People’s Medicine in the Early South
In 1951, when William Postell published a brief study of The Health of Slaves on Southern Plantations, the frontispiece conveyed a curious message. The print suggested that residents of rural cabins, where good health rested firmly upon the family Bible and the home medicine chest, had two outside alternatives in times of sickness. At the back door a “black mammy,” labeled QUACKERY, waited with her witch-like charms while her kinfolk danced Indian-fashion around a moonlit campfire. At the front door, meanwhile, appeared THE PHYSICIAN, carrying the latest in bottled drugs. So that no one would have any doubts about the preferable way to turn, the professional doctor was bathed in sunlight and his nonprofessional counterpart was wrapped in darkness.
The allegorical picture by a “medical artist” dramatically illustrates widely held assumptions about the evolution of Southern medical care. The history of health in the South is often told in terms of modern medicine’s giant leaps forward — the first use of ether for anesthesia in Georgia, the campaign of the Southern Health Board to eradicate hookworm, the completion of successful heart transplants in Texas — all landmarks that have been achieved, and memorialized, by white male doctors. And nowadays such triumphs are often linked to the prestigious medical schools and modern hospitals, both public and private, that have grown up from Baltimore to Houston. Indeed, over the past century these powerful scientific-commercial institutions have extended the system of modern medicine so pervasively throughout the South that it is difficult to recall, much less comprehend, the alternative health care traditions that once predominated.
But those traditions existed in the South. Nowhere else in the country did patterns of “pre-modern” health treatment derive from such diverse sources, develop so fully, and endure so long. Even now these patterns, woven from the knowledge of Native Americans, Africans and Europeans, are not entirely dead in parts of the rural South. And they are of more than nostalgic interest in an era when medical values appear selfish and warped, when the human and financial costs of medical care seem absurdly high, and when the medical establishment acts more concerned with public relations than with public health.
While the eighteenth-century realm of purgatives and balms is now remote, some of its underlying principles have an enduring appeal. As scientific-medicine- for-private-profit begins to appear something less than total enlightenment and sunshine, we can begin to ask whether traditional health care was entirely superstition and darkness. The answer bears little relation to Postell’s frontispiece. Long before the white scientist walked in the front door, Southerners of all races benefited from health care which, whatever its limitations, gave primary attention to patients, relied heavily on low-cost and easily obtainable herbal remedies, and was available on a comparatively equal basis to all.
Hominy, Herbs and Healers
When non-Americans first reached the western hemisphere, they found that in many regions the native people, growing the unfamiliar crop known as maize, were obtaining a higher yield of food per acre than farmers in the Old World. As Europeans and Africans took up maize cultivation, they began to suffer from the niacin deficiency known as pellagra. Historian William McNeill points out that the Amerindians had “escaped pellagra by soaking maize to make ‘hominy grits,’ and by supplementing their diet with beans in those regions where hunting was no longer possible.” He explains that maize kernels “were soaked in a lime solution, which broke down some of the molecules ... in a way that allowed human digestion to synthesize needed vitamins that are absent from the maize itself.” Gradually this special preparation of corn, which offset its nutritional disadvantages, passed into non-Indian, Southern culture. Archaeologists can still point out the well-worn “hominy holes” in ancient rock formations where regional tribes first evolved the recipe for grits.
Indian skill with domesticated crops was more than equaled by their knowledge of wild plants. When John Hawkins, the English sea captain, touched the Florida coast in 1565, he noted that the inhabitants “have for apothecary herbs, trees, roots and gummes...whereof I know not the names.” Hawkins did not stay, but Frenchmen settling there at the same time told Spaniards arriving a decade later that “when thei came into those partes, thei had been sicke the moste of theim, of greevous and variable diseases, and that the Indians did showe them this Tree, and the maner how thei should use it, and so thei did, and thei healed of many evilles.” The tree was sassafras, and soon the Spaniards were using it with such “greate effects, that it is almost incredible.”
When English settlers entered the deep South more than a century later, they complained that earlier Europeans had not paid close enough attention to Indian medicine. “Amongst all the Discoveries of America by the Missionaries of the French and the Spaniards,” wrote John Lawson of North Carolina in the early eighteenth century, “I wonder none of them was so kind to the World as to have kept a Catalogue of the Distempers they found the Savages capable of curing, and their Method of Cure .... Authors generally tell us that the Savages are well enough acquainted with those Plants which their Climate affords, and that some of them effect great Cures, but by what Means and in what Form, we are left in the dark.”
The English tried to be more observant of Indian practices. John Brickell (who borrowed much of his data from Lawson) stated that the natives could “perform notable Cures, of which it may not be amiss to give some Instances, because they seem strange, if compared with our Method of curing Distempers.” He reported that while they gathered plants, leaves and tree bark from the countryside, they also cultivated special gardens of medicinal herbs, “that upon all Occasions they might be provided with these vegetables that are proper for the Indian Distempers, or any other use they might have occasion to make of them.”
