Race, Medicine and the South.
Abstract: Three recent studies by historians Todd Savitt, Steven Stowe, and Marie Jenkins Schwartz demonstrated both the importance of social history methods to southern medical studies and the insights that medical history offers to understanding slavery and race in the U.S. South. Todd Savitt's collection of essays combine the insights of contemporary public health and medical science with meticulous archival research to present an important body of work detailing African American health and medical institutions before and after emancipation. Steven Stowe and Marie Jenkins Schwartz, both of whom produced important earlier works on slavery and southern family life, turn their attention in these volumes to the social relations of antebellum medical practice. While Stowe delves deeply into the "country orthodoxy" of southern doctoring, Schwartz explores the medical practices and contested social relations that surrounded enslaved women's reproduction. Looking at southern society through the lens of medical knowledge, institutions, and practice, all three works illuminate interconnections between health and power in many aspects of nineteenth-and early twentieth-century southern life.
Article Type: Book review
Subject: Books (Book reviews)
Author: Fett, Sharla M.
Pub Date: 09/22/2009
Publication: Name: Journal of Social History Publisher: Journal of Social History Audience: Academic Format: Magazine/Journal Subject: History; Sociology and social work Copyright: COPYRIGHT 2009 Journal of Social History ISSN: 0022-4529
Issue: Date: Fall, 2009 Source Volume: 43 Source Issue: 1
Topic: NamedWork: Race and Medicine in Nineteenth- and Early-Twentieth-Century America (Nonfiction work); Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Nonfiction work); Birthing a Slave: Motherhood and Medicine in the Antebellum South (Nonfiction work)
Persons: Reviewee: Savitt, Todd Lee; Stowe, Steven M.; Schwartz, Marie Jenkins
Accession Number: 209577954
Full Text: Race and Medicine in Nineteenth-arid Early-Twentieth-Century America. By Todd L. Savitt (Kent: Kent State University Press, 2007).

Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century. By Steven M. Stowe (Chapel Hill: University of North Carolina Press, 2004).

Birthing a Slave: Motherhood and Medicine in the Antebellum South. By Marie Jenkins Schwartz (Cambridge: Harvard University Press, 2006).

Within the last fifty years, the history of medicine has undergone a transformation from a learned enterprise of scholarly physicians writing in reference to the development of their profession to a vibrant subfield of social and cultural history. Historians of medicine working in the area of U.S. southern history have offered new insight into the social relations of slavery and segregation and illuminated worlds of healing beyond hospitals and orthodox medicine. The three authors under review demonstrate how new interdisciplinary perspectives have expanded the scope of southern medical history. Todd Savitt, for example, stretches the conventional boundaries of medical history with the insights of public health and illuminates the often-overlooked early African American medical profession. In contrast, both Steven Stowe and Marie Jenkins Schwartz published first as social historians attuned to the volatile intersections of intimacy, slavery, and familial relations in the antebellum South. Not coincidently, their recent books have cast new light on southern medical history by drawing on the tools of literary analysis and feminist theory to dig deeper into antebellum cultures of healing. Taken together, these three books serve as a guide to the changing methods and questions of southern medical historiography over the past four decades.

At the same time, each author from different perspectives also underscores the centrality of medical practice and medical science to regimes of racial subordination in the South. Savitt's Race and Medicine in Nineteenth and Early-Twentieth Century America provides a comprehensive look at how racial hierarchy shaped all aspects of southern health care, including the institutions African Americans sought to build for themselves in the Jim Crow Era. Stowe's Doctoring the South takes an unconventional look at a conventional topic--the lives of southern white physicians--and finds that slavery and racial inequality permeated the everyday practice of rural white physicians. Schwartz's Birthing a Slave examines one slice of that practice in her study of white medical attention to enslaved women's childbearing. As the medical profession grew more and more implicated in the social reproduction of antebellum slave society, Schwartz demonstrates, slave women found themselves in a three-way struggle to define the meaning of their reproductive health. Looking at southern society through the lens of medical knowledge, institutions, and practice, as these books do, underlines the connections between health and power in many aspects of nineteenth-century southern life.

