EWM
concept 117 sources

Race and Medicine

western-medicine american-medicine public-health
Eras colonial, early-nineteenth-century, late-nineteenth-century, early-twentieth-century, twentieth-century, contemporary
First appearance colonial era (17th century)

Race and Medicine

Summary

The relationship between race and medicine in the Western tradition, and particularly in American medicine, is not a story of individual prejudice occasionally intruding into an otherwise neutral discipline. It is a structural history in which racial categories were constructed, maintained, and deployed through medical institutions, medical science provided the vocabulary that rationalized racial hierarchy, and Black bodies served as the primary material through which American medical training, experimentation, and professional advancement were built. James Marion Sims, celebrated as the “father of modern gynecology,” conducted exquisitely painful vaginal surgeries on enslaved women without anesthesia for years before performing the same procedures on white women.(Washington, Harriet A., 2006) Washington’s Medical Apartheid (2006) documents this history from the colonial period through the present, demonstrating that the Tuskegee Syphilis Study was not an aberration but one episode in a continuous institutional pattern. The consequences of this history are measurable in the present: African American infant mortality remains twice that of white infants, life expectancy falls years behind, and medical distrust rooted in documented abuse continues to reduce Black participation in clinical research even when participation would be beneficial.(Washington, Harriet A., 2006)

The Slave Economy and the Medical Economy

Medicine as Infrastructure of Enslavement

Enslavement depended on medicine, and medicine depended on enslavement. Physicians derived most of their income from treating slaves, but the medical interests of the enslaved person were often diametrically opposed to those of the owner and the physician.(Washington, Harriet A., 2006) The owner-physician relationship eclipsed the patient-physician relationship: the planter, not the slave, was the patient in every important sense, giving or withholding consent for procedures from sterilization to amputation to autopsy.(Washington, Harriet A., 2006)

The antebellum medical toolkit was itself dangerous. Heroic remedies including arsenic, mercury, calomel, copious bloodletting, and violent purges were hazardous to all patients, but they were applied even more aggressively to slaves, contributing to their higher death rates.(Washington, Harriet A., 2006) Planters routinely accused sick slaves of malingering, delayed calling physicians to save money, and sometimes employed medical violence to expose supposed frauds: one physician wrote his master’s thesis on the fraudulent illnesses of slaves and advocated corrosive chemical overdoses as a diagnostic tool.(Washington, Harriet A., 2006)

Physicians in an 1847 Alabama state medical convention recommended taking liens on enslaved persons if medical bills were unpaid; slave-owning physicians also bought slaves specifically for conducting experiments too painful or risky to perform on whites.(Washington, Harriet A., 2006)

Black Healing Traditions

African healers, enslaved or free, practiced an African healing tradition incorporating herbal knowledge, spiritual elements, and midwifery that was sufficiently effective that white women often preferred them to Western practitioners. Black healers first employed citrus juice for scurvy and inoculation for smallpox and other viral illnesses; midwives used African techniques and medicines so successfully that many white women called on them to attend births.(Washington, Harriet A., 2006) In 1721, an enslaved African named Onesimus taught Cotton Mather the African technique of smallpox inoculation, which reduced mortality in Boston from 14 percent to under 2 percent — a technique already in widespread use in Africa long before Western medicine adopted it.(Washington, Harriet A., 2006) In 1751, an enslaved South Carolina doctor named Cesar developed an effective snakebite antidote, was granted his freedom and an annual pension of one hundred pounds by the South Carolina General Assembly, and his recipe was published as a public service.(Washington, Harriet A., 2006) Slaves avoided Western medicine by denying illness, hiding medications, and concealing children’s sickness, correctly identifying that their owners’ primary interest was fitness for work, not welfare.(Washington, Harriet A., 2006) The respectful ritual treatment of the dead was spiritually central to African-based healing traditions — the ancestors’ intercession was considered essential to health — and slaves reviled Western medicine partly because physicians appropriated Black bodies for display and dissection after death.(Washington, Harriet A., 2006)

Fett documents that the chattel principle, articulated by James W. C. Pennington in 1849, permeated every dimension of slave health, casting the shadow of the marketplace over birth, sickness, and death.(Fett, Sharla M., 2002) Enslaved African Americans recognized the reduction of their lives to property and indicted it through oral traditions that compared their treatment to that of domestic animals; freedwoman Jenny Proctor recalled the white preacher who told his enslaved audience, “You just like the hogs and other animals — when you dies you ain’t no more.”(Fett, Sharla M., 2002) Fett’s research on conjure traces a parallel African American critique of white medicine.(Fett, Sharla M., 2002)(Fett, Sharla M., 2002) Stories about castor oil made from Black bones, white “cannibals,” and collected slave skeletons had antecedents in the fears of captive Africans on Portuguese and English slaving voyages, who suspected Europeans intended to consume them; the persistence of these stories in the South distilled what Fett describes as a “penetrating critique of a society that consumed black men and women for their skills and labor, only to exploit their bodies once again in death.”(Fett, Sharla M., 2002) White slaveholders feared the inverse possibility: that enslaved healers would use their botanical knowledge to poison white households, and a thin and unstable line was drawn between medicine and poison whenever a Black practitioner held the bottle.(Fett, Sharla M., 2002)