Thomas Ashe, a late seventeenth-century English observer in Carolina, commented that the natives’ “exquisite Knowledge” was “conveyed in a continued Line from one Generation to another, for which those skill’d in this Faculty are held in great Veneration and Esteem.” This statement was confirmed in the next century by John Wesley, the famous evangelist who preached in the fledgling colony of Georgia in the late 1730s. In his hugely popular book on Primitive Physic, first published in 1747, he observed of the Indians that, “if any are sick, or bit by a serpent, or torn by a wild beast, the fathers immediately tell their children what remedy to apply. And it is rare that the patient suffers long; those medicines being quick, as well as generally infallible.”
This praise was not based on hearsay; many whites had direct experience of Indian medical skills. In 1725, Alexander Long recorded being cured by “the greatest herbalist that ever I saw in all my life” while among the Cherokee. During the same decade Le Page du Pratz, a Frenchman who lived among the Natchez in Louisiana, told of a crippling and persistent pain in his thigh. White physicians in New Orleans bled him, suggested aromatic baths, and advised him that he should return to France “to drink the waters.” But his field hands urged him to consult the Natchez, “who, they said, did surprizing cures, of which they told me many instances, confirmed by creditable people.” When the Indians prescribed the application of a simple poultice, he was up and about within eight days, and the pain never returned.
From this point on, du Pratz was deeply respectful of Indian medical knowledge and conscious of European ignorance. Of several field plants he wrote, “The native physicians know more of its virtues than we do in France.” And in describing the socalled copalm tree, he stated, “I shall not undertake to particularize all the virtues of this Sweet-Gum or Liquid- Ambar, not having learned all of them from the natives of the country, who would be no less surprised to find that we used it only as a varnish, than they were to see our surgeons bleed their patients.”
Not long after his first sickness, du Pratz developed an eye infection, and a Paris-trained surgeon in Louisiana advised him it would be “necessary to use the fire for it.” Before the Frenchman consented to the crude technique of cauterizing, he was visited by the friendly Natchez chief. “The Great Sun observed I had a swelling in my eye,” du Pratz recalled, “and asked me what was the matter with it. I shewed it to him, and told him that in order to cure it, I must have fire put to it; but that I had some difficulty to comply, as I dreaded the consequences of such an operation.” Without replying, the chief summoned his doctor, who examined the eye and cured it perfectly in a matter of days. “It is easy from this relation to understand what dextrous physicians the natives of Louisiana are,” du Pratz concluded. “I have seen them perform surprising cures on Frenchmen.”
Cherry Bark, Ginseng and Snake Root
Afro-Americans were also capable of surprising cures. “The slave,” writes French scholar Frederic Mauro, “brought with him his cooking practices, his sense of a balanced diet adapted to the tropics, of medical formulas and of plants unknown in America.” Though Europeans benefited directly and indirectly from this tradition, they were generally unwilling to acknowledge and examine it. It was exceptional for Janet Schaw, touring the South in the eighteenth century, to note in her diary, “The Negroes are the only people that seem to pay any attention to the various uses that the wild vegetables may be put to.”
Some of this knowledge came from local Indians, with whom blacks had close contact during the early years of foreign settlement; some came in from the old country. A former slave woman interviewed in Texas in the 1930s claimed that her mother had learned knowledge of herbs from the Indians and from “old folks from Africy.”
‘‘My old granny uster make tea out o’ dogwood bark an’ give it to us chillun when we have a cold,” recalled Fannie Moore, an ex-slave from North Carolina. “Else she make a tea outen wild cherry bark, pennyroil, or hoarhound. For stomach ache she give us snake root. When you hab de fever she wrap you in cabbage leaves or ginseng leaves; dis made de fever go.” According to Solomon Caldwell of South Carolina, “I ’member my ma would take fever grass and boil it to tea and have us drink it to keep de fever away. She used branch elder twigs and dogwood berries for chills.”
Many of these treatments were complex and effective, and those who could practice them best were often known as “doctor.” Even when whites were officially in charge of plantation health, black midwives played a significant role. A white doctor among the South Carolina planters observed, ‘‘On every plantation the sick nurse, or doctor woman, is usually the most intelligent female on the place; and she has full authority under the physician, over the sick.” In 1729, a Virginia slave named James Papaw was granted freedom and a thirty pound a year pension for life when he agreed to make public a complicated “decoction of the woods,” said to be effective against yaws and “the most inveterate Venereal Distempers.” Several decades later in South Carolina a man named Sampson, enslaved to Mr. Robert Hume, received his freedom and a one hundred pound pension for revealing his elaborate remedy for rattlesnake poison.
