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(A copyrighted publication of West Virginia Archives and History)

Volume 55 Bringing Modern Medicine to the Mountains: Scientific Medicine
and the Transformation of Health Care in Southern West Virginia, 1880-1910

By Sandra Barney

Volume 55 (1996), pp. 110-126

The transformation of West Virginia during the industrial boom of the late nineteenth century was a complex process that affected mountain society on myriad levels. While traditional evaluations of the period focus on the invasion of outside capital and portrayed indigenous people as unwilling victims of powerful processes beyond their control, recent scholarship by such historians as Ronald L. Lewis, Altina Waller, and Mary Beth Pudup remind us that the introduction of modern industry and the involvement of the state in the national marketplace was a phenomenon as enthusiastically supported by some mountain residents as it was vigorously rejected by others.1

The diverse reactions exhibited by West Virginia residents to the introduction of modern institutions may, in part, be explained by acknowledging the competing interests of the mountain residents. For commercially ambitious mountaineers, increased involvement in the national market promised new wealth and the possibility of expanding their social and economic status. More rural residents, entrenched in traditional customs, were suspicious of the metamorphosis of the region, seeing it as an invasion of new philosophies and expectations that threatened to supplant, and eventually destroy, their way of life.2

The struggle between proponents of these two views was played out on a number of stages. For example, in The Americanization of West Virginia, John Hennen studies the confrontation that developed as new industrial interests fought to create an educational system that produced complacent workers.3 In some public venues, like education and health care, the contest between the old way and the new was complicated by the extensive benefits modern skills and knowledge offered. The transformation of medical practice in the southern mountains of West Virginia during the late nineteenth and early twentieth centuries demonstrates that modernization promised mountain people significant fundamental improvements if they accepted their roles as patients in the new order. When these benefits alone were insufficient to convince West Virginians of the advantages of modern life, ambitious physicians turned to other institutions in an effort to induce the state's residents to embrace new methods of health care.

Medical care in rural West Virginia during much of the nineteenth century was frequently primitive and often entirely absent. Claude Frazier, a physician who was raised in the state's southern coal camps where his father was employed as a company doctor, wrote in Miners and Medicine that "hardy mountain people had to rely entirely on themselves in sickness and in health." Faced with little outside assistance, they trusted herbal remedies administered by family members or "mountain grannies" who were, according to Frazier, "more often than not on solid ground with their home remedies."4

While rural West Virginians found it difficult to secure sophisticated medical assistance before industrialization, they sought the best health care they believed possible for themselves and their families. Once convinced that a product or a procedure was efficient, many embraced it enthusiastically. In the late nineteenth century, for example, mountaineers came to share the attachment of other Americans to patent medicines, and panaceas like oil for earaches and salves for chest ailments became increasingly popular in Appalachia.5

Recognizing the rising reputation of these tonics and believing that the state was obligated to regulate such trade, West Virginia initiated court cases against itinerant vendors who sold "dugs or nostrums" without paying the appropriate tax. When, in 1887, J. B. Ragland arrived in Boone County selling "Ragland's Lightening Relief" at fifty cents per bottle, he found a receptive market. The local sheriff, however, arrested Ragland for failing to pay "the special tax" levied on this type of commercial activity. Ragland's arrest and conviction eventually were upheld by the West Virginia Court of Appeals and he was forced to pay the assessed penalties and taxes.6

West Virginians relied on tonics, home remedies, and folk healers because they had little familiarity with formally educated physicians. With minimal information about scientific medicine and limited access to trained physicians, many mountain people did not consider medical science an option.7 In part, West Virginians distrusted educated physicians because their state government did not support a public institution to train medical doctors. Unlike its neighbors, West Virginia did not establish a state-supported medical school until well into the twentieth century. Although a "College of Medicine" functioned at West Virginia University in Morgantown from 1902 until 1911, it was never a fully accredited program and did not confer its own terminal degree. The university did not grant M.D. degrees until 1962.8

The state was also unable to provide vigorous supervision of medical practice in the nineteenth century. Without state supervision, legitimacy was based on personal experience and local custom and was only occasionally authenticated by formal education or training. Before the State Board of Health initiated formal procedures to license physicians in the 1880s, self-proclaimed medical practitioners often lacked even the most rudimentary knowledge and skills. The 1870 census recorded only two self-identified physicians in Logan County, for example, and neither of them was literate.9 These early, sometimes poorly trained, practitioners continued to practice after the state government stepped in to standardize the licensing of physicians because many of them were grandfathered into the new system.10