American Gynecology and the Founding Slave Hospital

The first women’s hospital in the United States was housed on a small slave farm in Mount Meigs, Alabama, where between 1844 and 1849 J. Marion Sims operated on Anarcha, Betsy, Lucy, and roughly nine other unidentified enslaved women.(Cooper Owens, Deirdre, 2017) Cooper Owens argues that these enslaved patients were the rightful “mothers” of American gynecology, a counter to the standard designation of Sims as “father”; they also served as his surgical nurses once his white medical apprentices quit, and during their five years on his farm they came to know more about the repair of obstetric fistulae than most American physicians.(Cooper Owens, Deirdre, 2017) After Congress banned the importation of African-born slaves in 1808, U.S. slaveholders’ interest in increasing slave births domestically expanded reproductive medicine alongside slavery, integrating the rising profitability of a slave-based nation with the rapid development of gynecology as a discipline.(Cooper Owens, Deirdre, 2017) Reproductive medicine thereby became essential to the maintenance of southern slavery itself: each enslaved woman sold was medically examined so she could be priced, and gynecological assessments shaped the antebellum slave market.(Cooper Owens, Deirdre, 2017)

Sims’s first three vesicovaginal fistula patients were Anarcha, a seventeen-year-old whose fistula had developed during her protracted labor under Sims’s own care, plus Betsy and Lucy, leased from their owners; he experimented on them for years without anesthesia before performing the perfected procedure on white women under chloroform.(Cooper Owens, Deirdre, 2017) Cooper Owens argues that the gynecological surgeons of the early and mid-nineteenth century “were not exceptionally cruel or sadistic” individuals; they were elite white men working within a culture of scientific racism in which ideas about Black inferiority were widely held, and enslaved women were a vulnerable population available because of the easy access slavery provided to their bodies.(Cooper Owens, Deirdre, 2017) The Campbell brothers of Augusta edited the Deep South’s first medical journal while running an exclusively slave hospital, integrating slavery with medical publishing in ways that linked individual experimental careers to regional and national professional infrastructures.(Cooper Owens, Deirdre, 2017)

The intellectual ground on which these surgeries proceeded was prepared by figures the country still venerates. Benjamin Rush, considered the Father of American Medicine, taught medical students that blackness was a genetic pathology and a form of leprosy.(Cooper Owens, Deirdre, 2017) Thomas Jefferson, in Notes on the State of Virginia, advanced the racial-science claim that African women preferred orangutans as sexual partners over men of their own species — a claim Jefferson stated in matter-of-fact language and treated as observable fact.(Cooper Owens, Deirdre, 2017) British surgeon James Johnson, reviewing Ephraim McDowell’s ovariotomies on enslaved women, dismissed the procedures by writing that “negresses” would “bear cutting with nearly, if not quite, as much impunity as dogs and rabbits.”(Cooper Owens, Deirdre, 2017) Dr. John Archer in 1810 claimed that the clitorises of Black girls developed earlier and grew larger than those of white girls because they sat unattended in the fields while their enslaved mothers worked.(Cooper Owens, Deirdre, 2017) Doctors pathologized normal Black diet and behavior, identifying clay or dirt eating as a disease called cachexia Africana and framing blackness itself as a vector of disease.(Cooper Owens, Deirdre, 2017)

The Medical Superbody

Cooper Owens names the contradiction at the center of antebellum gynecological practice the “medical superbody”: white doctors held that enslaved Black women were simultaneously physically superior to white women — more fertile, more impervious to pain, sturdier in labor — and biologically inferior to them. The two halves of that contradiction were not in tension for the physicians who held them; together they justified treating Black women as fit-to-suffer experimental subjects whose suffering required no medical accommodation.(Cooper Owens, Deirdre, 2017) Some southern physicians invoked the “Hamitic curse” as scriptural support for the claim that Black women escaped the pains of childbirth, a doctrine compatible with polygenism that placed Black women outside Eve’s lineage and thus outside the scope of ordinary womanhood.(Cooper Owens, Deirdre, 2017) Cooper Owens argues that surgical practice itself should have refuted the racial science underwriting it: doctors used identical operations on Black and white women’s anatomies, demonstrating they were the same, but the magnitude of their racial ideology was sufficient to obscure what their own hands were showing them.(Cooper Owens, Deirdre, 2017)

