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Ante-Bellum North Carolina: A Social History: Electronic Edition.

Johnson, Guion Griffis, 1900- 1989

CHAPTER XXIV SANITATION AND HEALTH

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CHAPTER XXIV
SANITATION AND HEALTH

           THE SPIRIT of reform which loosened the chains of the insane, educated the blind and the deaf, and sought to lighten the burdens of the poor extended into other fields of social life. It was obvious that many people were poor because they were sick. Cure the ills of the poor, said one class of reformers, and you will solve the problem of poor relief. Another class advocated medical reform merely because it looked toward the alleviation of human suffering.

           At the opening of the century the field of medicine in North Carolina was occupied largely by uneducated folk-doctors. Medical reform in this State was, consequently, a struggle of the educated physician to obtain the ascendency, a battle which continued from 1799 until the first legal victory in 1858.

SANITATION

           On the frontier there was little time for observing even the simple rules of sanitation. The settler had to make haste to girdle trees so that he might plant a crop; to fit logs together for his cabin so that he might have a habitation. He was satisfied to take an occasional swim in the near-by river or creek. Many a farmer boasted even in the ante-bellum period that he had never bathed in his life. The frontiersman took his ease in the woods just as many a tenant farmer in the South does today. Privies were luxuries of a settled life. The frontiersman smelled heavily of the sweat of continued labor. His long hair which seldom knew the touch of scissors or a razor was frequently alive with vermin and the consequent scratching gave rise to numerous skin diseases. His house, too, became infested, for his wife, who was mother to a numerous offspring and field hand as well, had no spare moments in which to brew decoctions to fight the chinches which hovered in the crevices between the logs.

           Long before the Revolution, the prosperous settler had left behind him the ways of the forest. He occasionally wore laces,



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powdered his hair, and bathed in scented soap. The Revolution ushered in a return to primitive ways because life on the tented field was rude. When the pendulum had swung again toward prosperity, the movement in behalf of the niceties of a civilized life was underway.

           But the average North Carolinian of the ante-bellum period was a man of small means. 1

There was no running water in his house. His wife and children "toted" pails full from a near-by spring or from a deep well in the yard or on the piazza. They did the family wash at the spring or on the creek bank and hung the clothes on bushes to dry. Once a week, or less often, the members of the family took turns at bathing by the fireplace in a wooden tub sparingly filled with water.

           Running water, however, had reached the village homes and the "big houses" of the plantations by the late ante-bellum period. For the most part, this water supply was provided by individual enterprise, for the idea of municipal water works 2

was still new in North Carolina. In town and country alike, those who had running water in their homes usually obtained it by means of water tanks placed upon platforms erected at a sufficient height to give the proper pressure. The tanks were filled from a deep well operated by a hand-pump or occasionally by a windmill. Sometimes the drains of the house led into the tank and the source of the water supply was the rain water collected in this manner. Most of those who had running water in the house had it piped only to the kitchen; only the most prosperous and luxury-loving had running water in a bathroom. The washstand with its marble top, its bowl and pitcher, and its towel rack was an indispensable piece of furniture in the bedroom of the genteel. There the master of the house took his morning shave and the mistress her morning sponge. In the homes of the less affluent, the "wash place" was a shelf or table on the back porch where there was a basin, a bucket of water with a gourd, and a homespun towel.

           The almanacs, often called the farmers' Bible, frequently urged their readers to bathe more often. For instance, Henderson's Almanac for 1813, published in Raleigh, recorded the fact that "the general affusion of cold water" was healthful. "Besides the luxury of cleanliness," washing the head in cold water every



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morning would prevent "head ache, tooth ache, & ear ache, strengthen the eyes, & all the faculties of the mind." General bathing cleared the pores of the skin and was useful once or twice a week, or oftener in warm weather. The Almanac recorded as a matter of wonder that "in many countries of Europe a bath is considered as necessary an appendage to a house as a kitchen." 3

           In 1828 Raleigh had the use of public "bathing rooms." In June, H. Hardie advertised that he had opened his house "for the accommodation of citizens and strangers . . . where warm, tepid or cold baths may be had every day throughout the warm season, Sundays excepted." 4

           Seventeenth and eighteenth century houses were so constructed in Europe as well as on the American frontier that there was little need of throwing windows open at night to admit fresh air and the canopied bed served a real purpose of protecting the sleeper from draughts. But with the better constructed houses of the late colonial and early ante-bellum period, the habit of sleeping in curtained beds in closed rooms still persisted. Doctors, the almanacs, newspapers, and the "family books of medicine" began a movement in behalf of fresh air. Benjamin Franklin had Poor Richard advise the readers of his almanac who suffered from insomnia to expose their bodies to the cold air. "Small close bedrooms, and particularly bed curtains, should always be avoided," declared John C. Gunn's Domestic Medicine, or Poor Man's Friend, which had a following in North Carolina. "In close rooms and curtained beds, you breathe unchanged air, which has become impure from previous breathing." 5

But so difficult was it to heat the houses of the lower classes in winter and so widespread was the belief that the night air of summer was injurious that even today the fresh-air movement has many converts yet to win.

           The windows of the ante-bellum period bore no screens. Shutters were the only means by which a careful housewife could keep the numerous flies, mosquitoes, and other insects from her house. While the family was at meal, a small Negro not infrequently operated a fly brush which was manipulated by a pulley attached to the wall, or, lacking this, he might agitate a turkey-feather fan in the general direction of the table.



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           With pigsties, stables, privies, ponds, and acres of uncut weeds adjacent even to houses in town, the insects were numerous enough to justify a fly brush in every room. For this reason and because of that mysterious factor known as miasma, the health reformers advocated that dwellings should be placed "on the southerly and southwesterly sides of mill-ponds, lakes, ponds, rivers, marshes, and waters in general." A citizen who styled himself "Raleigh," writing in the Register of June 29, 1802, on the "Capacities and Improvements of the State of North-Carolina," said: "Cleanliness is a virtue, and it is more important in the air than in any thing. Let our stables, barns, barn-yards, dungheaps or stercoraries, hogsties and privies, be placed on the northerly sides of our dwellings, and not too near them. When the wind blows from the north, the weather is less oppressive, or cooler, and our houses are shut up. The foul smells do not reach us then. . . . Tender women, children, sick persons, the aged and infirm, are much hurt by such smells."

           In 1822 after Raleigh had been visited by an epidemic of fevers, the town commission called a public meeting to consider what measure ought to be taken to prevent another attack. It was the general opinion that the stagnant ponds of two mills near town had been the source of the epidemic. Out of this meeting grew the proposal, at least, that the town have a board of health. 6

Ordinarily the town commission acted in this capacity, but it usually took an epidemic to frighten the commission into action. In 1833, when the State was having an epidemic of cholera, a night-watchman of Raleigh urged the commission to buy a supply of lime and hire men to sprinkle it freely about every lot in town. Under the title of "Prudentius" he wrote in the Star, "The city ordinance, commanding certain houses to be purified, should be peremptorily carried into effect. I go on guard of nights, and I know that the offence is great, is unwholesome, and, in fact, intolerable." 7

           In Fayetteville, too, the citizens demanded that the commissioners enforce the city health ordinances or "we will tell them of



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it in an audible voice in January next." One citizen, writing to the Observer under the name of "Health," declared, "The Ditches on Donaldson, Mumford and Old Streets, are in a horrid condition, and it is impossible to say, what else than Musquitoes may be generated." 8 In 1845 the editor of the Observer commented with satisfaction upon the unusual healthfulness of Fayetteville, saying, "We believe that a season as entirely free from sickness is scarcely within the memory of any of our citizens. This is perhaps in some degree to be attributed to the extraordinary dryness of the Spring and Summer; but with strict attention to the drains, and other wise municipal regulations for the preservation of health, nearly the same results could always be obtained." He thought that if a tenth of the money which the people of Fayetteville had used in fleeing from sickness had been applied to the improvement of their homes, the town would have been a beautiful and healthful spot. 9

           The Observer's plea for better sanitation in Fayetteville was evidently effective, for eleven years later the editor was boasting of the "good character for health which the town has deservedly acquired during the last eight or ten years." But in June a citizen died and his death was thought to have been due to his having "slept in the immediate vicinity of a very foul ditch, whose odors have been disgusting to all who have approached it since the warm weather set in. At night, and while sleeping, such putrid matters as are said to be there constantly exposed to the decomposing influence of a hot sun, are absolutely poisonous; . . . It is certain that other parts of the town (ditches, rear lots, low grounds, &c.) are not kept clean, and free from impurities which generate disease." The town commission was already at work, having the ditches on the main streets cleaned, "but most of the good to be done, must, after all," said the Observer, "be performed by citizens themselves, each on his own premises and in his own neighborhood." 10

           In the port towns, sanitation was a real problem. They not only stood constantly in danger from an epidemic introduced by incoming vessels despite the State quarantine laws, but they had numerous marshes and swamps which needed draining if the inhabitants were to be free of fevers. Dr. J. H. Dickson, in an address before the North Carolina Medical Society in 1852, said



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of Wilmington, "The sanitary condition of the place has undoubtedly undergone a great improvement within the past fifteen or twenty years, . . . Its improved hygeanic condition may, I think, be attributed to the filling up of the low swampy branches and lagoons which formerly existed in the heart of the town, and the improved condition of its river margin now constituting Water street." 11

           Not only the coastal towns, but the entire coastal area was an unhealthful region because of its numerous marshes, swamps, and pocosins. In Duplin County, for instance, all of the principal water courses, the North East, Goshen, Grove, Rockfish, Maxwell, Muddy Creek, and Limestone, formed large swamps. Ebenezer Pettigrew, a planter on Phelps Lake, thought that a dry fall which made stagnant the ponds, swamps, creeks, and ditches of Eastern North Carolina would "produce enough malaria to kill Napoleon's army." 12

Any swamp, however, which was constantly covered with water, such as the Dismal Swamp and the State swamp lands of Hyde, Beaufort, Washington, and Tyrrell counties, was comparatively healthful. In the upcountry, a stream stopped with timber or a stagnant mill pond was as malarious as the marshes of the low country.

