A Case of Parasitic Worms
Parasitic worms have always loomed in my imagination as a horror, though the threat of contracting them seems to have diminished with time, knowledge, and advanced hygienic practices. This could be said of many 19th century deadly ailments. Early nineteenth century medical science is characterized by an ignorance of the nature and characteristics of diseases as well as the ways they were transmitted. Often people were unaware of the role simple hygiene could play in limiting disease.
Duncan McLaurin, during his tenure in the 1830s as an academy teacher at Bennettsville, SC, gives us a glimpse of the dreadful experience of parents watching a child die of worms. In May of 1837 McLaurin writes to his brother expressing hope of sending John a copy of the National Intelligencer by way of an acquaintance traveling from Bennettsville to Laurel Hill on the Stage Road, but three people he hoped would convey the paper did not make the expected trip including “McE,” who I believe to be McEachen. McE remained in Bennettsville because a child in the family was desperately ill:
“McE staid in consequence of the
sickness of the oldest child by Julian. She the child
died this morning before day — Vast quantities of
worms had passed through her — Her mother
told me that they were passing from her I
believe, in both extremities without the least effort
on the part of the child She was three or four
years of age very intelligent and interesting
her mother when I first got there this morning
was truly distressed — word by a special messenger
was sent to her father and what pleased me well
She is resolved to bury the child at Stewartsville.”
Possible culprits for the child’s illness are the common parasitic roundworm, hookworm, or the Guinea worm. Contracting worms also is said to have been harder on people with immune system deficiencies, which might have been the case with a younger child. The Guinea worm emigrated from Africa along with the human cargo brought on slave ships. According to Peter McCandless, the author of Slavery, Disease, and Suffering in the Southern Low Country parasitic worms were common in waterfront areas in the United States, especially in the slaveholding South. The town of Bennettsville grew on the banks of a lake fed by a local river, upon which much business activity took place. Warm Southern American ports were also harbors of yellow fever and dengue carried by mosquitoes.
Early Mississippi Health Regulations and Medical Licensing Laws
This example of parasitic worms as a health hazard comes from Bennettsville, SC, but Mississippi, still somewhat of a frontier in the early 1830s, was dealing with its own health problems. In 1798 about the time the Mississippi Territory began experiencing an influx of settlers of European ancestry, Native Americans groups were characterized and praised as healers. However, they were all at the mercy of European diseases brought into the area and had little in the way of defense. Probably many of the native plant and herbal curatives used by European frontier settlers were learned from Native American botanical lore. Eventually, most southern slaveholding states would require slaveowners to provide health care for their human chattel – practices varied from household to household. The year 1798 also began American political control of a significant portion of the area which ensured the use of English and American medical and health practices.
On March 18, 1799 Mississippi Territorial Governor Winthrop Sargent and others signed legislation “Concerning Aliens and Contagious Diseases.” According to Felix J. Underwood, the author of the text Public Health and Medical Licensure in the State of Mississippi 1798-1937, the purpose of this law was “to prevent the admission within the Territory of foreigners of infamous character.. and to provide as far as possible against the fatal calamities of contagious diseases …” In 1816 a statute was added requiring a $2000 dollar fine and twelve years in prison for bringing smallpox into the state even if it was by inoculation. If you contracted smallpox and appeared in public without a paper from a doctor certifying your freedom from the disease, you were fined one hundred dollars. If one desired smallpox inoculation, petitioning the governor was required.
Also Underwood contends that in the year of statehood, 1817, Natchez was the most significant “city of consequence.” Mississippi’s first Board of Health was established there with penalties for failing to abide by the health laws. The Board of Health included five health commissioners and the police. Their duties included the following as well as enforcement:
- putting in place sewers, drains, and vaults and keeping them clean
- assessing the cost of these for taxation purposes
- removing “damaged or tainted” material, requiring a fine of ten dollars
- “order and regulate” the burying ground
- a certificate required for burying the dead
- a health officer stationed at Bacon’s Landing would announce the arrival of a ship suspected of carrying a communicable disease
- a fine placed upon suspected ship – five dollars for the commissioners visit and one dollar for each passenger
- establish a temporary hospital at Bacon’s Landing to harbor and care for those suspected of contagious disease.