The practice of examining enslaved women’s naked bodies, breasts, and genitalia openly — while according white women the privacy of remaining clothed during examinations except in emergencies — proceeded on the assumption that Black women were immodest about bodily display. The medical gaze that operated on Black female patients was structured differently from the medical gaze that operated on white ones.(Cooper Owens, Deirdre, 2017) Although medicine and law were both sites where, in Cooper Owens’s phrase, “race was made,” U.S. medical discourse was sometimes capacious enough to recognize enslaved women’s rape when the law was not: physicians could pathologize sexual violation in ways courts refused, but the recognition cut both ways, since medicalization also produced articles about cases that never reached prosecution.(Cooper Owens, Deirdre, 2017) An 1859 Mississippi court ruling declared explicitly that “the crime of rape does not exist in this State between African slaves,” reducing the violation of an enslaved woman to a “mere assault and battery.”(Cooper Owens, Deirdre, 2017) Louis Agassiz commissioned daguerreotypes of an enslaved South Carolinian named Drana, photographed frontally and from the side with breasts bared, to support his polygenist theory that the races did not share a common ancestor; the medical and natural-history archive accumulated images of Black women’s bodies in service of arguments those women could not contest.(Cooper Owens, Deirdre, 2017)

The Living Legacy of the Superbody

Cooper Owens argues that the antebellum framing of Black women as medical superbodies impervious to pain remains alive in twenty-first-century medicine. She recounts undergoing two cervical dilations in 2015 during in vitro fertilization without anesthesia or a numbing shot, her physician describing the expected pain as mere “cramping”; she frames her own gynecological experience as continuous with the legacy she had spent her career documenting.(Cooper Owens, Deirdre, 2017) Her work as a historian, she writes, taught her that the legacies from the nineteenth century are always present in the lives of Americans, and contemporary studies show that Black women experience chronic pain at higher rates than other Americans while having less access to pain-relief medication.(Cooper Owens, Deirdre, 2017) When she sat in the fertility clinic, all of the doctors were white and the nurses and ancillary staff were women of color; her bloodwork was sent to laboratories for genetic testing sorted by “racial group.” Academics had long declared race a social construct, but doctors continued to treat her blackness as biological.(Cooper Owens, Deirdre, 2017)

Caribbean Antecedents

The medical-racial categorization that operated on antebellum plantations had a longer history in the Atlantic world. Throughout the seventeenth century, Caribbean cities and their hinterlands were predominantly Black spaces; Africans and their descendants composed more than three-quarters of the population, and Spanish America was second only to Brazil in the number of forced immigrants it received during the early modern era.(Gómez, Pablo F., 2017) Gómez identifies 102 ritual practitioners of African descent in surviving Spanish Caribbean documents; more than half were criollos born in the New World, with the next-largest groups born in Upper Guinea and West Central Africa.(Gómez, Pablo F., 2017) These practitioners — mohanes, yerbateros, brujos, curanderos — operated alongside and frequently in competition with Galenic physicians; Domingo Congo told the Inquisition in 1658 that the reason for his imprisonment was straightforward: “The doctors of Caracas are my enemies because I heal the sick people they leave as incurable.”(Gómez, Pablo F., 2017) In Cartagena before the Inquisition’s institutional arrival, civil authorities had clubbed and hanged three enslaved Black women — Guiomar and two named Catalina — along with an enslaved man named Bartolomé in 1565, burning their bodies on the city’s beaches in what was likely the first witchcraft trial in the New Kingdom of Granada.(Gómez, Pablo F., 2017)

The racial logic was not applied uniformly. In 1627 the Portuguese physician Juan Méndez Nieto recorded that the archbishop of the New Kingdom of Granada, treated “without much benefit” by Francisco Díaz and other physicians, turned to Mohanes and female healers, who placed his arm “all day long” inside a freshly killed bull until it cooled.(Gómez, Pablo F., 2017) The archbishop’s choice illustrates a persistent feature of early-modern Caribbean colonial medicine: elite patients, including clerics, sought out Black and Indigenous healers when licensed physicians failed. The racial hierarchy structuring the protomedicato’s licensing regime did not prevent elite patients from going outside it.

The differential treatment of Black practitioners in the legal and administrative apparatus is visible in two contrasting moments. In a 1663 altercation in El Cayo, a surgeon named Francisco de Trujillo slapped the mulato healer Domingo de La Ascención after Domingo questioned his use of cardenillo plaster on an already-healed wound; de Trujillo cried that Domingo was “a dog that went around curing without knowing how to read or write” and threatened to report him to the Inquisition.(Gómez, Pablo F., 2017) The assault was not simply personal: de Trujillo was invoking the authority of literacy and formal credentials against the authority of experiential observation, and enforcing the hierarchy physically when it was challenged.

The same racial differential that left Black practitioners exposed to assault also left them exposed to torture — except when their reputations gave them a kind of protection. Spanish authorities declined to torture Francisco José Arará after two successive executioners in Cartagena died within days of each other with signs of poisoning; the governor attributed the deaths to the Black practitioners involved in the 1693 conspiracy being “brujos … perverse in their customs.”(Gómez, Pablo F., 2017) Whether or not there was any causal relationship between the Arará network and the executioners’ deaths, the episode shows that the colonial state’s willingness to administer torture was constrained by its own belief in the power it was trying to suppress.