CHILLS AND FEVERS

           It was often said in the ante-bellum period that the curse of the South was not slavery but malaria. It produced the characteristic "pallid southerner" so often referred to in the North and commented upon in books of travel. Dr. S. S. Satchwell of Wilmington, in addressing the North Carolina Medical Society in 1852, referred to malaria as the most vigorous agent of death in the South and declared that whoever succeeded in finding a means of combating it successfully would render even more good to humanity than Jenner in producing a vaccine for smallpox. Until then, the South would continue to have "the malarious physiognomy, the jaundiced eye, the tumid abdomen, the depressed spirits, the stunted growth, and the shortened life, characteristic of so many persons who live in a malarious region." 13



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           Throughout the ante-bellum period, malaria was thought to be of miasmatic origin. "We believe," said Dr. Satchwell, "in the truth of the current theory, that heat, moisture, and vegetable decomposition are capable of generating a specific poison that is competent to the production of Malarious fevers, . . . This is the doctrine of the day, the theory on which the profession has rested for more than one hundred years. . . . The inhabitants of the southern States know well that health in a very great degree depends on the selection of sites for their houses. We see them making wise discriminations in fixing them, though ignorant of theories of disease. Before locating their dwellings, we see them exploring swamps, mill ponds, low grounds, and marshes; looking well at their topography and general situation. And when they are finished, you will generally, if the district is malarious, find their houses on some barren hill, with a dry, sandy base, even though the occupant is obliged to walk a mile or more every day to his corn field." 14

           As Dr. Satchwell pointed out, the settlers of the southern region had learned not to sleep near stagnant waters. By the antebellum period any "dirt farmer" knew that "noxious vapors arising from matter which ought to be in the compost heap" were "absolutely poisonous." It was the odors which escaped from stagnant waters and the fogs which hung over them in early morning and at night which were thought to do injury. This was the mysterious miasma. "It is certain and true," wrote "Raleigh" in 1802, "that fogs and vapours are drawn towards the sun in the morning in July, August, and September, . . . Fresh water vapour" from decomposing vegetation "is the poison that makes bile, and brings on autumnal agues and fevers, the worst complaints of warm seasons." 15

           Despite the fact that the prevailing theory of the origin of malaria was miasmatic, a great many laymen as well as medical men questioned it from the time that Lancisi first set forth the doctrine in 1717. A few thought the disease to be caused by fungi; a few suggested that it was epidemical; some thought it to be caused by "moisture under different states of pressure"; and some by sudden changes in temperature of the atmosphere. Dr. Charles Johnson of Raleigh was one of the first physicians of the State to set



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aside the theory of miasma as "a groundless assumption," unsupported by facts. In an address before the North Carolina Medical Society in 1851, he based his contention upon the fact that we are sometimes exempt from miasmatic diseases "where vegetation and decaying vegetable matter, together with heat and moisture sufficient to produce putrefaction are abundant, and then again, have them committing fearful ravages, where there is no vegetable matter to decay, and where there is no moisture to aid putrefaction." 16 His renunciation of marsh miasma brought down upon him the ridicule not only of the North Carolina Medical Society but of many leading doctors of the country. It was not until 1898 that the blame for spreading malaria was fastened upon the lowly mosquito.

           The so-called miasmatic fevers were variously known as autumnal fevers, country fevers, bilious remittent and intermittent fevers, ague, Negro fever, nervous fever, typhus fever, and typhoid. Although most schools of medicine recognized a difference in ordinary malaria and typhoid fever, they considered the origins to be the same. Typhoid, now known to be a communicable disease caused by a bacillus introduced into the system with the food or drinking water, was thought to be a severe form of malaria and not a separate disease. Malaria was the "periodical fever" and typhoid, the "continued fever."

           Malaria was usually divided into two types of fevers, intermittent and remittent. Intermittent fever was a paroxysm of chill, fever, and sweating which occurred at varying intervals of one, three, four, or five days until it had "run itself out" or had been cured by Peruvian bark or dogwood. 17

The intermittent fevers were called, according to the frequency of the paroxysm, quotidians, tertians, quartans, or quintans. These types had various modifications, as, for instance, the double tertian, which consisted of two sets of paroxysms occurring every other day.

           The remittent fevers were also accompanied by paroxysms, but the intervals, instead of being "a perfect state of health," were only an abatement of the disease. Dr. O. F. Manson of Granville



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County, recognized as one of the most skilful physicians in the State in the last two decades of the ante-bellum period, divided remittent fevers into three forms; mild, grave, and adynamic. He thought that adynamic remittent fever was the connecting link between malaria and typhoid. 18 The severest form of malaria was malarial pneumonia and the severest form of typhoid was typhoid pneumonia. 19 All the miasmatic fevers were considered to be of "serious tendency, extensive prevalence, frequent recurrence, and complex nature," although undoubtedly the most extensive form of chills was mild enough to yield to household remedies without an appeal to "the faculty," as the medical profession was called.

           It was frequently said during the ante-bellum period that the early settlers in the South did not suffer much from diseases and that even the autumnal fevers were of a mild kind. This fact was attributed to the simple lives of the colonists, for it was held, especially in the early ante-bellum period, that "the state of nature" was a condition of perfect health and happiness. No less a scholar than Dr. Jeremiah Battle of Edgecombe County wrote in 1811 that the diseases of colonial North Carolina partook of the simplicity of the settlers' lives. "The ague of fever with distinct intermissions, was the principal autumnal disease, & this was generally looked for, but was not regarded as a serious evil, as the fits were short, & the intermissions a perfect state of health." But as civilization advanced, forests were cleared, mills erected, "exhalations rose & poisoned the health of those who were exposed to them." These exhalations did not reach far, however, for the woods still blocked their passage into the piedmont. More fields were cleared; society progressed toward a more luxurious mode of living; and the simple ague of early days gradually changed to a remitting type with bilious symptoms. "A few years ago we were astonished to see these bilious diseases making their inroads into those parts of the country that had always before been noted for their extraordinary healthiness." 20



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           The malarial region in North Carolina was in general the entire coastal area. It tended to spread inland along the water courses. As land opened up in the piedmont and the conditions under which the malarial mosquito bred were created there, the disease also spread into this hitherto little affected region. Typhoid was never strictly a fever of the low country.

           In combating the disease, those in the low country, who could afford to make the trip, regularly spent the summers from July to frost "in a more salubrious climate." Pittsboro, Hillsboro, Oxford, Warrenton, Jones or Shocco Springs, besides numerous places in the mountains were regular health resorts for the malaria-fleeing low-countrymen. 21

Mrs. Mary Norcott Bryan, of Wood-lawn plantation, a child of the late ante-bellum period, said of these trips: "It took us three days to make the journey from our home to Shocco Springs. I got awfully tired and restless being shut up in a close carriage for that length of time, but we had regular places to stop on our way to and fro, and the noon-day stop by the side of a shady tree on the roadside was restful." 22

           So general was the illness among those who stayed behind that the autumn sessions of the country and superior courts were always poorly attended and sometimes dismissed entirely. In 1824 three of the superior court judges, Norwood, Nash, and Badger, in petitioning the Legislature to change the time of holding the autumn court, said: ". . . the period at which the fall circuits throughout the State now commence (the first Monday in September) subjects the suitors and witnesses in the Eastern courts to an exposure to disease, which as an annual scourge afflicts with its ravages one half of our country. Indeed, such sometimes, is the almost certain consequence of exposure to its visitations, that he who would contend for his rights before a tribunal located in the East, must, if the litigation promise to be protracted, reconcile his mind to grapple also with death." 23

           Although the east expected a visitation of fevers every year and the piedmont occasionally, some years were greater "fever-breeders" than others. Because of the lack of differentiation between malaria and typhoid fever, it is difficult to ascertain whether the sickly years were due to a large crop of malaria-bearing mosquitoes or to epidemics of typhoid. In some instances, the disease



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was not confined to the autumn months, but continued throughout the year. During the winter of 1856-1857, for instance, Dr. N. J. Pittman reported that the fever continued in Edgecombe County on into the winter. 24 Some persons had chills regularly throughout the year over a period of several years. These cases were said to be chronic intermittent fever and were usually confined to persons of anemic tendencies. 25

           The year 1842 was especially sickly for the lower piedmont. Late in October the Mecklenburg Jeffersonian wrote: "Never within the recollection of our oldest citizens has our village and county been so sickly as during the past two months. And according to all accounts, the same may be said of a strip of country about fifty miles wide, of about the same elevation, beginning at the northern boundary of this State, and running through Caswell, Guilford, Davidson, Rowan, Cabarrus, and Mecklenburg counties into York District, S. C., and probably farther south. North and South of us the sickness seems to have been more fatal than in this region. In Davidson and Cabarrus, on the one side, and York on the other, there have been a great many deaths; while in this county, for the amount of sickness (near one half of our whole population have been sick) there have been comparatively few deaths." 26

           Chills and fevers were unusually prevalent in 1844 and 1845, and the amount of sickness increased within the next two years to such an extent that it was spoken of as the Great Epidemic of 1846 and 1847. On October 6, 1846, the Fayetteville Observer declared the prevalence of fevers to be greater than at any time in twenty years. "This has been especially true of nearly all the middle counties in the State, in which many hundred, we might say thousands,--of people have had fevers." Dr. O. F. Manson thought most of the cases to have been of the "grave remittent" type which often terminated in death if improperly treated. 27

Dr. Charles E. Johnson of Raleigh declared that during the epidemic "heads of large families, who had never taken a dose of medicine or seen a case of ague and fever, in their lives, became as familiar

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with these disorders and their treatment, as with household words. Other portions of our State, extending even into the gorges of the mountains, heretofore unfrequented by these maladies, suffered in a like unaccountable manner." 28

           In some of the worst cases of bilious remittent fever, the skin turned yellow so that the disease was often confused both in the popular and the professional mind with the genuine yellow fever of the tropics. 29

The fever might also be accompanied by "the black vomit," another symptom of yellow fever. It is possible, therefore, that some of the so-called epidemics of yellow fever which occurred in North Carolina in the early ante-bellum period were merely epidemics of "grave remittent" or typhoid fevers. In 1843, when it was reported that yellow fever had appeared in Washington, Dr. James A. Norcom, a veteran physician of Edenton, wrote to his son John who was a physician in the fever-stricken village: "I can easily credit this report from the fact of my having seen, within the last 8 or 10 days, several cases of Fever of a very formidable aspect. . . . I have been looking for Yellow Fever here; and I have seen 3 or 4 cases of fever, which would have been called yellow fever in a community in which yellow fever was prevailing." They exhibited many of the characteristics of the disease, but Dr. Norcom thought them to be only malaria and typhoid. "I have rarely seen the two great forms of our annual Endemic so distinctly marked, as in the diseases of the present season, viz: The Inflamatory Intermitting or Remitting Fever, & fever of the same type of a typhoid character." 30

           The mere whisper of yellow fever was enough to throw the State into a panic and send townspeople fleeing from their homes, often into the wilderness, for no neighborhood would receive visitors from a pestilence-ridden community. There were so many deaths from the fever in Washington in 1843 and the medical opinion was so divided as to the nature of the disease that the Washington Republican finally took the responsibility for making an announcement: "That the Yellow Fever is in Washington, seems to us to be useless longer to deny. . . . And by way of giving the whole truth, we will state that there was [sic] 26 deaths in this town from the 31st of August to the 4th of October inst.