By 1819 the governor was given the authority and responsibility to make sure preventative steps were taken statewide to promote health as well as providing care. In 1822 legislation passed requiring a fine for selling unwholesome food. On the second offense, the culprit could be pilloried for one hour a day for three days in addition to the fine. In the Code of 1823, the justices of the county court would be required to ensure “sufficient conditions in prisons to prevent escape, sickness, infection” and to “keep jails clean.” Hutchinson’s Code of 1848 would create the Vaccine Depot at Jackson.
With a government health mandate in mind, on February 12, 1819 the Mississippi legislature passed a law requiring medical licenses. It created a Board of Medical Censors, seven members appointed by the governor, who would approve licenses to those applying. At their first meeting they set up “rules and regulations, methods of ascertaining qualifications and granting license.” They were also authorized to grant temporary licenses. The governor appointed censors “of established skill and reputation in the medical profession,” who would meet twice a year. A license would cost ten dollars, and a list of license holders would be published in the newspaper. The Mississippi Free Trader, published in Natchez on 18 May 1819, delineates the authority of the Board of Medical Censors in the article titled, “Proceedings of the Board of Medical Censors.” By1820 the fine for practicing without a license was set at five hundred dollars.
Eventually, three medical districts would be formed, each with its own board. By 1827 a physician, within six months, was required to record a license with the county clerk of the county in which practicing, though the licenses were good for the entire state. The circuit clerk of each county kept a list of licensed physicians.
Apparently, Mississippi was progressing in the area of medical licensure until 1836 when the medical censor laws were declared unconstitutional by the state supreme court. An unlicensed person practicing medicine had appealed his case and won. His victory in court invalidated the state’s licensing process. It would be forty-six years before medical licensing regulations would again be required.
The method and level of education available to prospective physicians in Mississippi varied widely during the early nineteenth century. Physicians often studied under other physicians if they were not trained in out-of-state schools in places like New York, New Orleans, Philadelphia, Augusta, or Louisville and Lexington. It would be 1882 before Mississippi had its own medical school. In fact, during the 1840s Duncan McKenzie’s son Daniel would study medicine under several tutors with well-equipped libraries, who had practiced the trade. He would teach school to support himself while boarding with his tutors.
A Doctor, Cures, and Self-dosage
Up until the Civil War, the most common curatives included bloodletting, purgatives, mercury, digitalis, and opiates. Probably most families self-diagnosed and kept common remedies nearby, especially in the most rural areas of Mississippi during the 1830s. Duncan McKenzie had an acquaintance to whom he refers to in his letters as Dr. Duncan. I have not discovered if Duncan was his surname. It has been a challenge to find a record from the early part of the decade that shows he was licensed. In a May 1834 letter to his brother-in-law John McLaurin, Duncan McKenzie first mentions him, “Doctor Duncan passed along last march. he .. promised to write to me but I do not much expect he will.” Later in the same letter he speaks again of the doctor:
“I must correct a mistaken Idea in
regard to Dr. Duncan as I have Just Received a very full
and Satisfactory letter from him Dated Rodney May the 1st
Rodney a village on the Mississippi above natchez He called on
Capt Hugh Peter Fairley the Camerons &c all were well
except Daniel McLaurins family who were Sick of the Scarlet
fever Alexander a Sone of Danl,, Died of it a few days before
his arival there. The Doctor had not engaged in any business
at that time but had strong encouragement to take up
the practice of medicine in Franklin County…”
A couple of years later, Dr. Duncan expresses some concern about Duncan McKenzie’s wife Barbara McLaurin. He does not express his worries to McKenzie but writes to Duncan McLaurin. The concern may have involved Barbara’s health since Duncan McKenzie admits in a later letter that Barbara has had quite a bit of responsibility in caring for both her own young children and the black children living on their Covington County farm. Her work load even without young children was never going to be light. McKenzie adds that his young sons were growing fast. Allen and an older black child were able to help look after their younger siblings. However, illness was ever present.
In 1836 McKenzie admits that though Dr. Duncan has annoyed him with his comments about Barbara, he remains friendly with the doctor. He writes to John in 1836, “I must feel more or less attached to the poor fellow not only for his attention to me while Sick but for other ties I cannot discard him tho I often tell him of his folly.”
