Folk Medicine in Southern Appalachia.

Folk Medicine in Southern Appalachia. By Anthony Cavender. (Chapel Hill and London: University of North Carolina Press, c. 2003. Pp. xx, 266. Paper, $19.95, ISBN 0-8078-5493-X: cloth, $55.00, ISBN 0-8078-2824-6.)

Anthony Cavender offers a distinct regional and historical perspective on the ever-growing literature about folk healing beliefs within their cultural contexts. He focuses on southern Appalachia, a region whose boundaries continue to be disputed, and aims at correcting stereotypical, often uncomplimentary views of the region's inhabitants. According to Cavender, while southern Appalachia is geographically isolated, it is not a world apart from the rest of the United States. His "inclusionist" approach asserts that, as in other parts of the country, the use and practice of folk medicine has declined in southern Appalachia since World War It. The same cultural context of healing, health, and illness is found elsewhere among other Euro-American and African American populations. This persistent disclaimer contradicts the uniqueness of folk modalities in southern Appalachia and has a clear "corrective" agenda: Cavender wants his readers to stop viewing Appalachia as a place of "otherness" frozen in time.

Sources consulted include home remedy information handed down within families and published by local groups; records of missionary aid societies; material found in recorded folklore: local medical societies' records; 321 archived interviews with residents of eastern Tennessee, western North Carolina, and southwestern Virginia; and interviews conducted by Cavender. Cavender chronicles dietary, hygienic, and cultural practices that contributed to early health problems. He asserts, as have many other scholars, that poor distribution of health-care providers, insensitivity to the belief systems of indigenous people, and the changing nature of disease in the early twentieth century (from contagious to degenerative) all favored the popularity of folk medicine.

Purveyors of folk medicine in southern Appalachia were drawn from a variety of ethnicities, races, and religions, though they were predominately Protestant. Healing methods utilized by the eastern band of Cherokee in North Carolina, which emphasized natural (rather than supernatural) causes of illness and the value of animal substances, were influential. African Americans also were deemed to possess healing powers that white southern Appalachians accessed through contact with blacks' bodily fluids and hair. All sought medicinal relief from local plants. A lively economy flourished in the early twentieth century, as "root digging" produced plants for local use and large-scale exportation. These home remedies were overshadowed but not obliterated by commercial medicines after 1865. Store-bought proprietary and patent medicines flourished until synthetic drugs decreased the demand for root drugs.

Of particular value are charts that show how certain illnesses would be treated by traditional versus commercial medicine, plants and their medicinal uses, and demographic information on interviewees. Cavender's lengthy section chronicling specific ailments could benefit from a similar use of charts. Illness clusters are detailed. Cavender shows that some residents resorted to magical remedies for illnesses as well as social conflicts; the verbal charms invoked to relieve the sufferer are fascinating. Folk healers also were used in conjunction with physicians and other alternative modalities.

A few shortcomings emerge in Cavender's text. First, his rather plodding writing style lacks an overarching narrator's voice to link information with a lively narrative style. Second, and more important, the book lacks gendered analysis, an odd and glaring omission given the thrust of so much recent scholarship. Little is said about which diseases were more likely to be diagnosed in women than in men (e.g., nerves), or which healers were likely to be female or male. Were home remedies the purview of women, as caretakers of their families' health, while paid "doctors" (a term of respect but rarely credentialed) were male? When he uses case studies of herbalists, cancer doctors, faith healers, and Native American healers, Cavender discusses only one female healer. Interestingly, this is also the only time that percentages of female patients and their specific complaints are addressed, and the healer herself recorded this data. Readers are left wondering about such crucial cultural questions as who controlled medical and reproductive knowledge and how being a folk healer related to social status. Who was able to earn a living as a doctor? Were female and male healers held to the same standards of morality and propriety? How did these factors change over time? Finally, Cavender also addresses reciprocity of practices between Native and Euro-Americans, but information about the effects of power relations and major conflicts between these groups is oddly absent.

Cavender concludes with a quick survey of present-day healers. Their survival disproves predictions that they would vanish with the rise of official medicine. Yet, despite their persistence, Cavender emhasizes that "The knowledge and use of folk medicine among Southern Appalachians has diminished over time" (p. 185). This text would be of value to scholars of medical sociology, local history, and the history of folk medicine.

San Diego State University 

SUSAN CAYLEFF