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among the white population; there have also been some few deaths among the negroes. . . . Our people are many of them out of town, and our population much thinned. 55 families had left from last Friday to last Tuesday night, when we made up our estimate." 31

           So few detailed accounts have been left of the earlier epidemics of yellow fever in the State that it is difficult to ascertain whether they were the genuine tropical fever or a serious form of the familiar miasmatic fevers. In 1810 an epidemic of yellow fever was said to have been introduced into Elizabeth City by the schooner Little Charles which unloaded at Norfolk a part of a cargo of coffee from Havana and then proceeded to North Carolina where it unloaded the remainder of its cargo and its ballast. Sixteen out of seventeen or eighteen persons afflicted with the disease died, and the entire State was alarmed. "The greatest precaution is needed to prevent the Disease from spreading thro' the different parts of the country," wrote the Edenton Gazette. "We trust the Commissioners of this town will use every means in their power to prevent its reaching here." 32

The Virginia papers ridiculed the idea of the disease being yellow fever. "We believe we can fully account for all this uproar and alarm," wrote the Norfolk Herald. "We are confident there was no yellow fever in the case, but that it was bona fide brandy fever." Since the crop of apples and peaches was unusually abundant in North Carolina, some of her citizens became "unremittingly drunk," sickened, and died. 33

           Tuberculosis of the lungs, generally known as consumption and sometimes called hectic fever, was also thought to be related to the miasmatic diseases. "Thousands are yearly falling in the spring time of life by the untimely stroke of this most fatal of diseases," wrote Gunn in 1832 in his Domestic Medicine. 34

In 1860 there were 761 deaths from consumption alone in North Carolina. 35 Doctors thought that those who frequented "the haunts of gaiety, fashion, and folly," were more subject to the

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disease than those "in the humble walks of life where the busy hum of industry is heard."

SUMMER AND WINTER COMPLAINTS

           Another bilious disease, almost as great a scourge to the South as malaria and typhoid, was dysentery, known variously as cholera, cholera morbus, epidemic dysentery, flux, or simply as "summer complaint." The disease, especially fatal among children, was known as cholera infantum.

           Dysentery was so closely allied with the ordinary chills and fevers, often accompaning an attack of fever, that some doctors, notably Dr. L. L. Holmes of Chatham County, were of the opinion that dysentery was of malarious origin. 36

Imprudence in diet, crude and indigestible food were considered to be both predisposing and exciting causes, but more often merely exciting causes. Since the disease occurred most often in hot weather, the heat was also thought to be a predisposing cause.

           Almost any physician of the ante-bellum period in listing the diseases of his locality placed dysentery next in prevalence to malarious fevers. Dr. Dickson of Wilmington wrote in 1852, "Sporadic cases of Dysentery occur pretty regularly in spring and autumn and perhaps the cases are sufficiently numerous during some seasons to entitle it to be considered epidemic. It is undoubtedly to be ranked among the endemic or climatic diseases of this locality. It is for the most part quite amenable to treatment, but cases do sometimes occur, almost equalling in severity the tropical form of the disease." 37

           Indeed, so prevalent was the disease throughout the State that the first prize offered by the North Carolina Medical Society of 1799 was for the best essay on the treatment of dysentery. 38

The usual form of the disease was mild in character and easy of treatment, but occasionally the dreaded form known as Asiatic cholera was thought to have appeared in North Carolina. Whenever such a report got abroad, it caused as much of a panic as did a yellow-fever scare. In 1832 Asiatic cholera was reported to be in Elizabeth

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City where there were thirteen deaths out of seventy-six cases. 39 It was reported to be prevalent again in the State in 1833. 40 When it appeared in Washington in 1834 Dr. James A. Norcom wrote to his son John who was working in the stricken area: "In the situation in which you are placed . . . your own preservation will, in a great measure, depend upon a firm & steady mind. If you resolve, in any event, to stick to your post, and to die or live in the honest & conscientious discharge of your duty, you will find your solicitude gradually subsiding and your mind daily acquiring the tone & energy necessary to carry you through the severest trial . . . the terror excited by a dreaded name and the mystery which has so long veiled the character of this awful scourge of our species has robbed the profession of all self command and sobriety of thought on the subject. It seems to me in many places to have undoctored the faculty & reduced the profession to a level with the most undisciplined minds." 41

           In 1849 cholera was so prevalent in the United States that the President by proclamation recommended that August 3 be observed "as a day of fasting, humiliation, and prayer to Almighty God, on account of the fearful pestilence which is pervading our country." In Raleigh the stores were closed, and the people assembled at the various churches. The North Carolina Standard urged the town commission to establish a dispensary and the Star of August I asked for an annual appropriation of $250 to combat the disease.

           The winter "complaints" were practically the same in the antebellum period as they are now: colds, sore throat, influenza, pneumonia, pleurisy, and congestion in the sinuses and ears. Because of the lack of reliable statistics, it is impossible to compare the amount of sickness then and now, but the peak of the winter epidemics usually occurred in March as it does today. Presumably, the extent of winter sickness in the ante-bellum period was as great then as at present, for occasionally so many were ill in one locality that the quarterly session of court was dismissed. On March 17, 1815, for instance, the Raleigh Register announced: "The prevailing Epidemic has raged with great violence in Hertford County and many



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have fallen victims to it . . . the late county court . . . only sat on Monday and part of Tuesday."

           In the early ante-bellum period, this winter sickness was frequently known simply as "the epidemic." In 1808, however, Dr. James A. Norcom recorded an epidemic in Edenton which he specifically identified as influenza. 42

In 1819 the Fayetteville Observer said of "the epidemic": "This formidable disease, which for a number of years past has committed such ravages, and inspired so much alarm in so many sections of our country, is, we are sorry to say, now prevailing in different parts of our state, and a few cases have appeared even in our town." Because the attacks were "so insidious" the Observer published for the benefit of "our country readers," the following instructions for treatment: ". . . immediately after the chill, take from twenty to thirty grains of Hippo or Ipecacuanha, with eight or ten grains of calomel, and work off the puke with snake root tea-- . . . when pain is violent in the breast, throat or head, or wherever situated . . . apply a blister, or plasters of mustard, flour and vinegar, to the pained part, and as the pain shifts, follow the seat of pain with plasters." 43

           In the twenties the "Spanish influenza," probably a variant of "the epidemic" of the teens, made its appearance in the State. "We are concerned to learn," wrote the Raleigh Register of February 24, 1826, "that this disease is very prevalent, and in a number of instances has proved fatal in the lower counties of this State. We have heard of several deaths in Nash, Edgecombe, Martin and Bertie; some of them after a sickness of a few days only . . . persons are variously afflicted: some are taken with pains in the head, face, ears or throat; others are seized with pains in their limbs. This disease being somewhat of a new character, the Physicians, we believe, have been at some loss how to treat it. Blood-letting has proved fatal. At the North, we learn, that Calomel, with some active adjunct, is used, and powerful Sudorifics; and when the throat is affected, gargling ought not to be neglected."

           In the thirties and forties, a disease known as a "grippe," such as Tyler's grippe, Polk's grippe, or merely as la grippe, prevailed



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in the State, usually beginning in the summer. On September 20, 1843, the editor of the Raleigh Star wrote, "This Community, as well as ourselves, are at this time laboring under the influence of an evil malady, called the Tyler Grippe--Symptoms, Headache, sore-throat, bad cough, and pain in the breast, limbs and stomach." Of the Polk grippe, W. B. Hathaway of Halifax wrote in 1845 to Ebenezer Pettigrew of Phelps Lake, "The disease that prevailed in Northampton (I have heard it called the Polk Grip) I have understood is in Col. Joyner's black family, and his white family has moved to Halifax." 44

           In the winter of 1849 pneumonia proved very fatal in the valley of the Yadkin. Dr. W. R. Sharpe of Davie County, who treated a great many of the cases, thought the "epidemic" to be of an unusual type of pneumonia. The most fatal type was that in which the patient showed no reaction for three days after the initiating chill. The second type he called congestive pneumonia and the third a pseudo-pneumonia similar to "the epidemic" which prevailed in the State between 1815 and 1820. 45

           In 1852, Dr. Dickson, writing of the diseases of Wilmington, stated that pleurisy and pneumonia, which were of frequent occurrence in the winter and spring, more often attacked the black population than the white, because the former were more exposed to the inclemencies of the weather. He thought that the use of emetics, such as those prescribed in cases of influenza already cited, were beginning justly to be called in question. He recommended that the first treatment be that of bloodletting to be followed by the use of cathartics. "The popular plantation prescription of Salts and Tartar, is an admirable one." 46

           In 1855 Dr. W. H. McKee of Raleigh reported to the North Carolina Medical Society that pneumonia had prevailed during the past winter to a much more alarming degree than it had for several years. "About the middle of January last, it first appeared as an epidemic. It was not confined to any particular class of citizens, but prevailed generally, attacking in some instances nearly all in a family, and in others only an isolated case." 47

In 1859 and 1860

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doctors in various sections of the State reported fewer cases of pneumonia than in several years.

           Doctors of the late ante-bellum period also reported epidemics of meningitis. In 1857 Dr. H. Kelly of Iredell County reported that "cerebro-spinal meningitis occurred, epidemically, during the past winter and spring: in some neighborhoods, it was very fatal; patients frequently dying within thirty-six hours after the attack." 48

Three years later the doctors of that locality had at last got the disease under control. 49

           Soreness of the throat was said to be of three types: inflammatory, putrid or pseudo-membranous, and membranous. Membranous sore throat was usually confined to children and is known today as diphtheria.