The European saludador parallel illuminates the racial specificity of this differential. Saludadores in Spain claimed God-given powers structurally similar to those Black Caribbean Mohanes claimed: driving away storms, walking on red-hot iron, cooling coals on their tongues. They were rarely prosecuted, because the protomedicato explained their power through Aristotelian-Galenic humoral theory as flowing from their natural complexion.(Gómez, Pablo F., 2017) Black Caribbean practitioners who claimed comparable gifts were instead treated as evidence of diabolical influence. The same behavior, the same claim to God-given healing power, produced different legal and social outcomes based on who was making it.

The medical-racial apparatus that the antebellum United States would inherit was thus built on a much older Atlantic foundation: a colonial system in which Black ritual practitioners’ authority and Black bodies’ availability were both objects of European management.

Scientific Racism and the Medical Construction of Racial Difference

The Fabrication of Racial Biology

Nineteenth-century American racial theory, whether classified as “liberal” or “conservative,” consistently perpetuated the theme of permanent racial inferiority.(Haller, 1971) Science provided the vocabulary and conceptual framework that rationalized racial inferiority and justified disfranchisement and segregation, making racial prejudice appear as scientific certainty.(Haller, 1971)

Samuel Cartwright invented fictional “black diseases” whose principal symptoms were resistance to slavery, including drapetomania (the urge to flee), and recommended forced labor and corporal punishment as treatment.(Washington, Harriet A., 2006) Josiah Nott published his “frail mulatto” theory, asserting that mixed-race people were an infertile, dying-out species, to reassure pro-slavery interests that racial mixing would not eventually erase whiteness.(Washington, Harriet A., 2006) The 1840 U.S. census falsely documented that mental illness was eleven times more common among free northern Black people than among enslaved southern Black people, providing statistical support for the pro-slavery argument that freedom itself caused Black mental deterioration.(Washington, Harriet A., 2006) Dr. Edward Jarvis investigated and found the census to be “a fallacious and self-condemning document,” containing invented insane Black patients in towns with no Black residents.(Washington, Harriet A., 2006) Secretary of State John C. Calhoun used this fraudulent data on U.S. government letterhead to rebuff criticisms of slavery at home and abroad; when Congress pressed for an investigation, Calhoun appointed the census’s original creator to review it, who pronounced it flawless.(Washington, Harriet A., 2006) The American Journal of Insanity in 1851 reprinted without comment an article asserting that “every fourteenth colored person” in Maine was “an idiot or lunatic,” citing data that had already been publicly refuted.(Washington, Harriet A., 2006) Dr. James McCune Smith, an African American physician who earned his M.D. from the University of Glasgow after American schools barred his entry on racial grounds, submitted a forensic demolition of the census methodology to the U.S. Senate in 1844.(Washington, Harriet A., 2006)

The institutional uses of fabricated racial data are illustrated by Dr. Peter Bryce, superintendent of the Alabama Insane Hospital, who diagnosed a former slave’s multi-year mental illness as “Diagnosis: Freedom,” despite his own records showing the patient had been free for only five of the twelve years he had been mentally ill.(Washington, Harriet A., 2006) The PHS’s 1929 syphilis survey in Macon County, Alabama, found a 36 percent syphilis rate, yet 61 percent of those cases were congenital or nonvenereal syphilis, not sexually transmitted — a fact researchers persistently ignored when characterizing Black men as sexually irresponsible.(Washington, Harriet A., 2006)

Taxonomy as Racial Hierarchy

The intellectual infrastructure of medical racism was built on the authority of natural history. In 1735, Carolus Linnaeus’s Systema naturae designated Africans as Homo sapiens afer, theorizing that Black men had evolved along a separate evolutionary track from white men; in Linnaeus’s taxonomy, Homo afer was “ruled by caprice,” while Europeans were “ruled by intelligence.”(Washington, Harriet A., 2006) This classificatory language, dressed in the prestige of scientific nomenclature, underpinned medical and physiological arguments about racial hierarchy for more than a century, providing physicians with a seemingly objective framework for treating Black patients as constitutionally different from and inferior to white ones.

Louis Agassiz, Harvard’s celebrated ethnologist, translated taxonomic hierarchy into a theory of inherent Black sexuality: he interpreted the sexual availability of Black women in the antebellum South as evidence of innate racial character rather than as the predictable consequence of enslavement and the absolute absence of legal protection.(Washington, Harriet A., 2006) Such framings exempted white men from accountability for sexual violence by naturalizing its conditions, and they fed directly into medical theories about Black reproductive physiology that justified surgical experimentation without consent.

