Pathways to Power: Physicians In Charleston, South Carolina, 1790-1860

This dissertation tells of the efforts of a group of scientifically trained physicians in Charleston, South Carolina to gain power and authority within their profession, and their community, during the Antebellum Period. Physicians were not ultimately able to declare professional supremacy and near monopolistic authority in health care until scientists discovered microscopic pathogens during the bacteriological revolution of the last half of the nineteenth century. This work begins with a brief review of the medical history of Charleston and its physicians and recounts the difficulties faced as they tried to establish themselves as medical authorities in a new world. The story then shifts to look at the competitors physicians faced in a medical marketplace that was much more diverse and competitive than that found in society today. A significant part of this work focuses on the problem of yellow fever because historians have highlighted the fear of this disease as one of the greatest influences on the development of medical and public health policies and institutions, particularly in the South, during the first half of the nineteenth century. Public health workers and officials, supported by physicians, were almost entirely concerned with discovering the origins and controlling the appearance of epidemic disease. Once yellow fever was present in the city, physicians found themselves unable to effectively treat the disease or stop its transmission. In fact, they could not even arrive at a consensus with regard to any of these aspects of the disease, and this served to hamper their efforts to increase their cachet in the community. The last three chapters of the dissertation illustrate how physicians fought to capture the mantle of authenticity in the field of health care at a time when they could not command authority through the adoption of their professional precepts. On Christmas Eve, 1789, several of Charleston\u27s preeminent physicians established the Medical Society of South Carolina. This body improved cohesion within their ranks and created a space where physicians could construct their identity, adopt professional standards, and begin to cement their position in the community as the sole medical authority. In the 1820s, the physicians founded the Medical College of South Carolina, a space where professional orthodoxy could be produced, authenticated, and reproduced for dissemination. Physicians in Charleston also eased professional anxieties and asserted their authority by embracing a policy of regional medical separatism that dovetailed with sectionalism so prevalent in the 1850s. As individuals with common goals coalesce into groups trying to take power, they seek to create structures that support their efforts. Institutions are created to allow space for groups of people to construct their identities, and produce discursive formations that help them promote their agendas