Becoming an M.D. in the mid-nineteenth-century United States was not an outlandish choice for a young man; it was not like running away to sea. But medicine, straddling the line between trade and profession, filled with economic and therapeutic uncertainties, was anything but the main chance. In the South, before and after the Civil War, the ideal of manly success was to master a flourishing plantation, the traditional seat of a man’s economic power, political influence, and social esteem. Nonetheless, thousands of southern men made orthodox medicine their choice during the mid-nineteenth century, and increasing numbers of them (including some...

Just as medical institutions created but also crossed a line between their world and the larger society, so the culture of learning inside schools made orthodoxy less of a realm apart than many students and teachers supposed. Histories of medical education have focused largely on broad institutional and professional changes and have had surprisingly little to say about the everyday modes of teaching and learning. This chapter looks at midcentury medical education in this immediate sense, seeing it as a matrix of ideals and practices created by teachers and students together, one shaped by happenstance, as well as by design....

“I am now in very fact a Doctor and feel fully repaid for all the sacrifices made and privations suffered,” Samuel Van Wyck wrote to his wife in Anderson Court House, South Carolina, after receiving his medical degree in the spring of 1860. Two years earlier, he had quit the tannery business to plumb the mysteries of medicine. “So far I have done as well as my best friends could wish,” he wrote, referring to his teachers and fellow students. “I now long to be a candidate for public favor and once more in the way of making a living.”...

In the early afternoon of November 27, 1873, someone in the G. Wilson Efferson household in Springfield, Louisiana, asked neighbor Washington King to carry a message to Dr. George Colmer. Sometime later, probably the same day, Colmer wrote this entry in his daybook:

Nov.27 (Thursday) About 2 P.M. Washington King arrived at my office with a request to go to Efferson’s house and relieve Mrs.E of an afterbirth. She sent word that she was “just as she was before,” and therefore instead of going out, Rx.

Just below this entry, Colmer added:

28—Visit to residence—fetched by Efferson (Wilson’s...

The solitary rides, the rainy nights, the advice of colleagues, the money owed—all emptied out at the bedside where waited the sufferer. Malady waited there, too, a protean, lively thing, part invader, part nemesis. This chapter seeks to illuminate the everyday diagnostic and therapeutic means physicians employed to make the bedside an orthodox place, and how these efforts in particular shaped the medical and social meaning of local practice. This means looking first at people medicating themselves and their reasons for summoning the physician in the first place. Then we will look at the physician undertaking his diagnosis and...

As physicians continued their treatment over time, they were drawn into the lives of others. Simultaneously, they were drawn more fully into the ways the sickroom configured their “experience” into something that was both orthodox and yet intensely personal. Malady’s surprises, the array of therapies, and the social bedside continued to shape everything the physician said and did in a case. To an important extent, as this chapter shows, the physician created continuity from these pressures by keeping a written record of what he witnessed, flexing his experience against disease, the patient, and whoever else was in the sickroom. As...

Because so much of what physicians wrote about concerned the drama of individual sickrooms and the complexity of other people’s bodies and lives, it is striking to see M.D.s stepping back from the bedside to speak as critics and advisers with an overview. Yet many ordinary physicians did just that, projecting their experience onto the larger backdrop of society and nature. For many doctors, it seems, speaking broadly about health provided some intellectual and emotional respite from the sickroom’s demands. Moreover, a wide-angled view followed logically from their conviction that individual practice encapsulated science in the most direct, inclusive sense....

In multiple ways—in school, at the bedside, at their most professionally expansive—physicians aspired to an overarching orthodoxy while invariably casting it in terms of self, locale, and everyday work. In all of these places and forms of practice, because physicians were such insistent writers of their work, they continually reinscribed the objectivity of someone else’s sickness within the plane of their own subjective ‘‘experience.’’ The case narrative was the physician’s most sophisticated way of doing this. It brought together the essentials: a doctor’s personal story of something gone wrong, peoples’ debility and need, and his efforts to set...

In this study, the mid-nineteenth century has been weighted toward the years before the Civil War. And yet, as noted at the outset, this should not imply that the essentials of everyday rural medicine changed sharply after the war. Although the conflict altered the lives of many individual practitioners, most ordinary physicians in the 1870s and 1880s held on to the central expectations and practices at the heart of antebellum country orthodoxy. Indeed, the persistence of the country orthodox style of practice through the Civil War is testimony to the depth of its antebellum influence and thus a good way...