Race and Medicine in Nineteenth and Early-Twentieth Century America compiles Todd L. Savitt's numerous essays on African American medical history, originally published between 1975 and 2003. Savitt's early career reflected some of the intellectual trends in medical history as he transferred in the late 1960s from medical school to graduate studies in history at the University of Virginia. Savitt's 1978 book, Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia, opened the door to a new kind of social history of medicine in the South. Drawing upon his earlier medical training, Savitt incorporated the latest medical science on public health with meticulous archival research. Furthermore, Savitt's work first appeared in the midst of an explosion of literature on African American culture and community in the antebellum South. Although Savitt does not extensively engage that literature, his work reflects its influence. Whereas earlier white historians like U.B. Phillips and William Dosite Postell portrayed slave health largely as a problem of slaveholder management, Savitt acknowledged the "African heritage" of enslaved sufferers and argued for a "dual system of health care" (171) in which black and white cultures of medicine overlapped and often conflicted. (1) Savitt's groundbreaking work brought African American practitioners, as well as white domestic medicine into the arena of southern medical history, paving the way for methodologies informed by social history, feminist theory and anthropology.

A sampling of Savitt's work on slavery and medicine appears in Race and Medicine, but the bulk of the volume reflects his considerable scholarship on African American medical history in the post-emancipation period. Chapters have been revised to reflect new literature, changes in medical science and current language usage. Academic readers will find especially useful the extensive updated notes, which serve as a bibliography of recent work on specific topics. Newly written introductions, one on sickle cell anemia and one on African American medical schools, lay the groundwork for clusters of essays on these two topics.

Out of the book's four parts, the first section on "Diseases and Disorders of African Americans," explores developing medical discourses on infant mortality, filariasis, and sickle cell anemia. In this section, Savitt's questions often reflect more traditional concerns of medical history: Who should receive credit for identifying and naming a disease? How might contemporary medical science (research on Sudden Infant Death Syndrome, for example) offer fresh interpretations of historical evidence, such as planter complaints about enslaved women "overlaying" their infants? At the same time, Savitt also touches on the social dimensions of illness to show physicians' recognition of "the human being behind the clinical descriptions." (35) For example, white medical student Benjamin Washburn's medical journal article on Ellen Anthony's sickle cell disease included descriptive remarks that placed an African American working-class woman's disease within a context of disability and impoverishment in the Jim Crow South.

The social relations of commodification, enslavement, and a heavily racialized emancipation process emerge more prominently in the second section on "Health and Health Care during Slavery and Reconstruction." In addition to a chapter that summarizes many of the main themes of Savitt's book Medicine and Slavery, additional chapters in this section illuminate the interdependence of the southern medical profession and the antebellum institution of slavery. White doctors relied upon the bodies of enslaved men and women to build their medical practice as well as to supply "human specimens" (78) for medical research and training. In turn, slave owners relied upon medical doctors not only to treat enslaved patients, but also to certify slaves as sound for life insurance policies and sale. Writing in the wake of the 1972 Congressional hearings on the Public Health Service's Tuskegee Syphilis Study, Savitt broadened the historical context for institutionalized racism in medicine, extending well back into the antebellum period. Although, as Savitt elsewhere argues, antebellum theories of racial science did not necessarily translate explicitly into white medical treatment of African American patients, broader assumptions about black dependency and the degradation of the black body infused the social relations of healing across racial lines.

Deeply ingrained inequalities in antebellum health care furthermore help to explain the difficulties that newly freed African Americans faced in gaining access to health care and hospitals after the Civil War. Although "provision of medical care should have been the least controversial" (101) of the Freedmen's Bureau activities, Savitt demonstrates the intensely political nature of health care delivered by the Federal government in the war-torn southern states. Furthermore, he critiques the "racial attitude consciously or unconsciously exhibited" (116) by public health officials who established a temporary and inadequate system that left freedpeople "as dependent on the largess of whites" (117) as in slavery. Recently, scholars Jim Downs and Gretchen Long have picked up this thread of inquiry, extending the critique of dependency as well as shining new light on local African American health care efforts. (2)

