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Kentucky Folk Medicine Today
By: Dr. Erika Brady
A Cure for Every Ill: Kentucky Folk Medicine Today
An exasperated schoolteacher in Louisville sends a fifth-grader to the water fountain down the hall to cure his hiccups-"hold your breath and take ten swallows of water!" A Pennyrile farmer, wrist smarting from a fresh bee-sting, treats it on the scene with a poultice of spittle and tobacco. Guests attending a baby shower in Paducah cluster around the expectant mother, as she suspends her wedding ring on a thread over her swollen belly-if the ring moves back and forth in a straight line, tradition claims the child will be a boy; if it circles, a girl.
Despite a negative prognosis extending back over two hundred years, vital signs indicate that folk medicine is alive and well in the Commonwealth-and indeed, throughout the US. It comprises the sum of practices and attitudes pertaining to health that have been shared informally over time within a community, family, or region. These practices and attitudes are not institutionalized or protected from change, and both reflect and respond to the fears, needs, and beliefs of the group. Although biomedical research has vindicated the efficacy of many folk medical practices, they derive their authority not from institutional approval, but from their time-honored familiarity, their conformity to familiar attitudes toward suffering and relief, and their association with individuals in the family and community who are understood to be personally accountable as well as knowledgeable: for most of us, our first experience with a folk medical practitioner is "Dr. Mom." In some respects, the current popularity of as-yet unproven or unprovable "alternative" or "complementary" health practices may be regarded as a market-driven global appropriation of health belief practices often originating in the folk tradition.
Stereotypes associated with folk medicine are dominated by the image of backwoods grannies, and assume that its practice is rare and diminishing, surviving only among the ignorant and uneducated or where formal medicine is unavailable. But nonconventional treatment is hardly rare: recent studies suggest that as many as 90% of the health-related actions taken by people in North America who are self-defined as sick are not connected with formal, "official" medical practice. An article appearing in the 1993 New England Journal of Medicine estimated that out-of-pocket expenses made by patients for nonconventional treatment totaled 25 billion dollars more than out-of-pocket payments for hospitalizations during the same period. Nor is level of education necessarily a determining factor. Statistics indicate that middle class, college-educated individuals are more likely to try alternatives to official treatment-most often along side of, rather than in place of, conventional biomedical care.
Folk medical beliefs, while not always "true" or "correct," most often are based on a reasoned observation of symptoms, consistent diagnosis, and application of treatment-experiential data gathered and shared in communities for generations, sometimes millennia. Tradition-based practices in ancient Babylon and Egypt found in manuscripts more than five thousand years old prescribe herbs such as dill and mint for indigestion, both of which are still treatments of choice in rural Kentucky. Estimates vary, but between 24% and 30% of botanical substances used in the context of folk medicine worldwide have been demonstrated to have clear pharmaceutical efficacy. A much higher percentage may be effective, but defy the rigorous laboratory testing procedures required by the Food and Drug Administration for validation.
Folk medicine is sometimes assumed to be "merely" a random catch-all for a community's beliefs-a projection of the universal desire for control over health and disease in which wishful thinking is the active agent. But even the official form for treatment recognized in the US today-so-called "allopathic" medicine-reflects cultural expectations, norms, and beliefs. In this system, the practitioner aggressively works to reverse physical symptoms by eradicating their physical source, a process which fits neatly with Americans' attraction to direct action, heroic measures, and ingenious practical problem solving. No less an authority than the most recent edition of the Merck Manual of Diagnosis and Therapy observes that "contemporary biomedicine is a highly refined form of folk medicine. It is the traditional practice in the industrialized Western countries, carries tremendous emotional and intellectual weight, and is based on empiric observation."
