Southern Discomfort Part 1: The Harsh Landscape of 17th and 19th Century American Health Care

Parsing some of the context that led to generations of fear.

Everyone has that one beloved character in a book, novel, or movie that set in some faraway time and unceremoniously dies off thanks to some easily preventable and treatable ailment.

I personally have yet to get over Beth March’s death in Little Women.

Fools I would think, rereading it for the seventh time, hoping the outcome would magically change and the doctors would produce a 10-dollar antibiotic or a cough syrup and save poor Beth.

As a child, these kinds of deaths would infuriate me. Plot aside, how dare the Mother/Best Friend/Husband/Beloved Child be killed off because of an infection or raging fever! Many of my American Girl Doll or Little House on the Prairie books are permanently wrinkled with tears of anguish and anger.

Chapter 1, aptly titled Southern Discomfort, of Medical Apartheid by Harriet Washington, may give us some grace for those childhood plot twists and also illuminates a key factor in the origin of distrust among modern African American communities.

What kind of medical establishment did the first generations of African Americans come into contact with?

The first enslaved African populations were brought over to America in 1619. Slavery legally ended in 1865.

Medicine between the 17th and 19th centuries was limited, as the understanding of diseases and how they spread was slim. Basic, public health care measures we take for granted now such as frequent hand washing, clean surgical uniforms, sterilized equipment, clean water, pathogen-free housing, and working sewage systems were not yet in place or practiced.

Washington points out that quantitative disease reporting was practically nonexistent and the number of public health institutions was very low and these institutions lacked permanency and stability.

Washington writes that they were “…Rising momentarily with epidemics of yellow fever or smallpox and subsiding from neglect after the crisis resolved.”

In a world with no antibiotics, no long-term public health institutions, and few effective therapies to combat disease, the storm of tuberculosis, yellow fever, malaria, and other diseases created epidemic crises that would rock communities. Washington does note that this context matched the medical understanding and issues across the sea in Europe. However, when modernization began to have an effect on the European medical community, the changes didn’t immediately affect American medicine because passage across the ocean was long and slow. Washington’s research reveals that the South was insular, and when the progress in medicine did cross over, it took time for it to even impact the Southern medical context.

Additionally, medical training during this time was short and limited. Doctors did not take as many years to train and had exposure to shoddy research influenced by untested theories that did not reflect reality.

Medical horrors abounded in the South as new strains of viruses from abroad mingled with native ones and set the stage for a cultural memory that would be hard to shake.

Washington notes that in the 18th century, the responses to these diseases were fatally misinformed. The “cures” were often physically violent and destructive to the body, as doctors experimented with “flushing” sick patients with harsh, caustic medicines. Compounds of mercury and chlorine, metabolic poisons like calomel and arsenic, and addictive narcotics such as cocaine derivatives, opium, and morphine either outright killed patients or left their bodies wracked with lung issues, addiction, and weakened bodies. The known pathogens were already mysteries to doctors, so when the pathogens of multiple continents in the South (Africa, North America, and Europe) came together there was more wild experimentation that costs patients their lives.

While this narrow medical understanding affected every single person, regardless of the social construction of race their skin color slotted them into, Washington drives home in this chapter the importance of how this hellish medical context particularly affected generations of African Americans. At this point, the majority of the Black population resided in the South, the very context where disease mistreatment and epidemics were raging. She shows that the region was particularly unhealthy and the treatments hardly worked. Enslaved population’s first and only contact with the American medical establishment was nightmarish and it broke trust. The herbal and holistic medical treatments their people groups had practiced for centuries were ignored or outright stopped.

Medical records show that Southern Medicine (practiced without the consent of Enslaved people) was ineffective, harsh, and experimental. Enslaved people endured and died in the worst, crude experiments of dosages, surgeries, and treatments. This haphazard, cruel, and nonconsensual medical practice over generations rightfully instilled the beginning of deep mistrust, fear, and pain between these communities and the entire American Medical establishment.