to the North and a rallying cry for the South.

Smiley, David L. “The Quest for the Central Theme in Southern History.” South Atlantic Quarterly 71 (1972): 307-25. Smiley reviews the literature on central themes for southern history, and, finding all arguments wanting, declares that “the American South defies either location or analysis.”

Stowe, Steven M. Intimacy and Power in the Old South: Ritual in the Lives of the Planters. Baltimore: The Johns Hopkins University Press, 1987. Stowe's “history of everyday life” view of the lives of southern plantation owners provides a cultural context for the society in which southernist medicine developed.

Works on Climate, Environment, and Medical Geography Ackerknecht, Erwin H. “Diseases in the Middle West.” In Essays in the History of Medicine, In Honor of David J. Davis, M.D., Ph.D., edited by University of Illinois Davis Lecture Committee, 168-81. Chicago: University of Illinois Press, 1965. Ackerknecht gives an epidemiological profile of the nineteenth-century Midwest, which serves as a useful contrast to the southern disease environment during the same period.

———. History and Geography of the Most Important Diseases. New York: Hafner, 1965. Ackerknecht's work is important for its demonstration of the persistence of medicogeographical strains of thought well into the twentieth century.

138 Arsenault, Raymond. “The End of the Long Hot Summer: The Air Conditioner and Southern Culture.” Journal of Southern History 50 (1984): 597-628. Arsenault's compelling essay examines the effect that the air conditioner has had on southern culture and analyzes the historical link between climate and the idea of the South.

Chinard, Gilbert. “Eighteenth Century Theories on America as a Human Habitat.” Proceedings of the American Philosophical Society 91 (1947): 27-57. Chinard's article examines European observations of and reactions to the North American climate, which is useful for tracing the evolution of ideas of regional distinctiveness.

Cobb, James C. The Most Southern Place on Earth: The Mississippi Delta and the Roots of Regional Identity. New York: Oxford University Press, 1992. Cobb contends that the Mississippi Delta is a climatic and cultural microcosm of the South.

Cowdrey, Albert E. This Land, This South: An Environmental History. Lexington, KY: University Press of Kentucky, 1983; rev. ed., 1986. Cowdrey's geographical portrait of the South analyzes the historical interplay between the region's environment and its disease profile.

Crosby, Alfred W. “The Past and Present of Environmental History.” American Historical Review 100 (1995): 1177-89. Crosby gives a thorough conceptual overview of the field of environmental history.

Duffy, John. “Medicine in the West: An Historical Overview.” Journal of the West 21 (July 1982): 5-14. Duffy depicts the nineteenth-century medical conditions in the American West.

Fischer, David Hackett. “Climate and History: Priorities for Research.” Journal of Interdisciplinary History 10 (1979-80): 821-30. Fischer urges a synthetic approach in seeking connections between climate and history.

Flores, Dan. “Place: An Argument for Bioregional History.” Environmental History Review 18 (Winter 1994): 1-18. Flores gives a historiographical review of bioregional history.

Foran, Wiliam A. “Southern Legend: Climate or Climate of Opinion?” Proceedings of the South Carolina Historical Association 1956 (1957): 6-22. Foran scathingly reviews the environmentally determinist view of southern culture.

Hildreth, Martha L., and Moran, Bruce T, eds.. Diseases and Medical Care in the Mountain West: Essays on Region, History, and Practice. Reno: University of Nevada Press, 1998. This collection is something of a slimmer Western equivalent to Science and Medicine in the Old South. Hildreth's and Moran's introduction and Ronald Numbers's “The Significance of Regions in American Medical History” are of particular use for assessing regionalism in American medicine.

Horsman, Reginald. Race and Manifest Destiny: The Origins of American Racial Anglo-Saxonism. Cambridge, MA: Harvard University Press, 1981. Horsman's account of racial discourse in America in the nineteenth century concentrates almost exclusively on the Caucasian/African-American (as opposed to North/South) dichotomy. 139

Hudson Brian. “The New Geography and the New Imperialism, 1870-1918.” Antipode 9 (Sept. 1977): 12-18. Hudson chronicles the lasting American belief in climatic determinism.

