Medicine

The first physician in South Carolina of European ancestry appears to have been Henry Woodward, a ship’s surgeon in the party that landed in 1666 to assess Carolina for the Lords Proprietors and King Charles II. Although the subsequent colonists had among them “doctors” of unknown abilities, they understood the need for “seasoning” (which probably meant acquisition of malaria), and they sometimes marveled at the cures wrought by Native American medicine men. Early on there were outbreaks of malaria (1684), smallpox (1697), yellow fever (1699), and dysentery (1715). Smallpox, imported from Europe, decimated the Native Americans. The slave trade accounted, at least in part, for later epidemics of smallpox and yellow fever and the endemic occurrence of filariasis– a parasitic infection that persisted in the Charleston area until the 1920s. In 1707 the first quarantine station or “pest house” was built on Sullivan’s Island, where newly imported slaves were kept prior to their sale in Charleston and elsewhere.

During the eighteenth century, some South Carolina physicians achieved prominence mainly as naturalists. John Lining, who has been called the first American physiologist on the basis of metabolic observations on himself, excelled in botany and meteorology. Lionel Chalmers published in two volumes An Account of the Weather and Diseases of South Carolina (1776) and also an Essay on Fevers (1767). Alexander Garden was honored by Linnaeus not only in the naming of the cape jasmine (gardenia) but also in the naming of various fish and reptiles. Lining, Chalmers, and Garden were all born in Scotland, which during the early eighteenth century was the most important center of medical education as a result of the Scottish Enlightenment. William Bull II, by graduating at Leyden in 1734, became the first native-born American to receive his medical degree from another country. Later, John Moultrie, Jr., became the first native-born American to receive a medical degree from Edinburgh, where his dissertation on yellow fever was apparently the first systematic account of that disease to emanate from North America. The first attempt at a hospital in South Carolina consisted of a brick building dedicated in 1738 by the vestry of St. Philip’s Parish, Charleston.

The Revolutionary War found the colony’s physicians, like others, to be divided in their loyalties. Some, including Garden, returned to England. Noteworthy patriots included David Ramsay, Peter Olyphant, and Peter Fayssoux. Olyphant, Fayssoux, and others were among those captured when Charleston fell on May 12, 1780; they bitterly protested the treatment of prisoners by the British. Olyphant later became director of American hospitals to the army commanded by Nathanael Greene and later deputy director of the hospital of the Southern Army. Fayssoux became surgeon general to the Southern Department and chief physician for the Continental Hospital (that is, the Medical Department).

After the war, in 1789, Fayssoux hosted a meeting of Charleston physicians that led to the formation of the Medical Society of South Carolina. Incorporated “to improve the Science of Medicine, promoting liberality in the Profession, and Harmony amongst the Practitioners,” the Medical Society was meant to be a statewide organization but in reality represented mainly the Charleston area. Early functions included a fee bill (1792) and a code of ethics (1810) that included a prohibition of dueling by its members on account of a “professional quarrel.”

To celebrate the turn of the nineteenth century, Ramsay presented a Review of the Improvements, Progress and State of Medicine in the XVIII Century (1801), an early American medical history. Ramsay also started a medical journal (Charleston Medical Register), which did not survive beyond its first issue. More South Carolinians began to obtain medical degrees, now usually from the University of Pennsylvania rather than from Europe. Influenced by Benjamin Rush of Philadelphia, the new graduates promoted the use of blood-letting, which was further enhanced in South Carolina by three local translations of the work of the French physician François-Joseph Victor Broussais. South Carolinians who continued the physician-naturalist tradition of the previous century included John Lewis Edward Whitridge Shecut, whose Flora Carolinensis (1806) was the best account of botany in the state up to that time; Edmund Ravenel, an authority on conchology; John Edwards Holbrook, an expert on herpetology and ichthyology; Robert Wilson Gibbes, nationally known for his work on fossils; and Henry William Ravenel, who made major contributions to mycology.

The early nineteenth century gave rise to systematic attempts to improve medicine in South Carolina. In 1817 the General Assembly created two examining boards for physicians, apothecaries, and midwives, one of which was to be in Charleston and the other in Columbia. In 1821 Dr. Thomas Cooper, president of South Carolina College, proposed a medical school that would be divided between Columbia and Charleston. In 1822 the Medical Society of South Carolina endorsed Charleston as the sole site, leading to the opening two years later of the Medical College of South Carolina, which reorganized as the Medical College of the State of South Carolina in 1832. In 1827 the South Carolina Lunatic Asylum in Columbia opened its doors to receive patients. The sixth hospital of its kind in the United States and designed by Robert Mills, the institution reflected progressive concepts in the treatment of mental disease. In 1834 a Marine Hospital, also designed in part by Mills, opened in Charleston to replace earlier efforts to care for sick and disabled seamen. Small, private hospitals for slaves were built in Charleston, including a small surgical infirmary opened by the medical school that could be considered the state’s first hospital devoted entirely to teaching. In 1856 Roper Hospital, the first community hospital of any size in South Carolina, opened with a daily charge of about 25¢.

