Slavery and Medicine

Summary

Medicine and American chattel slavery shaped each other for nearly three centuries. Slaveholders bought, sold, and managed enslaved people partly through medical examinations that priced them by their capacity to labor and bear children. Southern doctors used enslaved people as patients, as experimental subjects, and as a captive clinical population for medical schools. At the same time, enslaved people maintained their own healing traditions: West African and Native American botanical knowledge, conjure and hoodoo, midwifery, and elder women’s care. These two systems coexisted, contested each other, and sometimes borrowed from each other. Sharla Fett has argued that enslaved African Americans were not passive victims of medicine but cultivated a rich health culture with their own practitioners, therapies, and botanical knowledge. Deirdre Cooper Owens has shown that the new American specialty of gynecology was built on the same population.

The Chattel Principle and the Valuation of Bodies

The structuring fact of plantation medicine was the chattel principle: the legal and economic reduction of enslaved persons to property. As Fett puts it, the chattel principle permeated every dimension of slave health, from slave markets to courtrooms to plantation fields.(Fett, Sharla M., 2002) White slaveholders defined slave health primarily in terms of “soundness,” a measure of an enslaved person’s capacity to labor, reproduce, and obey, directly tied to market value.(Fett, Sharla M., 2002) White doctors participated actively in the slave trade by examining enslaved bodies and issuing certificates of soundness in slave markets, courtrooms, and insurance transactions.(Fett, Sharla M., 2002) Soundness extended beyond the physical body: buyers subsumed assessments of “character” under soundness guarantees, interpreting marks on enslaved men’s and women’s bodies as signs of past and future defiant behavior, so that the objectification of Black health under slavery involved minds and personalities subjected to market assessments, not only bodies.(Fett, Sharla M., 2002)

Enslaved people understood this calculus and sometimes attempted to use it against itself. Some manipulated the concept of soundness to resist sale, claiming illness or hidden infirmities to discourage prospective buyers and delay being separated from family — the logic of the slave market deployed as a form of self-protection.(Fett, Sharla M., 2002)

After Congress banned the importation of African-born slaves in 1808, U.S. slave owners turned more attention to increasing slave births domestically, and reproductive medicine expanded alongside slavery as one of the country’s growing industries.(Cooper Owens, Deirdre, 2017) Each woman sold was medically examined so that she could be priced for sale; doctors formed a cohort of elite white men whose work, especially their gynecological examinations of Black women, shaped the country’s slave markets.(Cooper Owens, Deirdre, 2017) The slave warranty cases that produced the legal template for “lemon laws”, actions against the seller of a defective product, turned on disputes about whether enslaved women had concealed reproductive disease at sale, sometimes hiding venereal infections to escape mean owners or grueling work.(Cooper Owens, Deirdre, 2017) Reproductive medicine and the law of sale ran along the same track.

Plantation Healthcare: Slaveholder Medicine alongside Enslaved Practitioners

Plantation healthcare was not a single system but a contested terrain. Slave owners themselves practiced experimental medicine on their bondwomen, trying drugs by trial and error in ways that risked killing them while attempting to heal; one WPA interviewee, Julia Brown, recalled that her former owner “would try one medicine and if it didn’t do no good he’d try another until it did do good.”(Cooper Owens, Deirdre, 2017) The kind of casual experimentation Brown described was widespread enough that the antebellum-era physician William Beaumont in 1833 felt the need to articulate an early ethical framework for human experimentation, requiring voluntary consent and discontinuation upon distress.(Cooper Owens, Deirdre, 2017) (Cooper Owens, Deirdre, 2017)

Alongside slaveholder medicine ran an enslaved health culture. Fett argues that enslaved African Americans were not passive victims of medical malice but cultivated a rich health culture, a constellation of ideas and practices related to well-being, illness, healing, and death, that worked to counter the onslaught of daily medical abuse and racist scientific theories.(Fett, Sharla M., 2002) African American healing traditions drew on Igbo, Yoruba, Bambara, Kongo, and other African healing systems transformed under New World conditions, as well as Native American and European influences.(Fett, Sharla M., 2002) These communities maintained a relational vision of health that connected individual well-being to community relationships, ancestral ties, and spiritual revelation, fundamentally diverging from slaveholder notions of soundness.(Fett, Sharla M., 2002)