The lack of formal academic education does not mean that all nineteenth-century practitioners were completely without training. Many mountain physicians gained their education through apprenticeships with older, experienced physicians, a standard practice across rural America in the nineteenth century. Emmanual Church, who practiced in McDowell County after the Civil War, was "a typical mountaineer, uneducated--hardly able to read or write." Church studied medicine with a Dr. Crockett in Graham, Virginia, and received a county license to practice before the West Virginia State Board of Health began examining prospective doctors. Hiram Christian, who also apprenticed with Dr. Crockett, eventually set up a medical service at Sandlick in the Tug River Valley.11 These men certainly gained significant knowledge through their empirical training, but the care they provided was sometimes inferior to that offered by their better-educated colleagues. In 1881, when a self-taught physician named Hess diagnosed smallpox as chicken pox and failed to observe the appropriate precautions, he allowed a deadly epidemic to spread through the villages of eastern Mercer County and adjacent Pocahontas, Virginia.12

While rural mountain residents of pre-industrial West Virginia did not generally enjoy the services of formally educated physicians, their health was, in fact, remarkably well preserved by the relatively unpolluted environment in which they resided. According to Claude Frazier, rural West Virginians were generally well because "they escaped many of the big epidemics of cholera and typhoid that swept" through urban America.13 A comparison of infant deaths in Logan County in 1872 and 1910 supports his claim. Infant mortality from contagious diseases was actually lower before the region was transformed by industrialization than it was almost fifty years later.14

Involvement in the national economy through the mass production of coal created new challenges to the well-being of the state's citizens whose lives and health care custos were intrinsically transformed by the industrial order. In particular, mountain residents saw their landscapes recast as new towns were formed and previously existing villages dramatically increased in size.15 Bluefield, for example, contained 1,775 residents in 1890, but it grew to accommodate a citizenry of over 11,000 by 1910. Beckley developed from a village of 158 in 1890 to a community of over 2,000 just twenty years later. Williamson and Scarbro, unincorporated settlements in 1890, grew into towns with populations of over 1,000 residents by 1910.16

The workers who flocked to these towns engaged in dangerous work in the coal mines. In 1909-10, accidents killed more than one hundred miners in McDowell County, sixty in Fayette County, and nineteen in Raleigh County.17 Non-fatal injuries were even more prevalent. McDowell County operations, clearly the most dangerous in southern West Virginia, lost 246 men in non-fatal accidents, while Fayette County followed closely with 213 during the same period.18 To treat the injured miners and to care for their families in the newly established coal camps, companies hired physicians, who began to transform medical practice in the mountains.

Company operators employed doctors because many of the coal camps were simply too remote to attract independent physicians. According to coal archivist Stuart McGehee, "labor was scarce, and trained doctors were an incentive to attract good miners."19 These physicians generally possessed more formal training than the empirically educated practitioners who had previously provided care to the region's inhabitants. Trained to use anaesthesia, aware of the germ theory of disease, and possessing prophylaxis to prevent infection, these newly arrived physicians were well equipped to compete with the empirically trained healers who traditionally served the region.20

When formally educated physicians entered a community, traditional practitioners often moved to less settled areas where the competition was not so fierce. Emmanual Church withdrew from McDowell County when the coal companies arrived to the mountains of Greenbrier and Pocahontas counties where he continued his practice. Hiram Christian also left his practice when competition for patients became too intense. Rather than relocate to a more isolated area, he switched careers and set himself up as an attorney in Welch. Finding the legal profession too crowded in the McDowell County seat, he eventually moved to War, where he was the only lawyer and became the community's justice of the peace.21

During the late nineteenth century, the numbers of educated physicians practicing in central Appalachia increased considerably as railroads, lumber companies, and coal mines brought in well-trained doctors to care for employees and their families. The increased number of physicians in the coal regions did not a reflect a rise in the aggregate number of doctors so much as a redistribution of physicians. Educated practitioners determined that mining regions were potentially lucrative locations in which to practice.