By 1838, a year or so after the Mississippi Board of Medical Censors and their licensing was declared unconstitutional by the state courts, Duncan McKenzie writes to his brother-in-law about the doctor:
“Dr Duncan is as usual driving form Shop to Shop, has a change of
meals but no change of clothes, his poor old horse Stands to the rack
but one thing in favor of the Dr he is above law, the law of this
State provides or allows a man of his profession a horse appraised to
$100 sadle and bags & the Dr has Just that much property
and no more, he only gets credit in Some places whenever he
wants a garment he goes off to Some place where he is not known
and his appearance will command credit at least for a coat
and perhaps for a whole Suit…”
Evidently, by 1838 Dr. Duncan has become quite the alcoholic, according to teetotaler Duncan McKenzie. In his letters Duncan McKenzie has a great propensity for declaring people alcoholics and blaming their shortcomings on “Ruddy Bacchus!” Therefore, it is difficult to judge just how frequently certain people were actually alcoholics. In any case, there is evidence that Americans generally indulged often in homemade alcoholic beverages. Duncan McKenzie writes the following about Dr. Duncan:
“I forgot the Doctor, but
to say the least of him is the best, in fact I do not
know where he is at present, and can only guess what
doing, Suppose drinking toddy, for some time after he came
to this neighbor hood he would keep himself Sober
especially when in my company, but of late the bate
allures him, I am resolved that no drunkard Shall
lodge with me long at one time …”
A year later the doctor is visiting a sick child. Duncan McKenzie reports that, “…if providence sees fit the child may live, as no one doubts Dr D — Skill when Sober.” McKenzie goes on to explain that the Mississippi legislature has passed legislation, soon to be known as the “Gallon Law,” (an anti-tippling law) which limits the sale of spirits. McKenzie explains that this law “… has been of immense Service to the Dr and many others, the same act forbids innkeepers giving Selling or Suffering liquors to be drank in their houses on penalty of $500 & 6 mons. imprisonment.”
In May of 1834 the McKenzie family came down with measles – at least the children – some weeks after a visit from Dr. Duncan in March, “…all the children & our man Colison had the measles which threw us back in planting…” In the 1830s the measles could be deadly but apparently was not as common among the rural population as it was in the towns. In any case the McKenzie children would benefit from their immunity to the disease as it was rampant among the Smith County Confederate soldiers stationed at Enterprise, MS in the early days of the Civil War. Both Kenneth and Allen were deployed there and watched a significant number of their companions perish from the disease.
In November of 1836 Duncan McKenzie writes to his brother-in-law John that he is recovering from an illness, which he does not detail in this letter. He directs John to reference letters that he has written to others in the Richmond County community for specifics. He explains that he took the purgative, Calomel. Defined as a mercury compound that causes salivation, ulceration of the mouth, and loss of teeth, this purgative was used as a curative for many ailments. Duncan describes the side effects:
“…it is a fact that there was 600 grain of Callomel
in my body at one time, and no less true that from that or Some
other un known cause my jaw bones burst I thot for some time
that the fractures were confined to the lower jaw but the reverse
is the fact, as not more than two weeks since while minding of
a gap on the field from whence they were hauling corn, it being
immediately after dinner, I was picking my teeth when to my
astonishment I picked out a fracture of bone from the right extremity
of the upper jaw. this piece of bone is 1.2 inch long by 1/8th in
diameter being the largest except two others which came from
both extremities of the lower jaw. numerous small particles
have come out both above and below. you may judge that
I have partially lost the power of mastication”
It is unknown whether a doctor prescribed this dosage or whether it was self-dosage. According to James Harvey Young in the Encyclopedia of Southern Culture, self-dosage was the “first line” of prevention and cure in the antebellum South. Many literate and more well-off homes may have used popular books such as J. C. Gunn’s Domestic Medicine or Poor Man’s Friends published in Knoxville, TN in 1830 as a guide to self-dosage.
The Six hundred grains of calomel would be equal to about thirty-eight grams or one and a third ounces, likely in powder form. According to the author of Victorian Pharmacy, loss of teeth was a frequent side effect of calomel use. Louisa Mae Alcott, the 19th century author of Little Women, was treated for typhoid fever with calomel in 1863 and “never recovered from her ‘cure.’” Calomel for many years was the standard long term treatment for syphilis. Calomel and laudanum, the tincture of opium, were the most frequently prescribed drugs before and probably during the Civil War. However, the most useful treatment during this period was likely quinine.