Hume, Edgar Erskine. “The Foundation of American Meteorology by the United States Army Medical Department.” Bulletin of the History of Medicine 8 (1940): 202- 38. Hume recounts the U. S. Army's nineteenth-century developments in meteorology.

Jacobson, Matthew Frye. Whiteness of a Different Color: European Immigrants and the Alchemy of Race. Cambridge, MA: Harvard University Press, 1998. Jacobson's work deals in different sections with the importance placed on immigrants' physical acclimation to their new environments, which was a major theme of regional medicine.

Jones, Michael O. “Climate and Disease: The Traveller Describes America.” Bulletin of the History of Medicine 41 (1967): 254-66. Jones surveys perceptions of healthy and unhealthy climates in the United States in eighteenth- and nineteenth-century travel writing.

Kirby, Jack Temple. Mockingbird Song: Ecological Landscapes of the South. Chapel Hill: University of North Carolina Press, 2006. Kirby's environmental history gives a lush portrait of ecology and culture in the South. The volume is thematically driven and so must be combed thoroughly for analysis of specific topics, but it is comprehensive, wide-ranging, and compulsively readable.

———. Poquosin: A Study of Rural Landscape & Society. Chapel Hill: University of North Carolina Press, 1995. Kirby's case-focused treatment of the James-Albemarle subregion of Virginia and North Carolina explores the relationship between the land of the rural South and its inhabitants.

Koeniger, A. Cash. “Climate and Southern Distinctiveness.” Journal of Southern History 59 (1988): 21-44. Koeniger convincingly argues that “climate has played a larger role in shaping southern distinctiveness than contemporary historians are prone to acknowledge.”

Kupperman, Karen Ordahl. “Fear of Hot Climates in the Anglo-American Colonial Experience.” William & Mary Quarterly 41 (1984): 213-40. Kupperman's article illustrates excellently the general attitudes toward climate, especially that of the American South, that early colonists possessed.

Miller, David C. Dark Eden: The Swamp in Nineteenth-Century American Culture. New York: Cambridge University Press, 1989. This is a largely literary analysis of the cultural resonance in antebellum America of the swamp, which was associated with both southern culture and disease. Miller's writing is often too obtuse to be taken seriously.

Nash, Linda. Inescapable Ecologies: A History of Environment, Disease, and Knowledge. Berkeley: University of California Press, 2006. Nash's work is a perspicacious assessment of the relationship, perceptual and otherwise, between health and the environment in California's Central Valley from the antebellum period through the present.

140 Rupke, Nicolaas A., ed. Medical Geography in Historical Perspective. London: The Wellcome Trust Centre for the History of Medicine, 2000. This is a collection of essays centered around several themes in medical geography. Conevery Valenčius's introduction is an excellent review of several threads in medicogeographical scholarship.

Stewart, Mart A. “Environmental History: Profile of a Developing Field.” The History Teacher 31 (1998): 351-68. Stewart's historiographical review is an excellent and thorough introduction to the major works and disparate themes of environmental history.

———. “'Let Us Begin with the Weather': Climate, Race and Cultural Distinctiveness in the American South.” In Nature and Society in Historical Context, edited by Mikuláš Teich, Roy Porter, and Bo Gustafsson, 240-56. New York: Cambridge University Press, 1997. Stewart assesses the distinctiveness (or lack thereof) of the southern focus on the relationship between climate and culture. The article's copious citations are a useful review of the field.

———. “What Nature Suffers to Groe”: Life, Labor, and Landscape on the Georgia Coast, 1680- 1920. Athens, GA: University of Georgia Press, 1996. This environmental history focuses on the Atlantic coast and Sea Islands of Georgia as a medium to examine the relationship between the land of the South and the southerners who have inhabited it.

Thompson, Edgar T. “The Climatic Theory of the Plantation.” Agricultural History 15 (1941): 49-60. Thompson attacks the theory that the southern climate necessitated the development of plantations.