But useful knowledge of herbs and medicines did not always suit the planters’ interests, for enslaved workers often made use of these skills in the struggle for independence and liberation. South Carolina slaves regularly induced abortion by boiling four ounces of root bark from the common cotton plant in a quart of water until it was reduced to a pint, then drinking a dose two or three times per hour. The process proved so effective that a white doctor in Georgia eventually publicized his own decoction of witch-hazel leaves to prevent the abortions which the blacks freely induced. Of greater concern to Caucasians was the constant threat of poisoning. In the mid-eighteenth century, South Carolina’s noted doctor-botanist, Alexander Garden, troubled by the skills in the hands of “negroe Strollers and’ old women,” set out to “investigate the nature of particular poisons (chiefly those indigenous in this province and Africa).” He asked experienced friends to give him what information they could “about African Poisons, as I greatly . . . suspect that the Negroes bring their knowledge of the poisonous plants, which they use here, with them from their own country.”
Several years later, in 1751, a rash of suspected poisonings had led South Carolina legislators to pass a law designed to curtail black knowledge about, and access to, medicinal drugs. The act stated that “in case any slave shall teach or instruct another slave in the knowledge of any poisonous root, plant, herb, or other poison whatsoever, he or she shall suffer death as a felon.” It was made unlawful for white physicians “to employ any slave or slaves in the shops or places where they keep their medicines or drugs,” and up to fifty lashes were prescribed for any “negroes or other slaves (commonly called doctors)” who attempted “to administer any medicine, or pretended medicine, to any other slave; but at the instance or by the direction of some white person.” Similar harsh laws prohibiting the exercise of black medical knowledge spread throughout the slave South over the following century and had an inevitable effect on limiting the use of Afro-American skills. But the re-enactment of such laws suggests that none of them were entirely successful in their purpose. In 1844 a Tennessee court, ruling on the case of a respected black healer named Jack, observed that “such doctors might foment insurrection” and declared that “it was thought most safe to prohibit slaves from practicing medicine altogether.”
Hesitantly, Europeans in the South learned to take advantage of these alternative traditions and the plants upon which they were based. New and effective remedies were often sent back to the Old World. In 1745, for example, the London Magazine mentioned the use of Virginia snake root in a preparation for the plague. A century later, James W. Mahoney of North Carolina published an entire volume entitled, The Cherokee Physician, or Indian Guide to Health (Asheville, 1849). Virgil J. Vogel, author of American Indian Medicine, noted recently, “Perhaps the most celebrated remedy to reach the world by way of the Carolinas was the Indian pinkroot (Spigelia Mariiandica L.), a Cherokee remedy for worms, which was adopted into the London, Dublin, and Edinburgh pharmacopeias, and was official in the American pharmacopeia from 1820 to 1926.” At first Europeans were less familiar than Indians and Africans with the semitropical flora of the deep South. And as time passed, health care among whites was moving slowly out of the hands of parents, ministers and midwives into the hands of paid apothecaries and surgeons. But these facts did not prevent European immigrants from importing their own substantial knowledge of traditional medicine or from exchanging, enriching and expanding these skills in the New World.
By the nineteenth century, white Southerners regularly publicized established treatments as well as new ones. For example, John S. Wilson, a physician from Columbus, Georgia, who had practiced in south Alabama, published articles in the American Cotton Planter and edited a “Health Department” for Godey’s Lady’s Book during the 1850s. He was at work on a book called The Plantation and Family Physician when the Civil War broke out, and in 1863, while serving as a Confederate Army surgeon, he published a sixteen-page booklet entitled The Southern Soldier’s Health Guide. Nothing illustrates the persistence of traditional medicine in the region better than the fact that during that same year, the Surgeon General’s Office of the Confederacy in Richmond issued a “Standard Supply Table of the Indigenous Remedies for Field Service and the Sick in General Hospitals.” Confederate soldiers were reminded that, “The interests of the government which they serve, and the importance of relying upon the internal resources of their own country, should prompt the adopting as far as practicable, of these remedies as substitutes for articles which can now be obtained only by importation.”
The motivation for self-sufficiency in health care, both regional and individual, dwindled away in the South during the century after the Civil War. Slowly, medical treatment by professional, scientific doctors became more commonplace and pervasive; methods of self-help were increasingly frowned upon, prohibited or forgotten. But the principles behind Southern traditional medicine never quite died out, and now, in the face of a highly institutionalized, bureaucratized and unresponsive modern health system, they are taking on renewed life.
Imagine a time when healers give individualized attention to the sick, understanding the need to treat a specific illness as part of the whole person and to view each individual as part of a community. Consider a place where simple and organic treatments are applied with the smallest expense and the least bureaucracy possible. Conceive a society where no yawning chasm exists between the care purchased by a few and the care received by all. If these conditions prevailed in the early South to an unrecognized degree, there may well be a place for such principles of traditional medicine again somewhere in the future of the region.