Kentucky folk medicine has its roots in the European settlement of the region in the late eighteenth and nineteenth centuries. Despite the image of backwardness that clings to the Kentucky frontier, the state can boast a rather remarkable history in the annals of official medicine: a medical school was established in Lexington as early as 1799, and in 1809 the remarkable Danville physician Ephraim McDowell performed the world's first documented ovariotomy on the equally remarkable Jane Todd Crawford-without benefit of anesthesia. Nevertheless, physicians remained relatively rare in the region, and indeed, were not necessarily the practitioners of choice even in areas where they practiced. The nineteenth century was the high point of medical sectarianism in the US, and the fearsome methods of allopathic physicians of the period (succinctly described by contemporary pundits as "puke 'em, purge 'em, bleed 'em, sweat 'em) led many to seek help elsewhere, from a number of different rival schools of medical practice whose influence survives anonymously in Kentucky folk medicine today.
The Kentucky Shakers, for example, were much impressed with the methods of Thomsonian medicine, a kind of self-help school in which acquisition of Samuel Thomson's New Guide to Health of Botanic Family Physician (1822) entitled one to practice a form of health maintenance base on bodily cleansing inside and out, using herbs as well as steam baths and other forms of hydrotherapy. The Shakers grew and marketed medicinal plants, seeds, and extracts extensively both in and out of the state, influencing local practice by reinforcing the practice of keeping a medicinal garden, and by extending the range of plants included in these homely utilitarian patches. The prevalence of mineral springs throughout the state, and their commercial exploitation as hydrotherapeutic resorts such as those found at Dawson Springs, Chalybeate, and many other locations guaranteed that the principles, if not the name, of Thomsonianism would survive into the late twentieth century: many of these springs, though no longer popular as spas, provide water still used as a cleansing tonic by some. Other medical sects besides Thomsonianism, such as homeopathy, a system of healing based on a theory that "like cures like," competed with allopathic practice on the Kentucky frontier.
But perhaps the most pervasive and persistent influence on Kentucky folk medicine was not derived from an organized school or theory of care, but was rather the accumulated knowledge of generations of ordinary men and women: English, Scots, and Irish settlers whose families had brought with them plants unfamiliar to the New World as a safeguard from the medical dangers they would face. Dandelion, chickweed, comfrey, plantain (called by the natives "the white man's footprint") all arrived in Kentucky with the early European settlers as part of their family pharmacopoeia. In addition to this ancient European tradition, colonists on the Eastern seaboard and settlers on the Kentucky frontier found new plants whose medicinal uses they learned through the generosity of American Indian practitioners, whose health and hygiene many contemporary observers considered to be superior to that of whites. Herbs such as Seneca snake root, black cohosh, bloodroot, and sassafras joined chamomile, peppermint, sage, and balm in the treatment of Kentucky ills.
The immensely popular publication Domestic Medicine, written by Knoxville physician John Gunn and published in 1830, demonstrates the extent to which herbal practice in the upper South had become a combination of Native American and European practice by that time. An allopathic physician by training, Gunn zestfully describes the ease with which anyone with the right tools could undertake a home amputation-but he also recognized the utility of the home herb garden of the Tennessee / Kentucky frontier, and includes a description of more than fifty native and introduced herbs then in medicinal use. It is said that in the rural Kentucky of the nineteenth century, a household might own three books: a Bible, perhaps a hymnal or almanac, and Gunn's Domestic Medicine. It is not uncommon, even today, to find rural Kentucky families that cherish a battered early edition of this influential work, margins, and end papers scribbled with notes chronicling the family's medical successes and failures over generations.
Two of the herbs discussed by Gunn represent especially revealing insights into the origins and persistence of Kentucky folk medicine. Both tobacco and sassafras are presently in deep disrepute with the medical establishment. Since the early 1960s, FDA regulations have forbidden the sale of sassafras root bark for the purpose of ingestion, laboratory tests having determined that the plant contains the chemical safrole, which in concentration is carcinogenic in laboratory animals. The connection between tobacco and lung cancer has been the source of contention in public policy for several decades now. Yet both these plants inspired passionate enthusiasm on the part of early European explorers who found them in extensive use among Americans.