Valenčius, Conevery Bolton. The Health of the Country: How American Settlers Understood Themselves and Their Land. New York: Basic Books, 2002. The Health of the Country provides a wonderful account of the complex, malleable, and evolving relationship between settlers of Arkansas and Missouri and the land that they encountered. Chapter VI deals briefly with southern regional medicine.

Worster, Donald. Nature's Economy: A History of Ecological Ideas. San Francisco: Sierra Club Books, 1977 (as Nature's Economy: The Roots of Ecology); 2nd ed., Cambridge: Cambridge University Press, 1994. Though the history of medicine is largely absent, Nature's Economy is a good overview of the ecological theories upon which climatic understandings of medicine rested.

Studies of Confederate and Civil War Medicine Adams, George Worthington. Doctors in Blue: The Medical History of the Union Army in the Civil War. New York: Henry Schuman, 1952. This remains the classic survey of Union military medicine.

———. “Caring for the Men.” In The Image of War, 1861-1865, vol. 4, pp. 231-74. Edited by William C. Davis. Garden City, NY: Doubleday, 1983. Adams presents a thorough overview of Civil War medical practice.

———. “Confederate Medicine.” Journal of Southern History 6 (1940): 151-66. Adams gives a concise survey of wartime Confederate medicine. 141

Anderson, John Q. A Texas Surgeon in the C.S.A. Confederate Centennial Studies, no. 6. Tuscaloosa: Confederate Publication Co., 1957. This is a biographical sketch of a Texas surgeon serving in the Confederate Army.

Baird, Nancy D. “The Yellow Fever Plot.” Civil War Times Illustrated 13 (November 1974): 16-23. This article, written for a popular audience, chronicles the alleged attempt by a Confederate doctor to introduce yellow fever into northern cities in 1864.

Blustein, Bonnie Ellen. “'To Increase the Efficiency of the Medical Department': A New Approach to U.S. Civil War Medicine.” Civil War History 33 (1987): 22-41. Blustein's Neo-Marxist appraisal of reform efforts in the Union Medical Department emphasizes the importance of evaluating medicine in context (and context in medicine).

Bollet, Alfred J. Civil War Medicine: Challenges and Triumphs. Tucson, AZ: Galen, 2002. Though written for a school-age audience, this is a comprehensive introduction to the subject.

———. “To Care for Him That Has Borne the Battle—A Medical History of the Civil War.” Medical Times 117 (April 1989): 121-26; 117 (May 1989): 101-8; 117 (October 1989): 74-80. Bollet's serial article is a good if unfocused overview of wartime medical issues.

Breeden, James O. “A Medical History of the Later Stages of the Atlanta Campaign.” Journal of Southern History 35 (1969): 31-59. Breeden's article is light on argumentation but contains illuminating statistics about the prevalence and incidence of disease during Sherman's 1864 Atlanta campaign.

———. “Confederate Medicine: The View from Virginia.” Virginia Medical Quarterly 118, no. 4 (1991): 222-31. Breeden gives a concise overview of Confederate medical practice in the Civil War.

———. “Medical Shortages and Confederate Medicine: A Retrospective Evaluation.” Southern Medical Journal 86 (1993): 1040-48. Breeden analyzes attempted remedies for the shortage of medical supplies in the Confederacy.

———. “The 'Forgotten Man' of the Civil War: The Southern Experience.” Bulletin of the New York Academy of Medicine 55 (1979): 652-69. Breeden's depiction of the Confederate field doctor focuses on medical practice rather than theory.

Brooks, Stewart M. Civil War Medicine. Springfield, IL: Charles C. Thomas, 1966. This account, though frequently cited, is a relatively humdrum discussion of the topic.

Calcutt, Rebecca Barbour. Richmond's Wartime Hospitals. Gretna, LA: Pelican, 2005. Calcutt depicts the medical scene in Civil War-era Richmond.

Coddington, Edward B. “Soldiers' Relief in the Seaboard States of the Southern Confederacy.” Mississippi Valley Historical Review 37 (1950-1): 17-38. Coddington discusses civilian efforts to provide material relief to Confederate soldiers. 142

Courtwright, David T. “Opiate Addiction as a Consequence of the Civil War.” Civil War History 24 (1978): 101-11. Courtwright claims that “the Civil War was a factor in the spread of opiate addiction in America.”

