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ISBN 978-0-8078-5493-8

Published: Fall 2003

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Copyright (c) 2003 by the University of North Carolina Press. All rights reserved.




Introduction

An Overview of Folk Medicine Research in Southern Appalachia

Scholarly interest in Southern Appalachian folk medicine began during the late nineteenth century when the idea of Appalachian "otherness" emerged in American consciousness. As shown initially by Henry Shapiro and later elaborated on by Allen Batteau, local color writers, journalists, folklorists, historians, anthropologists, and missionaries contributed to the invention of Appalachia's image as a distinct world separate from the rest of America.[1] For some, Appalachia was a place "frozen in time," a place inhabited by the "contemporary ancestors" of America's progressive middle and upper classes. Appalachians were viewed as noble savages of pure Anglo-Saxon blood who, though in one sense culturally backward, nonetheless possessed in large measure those unique American values and virtues upon which a great nation had been built. From the perspective of the progressive WASPs in the Northeast, a journey into Appalachia was tantamount to a journey into the mindscape of their ancestral past. In 1889 anthropologist James Mooney, who had been doing research on the Eastern Band of Cherokee in western North Carolina, offered an incidental observation about Appalachian people in the Journal of American Folk Lore: "The mountaineer of western North Carolina belongs to a peculiar type which has been developed by environment and isolation into something distinctly American, and yet unlike anything to be found outside of the Southern Alleghenies."[2] Mooney perceived Appalachians as "uncontaminated by modern civilization" and the region as fertile ground for the collection of cultural survivals. His perspective was shared by many others, but most notably English folklorist Cecil Sharp, author of English Folk Songs of the Southern Appalachians (1917), who convincingly advocated "the supreme value of an inherited tradition, even when unenforced by any formal school education."[3] And so began the search for survivals of early American culture and its British connections in Appalachian folksongs, folktales, folk dance, superstitious beliefs, and folk speech and, concurrently, the emergence of Appalachian "folk" as quintessentially "American folk."

The search for cultural survivals eventually blossomed into a full-blown cultural preservation movement in the early 1900s, which continued well into the 1970s, when folklorists and other scholars became aware of the erosion of Appalachia's folk culture by the forces of modernization. State folklore societies were established in North Carolina (1912), Kentucky (1912), Virginia (1913), West Virginia (1915), and Tennessee (1934) to promote the collection of folklore. At this time, folk medicine was not considered a discrete domain of academic study. Information on folk medical beliefs and practices was collected, albeit incidentally and haphazardly, and more often than not categorized under the rubric "superstitions" in folklore collections. One of the more laudable aspects of the state folklore societies' efforts was the active engagement of laypeople in the collection and documentation of folklore. A perusal of the articles on Southern Appalachian folk medicine published in state folklore society journals, such as The Tennessee Folklore Society Bulletin and Kentucky Folklore Record (formerly Kentucky Folk-Lore and Poetry Magazine), indicates that many of them were written by informed laypeople.[4] In most cases, these articles are based on the authors' memories of folk medical beliefs and practices or such information gathered from older relatives, friends, and neighbors. Almost invariably, the articles are descriptive, usually consisting of lists of home remedies and magical beliefs and practices, and they are frequently tinged with nostalgia. Many of the journal articles written by academicians, however, exhibit the same descriptive format, as do major compendia on folk medicine produced by academicians.[5]

The turn of the twentieth century marks the beginning not only of the cultural preservation movement in Southern Appalachia but also of a health reform movement promoted by advocates of the then relatively new model of scientific medicine known today as biomedicine. In contrast to the perspective of cultural preservationists, health reformers shared the belief of many other Americans that there was nothing noble or endearing about cultural lag in Appalachia and that extreme reform measures were needed to help a population that, as historian Arnold Toynbee observed, represented the "melancholy spectacle" of a people who once possessed civilization but lost it.[6] The vanguard of the health reform movement comprised women reformers affiliated with Protestant home missions associations, the General Federation of Women's Clubs, and other benevolent organizations like the Frontier Nursing Service. Working in alliance with physicians, these industrious women, most of whom were college educated and recruited from the Northeast and Midwest, built a health care infrastructure that did not previously exist in many areas and in the process introduced modern medicine to Southern Appalachia.[7]