John Frampton's immensely popular 1596 translation of Spanish botanist Nicolas Monardes' work, titled in English Joyfull newes out of the new-found world [sic], reported of sassafras that among Spanish soldiers "...it did in them great effectes, that it is almost incredible: for with the naughtiye [rotten] meates and drinkyng of the rawe waters, and sleeping in the dewes, the moste parte of them came to fall in continuall Auges..." Native American herbal healing practice, with its emphasis on sweating and tonics for the well-being of the whole body, was simplified by Europeans to conform with the ancient Greek concept of the balance of the four major fluids or "humors" of the body. Adopted within this system, sassafras was understood to be a blood cleanser and toner.
It was the supposed effect of sassafras as a blood cleanser that first interested the Europeans. The medical scourge of the sixteenth and seventeenth centuries was syphilis, which was commonly supposed to be a contamination of the blood. If sassafras root could indeed purge the blood of its poisons, it would make the fortunes of those who imported it to the cities of Europe. The settlers of Jamestown for a time neglected their subsistence crops and endangered their survival by their frantic harvesting of sassafras for export from the woods of Virginia. Unfortunately, sassafras did not cure syphilis; what is more, its early if inaccurate association with a sexually transmitted disease ruined its chances in Europe as a fashionable social drink, a successor to chocolate as the latest New World fad.
But settlers in North America maintained their faith in the plant, not as a cure for syphilis but rather as a favored seasonal regulator of the blood thickness as part of what medical anthropologist Anthony Cavender has termed "folk hematology." In his Domestic Medicine, John Gunn asserted that a description of sassafras was unnecessary, it being in such common use as a blood purifier by the people of Kentucky and Tennessee. Despite the FDA ban, sassafras is still in extensive use as a late-winter tea in Kentucky, and can be found sold in small packets at that time of year in the produce sections of many rural and small-town groceries. (Its dangers remain a source of controversy-the prominent ethnobotanist James Duke claims that the carcinogenic properties of the safrole found in a cup of sassafras tea are about 1/14 of those found in eight ounces of beer.) The largest known sassafras tree in the world flourishes in the Kentucky city of Owensboro.
Failing to develop a successful European market for sassafras, early settlers turned to another plant highly recommended by the natives-tobacco. Unlike sassafras, whose use by the Indians was relatively practical, the use of tobacco had strong spiritual overtones: it is still a component in Native American ritual practice. As such, it was both attractive and suspect among Europeans. Monardes describes how a native practitioner "tooke certayne leaves of the Tobaco and cast them into ye fire and di receive the smoke of them in his mouth and nose with a Cane, and in taking of it he fell downe uppon the ground as a Dead man, and remayning so according to the quantity of the smoke he had taken, when the herbe had done his woorke he did revive and awake, and gave them aunsweares according to the visions, and illusions whiche he sawe, whiles he was rapte in the same maner, and he did interprete to them as to him seemed best, or as the Divell had counselled him..." In his 1830 work, John Gunn devoted an unusual amount of space to the medical properties of tobacco, including the poultice practiced to this day for skin irritations such as insect stings, but cautioned "it can scarcely be necessary to advise my reader that the tobacco plant is an active and powerful medicine, and dangerous when used to injudicious excess." The ambivalence toward what can only be termed the "moral" implications of tobacco use remains a potent issue in national health policy and Kentucky economics today.
Few plants and practices in traditional use have drawn such vigorous fire. Until recently, the medical establishments simply assumed that, as the effectiveness of biomedical practice increased, other competing forms of treatment would die out, and the official attitude toward most such forms was dismissive rather than actively hostile. Yet with the increasing specialization and sophistication of biomedicine has come the recognition that techno-medicine leaves something out of the healing process. Perhaps, as many Kentucky herbal practitioners argue, the healing properties of plants cannot always be isolated and identified in the laboratory-or perhaps their healing properties lie in their powerful association with the family, community, and the land, a symbolic triumvirate especially dear to Kentuckians, whose attachment to tradition is legendary.
Erika Brady is an associate professor of folk studies at Western Kentucky University. She holds an adjunct professorship in family practice and community medicine with the University of South Alabama College of Medicine, and conducts regular preceptorships for medical residents on rural rotation from the University of Louisville.