SMALLPOX

           The nineteenth century opened with smallpox still one of the dreaded diseases of the world, for it was not until 1798 that Edward Jenner discovered the vaccine for smallpox and not until many years later that it was popularly accepted. Jenner developed the vaccine as a result of the observation that the pustules which appeared on dairymaids' hands when their herds had cow-pox seemed to immunize the women against smallpox. For this reason, the vaccine itself and the pustules resulting from vaccination were known popularly for many years as cow-pox or kine pox.

           While Jenner was perfecting his vaccine in England, Dr. Calvin Jones of North Carolina, as well as a great many other American doctors, was experimenting with inoculation. This form of combatting smallpox had been introduced into England early in the eighteenth century. In a way similar to the method of vaccination, the smallpox virus from a mild case was introduced into the system with the view of reproducing the disease also in a mild form and thus affording protection from further attack. While it was attended with little risk to life, it did result sometimes in severe cases which left the patient disfigured for life. In March, 1800, writing from Smithfield, Dr. Jones advertised for patients: "If there should apply to be inoculated for the Small Pox, such a Number of Persons, as would sufficiently compensate for the Trouble



Page 735

and Expence, I will open a Hospital for that Purpose in the Month of April. . . . I have not such Confidence in my own Skill, as to be willing to undertake the Management and Safe Conduct of this Disease in a Season of the Year which I should think to be in any Degree unfavourable. The Terms will be Eight Dollars for each White Person and a Guinea for mulattoes and Negroes; . . . Having had some Experience in the Small Pox, I believe I shall be generally able to promise . . . a mild Disorder and a good Recovery." 50 In April, however, he advertised that he would have to postpone the inoculations another year because of "much profesional and other Business." 51 In April, 1801, he again declined to make the inoculations but this time because news of Jenner's discovery of the "variotoe or cow-pox" had reached this country. "It is the hope of seeing the Vaccine Disease substituted for the Smallpox, that alone induces me to decline the inoculation." 52

           Dr. Jones and others wrote at great length in the newspapers of the State explaining the effect of vaccination for smallpox in the hope of "paving the way for its introduction into this country" and of seeing the disease quickly eradicated. But it took severe epidemics and years of education on the subject for vaccine to be accepted by the people. In July, 1801, when Hay of Fayetteville, on returning from a trip to Ireland, brought back some vaccine with which to inoculate the children of his family, the whole town became alarmed. The vaccination had to be stopped, the children "removed to a remote and private Situation," and the town commissioners had to issue a public statement before the excitement died down. 53

By 1802 many of the progressive doctors in the State had obtained vaccine and were inoculating those who would permit it. 54 In 1808 when an epidemic of smallpox occurred in Burke County, the Raleigh Register lamented, "How much it is to be desired, that the people would generally inoculate with the Kine Pock." 55

           In 1813 Congress passed an act to encourage vaccination, appointing Dr. James Smith of Baltimore vaccine agent for the United States and permitting packages containing vaccine or letters relative to vaccination to go without charge through the mails. The



Page 736

following year Elijah Cain of Hillsboro and other prominent citizens of North Carolina petitioned the Legislature to follow the example of Virginia and Maryland and appropriate a sum to distribute the vaccine free to the people, but the Legislature, "taking into consideration the low state of our financial affairs," refused to make such a use of the public funds. 56 The federal act was in operation nine years before its repeal in 1822 which was due to "the North Carolina accident."

           In the autumn of 1821 Dr. Smith sent Dr. John F. Ward of Tarboro, through mistake, a paper containing genuine smallpox crusts instead of the usual vaccine fluid. Dr. Ward used the crusts for inoculation and those thus inoculated developed mild cases of smallpox. Unwittingly they spread the disease and by January there was an epidemic in Edgecombe and Nash counties in which ten persons out of sixty afflicted died. As soon as news of the accident got abroad, the President of the United States revoked Dr. Smith's commission. Dr. Smith had himself volunteered to resign and pleaded that the work of distributing the vaccine might go on. But the North Carolina congressmen, led by R. M. Saunders and H. G. Burton, declaring that the act authorizing the agency was "a nuisance of the most dangerous kind," and that Dr. Smith had "slaughtered with indifference" citizens of North Carolina, were not satisfied until they had obtained its repeal. 57

           The publicity given to this unfortunate occurrence deepened the prejudice against vaccination already existing in the popular mind. During the height of the excitement, Dr. Webb of Hillsboro offered to give free vaccinations for two hours every Wednesday, assuring the people that since the disease was raging in the State it was "the more necessary that attention should be paid to this mode of preventing the ravages of that fatal disorder." 58

Two years later, smallpox was generally prevalent throughout the Atlantic states. When it reached North Carolina, the Raleigh Register called upon every head of a family immediately to have his household vaccinated. 59



Page 737

           When smallpox appeared in Edenton in 1827 the commissioners called a town meeting which authorized that the infected premises be inclosed by a fence. The meeting classified all adult males into guards who watched the houses night and day to see that no one entered or left. 60

           One of the worst epidemics of the ante-bellum period was that of 1836 when the disease appeared in Western and Piedmont North Carolina. In Ashe County, where there were about seventy cases, the alarm was said to be so great that it was almost impossible to get any person to bury the dead. 61

When smallpox appeared in Hendersonville in 1850, the schools closed; a great many submitted to vaccination; and almost every family left that could get away. 62 It is a significant fact that the doctors seldom mentioned smallpox in reporting the diseases and epidemics of their counties to the North Carolina Medical Society between 1850 and 1860. Jenner's vaccine had done its work.

OTHER COMMUNICABLE DISEASES

           At various times during the ante-bellum period the State was subject to epidemics of other diseases not so fatal as typhoid and yellow fever, cholera, influenza, and smallpox, but none the less alarming. On March 31, 1815, for instance, the Raleigh Star reported that "nearly one tenth part of the population of Northampton County" had died of an epidemic of camp plague and that "upwards of twenty persons" had died in the vicinity of Smithfield within ten days. In 1845 Raleigh had an epidemic, thought by some to be the dreaded "Black Tongue," a form of erysipelas, and by others to be merely "St. Anthony's Fire," a superficial skin disease. 63

           One reason, no doubt, for the difference in opinion over the epidemic in Raleigh was the fact that an epidemic of erysipelas was sweeping Mecklenburg County. One-fourth of those who had the disease are reported to have died. The head was frequently enormously smollen, the eyes closed, and the throat so congested that swallowing was difficult or entirely impossible. A Kentucky hog drover was said to have brought the disease to Charlotte. 64



Page 738

           In 1860 Dr. W. R. Sharpe reported a terrifying epidemic of "erysipelatous inflammation of the brain or its members" which occurred in Davie County in the spring of 1856 and 1857. Those most subject to the disease were from fifteen to twenty-two years old. The attack often came suddenly, the patient complaining of a violent pain in the head. Soon he would become unconscious, fall into convulsions, and in from six to twelve hours, be silent in death. Those who recovered usually complained of violent pain in one eye or ear, and exhibited swelling on the afflicted side of the face. "This disease struck terror to the neighborhood where it first appeared," wrote Dr. Sharpe. "I was myself shocked and confused with the first few cases, which appeared as sudden and overwhelming as an avalanche. I have seen this disease commence with the father, and in four days attack six children, one after another, leaving only the mother and sucking child untouched--each appearing to be in perfect health an hour before the attack." 65

           It is difficult to estimate the extent of the venereal diseases in ante-bellum North Carolina, for the three common types, syphilis, chancroid, and gonorrhea, now classified under those headings were thought to be identical in origin and nature until 1838; and it was not until 1905 that Schaudinn and Hoffman isolated the spirillum indicative of syphilis. The relation of syphilis to the general health and to the break-down of the major bodily organs was not generally known until recent years, although many ante-bellum doctors strongly suspected such a relation to exist. Many a death listed in the census returns of 1850 and 1860 as heart disease, mortification, ulcer, kidney disease, cystitis might more properly have been listed as venereal diseases. In fact, the census of 1850 lists only eleven deaths in North Carolina from venereal diseases; and the census of 1860, only seven. 66

           Dr. John Brickell who practiced medicine in Edenton about 1731 wrote of gonorrhea and syphilis, "Clap and French Pox . . . are common Distempers in Carolina." 67

He said of yaws, a peculiar

Page 739

disease of the skin to which dark-skinned peoples in tropical climates are subject: "The Yaws, are a Disorder not well known in Europe, but very common and familiar here; it is like the Lues venerea, having most of the Symptoms that attended the Pox . . . but is never attended with a Gonorrhea in the beginning. This Distemper was brought hither by the Negroes from Guinea, where it is a common Distemper amongst them, and is communicated to several of the Europeans or Christians by their cohabiting with the Blacks, by which means it is hereditary in many Families in Carolina, and by it some have lost their Palates and Noses." 68

DISEASES OF WOMEN AND CHILDREN

           "It is an appalling fact," wrote Dr. W. C. Lankford of Franklin County at the close of the ante-bellum period, "that there are more diseases, peculiar to women, which come to the knowledge of the physician, than of all the diseases which 'man is heir to'; and what is still more to be pitied, they are on a rapid increase." 69

Most of the diseases were those incident to childbirth. Large families were the rule even among the gentry. The mother bore a child every year or so until the process was stopped by age or ill health.