Within this culture, enslaved women carried a central healing role. They grew herbs, made medicines, cared for the sick, prepared the dead for burial, and attended births in both Black and white households across the South, yet white society denied them the moral authority granted to white domestic healers.(Fett, Sharla M., 2002) Three structural factors gendered sickcare as enslaved women’s work: the overlap with other female domestic labor, the unpleasantness of antebellum heroic medicines (emetics, purges, blistering), and the location of care in slave quarters and outbuildings rather than in the slaveholder’s house.(Fett, Sharla M., 2002)(Fett, Sharla M., 2002) Older enslaved women like Nurse Binah at Gowrie Plantation in South Carolina were irreplaceable health workers whose accumulated expertise exceeded that of visiting white physicians; when Binah suffered apoplexy during an 1848 epidemic, overseer Cooper was forced to assume her workload and discovered firsthand how demanding it actually was.(Fett, Sharla M., 2002) The skills themselves were lifelong acquisitions, beginning with child nursing, deepening through motherhood and the management of childhood illness, and culminating in community-wide midwifery and herbalism in old age, with healing knowledge frequently passing between mothers and daughters.(Fett, Sharla M., 2002) Within enslaved communities, older women healers held authority grounded in spiritual empowerment, elder respect, and herbal expertise rather than gender norms, criteria not recognized by planters, while in slaveholders’ plantation ledgers older women nurses were rated at the lowest market values.(Fett, Sharla M., 2002) Midwifery in particular afforded enslaved women unusual mobility across plantation boundaries, enabling travel between Black and white households and the maintenance of kin networks.(Fett, Sharla M., 2002)

The racialized ideology of antebellum motherhood posed the devoted white mistress as a supermaternal domestic healer against the callous, neglectful enslaved mother: romanticized images of white nursing became a support for the idealized image of the bounteous southern lady, obscuring the extent of enslaved women’s healing labor and denigrating their knowledge while sanctioning its exploitation.(Fett, Sharla M., 2002) Enslaved women’s healing work occupied a physical geography that defied the “field vs. big house” binary in plantation historiography. It was centered in the “yard” adjacent to the slaveholder’s residence but close to slave dwellings, the sickhouse, and the overseer’s building — a space where smokehouse, kitchen, and dairy work all intersected with doctoring, and where enslaved women drew on expertise in childcare, botanical knowledge, and productive processes accumulated across lifetimes as bondswomen.(Fett, Sharla M., 2002)

Cross-racial use of these practitioners was common despite the public ideology that denied their authority. Mildred Graves, an enslaved Hanover, Virginia, midwife, was mocked by white doctors as a “witch doctor” but went on to deliver Mrs. Leake’s baby successfully when those same doctors had given up.(Cooper Owens, Deirdre, 2017) In Mississippi, the slave nurse Rena Clark identified herself as an “herb doctor” specializing in women’s complaints, refused to treat men, and invoked West African healing language rather than the term “midwife.”(Cooper Owens, Deirdre, 2017) The therapies ran across the color line, even as the legal authority remained on one side of it.(Fett, Sharla M., 2002)

Theophus Smith’s concept of the “pharmocosm”, a pharmacopeic cosmos enlivened by healing and harming capacities, describes the sacred worldview underlying African American slave doctoring, distinguishing it from the secular instrumental frame within which white slaveholder medicine operated.(Fett, Sharla M., 2002)