———. “The Hidden Epidemic: Opiate Addiction and Cocaine Use in the South, 1860- 1920.” Journal of Southern History 49 (1983): 57-72. Courtwright explores the effect of the Civil War on opiate addiction in the South.

Cunningham, H. H. “Confederate General Hospitals: Establishment and Organization.” Journal of Southern History 20 (1954): 376-94. Cunningham gives a straightforward chronological account of the founding and progress of the Confederate Medical Department and its associated hospitals.

———. Doctors in Gray: The Confederate Medical Service. Baton Rouge: Louisiana State University Press, 1958; pbk. ed., 1993. Cunningham's survey of the Confederate medical corps concentrates on the structural elements of the medical corps and remains a good introduction to the subject fifty years after its publication.

———. Field Medical Services at the Battles of Manassas (Bull Run). University of Georgia Monographs, no. 16. Athens, GA: University of Georgia Press, 1968. Cunningham traces the Union and Confederate medical departments in the early Civil War.

———. “The Confederate Medical Officer in the Field.” Bulletin of the New York Academy of Medicine 34 (1958): 461-88. Cunningham's article covers various aspects and duties of the regimental physician in the Confederate army. Cunningham deals almost exclusively with practice, not theory.

Davis, Stephen. “A Confederate Hospital: Surgeon John Patterson and the Clayton during the Atlanta Campaign, 1864.” Journal of the Medical Association of Georgia 75 (1986): 14-24. This article surveys medical conditions during the Confederate defense of Georgia.

Denney, Robert E. Civil War Medicine: Care & Comfort of the Wounded. New York: Sterling, 1994. This is a scrapbook of excerpts of primary accounts of Civil War medicine, organized chronologically and placed one after the other. Though the accounts are valuable, the book's structure limits its usefulness.

Donald, W. J. “Notes and Documents: Alabama Confederate Hospitals.” Alabama Review 15 (1962): 272-81; 16 (1963): 64-78. This is essentially a list, in prose form, of Alabamian Civil War hospitals and doctors.

Faust, Drew Gilpin. This Republic of Suffering: Death and the American Civil War. New York: Knopf, 2008. Faust's study of death in the American Civil War analyzes the way in which the carnage of the conflict influenced the civilian populations of the North and the South.

Franke, Norman H. “Official and Industrial Aspects of Pharmacy in the Confederacy.” Georgia Historical Quarterly 37 (1953): 175-87. 143 ———. “Pharmaceutical Conditions and Drug Supply in the Confederacy.” Georgia Historical Quarterly 37 (1953): 287-98. ———. “Pharmacy and Pharmacists in the Confederacy.” Georgia Historical Quarterly 38 (1954): 11-28. In these three companion articles, Franke assesses the need for medicines in the Confederate States, presents the methods for obtaining drugs, and discusses the social position of pharmacists in the Confederacy.

Freemon, Frank R. “Administration of the Medical Department of the Confederate States Army.” Southern Medical Journal 80 (1987): 630-7. Freemon's article is a whirlwind treatment of Confederate military medicine, and is valuable for providing a brief survey of the topic.

———. Gangrene and Glory: Medical Care During the American Civil War. Madison, NJ: Fairleigh Dickinson University Press, 1998. Freemon presents a balanced and insightful account of Civil War medical history. Though too anecdotal at times, the book is an excellent overview, and comprehensively treats a number of related topics.

———. “Medical Care at the Siege of Vicksburg, 1863.” Bulletin of the New York Academy of Medicine 67 (1991): 429-38. Freemon analyzes the impact of disease on the Vicksburg campaign.

———. Microbes and Minie Balls: An Annotated Bibliography of Civil War Medicine. Rutherford, NJ: Fairleigh Dickinson University Press, 1993. Freemon's bibliography contains comprehensive listings of both primary and secondary sources related to Civil War medicine, and his annotations helpfully summarize the material. Though an updated version would be welcome, this is an invaluable guide to the field.