           Doctors, as it has already been pointed out, were seldom called except in cases of abnormal deliveries. The midwife or granny frequently delivered the sons of the rich as well as of the poor. The midwife was "usually a woman of mature years or even aged, well versed in the arts of primitive medical botany, the collecting and curing of roots and herbs, as well as the preparation of 'teas'," wrote Dr. Gaillard S. Tennent in 1906 in sketching the medical history of Buncombe County. "This relic of frontier life has clung to the population with all the tenacity of superstition, often fostered by necessity, and it is only in recent years that it is receding into the coves and corners of the county." 70



Page 740

           Most births occurred without the grateful relief of an anesthetic, for the use of chloroform in midwifery was still a mooted question. It was not until the close of the ante-bellum period that leading physicians in the United States admitted that chloroform was useful even in abnormal deliveries. 71

Doctors and midwives alike depended entirely upon toddies and "cheerful conversation" to "inspire courage, bear up the sinking spirits, and prevent entire despondency." 72 Most attendants permitted their patients to lie in bed or walk about the room as they chose until the stage of labor immediately preceding the birth of the child. When this period arrived, some had their patients return to bed, while others declared, "Most women prefer sitting on the knees of another and this is certainly the most natural and easy position." 73 In case labor pains should grow mild before the birth of the child, "advanced" doctors gave their patients ergot, the drug still used for that purpose today, but midwives invariably depended upon red pepper or ginger tea or a tea made of red raspberry or white hazel leaves. 74 If the patient was slow in discharging the placenta, the midwife massaged the patient's abdomen and instructed her to blow gently into her hands, while a doctor usually depended entirely upon the massage. 75 If the midwife failed to slip an ax or small knife under the patient's bed "to cut the after pains," some member of her family performed the service for her.

           On the third day after her delivery, the pioneer or farm mother was usually up about her duties, but a woman of the wealthier classes, with more servants at her command, usually insisted upon keeping to her room for three or four weeks, although she might be up caring for her newborn within a week or ten days.

           Dr. Lankford thought that the "absurd edicts of the mighty Moloch of fashion" were more responsible for "the frightening degeneration of female health" than were child-bearing and child rearing. These were "normal functions" which any normal mother could perform easily, but not so the activities which went on in



Page 741

"your palace of fashion." On a bleak, chill night you might look in upon a fashionable party and discover the cause which was undermining their health. The hour is late. "Exhilarating wine displays itself in the excited laugh, in the flashing eye, and in the sallies of wit. . . . Under such circumstances, how do we find the delicate female attired? Her bosom is dressed with 'muslin fashionably thin, arms bare to the shoulders, and feet covered with wafer-soled slippers. Every internal organ is groaning under the compression of stays and laces'." Dr. Lankford approved of the hooped skirt which had recently superseded the "half-dozen heavy skirts formerly worn," because it gave ease and comfort to the wearer. 76

           Instructions for the rearing of children which appeared in newspapers, almanacs, and books on family medicine are more modern than might be expected. Some of the aphorisms, translated from the French, which the North Carolina Medical Journal published in 1860 on the hygiene and nursing of infants are still in vogue today: infants should be washed in tepid water every day; infants and children should be carried into the sunlight and open air every day; a woman can and ought to nurse her child if she is in good health; an infant that takes the breast at regular intervals flourishes better than those who are suckled every time they cry; an infant needs nothing more than milk during the first months of life; at the age of six months it may begin to take light soups; no greasy articles of food should be given until after the first year. 77

Artificial feeding usually consisted of cow's milk modified with barley water or oatmeal gruel.

           Despite this advice, children were often fed imprudently with the result that cholera infantum, now known as colitis, was the great scourge of childhood. "Of all the complaints with which childhood becomes afflicted in its earlier stages, this is the most destructive," wrote Gunn in his Domestic Medicine. 78

Some thought teething to be the cause of cholera infantum; others thought it to be exposure to the night air in summer; still others thought the cause to be "the violent heats of summer" or "exposure to a moist and unhealthy state of the atmosphere." The usual treatment was calomel and ipecac. The mother was instructed to

Page 742

keep flannel over the child's abdomen and wool socks on its feet and to give it only barley water or rice gruel with plenty of tepid water. The folk remedy was a tea of cholera-morbus root, followed by a purge of rhubarb, and a tonic of yellow poplar bark.

           Next to cholera infantum, whooping cough and croup were perhaps the most dreaded diseases of childhood. Indeed, the census of 1860 lists more deaths in North Carolina from these two causes than from any other childhood disease, 427 from croup and 400 from whooping cough. Almost any almanac gave a remedy for the cure of these complaints. For whooping cough, Gales' Almanack for 1818 recommended a mixture of equal quantities of new milk and lye from hickory ashes, a tablespoonful to be given every hour of the day to a child, seven or eight years old. The juice of garlic or onion sweetened with honey was also a prescription for day-time use, while tincture of asafetida, paregoric, or laudanum were used to lessen coughing at night. In treating croup, the parent was advised to give a "puke" immediately and to repeat the dose until the desired effect was obtained. Plasters and blisters were to be applied to the throat and behind the ears and in severe cases the patient was to be bled as many as three times if necessary.

           A great many ante-bellum children suffered from worms, so much so that their mothers regularly lined them up to take their "worm medicine," which might be calomel, worm-seed oil, Carolina pink root, or turpentine. Measles, scarlatina, and diphtheria also took their toll. On May 5, 1835, the Raleigh Register wrote of an epidemic of measles, "This distressing complaint is now so prevalent in this City, that there is hardly a family, in which it has not made its appearance." Dr. Dickson of Wilmingon thought that scarlet fever was scarcely known in coastal North Carolina until the epidemic of 1835 after which it appeared every year, some years being worse than others. In 1846 the disease prevailed extensively and was very fatal. 79

Doctors were just beginning in 1860 to diagnose diphtheria as a separate, communicable disease. Heretofore it had been confused with croup, measles, and putrid and membranous sore throat. 80 The census of 1860 lists twenty-two

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deaths in North Carolina from diphtheria, but the first general epidemic in the State is reported to have occurred in the early sixties.

SURGERY

           In the ante-bellum period surgery in North Carolina was still in the hands of the regular practitioner. A few doctors in the State had reputations for being especially skilful in surgery, but neither their training nor their practice was chiefly surgical. In the last decade of the ante-bellum period, more attention was paid to surgery as a special branch of medicine so that North Carolina contributed a great many surgeons to the medical corps of the Confederate Army. Almanacs and books of family medicine gave instructions in surgery just as they did in administering pukes, giving blisters, and letting blood, for, as they pointed out, many accidents might occur when it was impossible to obtain the services of a physician. Indeed, many such accidents did occur with the result that the patient had "to take his chance." Sometimes a skilful person was about who could set a broken bone or a dislocated limb, bind a cut, or dress a gunshot wound, but frequently the afflicted person went through life with a shortened or atrophied leg or a thick, ugly scar. Such a case was that of Charles Blackwell of Rutherford County who broke his leg in 1808. "For want of Skilful and timely aid, the bone never could be set, in such a manner that the parts could unite," wrote Blackwell in 1813. "Of course they remain seperate [sic] till the present time. And in that situation" I have had "to support a wife and several small children," by my labor as a farmer. 81

           Because of the lack of hospitals in the State, persons who could afford to do so went to Virginia or more frequently to Pennsylvania or New York for a serious operation. On May 7, 1807, the Raleigh Register mentioned as a matter of curiosity the removal of a tumor from the neck of John Butler of Halifax at the Pennsylvania Hospital in Philadelphia. But in the issue of September 7, 1839, the Register was complaining that the southern people sought relief at the large cities of the North because they distrusted the ability of their own physicians. "If a man chances to find an ugly tooth in his head, and spare money in his pocket, he must forthwith fly to the North to 'have an operation performed.' There is,



Page 744

among us, no dearth of professional skill and intelligence, and they should be fostered and encouraged."

           When a North Carolina physician was called upon to perform an operation, he usually did so in his office or in the patient's home. Occasionally he took the patient into his own home. For instance, when Dr. Calvin Jones advertised in 1800 for patients to inoculate for smallpox, he stated that he had made arrangements to care for them in his own home so that he might give them constant attention. In 1813 Dr. John Poytress, post-physician for Beaufort, rented "that convenient House of Mrs. Pigott's, next door to Capt. Miners' Store," and opened a private infirmary which he maintained for a while. At the infirmary he treated each disease with its "particular mode of diet," and gave his patients "those luxuries, the Warm and Shower Bath, much neglected by too many, and highly useful in many cases." He also provided a special house for the accommodation of his patients' servants. 82

Except for a few institutions of this sort, North Carolina had no hospitals in the ante-bellum period. Although John Rex left an endowment in the forties for a hospital for the poor to be erected in Raleigh, it was not until many years later that the institution was built.

           Until the late forties, doctors could promise no relief from pain during an operation except that afforded by opium and spirituous liquors. The patient might be prepared for an operation by a dose of Bateman's drops or laudanum, both of high opium content, or by a stiff dose of whisky. Thus fortified, he was tied securely and held by assistants, while the surgeon did his work. Dr. J. L. Ludlow's Manual of Examinations for medical students, taken from the shelf of an ante-bellum physician in North Carolina, gives the following directions for "securing" a patient for a pelvic operation: "He should be placed upon his back on a low table, with his hips and shoulders elevated, and his pelvis resting upon the edge of the table; a roller is then fastened to each wrist, and while the patient grasps the soles of his feet, his hands and feet are securely fastened together by the rollers, and the patient's legs and thighs held firmly by assistants on each side." 83

           The Raleigh Star of February 9, 1848, records an operation



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performed by Dr. F. J. Haywood of Raleigh upon a Mrs. Woodward of Wake County "without the aid of any such agent as the chloroform." Dr. Haywood performed the operation "with the skill and nerve" for which he was distinguished and the woman stood the operation "with the firmness and fortitude" characteristic of her sex, although in the process the jaw was split open from behind the ear to the mouth.

           The same issue of the Star claims for Dr. Haywood the distinction of performing in 1848 the first operation in the State with the use of chloroform. "The effect was as perfect and happy as if an allwise and merciful Providence had prepared it especially for the purpose." The editor thought that now many, despite their dread of the knife, would be induced to submit to operations, when they learned that they could obtain relief without pain and without danger.

           The general practitioner usually performed operations upon the head whenever such cases arose, for there were few specialists in this field of surgery in the State. One such specialist, however, was Dr. John Beckwith of Raleigh who treated diseases of the eye for a period of more than twenty years until his removal to Petersburg, Virginia, in the forties. In the issue of September 7, 1839, the Raleigh Register referred with pride to his operations for the relief of blindness, declaring that he had as few instances of failure as the more famed doctors at the North. At the same time, Dr. Edmund Strudwick of Hillsboro and Dr. Edwin Anderson of Wilmington were performing successful operations on the eye.

