Throughout history, a focus has existed in improving the treatments of illnesses. During the late eighteenth century and early nineteenth century, germ theory was unheard of and methods of treating illnesses varied greatly. One of the most widespread treatments used was the herbal remedy. These remedies were administered to patients according to what part of their body was ailing them. For example, each extremity, as well each bodily organ, had a particular herb that was used to treat any ailments of it. Astrology determined which herb was associated with each body part. Each of the twelve zodiac signs related to a specific body part.1
Another method used to treat illnesses was bleeding, also called blood-letting. Significantly used, this method was part of a practice of medicine known as heroic medicine. Bleeding required the patient be cut with a lancet in order to bleed approximately one pint of blood at a time. The intention behind this method was to have the contaminated blood removed from the patient's body. A similar technique, leeching, involved the attachment of leeches to the patient's body for a period of time. Once the leeches were thought to have sucked out the contaminated blood, they would be removed. Methods which were premised on the idea of removing the illness from the body were vomiting and purging. With purging, the patient ingested numerous laxatives.2 Physicians administered mercury-chloride, or better known during this time as calomel, to the patient in order to induce diarrehea. Through the process of elimination, the body was expected to pass the infection outside of it. Side effects of ingesting calomel included poisoning and loss of teeth. Most of these effects were a result of overdosing.3 Although this method was thought to be helpful, many people died from dehydration.
Although ordinary illnesses were treated with the previously mentioned methods, epidemics were another issue. The ability to contain and prevent diseases from becoming epidemics were limited in America. Smallpox was one of these epidemics. Although it was widespread across the country, Savannah saw outbreaks of this disease more sporadically. With the introduction of a vaccination in the late 1700's, smallpox was beginning to be contained. In 1805, Savannah physicians were administering inoculations frequently.4
One epidemic which proved more difficult to handle and detrimental was yellow fever, also known as the black vomit. Yellow fever caused it's victims to have a high fever and to vomit and excrete bile. Sometimes the victim experienced swelling as the disease spread.5 At the time people began to contract yellow fever, the cause was unknown. Not until the late nineteenth century would the connection between mosquitos and the disease be made.
Most southern coastal regions of America including Louisiana, Alabama, South Carolina, and Texas were stricken by deadly yellow fever outbreaks.6 In Savannah, a ship from the West Indies brought yellow fever into the community on September 5, 1820. Within two months, 249 people had contracted it.7 These numbers were small compared to the next yellow fever outbreak which occurred in 1854. William Harden recalls, "The Yellow Fever epidemic of 1854 was the most disastrous, taking the live of many citizens including persons in the highest ranks of society. Many of our friends and relatives died during this period."8 It was estimated that the majority of the approximate 6,000 inhabitants of Savannah were victims to the fever with 1,040 of those dying within three months.9
Most of the measures taken to ward off the disease began after an outbreak in 1802. One method used to help purify the air was the burning of barrels of tar at night and pine wood during the day. This method proved to be unsuccessful. Another attempt was made when the city associated the wet cultures of rice with the disease. Since Savannah has a semi-tropical climate and the outbreaks appeared in the late summer months, the Georgia Medical Society concluded that the fevers were a result of stagnant water running off of the land.10 As a means to prevent reoccurrence, in 1817, "dry culture" contracts were offered to planters. Planters received forty dollars per acre of land to plant dry crops as opposed to wet rice crops.11 Although the attempt was not successful in eliminating yellow fever, as another epidemic hit in 1820, it did help to reduce a number of other fevers, including malaria, that the city's population succumbed to. "Here the death rate from autumnal fevers, - chiefly malaria - was reported, early in the century, at the amazing average of 70 per 1,000."12 As a result of the dry culture contracts, the number of fevers was reduced to "an average of 26 for the next 6 years, and declined even more during the ensuing period."13 The dry culture contract was the first example of its kind in health planning in the Southern cities.14
With each passing yellow fever epidemic, the city of Savannah evaluated the possible reasons for the continued outbreaks. A focus on sanitation began to emerge. Throughout the country, cities were attempting to implement various sanitation techniques to help contain and eliminate deadly diseases. Since many people were not convinced that sanitation was necessary and due to exorbitant costs associated with it, many cities limited their sanitary measures to the business districts and wealthy areas. Savannah also implemented sanitation plans with business in mind. Street cleaning and garbage collection were two of the first measures used in the city. City officials wanted the city to appear healthy even though disease was spreading. Savannah was like other cities in overlooking the needs of the poor. Once outside the business district, garbage collection was virtually non-existent.15