———. “The Medical Challenge of Military Operations in the Mississippi Valley during the American Civil War.” Military Medicine 157 (1992): 494-7. Freemon examines the role of disease in the siege of Vicksburg and the Trans-Mississippi Department during the later stages of the Civil War.

Gilchrist, Michael R. “Disease & Infection in the American Civil War.” American Biology Teacher 60 (1998): 258-62. This article contains a variety of useful and alarming statistics about mortality in the war.

Green, Carol Cranmer. Chimborazo: The Confederacy's Largest Hospital. Knoxville: University of Tennessee Press, 2004. Green's account discusses the Confederate States Medical and Surgical Journal, among other Confederate medical institutions.

Hall, Courtney Robert. “Confederate Medicine: Caring for the Confederate Soldier: An Introduction to the History of the Medical Corps of the Confederate Army in the War Between the States.” Medical Life 42 (1935): 443-508. Hall's lengthy (and lengthily titled) monograph focuses on the structure, organization, and practice of the official Confederate medical apparatus.

——— “The Confederate Medical Department: Its Influence upon War Operations.” Army Ordnance 17 (1936-7): 33-5. Hall briefly presents the daunting tasks faced by the Confederate Medical Department. 144

———. “The Influence of the Medical Department Upon Confederate War Operations.” Journal of the American Military History Foundation 1 (1937): 46-54. Hall gives a hagiographic portrait of “the valiant Doctor” Samuel Preston Moore.

———. “The Lessons of the War between the States.” International Record of Medicine 171 (1958): 408-30. Hall assesses the structure and practice of the army medical departments North and South.

Hallock, Judith Lee. “'Lethal and Debilitating': The Southern Disease Environment as a Factor in Confederate Defeat.” Journal of Confederate History 7 (1991): 51-61. Hallock indirectly assesses the acclimation theory of southern disease.

Harris, Brayton, and Kelley, Kathleen. “Invisible Enemies.” Civil War: The Magazine of the Civil War Society 9 (1991): 26-29, 58-60. This is a brief and not particularly scholarly account of disease in the Civil War.

———. “Myths and Miracles: Medicine in the Civil War.” Civil War: The Magazine of the Civil War Society 9 (1991): 18-22, 52-4. As in the previous entry, Harris and Kelley give a layman's survey of Civil War medicine.

Herschbach, Lisa Marie. “Fragmentation and Reunion: Medicine, Memory and Body in the American Civil War.” Ph.D. dissertation, Harvard University, 1997. This dissertation explores the complex relationship between nostalgia, injury, and the literal and metaphorical reconstruction of the soldier's body in and after the Civil War.

Key, Jack D. “U. S. Army Medical Department and Civil War Medicine.” Military Medicine 133 (1968): 181-92. Key surveys the structural development of the Union Medical Department.

Kramer, Howard D. “Effect of the Civil War on the Public Health Movement.” Mississippi Valley Historical Review 35 (1948-9): 449-62. Kramer focuses on sanitation efforts during the war.

Lynch, John S. “Medical Treatment, or Lack Thereof, Disabled More Soldiers than Bullets or Cannonballs.” America's Civil War 4 (September 1991): 11-12, 18-19. Unwieldy (and grammatically incorrect) title aside, this is a good brief survey of Civil War medicine.

Malpass, George N. “Medicine in the Confederate Army.” American Journal of Pharmacy 115 (1943): 173-77. This article is largely a celebratory portrait of Samuel Preston Moore.

Marshall, Mary Louise. “Medicine in the Confederacy.” Bulletin of the Medical Library Association 30 (1942): 278-99. Marshall presents an adequate survey of Confederate medicine.

Massey, Mary Elizabeth. Ersatz in the Confederacy: Shortages and Substitutes on the Southern Homefront. Columbia, SC: University of South Carolina Press, 1952; repr., 1993. Massey's oddly titled but well-researched work contains a chapter on the southern efforts to develop 145 indigenous substitutes for medicines.