Calomel use is further maligned in an opinion article by Pat Leonard, “William Hammond and the End of the Medical Middle Ages,” U. S. Surgeon General William Hammond was an innovator in medical and health efficiency. During his tenure, the early years of the Civil War, he made controversial changes in military hygiene practices, increased field access to pharmaceuticals, and spent quite a bit of money. One of his controversial decisions was the removal of the popular drug calomel, for he believed its side-effects outweighed its usefulness on the battlefield. In 1863 Hammond was removed from his position for a variety of reasons, though today his innovations are thought to have saved many lives.
General Health of Family, Friends, and Acquaintance
Nineteenth century letter etiquette in the United States of the 1830s required the writer to inquire after the health of family, friends, and acquaintance while remembering to send news of one’s own general health and that of others. Duncan McKenzie never failed to do this in his correspondence. In March of 1837 he writes to his brother-in-law Duncan:
“the family are in good health at present —
you charged me to be particular in describing my own health
it is equally as good as I would have any reason to expect
I am able to work some tho as yet I do not feel able
to perform any hard labor, last friday I took Hugh
with me after dinner to Split some rails about
300 being wanted we Split about 100 that evening
next morning Mr. Gilcrist asked me if I was going
to finish my rails that day, I told him not, I felt
worsted from the evenings work, I have not finished
them yet tho I am knocking along at something else”
Illness was very common and took its toll on farms when contagious ailments could stop work altogether. Likely, many died from exposing themselves to the elements too soon. In June of 1837 Duncan writes of an illness worsened by inadvertent exposure to a rainstorm. When he became ill, he tried first calomel, next rhubarb and barks, and finally nothing. The problem disappeared on its own. During the early nineteenth century many people looked to purgatives to rid the body of infection. Rhubarb in powdered form taken as a medicine seems to have a laxative effect. Duncan begins by explaining that they had all had a slight attack of sickness in the Spring. He references his son Kenneth often since evidently Kenneth has been, since early childhood, living with what Duncan calls a “rheumatic condition.” This kept Kenneth from the fields and put an extra burden on those who were able to work. :
“…April, in consequence of
his (Kenneth’s) inability to work, I had to undergo more of
it than my Strength was well able to bear the
weather at that time being wet and cold and
particularly on the 12th of April on which day I went
to an election and on my way home got very wet, the
friday following I was taken with a chill which was
followed by a severe fever, the chills & fevers continued
for Several paroxysms and every attack getting worse
I took Several doses of calomel until which time as a
Salivation was affected, the chills gave way but
Scarcely had my mouth got well. When the chills
returned which again was broke by the use of Rhubarb
and barks, I experienced an other attack Since which
Subsided without the use of any kind of medicine.”
In circumstances such as Duncan experienced here, people must have questioned the value of medications for every problem. Hence, a large number of folks likely were inclined to try to cure themselves first and call a doctor later. Today many of us have the same inclination. Later, in the same letter, Duncan says that Captain Hugh Piper’s son died of billious colic. He probably means biliary colic, which is gallstones that easily may have become pancreatitis. Today we might have outpatient surgery to have the entire gall bladder removed. However, it was not until the late nineteenth century that medical science provided certainty that one could survive without the gall bladder. Until then the best treatment was to clean out the gall stones and drain the duct. This could temporarily improve the way one felt, but it did not solve the gall stones problem.
Duncan writes in October of 1837 that he is pleased to hear of the “general welfare” of family and friends at Laurel Hill and returns the favor by saying the family in Covington has been enjoying “tollerable good health at present.” Barbara, Kenneth, and Hugh had endured mild illness. Kenneth’s was a bout with his chronic rheumatic condition from which he had recovered. Several cases of fever “in the neighborhood” resulted in the death of, “two of the most amiable young men that any country could boast D Wilkinson and A McInnis.” In March of 1838 a sickness of Barbara’s left her very weak but she was recovering well according to Duncan’s letter.