Lack of indoor plumbing also became a great concern. Chamber pots were used to hold bodily excrement and were emptied just outside the home. With increased sanitation concerns, the privy house, or necessary house, was increasingly used. Since the privies were separate from the home, they could be placed at a distance that was thought to have helped the waste from having a negative impact on a person's health.16 Unfortunately, the water supply was affected by the privies. Prior to 1854, wells were the main source of water. Since the wells were shallow, less than sixteen feet deep and the water was pumped through wooden pump systems, the water was often contaminated by the excrement leaking through the privy vaults. Because of the health threat that the contamination posed, in 1853, a city water works was built.17 The water system began operating in 1854 with the filtration process improving with each passing year.18 Although the quality of the water supply was better, the supply lines were limited to the wealthy with the poor white and black population receiving clean water only after years of protests. Overall, the water works system was considered to be a revolutionary change for the city and was more advanced in its ability to supply water than many other cities of the same size.19
Quarantines were another way the country's cities dealt with disease. By the mid-nineteenth century, quarantine laws were common. Despite the laws, which required ships to stay out to sea for twelve days before coming into the port in order to prohibit any disease among the passengers from spreading, many entered and unloaded anyway. Business, once again, played another role in the weakening of these laws. Quarantine laws were seen as a means to limit trading with businessmen competing to get the ship with their goods into port first.20 Another blow to the laws was the fact that the diseases which they were meant to deter occurred anyway.
A major problem which hindered the attempts to stop the spread of the disease was the officials of the city of Savannah. Since Savannah and South Carolina were strong competitors in commerce, Savannah's city officials did not want the public to know they were in the midst of an epidemic. In 1820, these officials, including the mayor and the Board of Health, issued statements that the city was healthy despite the increasing numbers of people dying from the disease. The truth was not revealed until newspapers in Georgia and other states forced the mayor to announce in public that the city was experiencing an epidemic. With this announcement, the population fled. Only 2,500 of 7,500 people stayed in Savannah with the majority of those remaining being black.21 Another incident occurred in 1854. As yellow fever swept both Charleston and Savannah, the cities' newspapers withheld information about the epidemics until they were almost over.22
Other ways to conceal the health of the people in Savannah continued to be used by city officials. Mortality rates were used as a basis for determining how healthy the city was. In 1820, these rates were purposefully altered to show only the deaths of whites. The mortality rate for blacks was suspected to be much higher and would have given a different picture of the health of the population to future businesses.23 Another alteration of mortality rates occurred with the Yellow Fever Epidemic of 1854. Regarding this situation, "on August 10, 1854, the mayor appeared before the Board and instructed it to delete words 'yellow fever' from its mortality reports in order to prevent injury to 'the reputation and interest of the city.'"24
Not only were the methods of managing illnesses and diseases in great transition during the Antebellum period, but the medical profession was also in the midst of great change. With the population growing and the frequency of illnesses increasing, the demand for qualified physicians across the country also began increasing. Disputes between doctors who practiced different methods began to arise. Although folk doctors, who relied on the herbal remedies as previously mentioned, were quite common in the early nineteenth century, they began to be scrutinized. Physicians who practiced heroic medicine were beginning to be rivaled by lay healers.25 Due to fatalities and side effects of the heroic and herbal medicine, many people began to place their faith in these lay healers. Lay healers were believed to be able to heal through the power of prayer by laying their hands on the ailing part of a person's body. Later, in the nineteenth century, Thomsonian physicians entered the picture with, yet again, an emphasis placed on the usage of herbs and roots as remedies.26 Along with the conflict of methods used, most physicians who practiced medicine in the late-eighteenth century did so on a part-time basis. Due to the lack of medical schools, those who were formally trained received their instruction from an experienced physician known as a preceptor.