Women reformers and physicians were not indifferent to folk medicine; most dismissed it not only as wrong-headed and outmoded, but also as deleterious and an impediment to the population's acceptance of a new and improved official medicine. Many no doubt agreed with Dr. Meriwether Lewis, a physician from Lenoir City in eastern Tennessee. In an article published in an 1877 issue of the Nashville Journal of Medicine and Surgery, he first describes some of the strange folk medical practices he had encountered among his patients and then offers the following commentary: "It is vain to ask, 'can such things be?' They are. Even in the last quarter of the Nineteenth Century, remedies are used amongst us, that are no less ludicrous and revolting, than was the barbarous materia medica of the Sixteenth Century."[8] Twenty years later, a contributor to the Journal of American Folklore described the culture of "mountain whites" as superstition-laden and "derived from a heathen ancestry," an "ensemble of a practical and speculative medievalism beneath the surface changes of modern times."[9] Though Lewis dismissed folk medicine as nonsensical, he was nevertheless prescient in his stance that physicians should become more aware of patient dependence on it: "In conclusion, we would say that we have not written the above article merely for the amusement of the reader, nor to while away an idle hour. We have written seriously and in earnest, fully believing that the better the physician is acquainted with the peculiar view of the common-people in regard to disease, and the more extensive his knowledge of their domestic remedies, the greater will be his influence over them for good. He will often find a secret cou[r]se of domestic practice carried on co[n]temporaneously with his own and perhaps neutralizing it completely."[10]

Unfortunately, the prevailing attitude of the medical and nursing professions toward folk medicine during the health reform movement, which lasted roughly from the late 1800s to the 1940s, was intolerance. It is therefore understandable that physicians and nurses were not inclined to conduct objective, dispassionate studies on the topic. The few references to folk medical beliefs and practices in the articles and memoirs they wrote served to illustrate the inanity and futility of folk medicine and, by contrast, the supremacy of official medicine.[11] Their writings, however, provide a valuable historical perspective on the epidemiology of Southern Appalachia. Official medicine's adversarial relationship with folk medicine is also vividly illustrated in novels situated in Southern Appalachia during the health reform movement. Lucy Furman's Sight to the Blind (1914) and The Glass Window (1925) are based on her experience as a teacher in a mission school in Hindman, Kentucky. Catherine Marshall's Christy (1963) is a fictionalized account of her mother's experience as a teacher in a mission school in eastern Tennessee in 1912. These novels forthrightly address the baleful dimension of folk medicine and the people's resistance to accepting modern medicine.[12]

Methodological Problems

The methodological problems attending the gathering of information on folk medicine by cultural preservationists diminish its usefulness in understanding the health care behavior of Southern Appalachians, past and present. Among the many problems, four stand out as significant.[13] First, the information is age-biased. Since the prevailing assumption was that folk medicine was vanishing, investigators solicited information almost exclusively from older informants. Since the younger generation was excluded, systematic analysis of the retention and loss of folk medical knowledge over time is problematic. Second, the information is class-biased. This bias is based on the long-standing misconception that only less educated people, especially those in isolated rural areas, use folk medicine.[14] Third, past investigators often neglected to distinguish between passive and active folk medical knowledge. In many cases, therefore, it is not known if informants actively used the home remedies they reported or only had knowledge of them. To paraphrase one observer, we do not know if folk medicine existed more in memory than in usage.[15] Fourth, no consideration was given to the context of the use of folk medicine. Little is known about the various factors influencing the use of folk medicine, official medicine, and other healing modalities in terms of a hierarchy of resort or the simultaneous use of two or more healing modalities during episodes of sickness.

Sources Consulted

Methodological problems aside, the enduring legacy of the cultural preservationists is an immense corpus of credible, useful information on folk medicine. Though largely descriptive, when viewed collectively and interconnectedly these materials reveal a coherent, integrated system of knowledge used by Southern Appalachians to understand the cause, prevention, and treatment of illness.