On a brighter note by November of 1838, Duncan is reporting on the birth of his daughter Mary Catherine. True to Scottish tradition, they named her after their mothers. Duncan and Barbara had lost a twelve-year-old daughter shortly before they left for Mississippi. Her name was Catherine, named after Barbara’s mother – fitting that this female child was named after Duncan’s mother as well. The birth seems to have come more suddenly than expected, for they did not have time to reach help outside persons on the farm:
“She fancied a pregnancy from
the 16th September, and on the 16th Jany quickend, very
perceptibly, after which time the tedious months rolled on till the morning of the 9th Augt
at one a clock she was
delivered of a daughter no one being in attendance but my
Self and negro woman Elly, yet all was well and I dressed the
little Stranger before anyone had time to come to our assistance.”
Later in the letter Duncan describes Mary Catherine as, “well grown for her age and as well featured as any other of the children were at her age.” Barbara is eating dinner at the table with the family shortly after her delivery. Duncan remarks that she recuperated more quickly than after any of other ten pregnancies and deliveries. If the number of pregnancies is ten or eleven, we only know of eight live births. Barbara may have miscarried at least twice. Elly was likely well-versed in childbirth, as perhaps many births taking place in slave quarters were attended by knowledgeable enslaved women rather than physicians. However, this all depended upon the motivations of an owner and the degree to which they had confidence in the abilities of their enslaved persons.
August a year later Barbara becomes very ill with a flu-like illness, but Duncan says she is so much better that she will be up and about shortly. He also mentions that Mary Catherine was still nursing at the time of Barbara’s illness. Probably because she feared transmitting her own illness to the child, she took her off the breast:
“… So soon
as she was taken Sick she took the breast from the child
tho lacking a few days of 12 months old, no other of the
family have any Symptom of it as yet”
Later in the letter he mentions that Barbara is “gradually gaining strength” when two other cases of diarrhea appeared in the family, “John and negro child Elly’s youngest.” They appear to have been recuperating. However, we learn in a later letter that Mary Catherine did succumb to illness, “ … the date of the 23rd August was that on which our little daughter Died and it was some three weeks or more before I wrote owing to the Sickness that prevaild in the family.” Many, many children afflicted with diarrhea died of simple dehydration even into the twentieth century because doctors and caregivers feared hydrating might interfere with the diarrhea’s natural purging of the system. Mary Catherine’s death must have been a crushing blow to Barbara since the birth of a female child was likely the reason for her rapid recovery. Having grown up within a household of sisters, Barbara may have craved female companionship in the home. In fact, some years later Barbara becomes quite attached to the female child of one of the enslaved people on the farm.
Health Care for Enslaved Population
I have mentioned before that the health care of the enslaved people was entirely in the hands of the owner. The owner decided when to call in licensed or professional help and often diagnosed and dosaged a medical problem. The variety of care experienced by the enslaved population probably ran the gamut. The motive of owners to provide these services likely grew from financial interest in property to genuine human decency or from simple self-preservation. To the extent that enslaved people could manage it, traditional remedies handed down through generations of descendants from Africa and colonial America were likely used with or without permission or owner’s awareness. On the other hand, prominent antebellum physicians such as Samuel Cartwright in Mississippi promoted perceived differences in black and white physiology to support medicine in the South as a unique challenge. Cartwright’s views were steeped in nineteenth century ignorance and racism, easily used in argument to support the continuation of slavery. His postulation that blacks were a race of childlike people may have encouraged many slaveowners to belittle complaints and self-diagnosis on the part of their property.
Kelly Brignac in “Exploring Race and Medicine through Diaries: White Perspective on Slave Medical Care in Antebellum Mississippi” studied the journal of Dr. Walter Ross Wade and the diary of Eliza Magruder. Dr. Wade seems to have been in total charge of the health and medical needs of the people on his plantation. His workers were expected to seek out medical help. It seems to have caused both anger and fear in Wade when contagious illnesses swept through the plantation and brought work to a standstill. In contrast, Eliza Magruder, a resident on her uncle’s plantation, performed her tasks with little involvement in the work of the plantation. She willingly undertook to seek out illness and poor health among the plantation workers by frequently visiting their living quarters. She seems to have spent time inoculating people against contagious disease. Her uncle appears to have supplied the pharmaceuticals and other medical resources for plantation use. In addition, her diary supports her emotional involvement with her task. This is in contrast with Wade’s rather distant health and medical maintenance.