DENTISTRY

           The general practitioner also pulled teeth and advised his patients about mouth washes. The average person was indifferent as to the care of his teeth, and it was not unusual to see a man in his twenties with several teeth missing. The almanacs abounded with prescriptions for mouth washes "to keep down the odor of a foul breath caused by loose and decayed teeth."

           There were eighty-three dentists located in the towns and villages of the State by the close of the period. They also frequently served the rural communities as well, for once or twice a year they might put their equipment into their buggies and make their "circuits," visiting such families as needed their assistance. Traveling



Page 746

dentists from the North, from Virginia, and from South Carolina also came into the State. Such a dentist was a Mr. Hurley who arrived in Hillsboro in August, 1821, and offered his professional services to the community for a short time. His advertisement in the Recorder of August 22, 1821, declared that he operated for all diseases of the teeth and gums; he freed the teeth from tartar; filled and plugged decayed teeth; straightened children's teeth; and inserted "artificial teeth after the most approved manner, . . . in a style so nearly approaching nature, as to bid defiance to detection." He rented a room at Faddis's tavern "suitable for the purposes of his profession," but, if requested, he would attend the ladies at their own houses.

           In 1828 a traveling dentist saved himself from the wrath of the law only by flight. In March an Englishman arrived in Raleigh without funds and asked for money to proceed to friends in Charleston. He was sick at the time and in a few days died. An hour after his burial, a dentist took up the body to obtain the teeth. Someone informed the intendant of police "of this disgraceful proceeding." The dentist, however, "effected his escape," but the Negro man who acted as grave-digger on the occasion "was taken and committed to prison." 84

           W. F. Bason, "medico-dental surgeon," who served the entire State and especially the piedmont in the late ante-bellum period, wrote a pamphlet in 1852 on the effects of diseased teeth and gums upon the general health. The rules which he laid down for the care of the teeth and the emphasis which he placed upon the effect of diet upon the teeth might have been written by a dentist today. 85

Dr. Bason, who was a graduate dentist, regretted the fact that "the unprincipled acts of some of those usurious pretenders who disgrace the dental profession" had made the public suspicious of the practitioner. He was preaching the new doctrine of periodical visits to the dentist not only to prevent pain in the future but the loss of teeth which often were "sacrificed before manhood even commences."



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           Toward the close of the period, most newspapers in the State were carrying the advertisements of "permanently located" dentists who boasted "a thorough dental education." In fact, Dr. Bason had a college degree in medicine as well as in dentistry. The North Carolina Presbyterian of July 16, 1859, contains five dental notices: Dr. R. Scott of Fayetteville, Dr. W. F. Bason of Haw River, Dr. Theodore M. Sikes of Pleasant Exchange, Dr. James Davis of Fayetteville, and Dr. S. A. McDowell and Dr. B. F. Arrington of Goldsboro. Some of the doctors still offered to "wait on the ladies at their homes"; some to make the charges moderate so that the benefits of the profession might reach all who had an interest in the preservation of the teeth. Dr. McDowell and Dr. Arrington, partners in practice, offered to furnish numerous styles of artificial teeth "to the profession when desired at usual rates."

THE FACULTY, OR PROFESSION

           The nineteenth century opened with only a few doctors of college training in the State. The profession was still in the hands of the head of the family. Very frequently the head turned over this responsibility to his wife so that it might be truthfully claimed that medicine was in the hands of the women in the early ante-bellum period. Dr. John Brickell, who practiced medicine in Edenton about 1731, referred in his Natural History of North Carolina to the diseases "Which almost every old Woman pretends to have an infallible Cure for." 86

In the rural communities the same women who served as midwives served also as general practitioners and were often the only medical assistance of any sort that might be had within a day's riding. 87

           There is no accurate list of the number of medical men practicing in North Carolina in the early nineteenth century. In 1823 Colin McIver gave the names of resident physicians in his North-Carolina Register and found that there were 273 men practicing in 56 counties. Most counties had only two or three doctors, but a few had more than ten, Halifax, fourteen; Caswell, thirteen; Warren, Wake, and Orange, ten each. A few counties, Ashe, Currituck, and Haywood, had no doctors. 88

By 1860 the number of physicians had increased to 1,266. 89



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           Dr. Edward Warren of Edenton, member of a distinguished medical family, declared in 1856 that the number of practitioners who had lived in North Carolina during the past fifty years was immense. The State had annually supplied a large quota of students to the medical schools, but, like the ministers, lawyers, and other professional men, they either did not return to practice in their native State or soon left for more profitable fields. Dr. Warren thought that scarcely an instance might be found in which a physician in the State had made a fortune from the practice of medicine. In fact, the average yearly income of a physician in North Carolina was little more than three hundred dollars. 90

As a result, doctors, like teachers and ministers, had to supplement their income by other activities. A great many made more from the sale of their medicines than they did from their services. Doctors not only compounded their own medicines but were often the only source of medical supplies in the community. A surprisingly large number of physicians were planters as well, and occasionally their planting operations became so extensive that they abandoned entirely their medical practice.

           It is no wonder that they found agriculture more profitable when it is considered that most persons paid their bills for medical service always reluctantly and sometimes only by the force of law. "It is remarkable," declared Dr. S. S. Satchwell of Wilmington in 1857, "that a man will willingly pay his lawyer a hundred dollars to secure his property, but most unwillingly pays his physician half that amount for saving his life." 91

Perhaps the physician was somewhat to blame for this attitude. A great many doctors considered it unethical to discuss the amount of a fee with their patients and permitted them to pay whatever amount they pleased at their own convenience. When a doctor did present a bill, it was usually only once or twice a year, a custom which still prevails in many parts of the State. In 1808, when the doctors of Edenton held a private meeting to attempt to agree among themselves upon a uniform rate, the whole town was thrown into a panic. 92 One of the chief sources of popular opposition to the North Carolina Medical

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Society was the fact that it placed emphasis upon the charge of a uniform fee.

           The college to which most North Carolina students turned for medical training was the University of Pennsylvania. In 1860 one hundred and seven of the 233 members of the North Carolina Medical Society had obtained their degrees there. Other popular schools were the University of New York, Jefferson Medical College of Philadelphia, and Charleston Medical College. A few had received their education at Harvard, Yale, New Orleans, the University of Virginia, Rutgers, and the University of Maryland.

           A great many doctors practicing in North Carolina in 1860 had obtained their medical education from local schools within the State. These schools were often conducted by doctors too advanced in age to attend longer to an active practice. In 1811, for instance, Dr. James H. Keys, who lived near Warrenton, advertised for two or three students. The terms would be reasonable, for he was undertaking the school "more as a matter of amusement, than of profit." No person need apply who was not well instructed in Latin. The doctor's practice was not large, because of his age, but "sufficiently so to induct any Young Gentleman into that knowledge, which is only acquired at the bed side of affliction." 93

Several years later, Dr. Charles Harris, who died in 1825, opened a medical school in the vicinity of Poplar Tent Church in Cabarrus County and educated about ninety for the medical profession. 94 In Asheville both Dr. J. F. E. Hardy and Dr. William Lewis Hilliard instructed students in medicine in the late ante-bellum period, and in piedmont North Carolina Dr. Edward M. Scott, "for several years Demonstrator in the National Medical College," was principal of the medical division of South Lowell Male Academy and Medical School. 95

MEDICAL THERAPY

           Medical therapy consisted chiefly of pukes and purges, blood letting, and blistering. The first step in curing almost any disease, especially those accompanied by fever, was the administration of an emetic. Tartrate of antimony and potash, generally known as tartar emetic, was the favorite puke used in bilious fevers because it was thought to throw off the bile. A grain of tartar emetic was



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dissolved in a cup of warm water, and the patient sipped the contents until he vomited. Ipecacuanha, frequently shortened to ipecac and sometimes also called hippo, was the favorite emetic in eruptive diseases, such as smallpox, measles, and scarlet fever, because it was thought to throw the eruption out on the skin. Calomel, castor oil, and epsom salts headed the list of purgatives, and the doctors also used rhubarb, cascara, senna, and jalap.

           If the patient did not grow better after taking an emetic and purgative, the doctor might decide to let some blood. If the blood was to be taken from an arm or leg, the doctor had the patient sit up in bed. He tied a piece of tape around the arm moderately tight just above the elbow. Grasping the arm with his left hand and keeping the thumb on the vein to be bled, the doctor would take the lancet in the right hand, letting the point touch the middle of the vein just above the left thumb. Pushing firmly and steadily upward into the vein, he would make a small cut. When the thumb was removed the blood gushed forth and the doctor would take from a pint to a pint and a half from a strong grown person. He then would remove the tape and place a loose bandage over the wound. Doctors bled from other parts of the body by the use of leeches or by cupping. If leeches were used, the practitioner prepared the surface by scarifying with an instrument which consisted of a number of small lancets acted upon by a spring so as to make a number of shallow gashes. He prepared the leeches by allowing them to creep over a dry cloth and then moistened the scarified part with a little cream or sugar to attract them. Doctors who cupped instead of using leeches, scarified the surface and then placed a heated cup over the wounds. As the cup cooled, it would stick fast and fill itself with blood. 96

           In case the patient suffered from a disease which caused him considerable localized pain, such as in pleurisy or pneumonia, the doctor might apply a plaster until a blister appeared, although in the fifties some doctors were advocating the removal of the plaster before reaching the blistering stage. Ready-made "blisters" might be obtained, but the doctor usually preferred to make his own blister of mustard or opium in the patient's home just before applying it. If the practitioner did not wish to blister, but merely to apply moist heat, he prescribed a poultice to be made of bread, hominy,



Page 751

flaxseed, or any vegetable or herb which would boil and mash soft and not inflame the skin when applied.