At the beginning of the nineteenth century, the need for medical schools and professional organizations became apparent. Northern cities, such as Philadelphia, were on the forefront of this progression and had already begun to make changes. However, Savannah had a significant role as well. Due to the numbers of unqualified people practicing medicine, including pharmacists, physicians made a push for major transformation in the profession. Physicians who had received a formal education and/or training were considered to be "regular" doctors. Regular doctors focused on the anatomy of the body. Other physicians practicing herbal remedies or faith healing were called "irregulars" or "quacks". In 1804, a petition was submitted to the Georgia legislature asking that the physicians be given permission to become incorporated. With this incorporation, the law would require physicians to be licensed and regulated.27 The petition was approved and as a result, the organization know as the Medical Board of Examiners, later known as the Georgia Medical Society was formed. The trend of forming professional medical organizations increased throughout the South over the course of the next twenty-five years.
As a result of the formation of the Georgia Medical Society, many improvements began to take place. The Society began to focus on the illnesses that plagued the South. Yellow fever was an example of one the diseases on which the members focused. The organization was responsible for implementation of the dry culture contracts of 1817. Another notable effort made by the society was it made the first attempt in 1805 to monitor the death rate in Savannah, however the census was not taken due to the opposition of the citizens.28
Although the Georgia Medical Society was valuable in many ways, the quality of training physicians received was questionable. Prior to 1845, in the South, the emphasis on the education of physicians was less than the Northern states. The Southern states only had five medical colleges with the closest one in Augusta, Georgia. Many future physicians traveled to Philadelphia or New York for their training if they were unable to enroll in a closer college.29 Not only was finding an institution to attend difficult, but enrolling in a respectable one was also a problem. With the number of openings limited in the medical schools' programs and greater profits in mind, many colleges cut corners and relaxed the requirements of prospective physicians. These requirements were similar across the country with the South's program taking four months instead of the typical five months necessary in the North.30 "In 1846 almost any man with an elementary education could take a course of lectures for one or two winters, pass and examination and thereby automatically achieve the right to practice medicine by state law."31 By 1850, the Thomsonian's and other sectarians had succeeded at having laws regarding licensing overlooked or overturned. Thus, more people were allowed to practice medicine.32
After graduation, the problems for physicians did not cease. Although the number of doctors, whether formally trained or self-declared, was increasing at a rate which quadrupled the rate of population growth, there remained a serious shortage of doctors in the South.33 In 1848, Savannah only had 36 physicians.34 By 1850, the number was reduced by four. Most of these thirty-two doctors were considered to be formally education and properly trained.35 City officials solicited physicians from other states to try meet the city's needs. Due to the shortage, practicing medicine was no longer a part-time job as it was in the late eighteenth century. On the contrary, it required long hours, especially when the city was in the midst of an epidemic. Dr. Richard Arnold, a physician in Savannah, speaks of his long hours when he stated in a letter to a fellow doctor, "'I rise at six every morning and from that until ten at night I can not say what hour I can devote to any particular subject.'"36 Although Arnold complained about the hours he worked, he made a very successful living practicing medicine. In 1846, he recorded $2500 for one month's work.37 Not all physicians were as successful in their practice as Arnold. Most physicians faced a reoccurring problem of non-payment of services by their patients. This placed a great strain on the profession and the willingness of physicians to provide care to certain groups of people.
Since physicians were concerned with payment for their services, the poor whites and blacks often went without healthcare. One the earliest means of providing healthcare outside of the personal physician was a charitable facility. In order to supply healthcare services to the poor, the Savannah Poor House and Hospital, also known as the Savannah Hospital was built in 1809.38 The Hospital continued to offer charitable services even though it became a private corporation in 1835. The funding for the hospital came from investors and approprations given yearly by the city.39
As the city of Savannah tried to continue to improve its reputation, it began to address the health concerns of the poor community. In 1853, pharmacists were contracted to supply the poor with medicine. Physicians, too, were integrated into this plan. The city was broken up into districts with a doctor appointed to each of the four areas. The physician was paid a salary and was expected to travel to the patient's home if needed, administer vaccinations, and provide them with the necessary medications.40 However, public water would not be routed to the poor for a few more years.