These advances met a public need since, as one visitor wrote, “Carolina passes for the most unhealthy province of the United States.” Yellow fever struck Charleston, as it did other large ports on the Atlantic seaboard, with increasing frequency and severity as the city grew subsequent to the Revolution. Malaria was responsible for the “sickly season” extending from May until late October or until the first killing frost, which caused lowcountry planters to leave their plantations for areas that were relatively free of the disease. Asiatic cholera appeared episodically. Attempts to regulate medicine through licensing were unsuccessful because, in the context of Jacksonian democracy, alternative practices (such as the botanic cures put forth by the Thomsonians) prevailed. At the eve of the Civil War, there were fewer than one thousand physicians in the state and only four hospitals of any size: three in Charleston and the State Lunatic Asylum in Columbia.

Among the antebellum South Carolina physicians who achieved national prominence were Josiah Clark Nott of Columbia and James Marion Sims of Lancaster District. Nott and Sims both practiced briefly in South Carolina, made their marks as innovative surgeons in Alabama, and enjoyed later success in New York City. Nott proposed in 1848 that yellow fever was of “animalcular origin” and possibly caused by an insect. Sims’s cure of vesicovaginal fistula removed the stumbling block to progress in operative gynecology. Theodore Gaillard Thomas, another native South Carolinian, continued Sims’s work in New York. Francis Peyre Porcher of Charleston anticipated the germ theory, publishing an article in 1861 on “Illustrations of Disease with the Microscope: Clinical Investigations.” When the American Medical Association (AMA) was formed in 1847, James Moultrie, Jr., of Charleston was made vice president, and he served as president in 1850. Moultrie was largely responsible for the organization of the South Carolina Medical Association (1848), of which he served as first president.

South Carolina physicians contributed substantially to the Confederate cause during the Civil War. Julian John Chisolm of Charleston wrote the Confederacy’s definitive surgical manual and designed a chloroform inhaler for administering anesthesia. Francis Peyre Porcher published a botanical manual on Resources of the Southern Fields and Forests, which allowed soldiers and physicians to improvise when medicine was unavailable. Samuel Preston Moore of Charleston was surgeon general of the Confederate army. Benjamin Walter Taylor of Columbia served as medical director of the Cavalry Corps, the second-highest-ranking medical position in the Southern armies.

After the war tuberculosis became increasingly common in South Carolina, especially among blacks as many freedmen migrated to the towns and cities. Available data suggest that overall mortality rates were roughly similar for blacks and whites before the Civil War; thereafter, mortality rates for blacks became substantially greater. Physicians, like others, struggled during the Reconstruction era, and medical organizations were relatively inactive. In 1865 Charleston established a full-time health department, believed to be the first in the United States. Thomas Grange Simons was instrumental in establishing national quarantine regulations and also a sewage disposal system in Charleston. Legislative acts created the State Board of Health in 1878 and the State Examining Board for physicians in 1894. Memorial Hospital (“City Hospital”) was completed in Charleston in 1888, and in 1893 Columbia Hospital opened with twenty-five beds. By 1900 South Carolina had eleven hundred physicians, most of whom were educated at the Medical College in Charleston. A medical school was established at the University of South Carolina in 1867, but although it lasted until 1876, it never recovered from the resignation of the faculty when a black student was admitted. Reorganization of the AMA in 1901 placed emphasis on county medical societies, which expanded and proliferated in South Carolina. In 1905 the Journal of the South Carolina Medical Association was begun, with Dr. Robert Wilson (1867–1946) of Charleston as editor.

By the beginning of the twentieth century, yellow fever had ceased its visitations, but South Carolinians were increasingly afflicted with tuberculosis and were still tormented by smallpox, malaria, hookworm, typhoid, typhus, and diphtheria. In 1907 pellagra, previously thought not to occur in the United States, was recognized in South Carolina. James Woods Babcock of Columbia spearheaded a national movement to eradicate the disease. In 1917 Joseph Goldberger of the United States Public Health Service came to South Carolina, where he supervised many of the experiments that established dietary deficiency as the cause of the disease. The occurrence of pellagra and the prevalence of diseases such as typhoid and hookworm underscored the limited access of the rural poor, blacks, and mill workers to public health measures and to adequate medical care.

