Many Americans shared the belief that there were ‘‘differences in salubrity’’ from one region of their vast nation to another. Physicians argued that regional differences in therapeutics were, therefore, neces- sary. Southern physicians were especially supportive of the concept of a distinctive medical environment, but physicians in other regions shared an interest in the study of race and possible racial differences in disease patterns. Southern medical societies, journals, and medical schools served as forums in which physicians could express and promote their doctrine of intrinsic racial differences in physiological and mental faculties. Studies of craniometry and phrenology were invoked as if they could supply scientiﬁcally valid answers to questions about race.
In attempts to support their racial hypotheses, some Southern physicians assembled major collections of human skulls. Slave owners used these racial hypotheses of physiological and medical differences as a rational- ization for slavery. Being medically different from whites and allegedly immune to certain diseases, black slaves should be capable of working in the ﬁelds in all seasons and weathers. Some doctors believed that blacks were more susceptible to cold and frostbite than whites, more tolerant of heat, and less tolerant of blood loss through venesection. Although black women were expected to work throughout their preg- nancy, doctors warned that they were more likely to develop prolapsed uterus than white women. Southern doctors concluded that blacks were very susceptible to tuberculosis, particularly a very severe condition known as ‘‘Negro consumption,’’ or ‘‘struma africana,’’ which was probably miliary tuberculosis. From the Revolution to the Civil War, the medical problems of the South included malaria, parasitic worms, dysentery, and, in major port cities, yellow fever. Blacks in particular suffered from a heavy burden of parasitic infections, respiratory diseases, malnutrition, and high rates of infant and maternal mortality.
The black infant mortality rate appeared to be twice as high as that of white infants. Environmental factors, primarily lack of proper sanitation and clean water, probably account for the perception that blacks were particularly susceptibility to typhoid fever, parasitic worms, fungal infections, and dysentery. The habit of clay eating (pica or geophagy) was another way to acquire parasites. Harvest times for many crops, late summer and early fall, coincide with the peak season for malaria. Blacks were allegedly less susceptible to malaria than whites, but ‘‘resistance’’ was very unpredictable. In modern terms, differences in the severity of malarial fevers and suscep- tibility to the disease might be explained in terms of more or less virulent stains of the malaria parasites found at different locations and human genetic variations. The genes for sickle cell anemia and thalassemia, for example, apparently enhance resistance to malaria (in heterozygotes; i.e., carriers). Sickle cell anemia might also explain joint pain, lung infec- tions, chronic leg ulcers, and the deaths of children with this genetic variant.
Importing slaves from Africa meant importing infectious diseases, such as malaria, smallpox, yaws, leprosy, guinea worm, ﬁlariasis, ascari- asis, tapeworm, hookworm, and trypanosomiasis. When the direct importation of slaves from Africa ended, those African diseases that could not survive in the Americas essentially disappeared. Some imported diseases, however, became permanently established.
For example, the parasite for sleeping sickness (Trypanosoma gambiense) arrived in the Americas, but without the tsetse ﬂy, the disease could not become endemic. In contrast, the ﬁlarial roundworm, Wuchereria bancrofti, which causes elephantiasis, became endemic in parts of the South. Adult worms invade the human lymphatic vessels and lymph nodes, causing an inﬂammatory response that may result in gross swell- ing of affected areas. The parasite can be transmitted by the American mosquito Culex quinquefasciatus. An endemic focus of ﬁlariasis existed in Charleston, South Carolina, until the 1920s, but elephantiasis made incursions into other parts of the South and even the North. Elephantiasis was so prevalent in Barbados in the West Indies that the disease was called ‘‘Barbados-leg.’’ The disease was also common in Charleston, apparently because both Charleston and Barbados were primary ports of entry for slaves.
Recognition of the relationship between the disease and the mosquito vector led to an intensive mosquito control campaign in the 1920s in the city. By the 1940s, Charleston was considered ‘‘ﬁlaria-free.’’ Fragmentary evidence in plantation records, diaries, slave narra- tives, interviews with former slaves, and folklore collections suggest that slaves used their own healing methods, perhaps derived from traditional African herbal medicine, in order to avoid the imposition of remedies prescribed by white doctors. Wherever possible, slaves apparently con- sulted black midwives, nurses, herbalists, root doctors, and magicians. In addition to diagnosing and treating illness, some black healers and magicians claimed the ability to protect slaves from whites and from other slaves. Some African healing traditions, especially those linked to spirituality and religion, as well as medicinal teas, herbs, poultices, prayers, songs, and sickbed gatherings, presumably survived in black families and communities after the Civil War.