The healthcare of slaves was complicated issue. Since slaves were considered to be property, their masters had to protect their investment. Many times, slaves received better healthcare than did the poor whites and blacks in both Southern and Northern cities. Physicians consistently visited the slave population of wealthier plantation owners. Many of these physicians were just out of school and saw it as an opportunity for starting their practices. However, the care of slaves was not without its drawbacks. Since slaves were seen as property, a great deal of liability fell upon the physician caring for an ill slave. Should a slave die while in the care of a physician, the physician could be sued. Also, the slave was not allowed any input as to what type of treatment he wished to receive. His master would be the one to confer with the physician and would ultimately make any decisions. Although the wealthier plantation owners tried to protect their investments through regular visits by physicians, many average plantation owners used physicians only as a last resort. Only when a slave was seriously ill would the master request a doctor's visitation.41 Definitely, a slave was solely dependent upon his master for healthcare.
Obviously, Antebellum America was a time of great transition. Due the growth of population, America was subjected to many illnesses. Because of these factors, healthcare in America became an important focus for the entire country. As cities vied for more business opportunities, they often found themselves enveloped in controversy and deceit. This was true for the medical profession as well. When analyzing the issues surrounding Antebellum healthcare, Savannah, Georgia serves as an appropriate case study. Through its many breakthroughs, including its formation of Georgia Medical Society and attempts to control the spread of disease, Savannah gives a representative picture of what the rest of North American cities were faced with in regards to healthcare.
1. Jack Larkin, The Reshaping of Everyday Life (New York: Harper Perennial, 1988) , 86.
2. Larkin, 88-89.
3. Evelyn Gay, The Medical Profession in Georgia: 1733-1983. (Fulton: Ovid Bell Press, 1983), 155.
4. Gay, 140-141.
5. Oscar Reiss, Medicine in Colonial America (Lanham: University Press of America, 2000), 274.
6. Martha C. Mitchell, "Health and the Medical Profession in the Lower South, 1845-1860," The Journal of Southern History 10 , no. 4 (1944) : 426.
7. F. D. Lee and J. L. Agnew, Historical Record of the City of Savannah (Savannah: Morning News Steam-Power Press, 1869), 77.
8. William Harden, Recollections of a Long and Satisfactory Life (New York: Negro Universities, 1934), 52.
9. William Harden, A History of Savannah and South Georgia (Atlanta: Cherokee, 1913), 412.
10. Lee and Agnew, 186.
11. Harden, History of Savannah, 294.
12. Richard H. Shryock., Medicine in America: Historical Essays (Baltimore: Johns Hopkins, 1966), 132.
13. Shryock, 132.
14. Lee and Agnew, 186.
15. David R. Goldfield, "The Business of Health Planning: Disease Prevention in the Old South," The Journal of Southern History 42, no. 4 (1976) : 561-562.
16. Larkin, 160-161.
17. Charles Seton Henry Hardee, Reminiscences and Recollections of Old Savannah (Savannah?: s.n., 1928?), 127.
18. Lee and Agnew, 161.
19. Walter J. Fraser, Jr., Savannah in the Old South (Athens: University of Georgia, 2003), 296.
20. Goldfield, 562-563.
21. Fraser, 199-202.
22. Goldfield, 564.
23. Fraser, 199-202.
24. Richard H. Haunton, "Savannah in the 1850's" (Ph.D. Diss., Emory University, 1968), 293.
25. Larkin, 89.
26. Evelyn W. Gay, The Medical Profession in Georgia: 1733-1983 (Fulton: Ovid Bell, 1983), 186.
27. Gay, 143-144.
28. Gay, 147.
29. Mitchell, 441.
30. Mitchell, 442-443.
31. Shryock, 152.
32. Shryock, 62.
33. Larkin, 87.
34. Joseph Bancroft, Census of the City of Savannah: 1848 (Savannah: Edward C. Councell, 1848), 16.
35. Haunton, 298-299.
36. Haunton, 300.
37. Haunton, 299.
38. Harden, History of Savannah, 332.
39. G.A. Gregory, Savannah and Its Surroundings (Savannah: Press of the Morning News, 1890), 63.
40. Haunton, 293.
41. Shryock, 63-64.