           The specific treatment prescribed in a number of particular cases will illustrate the application of these principles of antebellum therapeutics. In 1834 Dr. James Norcom of Edenton wrote that in treating cholera reliance could be placed in only three things: emetics, calomel, and the lancet, "the first to excite the prostrate energies of the stomach" and the portal circulation; "the last to reduce the quantity of the blood so as to adapt it to a weak & oppressed condition of the vessels in which it has almost ceased to circulate, aiding, at the same time, the languid powers of the organs of secretions" by doses of calomel suited to the individual case. 97

Dr. Simons' Family Medicine recommended the following treatment for typhoid fever:

           Along with his remedies, the ante-bellum doctor also dispensed his personal services, for he was often nurse as well as doctor. He might not visit a patient frequently if he considered him to be mildly ill. Even his pneumonia patients he might not see oftener than every other day, but when an emergency arose and the life of the patient depended upon expert nursing, he stayed constantly at the bedside until after the crisis. In 1832, for instance, when little Mary Gash was ill, her parents sent for Dr. J. F. E. Hardy, one of the busiest doctors in Western North Carolina. "When he came," wrote the mother, "she was out of her senses. He said her Case was desperate . . . perhaps he Could save her. At Least he would do all he Could. He Came on Saturday and Stayed untill Tuesday in which time ended the mortal scene." 99

Doctors

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who could afford it kept a swift horse so that they might reach their patients as quickly as possible, and if they had much country practice, they used the saddle instead of a gig to cover the territory all the faster.

NATIVE SIMPLES

           The average ante-bellum family called a doctor only in an emergency or when every other curative means had failed. In 1832, for instance, when a certain child became ill Monday "with a puking and a severe pain in her head, I had her bled and sweated," wrote her mother. But she still complained of a severe pain in her head and her mother put a blister on the back of the child's neck. When the blister did not draw well and the child fell into a coma, her parents became alarmed and called a doctor Saturday afternoon, five days after her first attack. 100

           Many a head of a family knew as well how to bleed or draw a blister as did a physician, and his wife, as has already been pointed out, was usually well informed in the knowledge of household remedies. Almost any account book of the ante-bellum period shows that the owner kept on hand a supply of the usual medicines. The Phillips Moore Account Book kept between 1804 and 1811 shows that the following medicines were purchased in Petersburg at various times: two bottles of essence of mustard, a half pound of magnesia, one ounce of vitriol, one-sixth ounce of asafetida, senna, opium, two ounces of sal ammonia, blistering plasters and salve, two bottles of sweet oil, and two pounds of copperas. Here was a variety of medicines sufficient to cure almost any antebellum complaint.

           A great many families, however, could not send abroad for medicines; neither did they obtain them from the supply which every doctor always kept on hand. They relied, instead, upon herbs which grew in the fields and woods. Every granny and a great many housewives, as well, knew the various plants and their properties; knew how to gather and dry them, brew them into decoctions or pulverize them to be taken as powders. These were the "native simples," so called because of the belief that every country produced a simple remedy for its diseases. A knowledge of their use still exists in a great many families today, especially among the Negroes and the rural whites. Almost any adult can



Page 753

recall having seen his grandmother gathering sage to be used in a tea to cure winter colds or catnip to brew for the baby's colic.

           Most of the books on family medicine published in the antebellum period gave instructions in collecting and preparing simples. The pages of the almanacs were crowded with their curative qualities. In 1849 James W. Mahoney published in Asheville The Cherokee Physician, or Indian Guide to Health, listing the herbs used by the Indians in curing diseases, many of which had effected a recovery "after such remedies as are usually prescribed by the whites had been tried and had utterly failed." 101

During the Civil War, the Confederate Government temporarily released Dr. F. P. Porcher, formerly surgeon in charge of the city hospitals of Charleston, from active service in the field and hospital to prepare a volume on the medical resources of the southern fields and forests so that the physician in his private practice, the planter on his estate, or the soldier in the field might be able to obtain readily the medicinal plants that grew all about him. 102

           In the colonial period John Lawson and Dr. John Brickell had published in their respective histories of North Carolina a brief list of the native plants with their medicinal uses. The knowledge of the use of these plants among the common people was, however, largely traditional. Both the grannies and the herb doctors guarded their knowledge with the utmost secrecy. In 1810 a native of Moore County, in writing a sketch of the county for Thomas Henderson, editor of the Raleigh Star, said, "I must confess my ignorance of a great manny plants in use among the Emperics of Moore. The want of regular bred Physicians, render the Number Quacks considerabl & they make a Secreat of the means used in many cases, which is in most instances a Security against discovery of the imbicility of their Skill and practice." 103

           The use of a great many of these native simples was not imbecile, but, on the contrary, highly efficacious, as Dr. Porcher pointed out during the Civil War. Sassafras tea was used in cases of pneumonia, measles, bronchitis, or cold. The leaves of the



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bené, commonly called and spelled benny, were used in cases of camp dysentery, of colds, and of coughs. The bark of the dogwood was substituted "with great advantage" for quinine in the treatment of malaria and typhoid fever. Thoroughwort or boneset, commonly called grow round, was also found to be "quite sufficient in the management of many of the malarial fevers" which prevailed among the troops during the summer months. The bark of the tulip-bearing poplar and of the willow were also effective in treating camp fevers. The inner bark of the sweet gum made into a tea, as well as the green leaves of the tree and of the myrtle and blackberry, easily checked diarrhea. A decoction of blackberry root checked "profuse diarrheas of any kind." The bark of the holly root chewed or made into a tea and the leaves of gentian and winter green made into a tea were good tonics. Wild jalap was an excellent purgative to be used instead of imported jalap and rhubarb. The boiled roots of swamp dragon furnished "an easily procurable and highly soothing material for poultices--admirably adapted to the wants of large bodies of men in camps, as well as of Negroes on our plantations." Dr. Porcher also advised every planter in the South to grow the opium, mustard, and flaxseed needed for home use. 104

QUACKERY

           The practice of medicine, which in all primitive tribes was in the hands of the magicians and which in Europe was not transferred from the hands of the faith healers to those of the alchemist until about the time of the Renaissance, was in the early antebellum period still cloaked somewhat in superstition. Even today there is considerable superstition associated with medicine in the popular mind, as the vogue of faith healers testifies. D. A. Tompkins declared in 1903 in his History of Mecklenburg County, "It is a fact not now generally known that some of the early settlers in this section regarded many diseases as directly due to the power and influence of witches. . . . The methods of the so-called 'witch doctors' were often ludicrous. . . . There are traditional instances which relate how the 'witch doctors' tried to cure cases of serious sickness . . . by reconciling any family differences with neighbors, even to the extent of returning all borrowed property, after which



Page 755

the treatment consisted of 'words' or 'prayers,' sometimes accompanied with annointing the parts of the body which seemed to be the seat of the 'witches' with concoctions, the making and compounding of which was a secret to all except those initiated." 105

           In the issue of September 12, 1820, a correspondent of the Western Carolinian who wrote under the name of "Medley" declared that quack doctors swarmed over North Carolina like Egyptian locusts. "They generally deal in secret remedies; they pretend to be the sole possessors of the arcana of medicine: they not infrequently charge the members of the faculty of physic with ignorance, &c. . . . I make no pretensions to the knowledge of physic, neither do I ever calculate on doing so; but I wish to see the removal of these excresences from society, knowing them to be the most dangerous animals in existence." Partly as a result of this letter, Governor Branch addressed a message to the Legislature that year on the low state of medicine in North Carolina, declaring that the "adventurous quack, presuming on the ignorance and credulity of the people," ran off with most of the practice. When their remedies proved ineffectual, they could easily move into another neighborhood and quickly develop another following because of the eagerness with which an afflicted person accepted any promise of relief. 106

           On July 28, 1815, the Raleigh Register published the plea of one Andrew Tally of Duplin County who described himself as "a man greatly distressed with what is said to be the Cholic." He wanted the services of a certain Dr. Jurden, formerly of Currituck. "I have sent after the said Doctor, but he could not be found. . . . He has been called an Impostor, but I don't mind that as I believe he can help me if I can get him. I will give him $100 if he will come and cure me, and if that is not sufficient I will give him more . . . as I am suffering death daily."

           Charlatans of Dr. Jurden's type were still plentiful in North Carolina at the close of the ante-bellum period. Dr. Walter A. Norwood of Hillsboro complained to the North Carolina Medical Society in 1852 that the people of the State "seem to have agreed that any man who calls himself a Doctor, and owns a horse and a pair of medical saddlebags, shall be respected accordingly." 107



Page 756

           These quacks were of various sorts. A great many were mere venders of nostrums, some of their own brewing, others of the patent medicine variety. They made no pretense at settling in a neighborhood and building up a practice but traveled from place to place on horseback or in their little carts selling their medicines as they went. "Thousands upon thousands, in our own State," said Dr. S. S. Satchwell in 1857, "are daily denouncing medical science, and at the same time administering to themselves and families, the most powerful remedies in the shape of nostrums. They refuse the 'mineral medicines,' as they call them, of regular physicians, but are ready to follow the prescriptions of corrosive sublimate and arsenic, of itinerant wart and cancer doctors. . . . A neighbor of mine, who is an honest, clever man, but noted for his want of confidence in physicians, recently paid a traveling quack one hundred dollars for a vial of drops, and the application of some mysterious mesmeric passes to one of his children, for the cure of epilepsy." 108

           Another type of quack was the one who professed to be able to cure ailments of a particular sort, such as cancer, carbuncles, polypi, warts, or a particular disease, such as hydrophobia. Such a doctor was one Peleg Rogers of Wake County who advertised in 1801 that he was "well acquainted with the Art of curing Cancer Worts; also with Eating away Cancers and Carbuncles; also Polypusses, or any Thing of that Nature. Whoever is thus afflicted, if they will apply may expect under God, to have speedy Relief." 109

A cancer doctor advertised in 1811 that he would sell his knowledge "on reasonable terms" as he had "some prospect of moving out of the State." 110

           The faith healers also had their clientele. In 1852 Dr. Norwood declared them to be "some of the most ignorant of our people." 111

The monarchy of England prior to the reign of George I had claimed to be able to cure scrofula and a few other diseases by the royal touch, but the ante-bellum faith healers placed no such limit upon their curative ability.

           There were also the herb doctors, who, Dr. Satchwell declared, had taken all of their medicines of any value from the materia medica of the regular practitioner and "perverted to their



Page 757

own ignorant and ignoble purpose." The cult of "botanic medicine" was based upon the theory that a country grows medicinal plants suitable for every disease of the inhabitants. It followers declared that they had derived their knowledge from Indian medicine men and from early settlers who had accidentally learned the uses of native plants. There were two schools of botanic physicians, the Eclectics and the Thomsonians. Wooster Beach of Connecticut was one of the founders of eclecticism. He began his career as an empiric in 1825 and later established the Reformed Medical Society of the United States. Samuel Thomson was a New Hampshire blacksmith who published a New Guide to Health in 1822, declaring that "all diseases are the effect of one general cause and can be removed by one general remedy." He sold his system for $20 to anyone wishing to practice on his family and for $100 to anyone wishing to practice on others.