McMurry, Richard M. “Marse Robert and the Fevers: A Note on the General as Strategist and on Medical Ideas as a Factor in Civil War Decision Making.” Civil War History 35 (1989): 197-207. McMurry demonstrates that the Confederate reluctance to reinforce troops fighting in the Deep South stemmed from considerations that were as much medical as military.

Quinone, Mark A. “Drug Abuse during the Civil War (1861-1865).” International Journal of the Addictions 10 (1975): 1007-20. Quinone concludes that the Civil War did not increase drug abuse in the United States.

Riley, Jr., Harris D. “Medical Activities.” In The American Civil War: A Handbook of Literature and Research, edited by Steven E. Woodward, 433-53. Westport, CT: Greenwood Press, 1996. Riley's overview of the field of Civil War medicine is a useful starting point, but not a comprehensive survey of the literature. This is a supplement to, but not substitute for, Freemon's Microbes and Minie Balls.

———. “Medicine in the Confederacy.” Military Medicine 118 (1956): 53-64, 144-53. This article replicates George Adams's earlier and better “Confederate Medicine.”

———. “Moore, Samuel P.” In Encyclopedia of Southern of Culture, edited by Charles Reagan Wilson and William Ferris. Chapel Hill: University of North Carolina Press, 1989. Riley gives an extremely brief sketch of Moore's life.

Rutkow, Ira M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. New York: Random House, 2005. Though Rutkow, by his own acknowledgement, focuses almost exclusively on the North, this engaging and well-written work is the best recent treatment of Civil War medicine.

Rutkow, Lainie. “Their Own Civil War: The Struggle by Homeopathic Physicians in the United States Army to Achieve Medical Pluralism, 1861-1865.” B.A. Thesis, Yale University, 1999. Rutkow's thesis adequately addresses an oft-overlooked aspect of Civil War medicine.

Sartin, Jeffrey S. “Infectious Disease during the Civil War: The Triumph of the 'Third Army.'” Clinical Infectious Diseases 16 (1993): 580-4. Sartin's article is a brief overview of disease in the war.

Schroeder-Lein, Glenna R. Confederate Hospitals on the Move: Samuel H. Stout and the Army of Tennessee. Columbia, SC: University of South Carolina Press, 1994. Schroeder-Lein's analysis reads like a biography of Stout.

Schultz, Jane E. “The Inhospitable Hospital: Gender and Professionalism in Civil War Medicine.” Signs 17 (1992): 363-92. Schultz's article is a feminist reading of nurse-doctor relations in Civil War hospitals.

Sharpe, William D. “Confederate Medical Services during the War Between the States.” Academy of Medicine of New Jersey Bulletin 11 (1965): 28-40. 146 Sharpe gives an overview of the challenges of the Confederate Medical Department.

———. Introduction to the Confederate States Medical and Surgical Journal. In History of Medicine Series, issued under the auspices of the Library of the New York Academy of Medicine, no. 47, v-xii. Metuchen, NJ: Scarecrow Press, 1976. Sharpe's brief introduction to a reprint of Confederate States Medical and Surgical Journal summarizes the journal's history, contents, and reception during its short period of publication.

———. “The Confederate States Medical and Surgical Journal: 1864-1865.” Bulletin of the New York Academy of Medicine 52 (1976): 373-418. Sharpe's article is a comprehensive summary of Confederate States Medical and Surgical Journal, with extensive quoting of articles and statistical analyses of the prevalence of specific topics. Sharpe contributes little insight of his own, but the article is a good introduction to the journal.

Shyrock, Richard H. “A Medical Perspective on the Civil War.” In Medicine in America: Historical Essays, 90-108. Baltimore: The Johns Hopkins University Press, 1966. Shyrock argues for the importance of including medicine in discussions of the Civil War, noting that “if medical aspects are omitted, the story is not only incomplete but unrealistic as a total picture.”

Steiner, Paul E. Disease in the Civil War: Natural Biological Warfare in 1861-1865. Springfield, IL: C. C. Thomas, 1968. Steiner attempts to describe several campaigns of the Civil War with a strict focus on the effects resulting from the prevalence of disease among Union and Confederate troops.