In the surge of black institution-building that followed emancipation, medical training of doctors and nurses ranked high among the freedom goals of southern African Americans. The third and fourth sections of Race and Medicine excavate the fascinating history of historically black medical schools and the hard-fought battle by African American physicians for professional status in the era of segregation. Only two of fourteen historically black medical schools, Meharry Medical College and the Howard University Medical Department, survived past the 1920s. The National Medical Association (NMA), founded in 1895 at the Cotton States and International Exposition in Atlanta, and its organ, the Journal of the National Medical Association also continue to the present day. However, as Savitt's essays prove, the "failures" of black medical institutions are equally important to the historical record.

The several chapters on early black medical schools and professional networks amplify Savitt's main argument about the critical lack of resources that undercut their viability. Savitt has combed national and local archives for medical school catalogues, correspondence collections and fundraising records that provide precise histories of historically black schools with origins in both white philanthropy and African American self-help. Meager funding, lack of space, faculty turnover, impoverished students, and a national medical school reform movement informed by the new clinical and laboratory emphasis in medical education all contributed to the demise of many of these institutions. Their stories constitute a less well-known but critically important part of post-emancipation efforts to establish educational and medical services by and for African Americans.

Savitt's painstakingly researched institutional history of early African American medicine offers a richly suggestive body of work for future cultural and social analysis. Although racial politics is clearly present in Savitt's analysis, the animosity of whites towards black medical and educational advancement begs further exploration. For example, Abraham Flexner's contribution to the standardization of medical school curriculum accelerated the demise of many small medical schools, both black and white. Savitt discusses Flexner's vision of a subordinated role for "a well-taught negro sanitarian," (258, Flexner's quote) which reserved more sophisticated medical research and specialized practice for whites. At the same time, the early twentieth-century reformist pressure on black medical schools in the context of separate but unequal health care merits a fuller exploration of the intersections of modern science and modern racial ideology.

Savitt's rich evidence also suggests the importance of gender as a category of analysis for understanding the ethos of African American professional medical training. For example, one of the more recent essays, "Training the 'Consecrated, Skillful, Christian Physician's Student Life at Leonard Medical School," first published in 1998, lays the groundwork for further investigation of the ways in which African American medical education rested on prevalent models of respectable black masculinity. Furthermore, although women are mentioned occasionally throughout (Lucy H. Brown was even assistant editor of a feisty but short-lived Charleston medical journal in 1898 called the Hospital Herald), the issue of black women's efforts to gain access to medical education in black or white schools is not developed in these pages.

Steven Stowe shares with Todd Savitt a focus on medical training and southern physicians but turns from institution-building to the everyday practice of southern doctoring. Among Stowe's previous publications on the culture of "everyday doctoring" is A Southern Practice, the edited manuscripts of physician Charles A. Henrz. (3) In Doctoring the South, Stowe seeks to show the importance of the "ordinary practice" of white physicians in the "social and cultural life" of the nineteenth-century South. (1) This goal is admirably achieved with richly textured readings of an array of medical writing including doctors' bedside notes, medical school theses, case narratives, and personal journals. Indeed, Stowe's close reading of different genres of medical literature adds considerably to the analytical depth of the study. Taking the spotlight off professional battles and famous practitioners, Doctoring the South instead illuminates the professional identities of white southern doctors at work in their local communities.

Antebellum southern physicians, argues Stowe, cultivated a distinctive "country orthodoxy" that resolved the pull between their fraternal affiliation with other men of science and their immersion in the local community. The book's three sections on medical training, medical practice, and reflections on the medical profession explore how physicians fashioned their identities over lifetimes of practice. Whereas medical training drew students into a cloistered scientific world and encouraged young men to think of themselves apart from their home communities, medical practice returned young doctors to local community life where reputation, morality, and social networks mattered as much as the science of medicine. Practitioners' letters and journals reveal the personal side of professional practice as physicians strove to establish their independent manhood and confronted a vernacular culture of suffering and care that contrasted with their formal training. The experience of doctoring in a specific place, contends Stowe, was the quality "at the heart of country orthodox medicine." (97)