There were 1,046 licensed practitioners in West Virginia in 1890.22 By 1900, that number had risen to 1,385, and by 1910, 1,755 individuals were licensed to practice medicine in the state.23 In relation to its population and geographical size, however, there were relatively few physicians across the still primarily rural state. In 1890, there was on average only one licensed doctor for every 729 West Virginians. By 1900, that ratio had dropped to one per 629 citizens; in 1910, it had climbed slightly so that, theoretically, an individual physician would serve695 patients.24

The coal mining counties of southern West Virginia were especially underserved by licensed physicians before the industrial boom. While Fayette and Raleigh counties in 1890 boasted a doctor-patient ratio that was only slightly higher than the state average, few other mining counties could report the same conditions.25 In the same year, residents would have found it difficult to secure the services of a licensed doctor in Logan or McDowell counties. There was only one doctor for every 1,216 residents of Logan County and one per 1,387 inhabitants in McDowell County. Licensed physicians were true oddities in Mercer County in 1890, where the ratio was 2,000 residents per physician.26

Number of Physicians in Southern West Virginia Counties, 1881-1909
County 1881 1890 1909
Fayette 16 28 92
Logan 1 8 32*
Mercer 7 8 48
McDowell 1 6 57
Raleigh 12 11 28

*Includes physicians practicing in Mingo County, which was formed from Logan County in 1895.27

However, southern West Virginia's coal mining regions experienced a dramatic rise in the number of educated physicians practicing in their communities during the years of industrial growth. In Fayette County, for example, the doctor-patient ratio decreased from 733 citizens per doctor in 1890 to 564 in 1910. In McDowell County, the patients-per-doctor statistic declined accordingly from 1,216 to 839. The most dramatic transformation of medical service occurred in Mercer County, where an influx of new physicians halved the patient-physician average in twenty years.28

Many of these doctors worked for industrial concerns, but others were private physicians drawn by the region's economic prosperity. In the early years of the boom, however, independent physicians were often frustrated by the opposition they met from native people. Some locals, unwilling to pay scarce currency for services they distrusted, remained loyal to their traditional healers. The lack of cash also meant doctors often had to accept compensation in produce or in manual labor. Without the financial security guaranteed by company employment, some physicians gave up their practices and moved from the region, as did Dr. W. R. Iaeger, the lone physician in McDowell County before the coal boom.29

Even with the support of industrial interests, physicians faced resistance from workers. Company employees sometimes rejected the requirement that they contribute a portion of their salary to retain a physician when they were not actually ill. To protest this policy, they occasionally feigned illness in order to acquire medicine. After securing a desired drug, one miner examined it and declared it to be useless, protesting that the doctor offered only "soda and flour."30

Considering the frontier-like conditions under which doctors labored and the opposition they encountered from those they sought to cure, it is surprising that educated doctors agreed to venture into West Virginia's coalfields at all. Those doctors who did hazard the coal camps undertook the mission for a variety of reaons. For some, the mountains were home and they welcomed the opportunity to pursue their chosen profession at a time when the region's economy was booming and its growing population legitimized the establishment of medical practices in rural communities.

Dr. Wade St. Clair did not venture far from home when he opened his practice in the growing town of Bluefield in 1902. A native of neighboring Tazewell County, Virginia, he attended the University of Virginia's Medical College and completed postgraduate training at New York's renowned Polytechnic Clinic. He also pursued additional training in the hospitals of Vienna, Austria, enjoying the benefits of an outstanding education that qualified him to set up practice in any community in the United States. By selecting the Bluefield area, he maintained family connections and positioned himself to take advantage of the financial benefits offered by the expansion of the coal economy.31

To pursue his ambitions, St. Clair joined with an outsider, Francke Fox, to set up the Bluefield Sanitarium. Fox, who hailed from North Carolina, was the son of a physician. A graduate of the University of Virginia who completed his medical degree at New York University, Fox established his first practice in Waynesboro, Virginia, in the Shenandoah Valley. This enterprise failed to prosper, however, and in 1892, he accepted a contract with the Norfolk and Western Railroad to care for its employees in the Pocahontas Coalfield.32

Fox and St. Clair combined to establish Bluefield's first hospital in 1902, an institution that eventually developed into one of the most modern and progressive in the region.33 When they expanded the facility in 1914, the doctors took advantage of the financial success achieved by St. Clair's father, a native industrialist who had profited from the region's development. Alexander St. Clair, who continued to reside on the family farm in Tazewell County, became a partner in the corporation established to fund the new facility.34 Through their partnership, St. Clair and Fox achieved the prosperity available to those physicians, whether local or newly arrived, who exhibited a willingness to treat medicine as a commercial enterprise and to pursue financial success aggressively. The Bluefield Sanitarium grew into a thriving business that offered miners and their families unique opportunities for medical and hospital care and illustrated the creativity and vigor of educated physicians' new medical ideas.