The numerous articles published in state, regional, and national folklore journals dating from the 1870s to the present and the major compendia on popular beliefs and practices mentioned earlier are rich sources of information. A valuable source for this study, one that is sometimes overlooked by students of folk medicine, is the collections of home remedies assembled by citizen groups affiliated with churches, women's clubs, and local history societies. State and local medical society histories and county histories provide valuable information as well, not only on folk medicine but also on the history of medicine in Southern Appalachia. This study is also informed by the memoirs and journal articles written by physicians and nurses associated with the Protestant Home Mission movement in Southern Appalachia who recorded their encounters with folk medical beliefs and practices among the people they served, usually the very poor. Considerable information was obtained from 321 interviews with residents of eastern Tennessee, western North Carolina, and southwestern Virginia reposited at the Archives of Appalachia at East Tennessee State University. Appendix A contains information on the chronological and geographical scope of these sources.

Geographical and Chronological Scope

Using both topographic and socioeconomic criteria, cultural geographers Karl Raitz and Richard Ulack define the boundaries of Appalachia differently than the Appalachian Regional Commission (see Map 1).[16] In a survey of 2,331 students from sixty-three institutions in and adjacent to the region, they found that the mental maps of Appalachia among "insiders" (native residents), "cognitive outsiders" (those who lived in Appalachia but did not consider themselves "Appalachian"), and "residential outsiders" (those who lived outside the region) varied. There was even disagreement about the boundaries of Appalachia among native residents. In this study Southern Appalachia embraces those parts of the South defined as "Appalachian" by Raitz and Ulack and many of the insiders queried in their study: much of middle and all of eastern Tennessee, the Blue Ridge Mountains and Shenandoah Valley of Virginia, much of western and all of eastern Kentucky, western North Carolina, southern West Virginia, northern Alabama, northern Georgia, northwestern South Carolina, and much of the Piedmont of North Carolina and Virginia [see Map 2].

The history of folk medicine in Southern Appalachia is much better known in some areas than others. Sources used for this study reflect the fact that more research has been done in what many outsiders consider the heart of Appalachia: western North Carolina, eastern Tennessee, and eastern Kentucky. This bias is balanced, in part, by comparable information gathered more recently in other areas, particularly northern Georgia, southwestern Virginia, middle Tennessee, western Kentucky, and northern Alabama.

This study focuses on the folk medical beliefs and practices evident in Southern Appalachia from the 1870s to the 1940s. This chronological framework conforms with the historical depth of the folk medicine sources discussed earlier. Many of the Southern Appalachians from whom information was obtained were members of the older generation when they were interviewed in the 1930s through the 1960s. In many cases, informant recall of the use of folk medicine extends back to the 1870s and earlier.

The 1870s to 1940s period is significant in the history of American medicine. From around 1880 to 1910 a remarkable transformation occurred. Of greatest importance was the ascendancy of the germ theory of disease, which displaced prevailing miasmatic and atmospheric theories and lingering concepts of humoral pathology.[17] Of related importance was Abraham Flexner's study of the status of medical education in America. Prompted by the American Medical Association but conducted under the aegis of the Carnegie Foundation for the Advancement of Teaching, Flexner's study found that many U.S. medical schools were inadequate in terms of faculty training, curriculum, laboratory facilities, library resources, and clinical observation to properly train physicians in the new official medicine. Following the appearance of Flexner's report in 1910, many medical schools were shut down, and the consolidation of medical education centering on germ theory moved vigorously forward.[18] In concert with the reform of medical education came the establishment of state licensing boards that for the first time had real authority over the practice of medicine.

The 1940s represent a milestone in the cultural transformation of Southern Appalachia. Of course, significant changes in the cultural landscape of the region had occurred earlier as well. In the 1880s the timber and mining industries and the Protestant home missions movement brought about significant change in selected areas. World War I introduced many young men to the far reaches of the world. During the Depression, federal works projects like the Civilian Conservation Corps and the Works Progress Administration greatly improved the region's infrastructure, as did the Tennessee Valley Authority. World War II was the capstone event of six decades of cultural transformation. Commenting on their personal experience of cultural change in the hills of northern Georgia, Floyd and Charles Watkins note that life "did not radically change from Reconstruction until World War II. Then most of the older ways disappeared in less than a decade."[19]