Duncan McKenzie, unlike Eliza Magruder and Dr. Wade, did not have a large number of enslaved people working on his farm. Since they worked side by side every day and Barbara had charge of the young children, their health destinies were closely intertwined. A contagious illness swept through both black and white on the small farm with equal threat. When one person, black or white, was incapacitated the burden on others increased. Duncan McKenzie appears in his letters to consider himself fairly knowledgeable about medicines. He seems to have paid particular attention to curatives advertised in the newspapers as well. We can speculate that Duncan probably assumed the authority to provide at least minimal medical care for the people on his farm. Clearly the white family on the small farm could not as easily distance themselves from the enslaved people working on the farm. When typhus spreads through the neighborhood in 1847, the outbreak is not only among the enslaved on the farm but Duncan himself contracts the illness. Evidence exists that Duncan was under the care of a physician, but we have no evidence that the enslaved victims of the disease got the same care, though it is possible they did. The disease eventually killed two on the farm, one black, one white.
Accidents and Alcohol
Illness was not the only health threat of the 19th century. Accidents happened every day, despite the fact that people were not knowledgeable of how to protect themselves from unseen infection. They did not have recourse to antibiotics or vaccines. Cleanliness was their best bet in overcoming an infected wound, but knowledge of bacteria invisible to the eye was limited.
In June of 1839 Daniel stepped on a nail, “which came nearly through between his toes an inch up in his foot — there is not fever or inflammation in it yet.” Perhaps there was not going to be, and perhaps they instinctively kept it clean, for Daniel lived to adulthood with all appendages in tact.
Another accident did result in death in 1839. Duncan describes two men and a “lad” digging a thirty foot well when the walls fell in and buried the youngster. It took more than twenty-four hours to recover his body since the cave in was so large.
Two social elements increased the possibility of accidental and premeditated death in deep South culture of the 19th century. These were alcohol use and a culture of masculinity and violence. In a June 1839 letter Duncan writes of a murder in the neighborhood:
“… one man was stabbed by another
and died instantly L McRae the murderer made his escape. It is a
case of late occurrence taking place on the 30th May ult
The murdered was a Saml Wilson a native of the state of
Illinois McRae is a son of Abe McRae and nephew to Morino
John of that name once of Marlboro District South Carolina”
Without reference to records of this event, records that probably don’t exist anymore, we cannot know the kind of conflict that may have instigated this murder, but a pattern of violence becomes clearer as letters from Mississippi to Duncan McLaurin during the 1840s reveal. The sources of these conflicts range from rebellious slaves to political conflict.
Likewise, we can surmise that indiscriminate use of alcohol fed into the masculinity culture in dangerous ways. It is perhaps a credit to Mississippi legislators in 1839 that some recognized the problem and attempted to solve it by passing the Gallon Law and attempting to curb the practice of dueling.
The Gallon Law, in Duncan McKenzie’s opinion, was beneficial to individuals with drinking problems like Dr. Duncan. McKenzie also claims that the frequency of taverns on the way home from selling crops is the reason many of his neighbors cannot get ahead financially. These were common arguments used by temperance groups across the nation. Evidently, among the general population, the Mississippi Gallon Law was quite unpopular.
This law, interestingly enough, was modeled on the Fifteen Gallon Law formerly passed in Massachusetts. Perhaps similar laws, meant to curb tippling, were an effort to control alcohol distribution without total prohibition. A summary of the Gallon Law and accompanying opinion appears in The Mississippi Free Trader of Thursday, 14 February 1839. Under the Mississippi law, Inns and taverns could not sell drinks nor offer them for free in quantities less than one gallon. Candidates for public office could not offer drinks to voters during elections. Violating the law carried a penalty of fine and imprisonment. The sale of any amount of spiritous liquors was forbidden to “Indians and Negroes.” Anyone receiving a liquor license would have to take an oath against selling on their property of any quantity under a gallon. The Gallon Law was seen by many as a violation of civil rights and likely to be abused by those who could afford bribes, leaving the less financially successful to suffer the burden. In addition, temperance efforts in the antebellum South became tainted by the movement’s association nationally with the abolitionist movement. By 1842 the right to grant and hold a liquor license without the gallon restriction was restored. It is interesting to note here that over a century later it would be 1969 before the 1919 Prohibition Law was repealed in Mississippi, the last state in the union to do so.
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