St. Clair and Fox were only two of the hundreds of doctors who set up practices in the West Virginia coalfields during the economic upswing of the Progressive Era. An examination of the West Virginia State Board of Health's reports demonstrates that, in addition to the significant increase in the number of educated physicians who settled in the state, the geographic origins and experience of these new physicians was quite different from that of the doctors who cared for the region's inhabitants before the coal boom.

Prior to industrialization and the drive to professionalize medicine, local mountaineers pursued empirical training and used their community status to earn legitimacy as medical practitioners. With the introduction of new professional standards, state residents were disadvantaged by the lack of formal medical education in the state. As professional credentials became increasingly critical, and eventually necessary, for licensure, West Virginians were either forced to go elsewhere for their medical training or see medical positions within the state filled by outsiders.35

In 1883, for example, only 6 physicians who had been educated in Illinois were practicing in West Virginia; by 1903, that number had increased to 304. Only 45 doctors trained in New York practiced in West Virginia in 1883, but more than 500 of their colleagues were licensed by the state in the succeeding twenty years.36 By 1903, in fact, medical colleges from thirty-three states and the Dstrict of Columbia were represented by graduates licensed to practice in West Virginia, reflecting the national recognition of the economic opportunity available in the coalfields.37

In spite of increased representation by physicians educated in other regions, the doctors who set up practices in the coalfields were most often trained in surrounding states. From July 1898 to July 1900, nearly 50 percent of those who passed the West Virginia licensing board graduated from schools in Maryland, Ohio, Kentucky, or Virginia.38 Of the 141 who applied for licensure in 1902, 87 were from the neighboring states.39

Many of the physicians who moved into the coalfields were still relatively new to the practice of medicine. Dr. J. S. Malory, an 1898 graduate of the Medical College of Virginia, opened his practice in McDowell County in the same year he completed his education. His classmate, Dr. A. Irvine, set up an office in 1899 in the nearby community of Bramwell, where he soon found himself competing with Dr. W. V. Clyde, an 1899 graduate of the Maryland Medical College. Dr. W. C. Hall, who completed his training at the University of Virginia in 1897, opened an office in Welch in 1898.40

The careers of these young men were quite varied; some of them spent only a few years in the area, but others committed themselves and their families to the region. Many of the physicians who entered the mountains as employees of coal companies moved on rather quickly. Dr. Woods, the company doctor for the Ritter Lumber Company, served the Dry Fork and Panther Creek regions of southern West Virginia from 1900 until 1907. When the company completed its cutting in the region, he departed with the rest of the workers. Dr. Kell, an independent physician in Welch, signed on to serve as the company physician for the Lathrop Coal Company in 1913. After supervising the health of the residents of Lathrop's four mine camps, Kell eventually left the area around 1926. Dr. S. D. Hatfield, the son of feudist Anderson "Devil Anse" Hatfield, opened a medical practice in Iaeger in 1907 and remained in the community until 1920. He was the only physician in the area after outside timber companies abandoned their activities, but he too soon departed because the roads were so primitive and the people had so little money with which to pay him.41

Hatfield's concern about financial compensation was shared by other doctors. Traditionally, folk and herbal healers had accepted non-cash payment for their services. Educated physicians, who embraced the ideals of the market economy and ignored the mountaineers' cultural practices, dismissed these traditions and demanded that their patients recognize medical attention as a service acquired through a cash exchange rather than barter.42

Accustomed to relating to their healers as members of their own communities, mountain residents often failed to comprehend fully the physicians' desire for immediate compensation. Some doctors resorted to harsh tactics to teach patients their proper role in the economic relationship that supported modern medicine. A physician in southern West Virginia was called to inspect the children of an isolated mountain family. Upon arrival, he discovered they had been exposed to diphtheria and one of the children was already exhibiting symptoms. The physician, who carried with him the appropriate anti-toxin, "refused to administer the medicine unless he was paid $60 in advance."43 In his book Coal Towns, Crandall Shifflet related the story of a mountain family who lost their farm to a doctor who foreclosed on their home when they were unable to pay the $300 medical bill accrued by a dying grandparent.44