———. Physician-Generals in the Civil War: A Study in Nineteenth Mid-Century American Medicine. Springfield, IL: C. C. Thomas, 1966. Steiner employs an odd quantitative method to ascertain why many physicians chose to join the armed services proper, rather than the medical corps, upon the outbreak of the Civil War.

Weiss, E. R. “Life and Times of Samuel Preston Moore, Surgeon General of the Confederate States of America.” Southern Medical Journal 23 (1930): 916-22. Weiss gives a brief sketch of Moore's life and the challenges he faced as Surgeon General.

Wells, Cheryl A. “Battle Time: Gender, Modernity, and Confederate Hospitals.” Journal of Social History 35 (2001): 409-28. Wells argues that Confederate hospitals became “degendered” spaces.

Welsh, Jack D. Medical Histories of Confederate Generals. Kent, OH: Kent State University Press, 1995. Welsh's book contains medico-biographical sketches of 425 Confederate generals.

———. Two Confederate Hospitals and Their Patients: Atlanta to Opelika. Macon, GA: Mercer University Press, 2005. This study is in essence a paraphrase, with little added analysis, of Confederate mortality statistics and the records of a Confederate medical officer.

Williams, Carrington. “Samuel Preston Moore: Surgeon General of the Confederate States Army.” Virginia Medical Monthly 88 (1961): 573-5. This article is valuable for details on the life of the Confederate Surgeon General.

147 Wilson, Robert. “Medicine in the Days of the Confederacy.” Journal of the South Carolina Medical Association 66 (1970): 169-72. This is an extremely brief overview of Civil War medicine in the South.

Relevant Works on Regionalism, Nationalism, and Medicine in Other Contexts Anderson, Warwick. Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines. Durham, NC: Duke University Press, 2006. Anderson's penetrating work illuminates the connection between nationalism and medicine drawn by early Filipino advocates for independence.

———. The Cultivation of Whiteness: Science, Health and Racial Destiny in Australia. Melbourne: Melbourne University Press, 2002. As Anderson explains, the language Australian physicians used to justify their country's severance from Britain was strikingly similar to southern arguments for medical distinctiveness.

———. “The Trespass Speaks: White Masculinity and Colonial Breakdown.” The American Historical Review 102 (1997): 1343-70. Anderson's excellent article illustrates the tenacity with which the American medical profession clung to climatic theories of disease well into the twentieth century.

Arnold, David. “Introduction: Tropical Medicine before Manson.” In Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900, edited by Arnold, 1-19. Amsterdam: Rodopi, 1996. Arnold traces the development of the concept of tropical medicine, which developed from notions of the insalubrity of warm environments that informed antebellum American medicine.

Hobsbawm, Eric, and Ranger, Terence, eds. The Invention of Tradition. New York: Cambridge University Press, 1983. Hobsbawm's introduction to this essay collection provides a theoretical and conceptual definition of “invented traditions,” noting in particular the use of history to forge identity.

Huisman, Frank, and Warner, John Harley, eds. Locating Medical History: The Stories and Their Meanings. Baltimore: The Johns Hopkins University Press, 2004. This collection situates in context the employment of medical histories by doctors and historians and analyzes the use of fraught terms such as “tradition” or “the tropics” in the history of medicine.

Rosenberg, Charles E. “Introduction: Framing Disease: Illness, Society, and History.” In Framing Disease: Studies in Cultural History, edited by Rosenberg and Janet Golden, xiii- xxvi. New Brunswick, NJ: Rutgers University Press, 1992. Rosenberg's introduction explores the contextual and social aspects of disease, the construction of which facilitates the political and politicized uses of medicine.

Warner, John Harley. “Science in Medicine.” In Historical Writing on American Science: Perspectives and Prospects, edited by Sally Gregory Kohlstedt and Margaret W. Rossiter, 37-58. Baltimore: The Johns Hopkins University Press, 1985. This historiographic literature review argues that many historians have ignored the lability and multiplicity of the meaning of “science” to American physicians in different periods.

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