           Hydropathy, or hydrotherapy as it is now called, enjoyed a tremendous vogue in ante-bellum North Carolina. The system was originated by Vincent Preissnitz, a Silesian peasant, who advocated the method of treating diseases by the application of hot and cold water. In rapid succession he invented the sponge bath, the wet-sheet packing, the sitz, foot and arm baths, the douche, the steam bath, the dripping sheet, the plunge, and the dry-blanket packing. He established baths in his native village in 1829 which were immediately popular, but he had his greatest following in the United States. The steam doctors referred to with derision by the regular practitioner in ante-bellum North Carolina were all followers of hydrotherapy. The cult was partly responsible for the increasing popularity of the summer resorts, especially those "watering places" which afforded medicinal waters or baths.

           Medical galvanism, based upon the theory that the galvanic current could be applied effectively in the treatment of all diseases; phrenology and cranioscopy, which in the hands of unscrupulous followers attempted to chart the cerebral areas and thus determine the human personality; and homeopathy, founded upon the theory of like curing like, the remedies being administered in minute doses, all had their followers in the State. 112



Page 758

           Some slaves and free Negroes practiced medicine despite the attempt to prevent it. There were the usual grannies, or midwives, who mixed a knowledge of conjure balls with that of native herbs, and there were also Negro men who professed a knowledge of medicine and doctored the whites as well as the colored. In 1807, for instance, James Rhodes, senator from Wayne County, presented the petition of Cato Sabo, a "person of color" who "practises physic in said county." Sabo wished to be allowed by law to "enforce the payment of debts incurred by his patients." The Legislature thought that it would be "highly improper to extend the privilege prayed for to persons of that description," but offered no complaint to his practicing medicine. 113

A bill before the Legislature of 1805 had sought to prevent a Negro "from administering medicine or presuming to practice physic" without obtaining a license, and a bill of 1821 sought to prevent the practice upon penalty of death. 114 Not even the fear of insurrection in 1830 and 1831 could induce the Legislature to pass a specific law against Negro doctors, although such a bill appeared in the House. 115

THE MEDICAL BOARD

           It was partly to suppress "the fatal and criminal practice of Quacks and Empyrics" that a group of medical men in the State met in Raleigh in December, 1799, and organized the North-Carolina Medical Society. The Legislature incorporated the Society which had elected Dr. Richard Fenner, president; Dr. Calvin Jones, corresponding secretary; Dr. William B. Hill, recording secretary; and Dr. Cargill Massenburg, treasurer. 116

In 1800 the Society again met in Raleigh and admitted several new members who first were examined by the "censors" to determine their qualifications. 117 In 1801 the Society was reported to be "increasing in respectability" and in 1803 its progress was declared to be flattering. 118 From this time until 1849 nothing more was heard of a North Carolina Medical Society.

           In 1800 the Medical Society had urged the "Medical Gentlemen of each district within this State" to organize associations. In



Page 759

1802 a group of doctors met at Martinsville and organized the Guilford Medical Society, with Dr. Vanstorie, president, and Dr. Saunders, secretary, in an attempt to rescue "the godlike Science of Medicine" from "almost entire Monopolization . . . by impudent and assuming Quacks." The society was "well aware that by the undertaking we shall expose ourselves to the rancour and inveterate malice of Empyrics," but the society looked for its reward in the approval "of the better and more enlightened part of the community." 119

           Beginning about 1818, there was an almost constant agitation in the Legislature for some kind of control of the practice of medicine within the State. In that year Boon Felton, senator from Hertford, introduced a bill to prohibit a physician from practicing "unless he can produce a diploma." 120

In 1820 Governor Branch called attention to "the adventurous Quack, presuming upon the ignorance and credulity of the people," and the Legislature responded with a bill to create a medical examining board. 121 In 1821 Alfred M. Slade of Martin introduced a bill in the House to create a medical board which should meet twice a year at Chapel Hill. The bill, which passed the House but was defeated in the Senate, would have made it unlawful for any one "to practice Physic or Surgery or any of the Branches thereof, or in any case to prescribe for the cure of diseases, for fee or reward," without a license granted by the medical board. 122

           In 1825 the Legislature appointed a joint select committee to consider the subject, and the committee drew up a lengthy report accompanied by a bill to establish a medical board, declaring that the evils of quackery "have been long seen and long lamented." The bill again passed the House and again was defeated in the Senate. The committee might well ask, "Why should North Carolina be behind other states in any effort to promote science, and to preserve life? . . . She has a population worthy of being protected & improved--And she has men in the profession of medicine, who would do honor to any state or to any Country." 123

           In 1827, 1828, twice in 1829, and again in 1830, committees were appointed and bills introduced to regulate the practice of



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medicine. In 1830 "sundry citizens" of Burke County petitioned the Legislature to establish a medical board, but the committee which considered the petition thought that it would require too much time to "adopt a measure so important and one so difficult to suit the views of so many people." 124

           Many persons thought that the regulation of the practice of medicine was not a subject for legislative enactment. "Quackery cannot be put down by legislation," they declared. "If the people will be deceived, they will be deceived." 125

But the friends of reform continued the agitation and a bill to create a medical board almost passed the Legislature of 1848-1849. The only question of disagreement was the manner of appointing the members of the board. Some wanted the power to be left with the Legislature; others wanted to give it to the doctors of the State. Unwilling to have this reform defeated again by such an issue, the men who had worked for the bill, Dr. W. B. Lane of Randolph, Dr. J. S. Erwin of McDowell, and Dr. W. M. Taylor of Nash, all members of the Legislature, and Dr. James E. Williamson of Caswell, Dr. Charles E. Johnson, Dr. William G. Hill, and Dr. William H. McKee of Wake, met in the clerk's room of the Senate Chamber January 27, 1849, and resolved to issue a call to the medical men of the State to organize. 126

           In response to this plea a small group of doctors met in Raleigh on April 16 and organized the North Carolina Medical Society "for the advancement of Medical Science and the elevation of our professional standard." 127

Dr. Edmund Strudwick of Hillsboro was the first president; Dr. William H. McKee of Raleigh, secretary; and Dr. William G. Hill of Raleigh, treasurer. The Society was based upon county medical societies which the regular practitioners were urged to organize. No person was to be admitted to membership in a county society "unless he is either a graduate in Medicine of some respectable Medical School, or has been a practitioner for at least five years; and who, moreover, is in good moral and professional standing in the place where he

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resides, and is a regular practitioner." Any member who procured a patent for a remedy or for an instrument of surgery or who gave a certificate in favor of such a patent or instrument would be disqualified. 128

           It was not, however, until the Legislature of 1858-1859 that the friends of a medical examining board were able to obtain a law carrying it into effect. The Medical Society appointed a committee to draft a bill and to form a lobby to push the bill through the Legislature. Even then, as Dr. Edward Warren of Edenton later explained, the committee "had to choose between surrendering, definitely and disgracefully, after a thirty years' fight, 129

and securing a victory which, though it may be only partial, is a triumph after all." 130 The bill provided for the appointment of a medical board by the Legislature or by the Medical Society in case the Legislature failed to act. It was tacitly agreed that the appointments should always be made by the Medical Society. Accordingly, the Society appointed the first state medical board at the May meeting in 1859. Any person, regardless of his training, who could pass a satisfactory examination was entitled to a license to practice, and the only penalty affixed for practicing without a license was the inability to collect one's debts by court procedure.

           Many of the leaders in the movement for medical reform were grievously disappointed in the act. The Virginia Medical Journal ridiculed it as an emasculated effort designed to encourage quackery. 131

But a great many doctors in North Carolina, especially those outside the Medical Society, objected to the law on the ground that it was "illiberal, unjust, and tyrannical," and predicted that "the time will come when the whole State will cry aloud for the repeal of this act." 132 The Medical Society had never been popular with the faculty as a whole. Only 233 out of the 1,266 practitioners in the State in 1860 were members. The native-trained practitioners felt as though the whole movement was an unjust effort on the part of college-trained physicians to monopolize the field. But the Society was gaining prestige.



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           In the eleven years of its existence prior to the Civil War, the Medical Society had made definite accomplishments. In 1858 it had begun the publication of the Medical Journal of North Carolina. As early as 1852 the Society had started a "medical geography" of the State, attempting to plot the trend of epidemics and to discover what diseases were peculiar to different localities. In 1859 Dr. William McKee, the first secretary of the Society, could report that a deranged condition of the liver and spleen prevailed in the malarial sections of the State; that inflammatory diseases attacking the joints and lungs predominated in the piedmont; and that goiter and cretinism were peculiar to the mountains. 133

           In the sixty years since the opening of the century, the field of medical science had greatly changed. Jenner's discovery of smallpox vaccine in 1798 had so decreased the epidemics from that terrible scourge that there was only one death in North Carolina from that cause in 1860. The faculty continued to puzzle over the cause of malaria, still believing that the foul odor of decomposing matter was a sufficient cause within itself, and malaria was still as much the curse of the State in 1860 as it had been in 1800. Quarantine of the communicable diseases was still within the hands of the local police, with the result that such diseases as measles, whooping cough, and scarlet fever spread with great rapidity.

           The century opened with medical therapy consisting chiefly of the use of strong drugs supplemented with blood-letting and blistering. The folk-doctors had long contended that every country produced a simple remedy for its local diseases. The regular practitioners were themselves getting away from the use of strong drugs. No less a man than Dr. William H. McKee of Raleigh declared to the North Carolina Medical Society in 1859, "The vast field of Botany, with its numerous medicinal plants is too much overlooked by the practitioner. Wherever any disease of a local character prevails, the remedy or antidote may be found, if only properly sought for." 134

The reaction against the powerful drugs of the regular practitioner had already ushered in a flood of new-fangled quacks. Before the close of the period, this revolt

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was leading the faculty toward the present-day theory of hygienic therapy: diet, fresh air, and sunshine with a minimum use of drugs. "I would enforce the truth," said Dr. S. S. Satchwell in 1857 when discussing the value of visiting springs and watering places, "that the observance on such occasions, of hygienic rules and regulations, and not the use of water, constitutes the main instrumentality of good." 135

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