Benjamin Rush, revered as the “father of American psychiatry” and a passionate abolitionist, nevertheless believed that black skin was a form of leprosy he termed “Negritude” and sought methods to whiten it, including testing sulfuric acid on Black cadavers.(Washington, Harriet A., 2006) Rush’s fusion of humanitarian impulse with pathologizing science illustrates the structural nature of medical racism: it did not require personal malice to produce dehumanizing knowledge.

The Exhibitionary Complex

Public display and medical inquiry shared a common premise in nineteenth-century America: that Black bodies were objects of legitimate study available for white inspection. The boundary between museum exhibition and clinical demonstration was, as Washington documents, a permeable one.(Washington, Harriet A., 2006)

Saartjie Baartman, a Khoikhoi woman from South Africa known in Europe as the “Hottentot Venus,” was displayed across Britain and France from 1810 as a sexual and physical curiosity. Her body was examined and publicized by scientists including Georges Cuvier, who subjected her to invasive examination during her lifetime and, after her death in 1815, dissected her, preserved her genitalia, and cast her body in plaster for the Paris Musée de l’Homme.(Washington, Harriet A., 2006) Baartman’s case illustrates how popular spectacle and medical science reinforced each other: the exhibition created the public appetite, and the anatomical study gave it scientific legitimacy.

Scientific American described Congo Pygmies as “small, apelike, elfish creatures” who “exhibit many ape-like features,” while the director of the Bronx Zoo told the New York Times that there exists “a close analogy of the African savage to the apes,” conscripting Darwinian language in the service of a racial hierarchy that placed Africans below Europeans on an evolutionary gradient.(Washington, Harriet A., 2006)

The most documented case of human exhibition in American history is that of Ota Benga, a twenty-three-year-old Mbuti man from the Congo who in 1906 was placed in the Bronx Zoo’s monkey house alongside a gorilla and an orangutan, with a placard identifying him as an exhibit. On a single Sunday, 40,000 visitors attended.(Washington, Harriet A., 2006) The New York Times defended the exhibition as educationally valuable for illustrating evolutionary precepts, dismissed Black clergy protests as opposition to science, and characterized formal education as likely “torture” for Benga.(Washington, Harriet A., 2006) P. T. Barnum had earlier displayed Joice Heth, a Black woman he advertised as 161 years old and as George Washington’s former nurse; after her death he arranged a public autopsy before a paying audience, collapsing the boundary between entertainment and anatomy.(Washington, Harriet A., 2006) Ota Benga was eventually released into the custody of a Baptist mission and found work in a Lynchburg tobacco factory, where he was by all accounts a competent worker and a beloved figure among local children. But he spoke often and tearfully of wishing to return to the Congo, and when he realized he could never save enough for passage, his depression deepened. He committed suicide in 1916. The zoo director published an unsympathetic obituary in the Zoological Bulletin, filled with what Washington characterizes as “uncomplimentary untruths that fit his racist agenda.”(Washington, Harriet A., 2006)

The demand generated by these exhibitions had direct anatomical consequences. The quest to locate the “essence of blackness” beneath the skin, stimulated by “white Negro” exhibits and the display of Black bodies, drove demand for the dissection and autopsy of Black people as a form of medical inquiry.(Washington, Harriet A., 2006) Exhibition produced not merely prurient curiosity but a scientific appetite for Black bodies that medical schools were equipped to satisfy.

Black Bodies as Clinical Material

Southern medical schools advertised the availability of Black “clinical material” as a selling point to prospective students; at the Medical College of South Carolina, surgery was performed exclusively on Black patients, slave or free.(Washington, Harriet A., 2006) An 1831 advertisement for South Carolina Medical College boasted that “subjects” (Black cadavers) could be obtained “without offending any individuals in our community.”(Washington, Harriet A., 2006) Harriet Martineau observed that in Baltimore, “the bodies of colored people exclusively are taken for dissection, because the whites do not like it and the colored people cannot resist.”(Washington, Harriet A., 2006)

The statistical evidence supports Washington’s argument about the scale of this practice: medical historian Todd Savitt found that by the most conservative estimate, Black patients constituted 48.7 percent of cases in Richmond medical journals between 1851 and 1860.(Washington, Harriet A., 2006) Thomas Jefferson characterized hospitals as places populated by “poverty alone,” where patients were “exposed as a corpse, to be lectured over by a clinical professor”; respectable whites avoided hospitals, making Black bodies the primary clinical material.(Washington, Harriet A., 2006) Georgia physician W.H. Robert told students that amputation should be weighed differently by race: amputating a slave’s limb was “a matter of comparatively little importance” compared to the deformity of amputating a rich white man’s limb.(Washington, Harriet A., 2006) The degrading clinical display of Black patients blunted physicians’ compassion: one medical student who felt initial sympathy for a Black girl dissection subject recorded a year later that he had amused himself frightening white women with “a piece of dead nigar” from the dissecting table.(Washington, Harriet A., 2006)

The consistent use of Black bodies for training created in graduating physicians a deeply ingrained habit of viewing Black people as demonstration material and experimental subjects rather than as patients deserving the same care as white private patients.(Washington, Harriet A., 2006)