Since medicine was frequently an uncertain enterprise, some physicians pursued alternative or related endeavors to augment their incomes. Like Drs. Fox and St. Clair in Bluefield, a number of physicians opened hospitals that both supplemented their incomes while also providing their communities with in-patient facilities.45 Other physicians scrambled to acquire government positions in state institutions or as county public health administrators, a reflection of government's ncreasing reliance on educated physicians as well as the doctors' own desire for a secure income.46

Finally, many physicians invested in industrial enterprises. A significant number of the investors in the Williamson-Thacker Coalfield were physicians. An assembly that included the future governor of West Virginia, Dr. Henry D. Hatfield, these men resided in communities such as Bramwell and Bluefield and used their profits as physicians to finance their business ambitions.47

Some physicians invested in industrial ventures as a way to diversify their earnings, but the vast majority of state doctors relied upon the revenue they generated through their professional activities. To protect that income, educated physicians agitated for the increased regulation of the practice of medicine and the elevation of their professional ideals. For many, if not most, physicians, the desire to heighten their professional status was a complicated one founded on both philanthropic concern and economic ambition. While they genuinely believed the care they provided was the standard against which all others failed, they also stood to profit by eliminating competition from traditional healers, empirically trained physicians, and various medical sects who gained prominence in the late nineteenth century. In order to protect the public and to better their social and economic conditions, West Virginia doctors followed the lead of the American Medical Association, a professional alliance founded in New York state in 1846, and organized coalitions to improve their status and protect the public health by elevating their principles of practice above traditional healers and sectarian competitors.48

The American Medical Association, and its state and local components, was founded to protect the precepts of clinically educated physicians who embraced allopathy, the principle that illness must be treated by medicines or procedures intended to terminate the symptoms of a disease. Physicians who embraced this axiom sought to uncover treatments through medical research and clinical inquiry and, over time, discovered the nucleus of information that now supports contemporary medicine.49 While allopaths were recognized as "regular" physicians who set the standard of medical practice, they were frequently challenged in the late nineteenth and early twentieth centuries by competitors such as homeopaths, osteopaths, and chiropractors.50 To combat those rivals and to elevate the principles of scientific medicine, allopaths around the United States joined county and state affiliates of the American Medical Association.51

West Virginia physicians formed a state medical organization in Wheeling in 1867. The Medical Society of West Virginia was the last state medical association to be instituted in the nation at that time. Like their colleagues elsewhere, state physicians adopted the American Medical Association's code of ethics and formally allied themselves with the national association.52 As recent converts to the drive for medical organization, state physicians were quite vociferous in proclaiming the sanctity of their profession. According to the booklet they published to celebrate their society's organization, "the true physician . . . stands upon a lofty eminence, clothed with the authority of science to interpret nature." The author of the pamphlet proclaimed that "no calling represents more fully or more honorably than ours, the intellectual tendency of the times in which we live," and finally declared that "a pervading sense of progress is everywhere at work in the medical world."53

In spite of its declarations, West Virginia's medical society was inferior to its neighbors both inside and outside the region. When Dr. C. H. Maxwell, a Morgantown physician, was appointed to represent the West Virginia society at the Pennsylvania Medical Association's meeting in 1907, he was more than a bit chagrined by the distinct differences he noted between his home society and that of the Pennsylvania physicians.

According to his calculations, the Pennsylvania Medical Association had enrolled more than 50 percent of the state's physicians, while West Virginia had recruited only 37 percent of those practicing within its borders. Local chapters were active in sixty-five of Pennsylvania's sixty-seven counties, but twenty of West Virginia's fifty-five counties contained no organized medical association.54 These comparisons embarrassed Maxwell, who recognized their detrimental consequences for the advancement of allopathic ambitions in the state. Without a strong medical association, allopathic physicians were stymied in their attempts to regulate the practice of medicine. He asserted that the inability of the state's physicians to seize control of the definition and regulation of medicine had adverse consequences for the profession as well as for the population of the state. Maxwell warned that West Virginians had not "been trained," and that they had not been "taught" that communicable disease was a "shame." Having failed to "create the proper public sentiment," doctors had not yet achieved full control of the public's expectations about the practice of medicine.55

Maxwell's evaluation reveals that, while formally educated physicians had acquired significant prominence in the medical marketplace, they had not yet acquired the ability to define medical care or to secure a monopoly over its delivery. These ambitions had to be achieved to support their claim to sole professional legitimacy and scientific knowledge. To that end, doctors pursued continued patronage and support for fledgling county medical societies and the creation of a closer alliance with the government.