Although on one hand, the "country orthodox" style may seem to be equally applicable to rural medical practice in the North and West, its southern character derived from its implication in "the racial order of southern communities." In consonance with Savitt's earlier arguments, Stowe asserts that white southern doctors' treatment of enslaved patients was "shaped by the institution of slavery rather than by the more abstract notion of race." (105) Racial ideology, embedded in a "commonsense" style of "medical storytelling" about enslaved patients, argues Stowe, gave southern physicians' everyday writings "an essentially ideological power to reinscribe and naturalize fundamental social relations." (104) Physicians' daybooks reveal that although racial ideology did not necessarily determine distinct therapeutics for enslaved patients, the social order of slavery "drove race deeply into a white doctor's sense of his daily work." (107) From the impersonal representation of many enslaved patients to physicians' silence concerning injuries due to slaveholder violence, the daily relations of a slave society gave country orthodoxy its distinctly southern character.

Attuned as Stowe's work is to the complexities of race and slavery, Doctoring the South is not, nor is it intended to be, a study of relations between white physicians and enslaved patients or healers. It is, rather, a multi-layered exploration of southern white doctor's identity and work in an era of medical transformation. Country orthodoxy was deeply conservative, resistant to the influences of clinical medical practice that threatened to distance physicians from their community matrix. Avoiding narratives of "linear change" that would pose antebellum medicine as something on "the way to 'modern' medicine" (20), Stowe explores the daily work of medicine on its own terms. As such, Doctoring the South is an important contribution to studies of southern community life as well as a deeply thoughtful examination of the praxis of regional medical science.

As Marie Jenkins Schwartz convincingly demonstrates in Birthing a Slave, one important focus of white southern medical practice by the late antebellum era was the reproductive health of enslaved women. Although her book is subtitled Motherhood and Medicine in the Antebellum South, Schwartz's voluminous research centers not so much on the meaning of motherhood as on the value of enslaved women's reproductive health to three contending interests. Enslaved African Americans, slaveholders, and white physicians each held stakes in bondswomen's childbearing. Schwartz aims to track these conflicting interests in enslaved women's bodies and childbearing during an era in which the professionalization of southern doctors became tightly interwoven with the perpetuation of the institution of slavery. In this sense, Birthing a Slave follows the approach of Schwartz's early study on slave childhood by demonstrating the ways in which slaveholders and the enslaved struggled to define and control intimate areas of slave family life. (4)

Birthing a Slave contributes an important U.S. antebellum piece of a broader Atlantic history of reproduction and slavery, whose theoretical outline was first brilliantly framed by Jennifer Morgan. (5) With the abolition of the Atlantic slave trade in 1808, the antebellum drive for medical professionalization, and the emergence of obstetrics as a field of medicine, slave owners and white male physicians found mutual interests in maximizing the fertility of enslaved women. As Debora Gray White's foundational Aren't I A Woman? and a more recent study by Sharla Fett have shown, enslaved women countered the commodification of their bodies with healing knowledge and practices grounded in the culture of slave communities. (6) Schwartz vividly reveals the critical role of white southern doctors in shaping this struggle to define the meaning of enslaved women's reproductive labor.

Building upon Savitt's concept of a "dual system" of black and white healing, Schwartz probes the tensions between both streams of southern health care. The unevenness of the social encounter between bondswomen and physicians is replicated in the asymmetry of the archive, which poses challenges to any historian seeking to uncover first-person perspectives on health and sexuality from enslaved women and men. Schwartz exploits the wealth of antebellum southern medical journals, highlighting the growing involvement of professional doctors in slave women's childbearing. Although she does not attend to the literary nuances of medical genre as does Stowe, Schwartz amasses hundreds of antebellum case studies that richly document the daily interactions of white doctors and enslaved women. In counterpoint to the white doctors' voices, the WPA narratives supply the bulk of evidence for enslaved African American perspectives, making clear the divide between the interest of white doctors and enslaved families. At the same time, the limitations of the WPA narratives, faced by all scholars who use them as evidence, insure that the full subjective impact of a system that defined birth as the production of a commodity and sanctioned the routine sexual exploitation of enslaved women and men may never be fully grasped in historical writing.