Grave Robbing and the Anatomical Supply Chain

In 1989, construction workers at the former Medical College of Georgia uncovered nearly 10,000 human bones in the basement; forensic analysis determined that 75 percent were Black, while Black people comprised only 42 percent of the local population.(Washington, Harriet A., 2006) The oral tradition of “night doctors” who stole Black bodies for medical dissection, long dismissed as superstition, was confirmed by this discovery; porter Grandison Harris had named Cedar Grove Cemetery as his milieu in a 1908 lecture to students.(Washington, Harriet A., 2006) When the grave of Addie Mae Collins — a twelve-year-old girl killed in the 1963 Birmingham church bombing — was opened in 1998, it was empty; her body, like thousands of others in Black Southern cemeteries, had been taken.(Washington, Harriet A., 2006) The 1991 discovery of a colonial-era Negros Burying Ground in Manhattan, with 427 skeletons, revealed widespread anatomists’ marks and missing coffins; forensic analysis found no characteristic bone ridges of syphilis, directly contradicting the common medical characterization of Black people as syphilitic.(Washington, Harriet A., 2006) In 1977, retired auto mechanic Casper Yeagin died in Howard University Hospital as an unidentified patient and was nearly dissected by medical students; his family had searched for more than two months while hospital staff denied he had been admitted.(Washington, Harriet A., 2006) A 2004 Johns Hopkins report found that 70 percent fewer African Americans than whites said they would consider donating their bodies to medicine; the history of coerced bodily appropriation is the context for that statistic.(Washington, Harriet A., 2006)

Post-Emancipation and Jim Crow Medicine

One in four freedmen died in post-Civil War refugee camps. Only 138 physicians ever cared for 1.1 million freedmen at the program’s peak, and some physicians openly expressed disdain for the Black “animals” in their care or flatly refused to treat them.(Washington, Harriet A., 2006) Black Union soldiers died at a rate 1.5 times greater than white soldiers.(Washington, Harriet A., 2006)

Eugenicists deliberately conflated biological hereditary fitness with class and race; the charts and illustrations used to popularize eugenic ideals consistently depicted the “unfit” as dark-skinned.(Washington, Harriet A., 2006) The plantation medicine system documented by Fett, in which enslaved people operated an alternative health culture alongside and sometimes in resistance to the Western medicine imposed by slaveholders, persisted in modified forms through the Jim Crow era, with Black communities maintaining parallel healing traditions partly because institutional medicine was either unavailable or actively dangerous.(Fett, Sharla M., 2002)(Fett, Sharla M., 2002) The slaveholder definition of slave health was soundness: a measure of a person’s capacity to labor, reproduce, and obey, directly tied to market value and certified by white physicians who issued documents of fitness for sale.(Fett, Sharla M., 2002)

The same ideological apparatus that produced Black “superbodies” found a parallel target in Irish immigrant women in northern cities. By the late nineteenth century, physician Lucien Warner could write that the African “negress” and the Irish “Bridget” shared good health and “comparative immunity from uterine diseases” — using the same superbody trope to justify treating both groups as research material.(Cooper Owens, Deirdre, 2017) London’s Punch magazine warned readers about an Irish “creature manifestly between the Gorilla and the Negro,” explicitly racializing the Irish in Anglo-American print culture.(Cooper Owens, Deirdre, 2017) Catholic charitable organizations such as the Sisters of Mercy and the House of the Good Shepherd nursed Irish immigrant women, including those with sexually transmitted infections, who were excluded from many public hospitals; some hospitals, William Sanger’s 1857 New York City study found, had explicit rules forbidding the admission of patients with “Gonorrhea or Syphilis” as charity patients.(Cooper Owens, Deirdre, 2017) Cooper Owens identifies the key difference between Irish and enslaved patients in what happened to them after surgical encounters: poor Irish women’s improved health allowed them to continue to work for wages as free women, and many of their daughters became nurses and teachers, while enslaved women returned to slave communities to toil; the development of the northeastern domestic-service industry has a direct link to the work of early gynecologists.(Cooper Owens, Deirdre, 2017)

The racial logic of post-Emancipation Southern public health was legible even in the mechanisms designed to extend care. Black midwives were recruited by state public health agencies as agents of medicalized childbirth in poverty-stricken Southern states, where they attended the majority of Black births, yet their race and low social status rendered them “dubious candidates” for this mission in the eyes of public health administrators — notorious, in the period’s language, for their “bags to show and bags to go,” a phrase that captured the perceived gap between their role as state agents and their inclination toward traditional practices.(Jackson (ed.), 2011) The state enlisted them because no white practitioners would serve Black rural communities, then simultaneously denigrated the knowledge they brought to that service.