Educated, allopathic physicians needed government support because they faced strong competition from other practitioners. Still new to their role in the modern medical system, many citizens persisted in their reliance upon traditional medicine as well as on the promises of such sectarian practitioners as homeopaths and chiropractors. Physicians looked to the government to aid them in their battle against the popularity of these alternative sources for health care.

Sectarian healers vehemently challenged the state association's campaign for the passage of laws regulating medical practice. In addition to rejecting the allopaths' insistence upon a monopoly over legitimate medical knowledge, sectarians also disputed the state government's right to interfere in their pursuit of a medical career. Legal challenges to West Virginia's medical practice law were pursued all the way to the United States Supreme Court which, in Dent v. West Virginia, upheld the state's right to regulate and control the practice of medicine.56

Although the Supreme Court affirmed the government's prerogative to license medical practitioners, sectarians also challenged the composition of the state's medical examining boards. The West Virginia Public Health Council, also known as the Board of Public Health, promulgated public health policy as well as examining and licensing fledgling physicians. The multiple duties demanded of the board were quite exhausting, but the state's recognition that regulating the practice of medicine was a component of its mandate to protect the public good significantly boosted allopathic physicians. Since allopaths dominated the board, they gained significant prestige and reinforcement for their claim that they alone were capable of dispensing medical care. Members of the state society actively opposed efforts to separate medical exmination from public health supervision. They feared that defining these duties separately would reduce allopathy to just another school of medical practice and might proscribe their attempts to achieve a monopoly over the public definition of legitimate medical care.57

With the Dent decision and their ability to maintain control over the State Board of Health, educated, allopathic physicians celebrated a critical victory in the struggle to protect and elevate their status. The allopaths who controlled the medical society and the Board of Public Health were secure in their ability to deny legitimacy to traditional and sectarian competitors. This success, made possible by the alliance of private physicians, organized medicine, and the government, completed the process begun during the late nineteenth century when educated physicians began streaming into West Virginia seeking to profit from the economic boom.

The arrival of large-scale industrializing forces in West Virginia in the late nineteenth century prompted a transformation of the state's medical system. Physicians, educated in clinical programs and trained in allopathic procedures, moved into Appalachia as investors opened the region to development. Like many of the capitalists who invaded the mountains seeking marketable resources, these physicians believed that they were bringing progress to a retarded region too long isolated from the modern world.58

To protect their professional standards and to prevent unqualified practitioners from preying upon the community, West Virginia's doctors emulated their colleagues at the national level and organized state and, eventually, local medical societies. In the early stages, these associations were quite fragile and doctors were challenged to recruit and maintain membership from the often isolated physicians who served the coal camps.59

While the medical associations struggled to gain legitimacy, doctors also reached out to form an important alliance with government. At both local and state government levels, academically trained physicians encouraged the state to take an active role in the regulation of medicine. They insisted that the government satisfy its duties as protector of the public good and prevent substandard healers from endangering the health of the state's citizens.

Through their association with the capitalists who acquired control of many of the region's resources, the promotion of their own professional societies, and their affiliation with the government, allopaths succeeded in creating powerful networks that elevated their professional model while denigrating other medical philosophies. These nascent alliances did not mature until the first decades of the twentieth century, but nineteenth-century physicians laid important groundwork for the creation of institutions and associations that shaped both the definition as well as the delivery of medical care in West Virginia throughout the twentieth century.


Notes

1. The best recent scholarship on the region has been collected in Mary Beth Pudup, Dwight E. Billings, and Altina L. Waller, Appalachia in the Making: The Mountain South in the Nineteenth Century (Chapel Hill: Univ. of North Carolina Press, 1995).

2. Ronald L. Lewis, "Railroads, Deforestation, and the Transformation of Agriculture in the West Virginia Back Counties, 1880-1920," in ibid., 303.

3. John Hennen, The Americanization of West Virginia (Lexington: Univ. Press of Kentucky, 1996).

4. Claude Frazier with F. K. Brown, Miners and Medicine: West Virginia Memories (Norman: Univ. of Oklahoma Pres, 1992), 59.

5. Sarah Stage, Female Complaints: Lydia Pinkham and the Business of Women's Medicine (New York: W. W. Norton, 1979), 27 and Leonard W. Roberts, Up Cutshin and Down Greasy: Folkways of a Kentucky Mountain Family (Lexington: Univ. Press of Kentucky, 1959), 96.

