Sickly Vapors: Disease and Doctoring in the Old South (UMiss Press 2024) by Thomas Helling, MD., is a carefully researched academic book examining illness, medicine, and medical training in the South from the 1600s to the late 1800s. Helling’s book includes a preface and thirteen chapters. Distinctive to Helling’s book, is his 1) careful attention to place-based context, 2) examination of overlapping events and practices shaping illness and medicine in the Old South, and 3) exploration of specific people who influenced medical training, as well as the establishment of medical schools, in this setting. A professor of surgery at the University of Mississippi Medical Center and School of Medicine, Helling aptly draws from his professional background and expertise, along with a strong interest in history, in writing this enlightening book.
In chapter one, Helling explores the colonization of the South from 1600s to the Civil War. European colonists seeking fresh opportunities and wealth traveled to the South to establish new lives. As colonial expansion unfolded, and increased crops of tobacco, sugar, rice, and cotton were planted and grown for economic benefits, a cancerous slave trade evolved. Depraved practices connected to slavery subsequently emerged and grew in the Old South. This contextual information, described by Helling in attentive detail, is pivotal to his discussion of sickness and medicine in the Old South.
In chapter one, Helling also examines how colonists and enslaved Africans encountered a hot climate, humidity, swamps, and thick vegetation. Illness, including typhus, cholera, smallpox, and consumption, raged. Since colonists and enslaved Africans had limited immunity to certain diseases, epidemics swept through communities. Few pharmaceuticals were available to alleviate illness. In addition, there were a limited number of doctors to help the sick. An introductory overview, chapter one provides a strong foundation for the subsequent chapters.
In chapter two, Helling provides an overview of the expansion of European settlements in the South. He portrays how specific regions of the South, including areas in Louisiana with swampy waters and swarms of mosquitoes, led to epidemics. Helling describes the qualifications of the physicians who practiced in the South in chapter three. Since America lacked institutions providing medical training, the availability of doctors in the South was limited.
Chapter four examines epidemics affecting the South. In discussing malaria, Helling writes “the ubiquitous mosquito that thrived in … sweaty bogs and swamps” led to conditions where this illness festered. At the same time, yellow fever, a “distemper named for the yellowish discoloration of skin and eyes caused by liver jaundice” grew. Though sweating, lancing, and opiates were used to confront this malady, yellow fever often was a death sentence for those who contracted it. Typhus fever, another sickness, resulted in the death of one in ten of the afflicted. Smallpox—which caused fevers, rashes, flat reddish spots, lesions, and blisters—often led to septis.
In chapter five, Helling shares information about physicians who practiced in the South. The impact of the American Revolution on illness and disease is reviewed in chapter six. Helling portrays how sickness exploded in regiments. This, along with a lack of hospital supplies, was devastating for weary soldiers. Chapter seven examines the growth of slavery in the South. Helling describes how enslaved Africans on transit journeys encountered, “malnutrition, mistreatment, and disease [that] killed as many as one in five on the voyage, sometimes almost half.” Sickness also was encountered on plantations where enslaved Africans lived in squalor and drank from spring, creek, and bayou water contaminated with bacteria. Legal maneuvering allowed slavery to continue and expand from the 1600s to the 1800s in the South.
Chapter eight focuses on Native American healing practices and how they were shared with colonists in the South. Native Americans held a strong knowledge of plants and herbs providing comfort for sore throats, skin conditions, and fevers. Colonists, at times, sought out these treatments.
Chapters nine and ten provide an analysis of the growing establishment of medical schools in the Old South, the development of hospitals, and the weighty context and outcomes of the Civil War. In the final chapters, eleven through thirteen, Helling describes Reconstruction in the South, as well as the collapse of Reconstruction when Jim Crow laws and White supremacy took hold. He writes of the disparities in health care for Whites and African Americans following emancipation. A segregated system grew with White health care organizations receiving large amounts of private funding. In contrast, Black health care agencies and hospitals receive inadequate funding.
The information provided in Sickly Vapors: Disease and Doctoring in the Old South is well-researched. Each chapter in Helling’s book is filled with carefully annotated endnotes drawn from archival research and scientific literature. Helling’s 29-page bibliography is as impressive, as it is extensive. Helling’s book also includes 16 pages of portraits, illustrations, and maps.
Thomas Helling
Helling’s book is a welcomed read for those wishing to learn more about how sickness and disease were encountered and combatted in the Old South from the 1600s to the late 1800s. It is a book filled with details about place-based context, offering appeal to readers interested in learning more about the South in general. Filled with historical information, the book also will be welcomed by those interested in accounts of the past in the South and how they link to the present context.
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