Particularly striking in Schwartz's work is the cumulative impression of white scrutiny of the reproductive capacities of enslaved women. Not merely confined to charting new births, slaveholders and overseers became familiar with the intimate cycles of slave women's bodies, even going so far as to seek control over where enslaved women stored their menstrual rags. The commodification of black reproduction led many white doctors to experiment in new treatments to stimulate labor, restore the menses, and repair gynecological injuries Schwartz's chapter on gynecological surgery goes far beyond the well-known experimentation of J. Marion Sims to show widespread surgical intervention "to repair 'disordered' vaginal organs." (245) Whereas earlier discussions of enslaved women's health have focused on the more familiar issues of pregnancy, childbirth, and feigning illness, Schwartz casts a broad net, reminding us that reproductive health even in the antebellum period extended to cancers, menstrual irregularities, and infertility.

In the final chapter on freedwomen's health, the underlying analysis could be deepened with a stronger theoretical treatment of how emancipation changed the political economy of African American birth and the relationship between black women's productive and reproductive labor. Schwartz's extensive research in post-emancipation labor contracts reveals how both white doctors and ex-masters withdrew their medical attention once the birth of African American children did not constitute an increase in planter wealth. Because pregnancy was defined as sickness, young families (and freedwomen in particular) were especially disadvantaged by labor contracts that charged for sick leaves. Birthing a Slave thus contributes important knowledge to the broader discussion of how freedwomen allocated their labor between fields and family in the years after the Civil War.

Finally, all three authors differ in interesting ways on the significance of the post-emancipation period for southern medical practice. While Schwartz agrees with Steven Stowe about the post-emancipation decline in white medical visits to black families, she follows conventional interpretations of the Civil War as an important turning point in orthodox therapeutics as represented in medical journals. Stowe, on the other hand, emphasizes how white doctors sought to hold on to the older ethos of country orthodoxy and downplays the influence of the Civil War on daily practice. Furthermore, both Schwartz and Savitt document the inadequacy of the Freedmen's Bureau in meeting the health needs of freed-persons. Savitt concludes that white neglect led primarily to further black dependency. In contrast, Schwartz, with her additional attention to African American cultures of healing, suggests that for some freedwomen, the withdrawal of white medical care may have offered "an opportunity to gain control over their bodies." (315) Writing in resonance with each other, all three authors provide thoroughly researched studies that confirm the importance of medical history to understanding the changing racial politics of the U.S. South.

Department of History

Los Angeles, CA 90041

ENDNOTES

(1.) U. B. Phillips. American Negro Slavery (New York, 1918); William D. Postell, The Health of Slaves on Southern Plantations (Baton Rouge, 1951).

(2.) Jim Downs. "The Other Side of Freedom: Destitution, Disease, and Dependency among Freedwomen and Their Children During and after the Civil War," in Battle Scars: Gender and Sexuality in the American Civil War, edited by Catherine Clinton and Nina Silbur (New York, 2006), 78-103; Margaret Geneva Long, "Doctoring Freedom: The Politics of African-American Medical Care, 1840-1910," Ph.D., University of Chicago, 2004.

(3.) Steven M. Stowe, ed., A Southern Practice: The Diary and Autobiography of Charles A. Hentz, M.D. (Charlottesville, 2000).

(4.) Marie Jenkins Schwartz, Born in Bondage: Growing Up Enslaved in the Antebellum South (Cambridge, 2000).

(5.) Jennifer L. Morgan, Laboring Women: Reproduction and Gender in New World Slavery (Chapel Hill, 2004).

(6.) Deborah Gray White, Ar'n't I a Woman? Female Slaves in the Plantation South (New York, l985);Sharla M. Fett, Working Cures: Hearling, Health and Power on Southern Slave Plantations (Chapel Hill, 2002).

By Sharla M. Fett

Occidental College
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