6. "State vs. Ragland," in West Virginia Board of Health, Biennial Report, 1887-88 (Charleston: Moses W. Donnally, 1888), 65-68.

7. Emma Bell Miles, The Spirit of the Mountains (Knoxville: Univ. of Tennessee Press, 1975), 24; Roberts, Up Cutshin and Down Greasy, 95; and Laurel Shackelford and Bill Weinberg, eds., Our Appalachia: An Oral History (Lexington: Univ. Press of Kentucky, 1988), 127.

8. Edward Van Liere and Gideon Dodd, History of Medical Education in West Virginia (Morgantown: West Virginia Univ. Library, 1965), 18.

9. Susan Ritchie, "A Comparison of Infant Mortality in Logan County, West Virginia in 1872 and 1910," unpublished paper in possession of the author.

10. "The Early Physicians of Sandy River District," Claude Frazier Collection, Eastern Regional Coal Archives, Craft Memorial Library, Bluefield, WV, hereafter referred to as Frazier Coll., ERCA.

11. Ibid.

12. Ibid.

13. Frazier, Miners and Medicine, 64.

14. Ritchie, "A Comparison of Infant Mortality in Logan County."

15. Carolyn Clay Turner and Carolyn Hay Traum, John C. C. Mayo: Cumberland Capitalist (Pikeville: Pikeville College Press, 1983), 32-33.

16. Department of Commerce, Bureau of the Census, Thirteenth Census of the United States, 1910, vol. 3: Population (Washington, D. C.: GPO, 1913), 1018-24, hereafter referred to as 1910 Census, vol. 3.

17. West Virginia Department of Mines, Annual Report, 1910 (Charleston: News Mail Company, 1911), 306.

18. Ibid., 334-35.

19. Stuart McGehee, "Sawbones: The Company Doctor Gets His Due," Coal People (August 1990): 11.

20. Frazier, Miners and Medicine, 65.

21. "The Early Physicians of the Sandy River District," Frazier Coll., ERCA.

22. Department of the Interior, Census Office, Report on Population of the United States at the Eleventh Census: 1890, vol. 2, pt. 2 (Washington, D.C.: GPO, 1897), 337, hereafter referred to as 1890 Census.

23. Ibid., 337; U.S. Census Office, Twelfth Census of the United States, 1900, vol. 2, part 2: Population (Washington, D.C.: GPO, 1902), 541, hereafter referred to as 1900 Census; and Department of Commerce, Bureau of the Census, Thirteenth Census of the United States, 1910, vol. 4: Population, Occupation Statistics (Washington, D.C.: GPO, 1914), 151, hereafter referred to as 1910 Census, vol. 4.

24. 1890 Census, 337; 1900 Census, 541; 1910 Census, vol. 3, 1012, 1018, 1020 and vol. 4, 151; and Board of Health, Report of the Secretary, 1881-83 (Wheeling: Moses Donnally, 1884), 94-102, Biennial Report, 1889-90 (Charleston: Moses Donnally, 1890), 31-36, and Biennial Report, 1908-09 (Charleston: News Mail Company, 1909), 21-30.

25. Board of Health, Biennial Report, 1889-90, 31-36 and 1910 Census, vol. 3, 1018, 1020.

26. Board of Health, Biennial Report, 1889-90, 31-36 and 1910 Census, vol. 3, 1018, 1020.

27. Board of Health, Report of the Secretary, 1881-83, 94-102, Biennial Report, 1889-90, 31-36, and Biennial Report, 1908-09, 21-30.

28. Board of Health, Biennial Report, 1889-90, 31-36 and Biennial Report, 1908-09, 21-30; and 1910 Census, vol. 3, 1018, 1020.

29. "The Early Physicians of the Sandy River District," Frazier Coll., ERCA.

30. Ibid.

31. Stuart McGehee, "A Century of Care: A History of Bluefield Regional Medical Center, Bluefield Community Hospital, Bluefield Sanitarium," unpublished manuscript, ERCA.

32. Ibid.

33. "Hospitalization Facilities of the Region," Bluefield Daily Telegraph, Semi-Centennial Anniversary Edition, 14 Decembe 1939.

34. McGehee, "A Century of Care," ERCA.

35. Van Liere and Dodd, History of Medical Education in West Virginia, 17-18; Board of Health, Biennial Report, 1887-88, 59 and Biennial Report, 1891-92, 54.

