Anthony Cavender - Folk Medicine in Southern Appalachia

Contrary to the enduring notion of Southern Appalachia as a world apart from the rest of America, this book is premised on an inclusionist orientation, which is to say that Southern Appalachian folk medicine is best understood within the larger context of Euro-American folk medicine. There never was nor is there now a variety of folk medicine unique to Southern Appalachia. To be sure, one can identify nuances of difference in comparison to other Euro-American populations. The fundamental folk medical beliefs used by Southern Appalachians to explain the cause of illness, however, are not peculiar to them. The same beliefs have been well documented among Euro-American populations in other parts of the country as well as among African Americans.

To some observers, past and present, the distinctiveness of Southern Appalachian people is situated not in ethnicity, for it would be problematic to argue that they are a distinct ethnic group, but rather in the commonly accepted belief that they were victimized by culture lag due to geographical isolation. As with other beliefs about Southern Appalachians, however, there is as much that rings false about the idea of culture lag as rings true. It is undeniable that some folkways persisted in the region long after they had been discarded by the more progressive Euro-American middle and upper classes in the North. One can easily summon examples of folk medical beliefs and practices in Southern Appalachia that have endured from the late eighteenth century to the present. This study does not dismiss the persistence of folk medicine, nor the presence of an impoverished, under-educated segment of the population that has long been viewed, quite incorrectly, as representative of the region and as the sole bearer of folk medical knowledge. The inclusionist orientation of this study, however, also recognizes the presence in the nineteenth century of a middle class of farmers and merchants and an elite class of large landholding farmers, entrepreneurs, doctors, and lawyers. These people were well educated and curious about the outside world. They were also significant agents of internal cultural change. Ignoring the existence of social stratification, as so many observers in the past did, in effect precluded an understanding of how folk medicine in Southern Appalachia evolved over time and, more important, how it mirrored the changing health care environment of America. The parallel development of the health care environment of Southern Appa-lachia at the turn of the twentieth century is attributable to industrialization, the active involvement of various benevolent organizations in improving public health, and curriculum reform in the medical schools. Even before these events, however, folk medicine in the region mirrored developments in official and popular medicine as a result of the peoples exposure to domestic medicine books, newspapers, almanacs, and patent medicine promotional literature, as well as their direct contact with physicians and patent medicine peddlers. In this context, Southern Appalachia was not shut off from the rest of America at all; to the contrary, it was very much part of it.

In part a historical construction of the folk medical beliefs and practices common in Southern Appalachia from the late nineteenth century to the Second World War, this study begins with a brief overview of the history of folk medicine scholarship in the region, focusing on its limitations in relation to prevailing notions about folk medicine and the people of Southern Appalachia. critically reviews recent research done by anthropologists, folk-lorists, and physicians from roughly 1970 to the present that, aside from indicating folk medicines resilience and persistence, considers its patterns of use and impact on the health care behavior of Southern Appalachians today.