Twentieth-Century Experimentation

Radiation Experiments

Between 1960 and 1972, University of Cincinnati radiologist Eugene Saenger irradiated 200 cancer patients, 150 of whom were Black; 42 percent of those given higher doses died within weeks, and subjects were told the radiation was therapy.(Washington, Harriet A., 2006) Saenger’s research partner Clarence Lushbaugh explicitly stated that they chose “slum” patients because they were Black, poor, and “poorly washed.”(Washington, Harriet A., 2006) Between 1949 and 1960, the Medical College of Virginia deliberately caused third-degree radiation burns to the skin of Black patients — including children at Dooley Hospital — to study racial differences in radiation damage, yielding one hundred Black subjects per year.(Washington, Harriet A., 2006) AEC scientists suppressed the word “plutonium” in all public communications about radiation injection experiments; a 1972 Argonne National Laboratory memo formally banned the term, replacing it with coded designations such as “product” or “49.”(Washington, Harriet A., 2006) A subject advocate estimated that three of every five radiation experiment victims were people of color; African Americans constituted 25 percent of plutonium injection subjects at a time when they were approximately 10 percent of the population.(Washington, Harriet A., 2006)

The racialization of radiation exposure was not limited to deliberate experiments. A 1966 survey found that 72 percent of California X-ray technicians had opted on their own initiative to administer 25-50 percent higher radiation doses to Black patients, citing vague beliefs that African Americans’ bones were “harder and denser”; a standard 1963 textbook explicitly charted higher recommended radiation doses for Black patients.(Washington, Harriet A., 2006) Black workers at the Savannah River nuclear plant received 1.8 times the annual radiation dose of white workers due to discriminatory job placement practices.(Washington, Harriet A., 2006)

The same overrepresentation of African Americans characterized prison pharmaceutical research. African Americans constituted 40 to 61 percent of prison populations in states where most prison research was conducted during the peak era of the 1950s through 1970s; by 2004 they were 44 to 46 percent of all U.S. prisoners, roughly four times their share of the general population, making prisons a structural funnel for racial overrepresentation in research.(Washington, Harriet A., 2006) The 1975 ACHRE data showed that Black inmates constituted 31 percent of prison research subjects — still three times their national population share — despite being 68 percent of the general prison population, indicating selection mechanisms that targeted the most vulnerable within the already-confined group.(Washington, Harriet A., 2006)

The Contemporary Health Gap

African American infant mortality remains twice that of white infants; Black adults die at one and a half times the rate of white adults; and Black Americans have dramatically higher rates of nearly every cancer, of AIDS, of heart disease, of diabetes, of liver disease, and of infectious diseases.(Washington, Harriet A., 2006) By 2004, Black Americans constituted approximately 50 percent of new HIV infections while comprising only 13 percent of the population; reduced access to clean needles, delayed clinical trials enrollment, and inferior treatment access all contributed to this disproportion.(Washington, Harriet A., 2006) A flawed 1980s VA study purporting to show that AZT was ineffective for Black AIDS patients was used to justify differential treatment for years before its methodological errors were identified, meaning Black patients were denied the first effective AIDS therapy based on unsound research.(Washington, Harriet A., 2006) Black tuberculosis patients in the early twentieth century were detained in segregated sanatoria for significantly longer periods than white patients, and TB mortality among Black Americans remained two to three times higher than among whites through the 1950s despite TB being a treatable disease.(Washington, Harriet A., 2006) Multidrug-resistant TB disproportionately affected Black Americans partly because detention policies prioritized institutional control over ensuring treatment completion; non-compliant patients were jailed rather than given case-management support, and jails with crowded, poorly ventilated conditions then became TB transmission amplifiers.(Washington, Harriet A., 2006)

Genomics and the Persistence of Racial Categories

The sickle-cell mass screening programs of the early 1970s were implemented without adequate infrastructure for genetic counseling; fourteen states passed laws mandating testing for Black Americans only, and the programs generated widespread stigma without conferring clinical benefit.(Washington, Harriet A., 2006) DNA fingerprinting exonerated numerous wrongfully convicted Black men in the 1990s but simultaneously enabled law enforcement to build racial databases; Black Americans were disproportionately included in CODIS — the FBI’s DNA database — relative to their share of the population, raising Fourth Amendment concerns about permanent genetic surveillance.(Washington, Harriet A., 2006) In 2002, police in Truro, Massachusetts conducted a DNA dragnet pressuring all adult men in a predominantly Black neighborhood to submit samples to identify a murder suspect, creating a coercive de facto database with no sunset provision.(Washington, Harriet A., 2006) The Human Genome Project largely excluded African DNA samples despite Africa’s being the most genetically diverse continent, skewing genomic medicine’s reference databases toward European genomes.(Washington, Harriet A., 2006) In 2005, BiDil became the first drug approved by the FDA for a specific racial group; the A-HeFT trial supporting that approval enrolled only Black patients, meaning the drug was never tested comparatively across racial groups, and researchers argued the apparent racial efficacy more likely reflected socioeconomic rather than biological differences.(Washington, Harriet A., 2006)(Washington, Harriet A., 2006) Forensic DNA phenotyping programs that generate composite faces of suspects from genetic material were piloted primarily in high-crime Black neighborhoods, embedding racial profiling into ostensibly neutral technological tools and generating false-positive matches against Black civilians.(Washington, Harriet A., 2006) Washington argues that racialized genetic research perpetuates the conflation of race (a social category) with ancestry (a biological one), treating admixed African American genomes as representing a discrete biological population when they do not.(Washington, Harriet A., 2006)