36. Board of Health, Report of the Secretary, 1881-83, 89-90 and Biennial Report and Report of Vital and Mortuary Statistics, 1903-04 (Charleston: Tribune Printing Company, 1904), 53-54.

37. Board of Health, Biennial Report and Report of Vital and Mortuary Statistics, 1903-04, 53-54.

38. Board of Health, Biennial Report and Report of Vital and Mortuary Statistics, 1898-99 (Charleston: Tribune Company, 1901), 160-63.

39. Board of Health, Biennial Report and Report of Vital and Mortuary Statistics, 1903-04, 53-54.

40. Board of Health, Biennial Report and Report of Vital and Mortuary Statistics, 1898-99, 160-63.

41. "The Early Physicians of the Sandy River District," Frazier Coll., ERCA.

42. Cathy Melvin Efird, "A Geography of Lay Midwifery in Appalachian North Carolina: 1925-1950" (Ph.D. diss., University of North Carolina, 1985), 6.

43. "The Early Physicians of the Sandy River District," Frazier Coll., ERCA.

44. Crandall Shifflet, Coal Towns: Life, Work, and Culture in Company Towns of Southern Appalachia, 1880-1960 (Knoxville: Univ. of Tennessee Press, 1991), 23.

45. Mary Kegley, Wythe County, Virginia: A Bicentennial History (Salem, WV: Don Mills, Inc., 1989), 105.

46. Henry D. Hatfield to Walter S. Hallanan, 15 June 1929, Henry D. Hatfield Papers, West Virginia and Regional History Collection, West Virginia University, Morgantown.

47. Rebecca Bailey, "Liberty and License: The Ascendance to Power of the Investors of the Williamson-Thacker Coalfield," unpublished paper in possession of the author.

48. Richard Shryock, Medicine and Society in America: 1660-1860 (Ithaca: Cornell Univ. Press, 1960), 148-49.

49. Ronald L. Numbers and John Harley Warner, "The Maturation of American Medical Science," in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. by Judith Walzer Leavitt and Ronald L. Numbers (Madison: Univ. of Wisconsin Press, 1985), 116-17.

50. Homeopaths, building on the teachings of German doctor Samuel Hahnemann, insisted that sickness could be cured by the administration of minute quantities of substances that actually provoked the offensive symptom from the patient. "Like cures like," a phrase often used to describe homeopathic medicine, reflected the belief that the body would heal itself if forced to respond to external stimuli. Chiropractors and their osteopathic predecessors insisted that illness rested in the maladjustment of bones and relied on manual alignment to remedy disease. Charles Rosenberg, "The Therapeutic Revolution: Medicine, Meaning, and Social Change in 19th Century America," in Sickness and Health in America, 100; Martin Kaufman, Homeopathy in America: The Rise and Fall of a Medical Heresy (Baltimore: Johns Hopkins Univ. Press, 1971), 7; and Norman Gevitz, The D. O.s: Osteopathic Medicine in America (Baltimore: Johns Hopkins Univ. Press, 1982), 12.

51. Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 90-91.

52. Transactions of the Medical Society of the State of West Virginia, Instituted April 10, 1867, Together with the Code of Ethics, Constitutions, and Bylaws (Wheeling: Frew, Hagans, and Hall, 1868), 8-9.

53. Ibid., 9.

54. C. H. Maxwell, "Pennsylvania and West Virginia Medical Associations--A Comparison," West Virginia Medical Journal (October 1907): 106.

55. Ibid., 107.

56. William W. Golden, "The Evolution of Medical Legislation in West Virginia," West Virginia Medical Journal (April 1918): 362; Virginia State Medical Examining Board, "Minutes of Board From Organization in 1884, Together with Results of Examinations from 1884 to December 16-18 1902," 14 April 1899, Virginia StateMedical Examining Board Records Collection, Library of Virginia, Richmond; and Dent vs. West Virginia, United States Reports, Cases Adjudicated in the Supreme Court at October Term, 1888, Vol. 3 (New York: J. C. Bancroft Davis Banks Law Publishing Co., 1904), 114.

57. Golden, "The Evolution of Medical Legislation in West Virginia," 362.

58. Numbers and Warner, "The Maturation of American Medical Science," 116-17 and Rosenberg, "The Therapeutic Revolution," 100.

59. Maxwell, "Pennsylvania and West Virginia Medical Associations," 106.


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