Blacks and women were underrepresented in the medical profession of South Carolina, as elsewhere. The census of 1890 counted only thirty black physicians in the state. Blacks found it difficult to obtain medical education and more difficult to obtain hospital positions. In 1896 the Palmetto Medical, Dental, and Pharmaceutical Association was founded for African American professionals largely through the efforts of Charles Catlett Johnson, Sr., of Aiken. Other founding members included James Richelieu Levy of Florence, Lawrence A. Earl of Anderson, and Alonzo Clifton McClennan of Charleston. Sarah Campbell Allan of Charleston was the first woman in South Carolina to be duly qualified and licensed by the State Board of Medical Examiners. Lucy Hughes Brown of Charleston seems to have been the first licensed African American woman physician. The first female graduates of the Medical College in Charleston were Love Rosa Hirschmann (later Gantt) and Emilie Melanie Viett (later Rundlett) of the class of 1901. Hilla Sheriff became known as the “first lady of public health” for her pioneering efforts in the upstate.

The Flexner Report of 1910 rendered a scathing analysis of the Medical College in Charleston, threatening its existence, as it did numerous other schools throughout the United States. In 1913 Dean Robert Wilson convinced the state to assume responsibility for the college with an annual appropriation of $10,000. The school later matured with the addition of full-time faculty members under the leadership of Kenneth Merrill Lynch, and in 1955 a five-hundred-bed teaching hospital was added.

Science-based medicine flourished in South Carolina, as elsewhere, during the twentieth century, and some South Carolinians made significant contributions to the medicine of their eras. Among these were James Woods Babcock, a pioneering alienist (psychiatrist); George H. Bunch of Columbia, first president of the South Carolina Surgical Society; J. Heyward Gibbes of Columbia, an outstanding internist; LeGrand Guerry of Columbia, a surgeon with special expertise in acute appendicitis; J. Decherd Guess of Greenville, a nationally recognized obstetrician and gynecologist; James Adams Hayne, who presided over the State Health Department for thirty-three years and whose son, Theodore Brevard Hayne, was the last student of yellow fever to die of that disease while studying it; Edward F. Parker of Charleston, an innovative otolaryngologist; D. Lesesne Smith of Spartanburg, who helped make the annual Southern Pediatric Seminar a nationally recognized model for continuing medical education; William Weston, Sr., of Columbia, arguably the second full-time pediatrician in the Southeast and an expert on nutritional diseases; and Charles Frederick Williams, who succeeded Babcock as superintendent of the South Carolina State Hospital.

Between 1929 and 1932 Theodore McCann Davis of Greenville developed and perfected transurethral resection of the prostate, which became a standard operation throughout the world. In 1940 Austin Tally Moore of Columbia initiated the era of artificial joints when he implanted the world’s first metal hip joint in a patient who had suffered a pathologic fracture of the femur due to a tumor. Between 1942 and his untimely death from the disease he sought to cure, Horace Gilbert Smithy, Jr., of the Medical College of South Carolina in Charleston pioneered aortic and mitral valvulotomies, pivotal events in the evolution of open heart surgery.

The closing decades of the twentieth century bore witness to improvements in South Carolina, as elsewhere in the United States, in health-care delivery systems, hospital-based medicine, public health, and the perceived physician shortage. By 1970, however, there were only 77 physicians per 100,000 persons in South Carolina, and the rural population remained poorly served. This physician shortage led to the founding of the University of South Carolina School of Medicine in Columbia, which opened in 1977. As of 2002, there were 8,872 practicing physicians in South Carolina, or 221 per 100,000 persons, with the state’s two medical schools graduating about 200 new physicians each year. The South Carolina Medical Association remains robust, and in 2000–2001 a South Carolina physician, Dr. Randolph D. Smoak, Jr., of Orangeburg, served as president of the American Medical Association.

South Carolina Medical Association. A Brief History of the South Carolina Medical Association. Charleston, S.C., 1948.

Waring, Joseph I. A History of Medicine in South Carolina. 3 vols. Columbia: South Carolina Medical Association, 1964–1971.

Woods, Barbara A., and Tracy D. Tisdale-Clawson. A Golden Century of Black Medicine: An Historical Overview of the Palmetto Medical, Dental, and Pharmaceutical Association, 1896–1996. Orangeburg: South Carolina State University, 1996.

Worthington, W. Curtis, H. Rawling Pratt-Thomas, and Warren A. Sawyer. A Family Album: Men Who Made the Medical Center. Spartanburg, S.C.: Reprint Company, 1991.