Iatrophobia: The Legacy of Medical Distrust

Washington coins the term “iatrophobia” to describe African American fear of medicine as a historically grounded response to centuries of documented abuse, rejecting the “paranoid” label frequently applied to Black research wariness.(Washington, Harriet A., 2006) A neurosurgeon at Tulane Medical School characterized Black experimental subjects as cheaper than laboratory animals; a radiation scientist as late as 1995 chose subjects because they were Black, poor, and “poorly washed.”(Washington, Harriet A., 2006)(Washington, Harriet A., 2006) African Americans have been used to perfect IQ tests that “proved” intellectual inferiority, to devise treponemal tests showing a distinctive strain of syphilis, and for painful dissections asserting that “negritude” is a permanent biological mark.(Washington, Harriet A., 2006)

The Tuskegee Syphilis Study has become the paradigmatic case around which American medical historiography has organized the intersecting topics of race, research ethics, and sexuality, representing what Jackson identifies as a characteristic emphasis of US contemporary medical history that differs markedly from its British counterpart.(Jackson (ed.), 2011) The distrust generated by this history has measurable contemporary consequences. Studies documented that Black men with AIDS who knew about the Tuskegee study were significantly less likely to enroll in clinical research, creating a paradox in which historical harm produced present-day health harm.(Washington, Harriet A., 2006) Even after President Clinton’s 1997 formal apology for Tuskegee, Black medical distrust remained elevated and did not return to pre-Tuskegee levels, indicating that apology without structural reform has limited effect on community trust.(Washington, Harriet A., 2006) Rhodes and colleagues note that “as a residue of their history with medicine, African-Americans in particular may be suspicious of health care generally and experimentation in particular.”(Rosamond Rhodes, Leslie P. Francis, and Anita Silvers, 2007)

In 1932 Macon County, Alabama, 82 percent of residents were Black, median income was one dollar a day, and medical care was effectively nonexistent for Black residents. The PHS exploited this extreme poverty and healthcare vacuum to conduct the Tuskegee Syphilis Study, which ran for forty years.(Washington, Harriet A., 2006) The study’s rationale rested on the belief that syphilis was racially dimorphic — that it attacked the muscles of Black patients, including the heart, while leaving their less evolved nervous systems relatively unimpaired, in contrast to the neurological ravages it supposedly inflicted on whites.(Washington, Harriet A., 2006) The study was not an aberration but the institutional expression of a medical culture that had been built on the premise that Black bodies were available for use.

[DISPUTED]

Whether the contemporary racial health gap is primarily attributable to structural racism, genetic variation, socioeconomic inequality, or some interaction among these factors is actively debated in public health scholarship. Washington’s argument is structural: the gap reflects the cumulative effects of a medical system built on racial exploitation. Others emphasize the confounding of race with poverty and access. The encyclopaedia treats the historical facts Washington documents as well-attested; the causal interpretation of the contemporary gap remains contested.

See Also

Sources

  • Washington, Harriet A. (2006). Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Doubleday. (source_id: washington-medicalapartheid-2006)
  • Haller, John S. (1971). Outcasts from Evolution: Scientific Attitudes of Racial Inferiority, 1859-1900. University of Illinois Press. (source_id: haller-outcasts-from-evolution-1971)
  • Rhodes, Rosamond, Margaret P. Battin, and Anita Silvers (eds.). (2012). Medicine and Social Justice. Oxford University Press. (source_id: rhodes-medicine-social-justice)
  • Fett, Sharla M. (2002). Working Cures: Healing, Health, and Power on Southern Slave Plantations. University of North Carolina Press. (source_id: fett-workingcures-2002)
  • Cooper Owens, Deirdre (2017). Medical Bondage: Race, Gender, and the Origins of American Gynecology. University of Georgia Press. (source_id: cooper-owens-medicalbondage-2017)
  • Gómez, Pablo F. (2017). The Experiential Caribbean: Creating Knowledge and Healing in the Early Modern Atlantic. University of North Carolina Press. (source_id: gomez-experientialcaribbean-2017)

Editorial Notes

This page draws primarily from Washington (2006), the first full-length history of medical experimentation on Black Americans. Additional sources (Haller, Fett, Rhodes) provide complementary perspectives from scientific racism historiography, plantation medicine, and contemporary medical justice.

Sources

This article draws on 117 evidence cards from 7 sources.