The botanical foundations of enslaved healing were partly African in origin and partly acquired through the specific labor conditions of the plantation South. The Atlantic slave trade itself carried plants across the Middle Passage: West African captives brought wild licorice seeds aboard slaving vessels, where the plant’s roots served as a common shipboard medicine, and African grasses crossed the Atlantic in the straw used to line slave ship holds.(Fett, Sharla M., 2002) Once in the Americas, enslaved African Americans developed a more intimate and expert knowledge of local medicinal flora than elite white planters, moving through fields and forests at eye level through agricultural labor and subsistence hunting, and building a complex botanical repertoire from that working knowledge of the environment.(Fett, Sharla M., 2002) African American herbalism was also a sacred art. North American Black herbalism fused African sacred plant traditions with African American Christianity; enslaved herbalists described the forest as a site of divine revelation, with God directing them to specific plants.(Fett, Sharla M., 2002) Archaeologist Leland Ferguson has interpreted crosslike marks found on the bases of Colono Ware pottery excavated in South Carolina as Kongo cosmograms, suggesting these slave-made vessels served as ritual medicine bowls that created a point of spiritual contact at the site where medicines were mixed and administered.(Fett, Sharla M., 2002)

Conjuration (hoodoo, rootwork) carried its own structural logic within enslaved communities. Conjure served a juridical function, reinforcing community behavioral norms around property, sexuality, and intergenerational respect; most illness attributed to conjuration originated in conflicts over love, sex, economic resources, and interpersonal power, placing sickness within a web of community relationships rather than locating it solely in the individual body.(Fett, Sharla M., 2002) Conjure doctors’ dual capacity to “cure or kill” gave them a stature beyond that of herbalists and midwives; white medical doctors were structurally unable to address conjure-based affliction because they could not conceive of sickness rooted in social conflict and spiritual power — as one freedman put it, “Whenever somebody fixes you, doctors never know what’s wrong.”(Fett, Sharla M., 2002) The moral economy of conjure differed from that of other enslaved healers: payment was morally and ritually necessary for the conjure doctor’s work, distinguishing it from the gift logic of herbalists and midwives who worried that charging fees would taint their God-given healing capacity.(Fett, Sharla M., 2002)

Cachexia Africana and the Pathologisation of Blackness

White medical writing did not simply observe enslaved bodies; it pathologised them. Doctors discussed the “dirty” appearance of Black female bodies and identified clay or dirt eating as a disease called “cachexia Africana,” promoting the general belief that blackness was unclean and that Black bodies were vectors of disease.(Cooper Owens, Deirdre, 2017) 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) These framings supported a clinical practice that treated normal Black diet and behavior as disease, while denying the disease that the conditions of enslavement actually produced.

The pathologising frame also licensed a particular kind of medical writing about reproduction. The clitorises of Black girls, the menstruating breasts of Black women, the hardness of Black women’s labor, the supposed immunity of Black women from childbirth pain, each became its own published claim, each cited the next, and the body of literature took on the character of a self-confirming archive. The Hamitic curse, a misreading of the Old Testament, was even invoked by some southern physicians to explain why Black women supposedly escaped childbirth pain, placing them outside Eve’s lineage and outside the scope of womanly suffering.(Cooper Owens, Deirdre, 2017) (Cooper Owens, Deirdre, 2017)

Slave Hospitals and Captive Clinical Populations

The institutional form of plantation medicine that mattered most for the development of new specialties was the slave hospital. Slave hospitals were built on plantations and at the edges of southern medical schools as captive clinical populations for surgery, teaching, and experimentation. In Augusta, Georgia, the brothers Henry F. and Robert Campbell ran the Jackson Street Hospital, which served an exclusively slave population, while editing the Deep South’s first medical journal, the Southern Medical and Surgical Journal. Enterprising elite men like the Campbells connected their private practices with slave hospitals, regional medical societies, and leading journals into a single network.(Cooper Owens, Deirdre, 2017)

The most famous antebellum slave hospital was J. Marion Sims’s small wooden building in Mount Meigs, Alabama. From 1844 to 1849, Anarcha, Betsy, Lucy, and about nine other unidentified enslaved women and girls lived and worked together there in what Cooper Owens describes as the first women’s hospital in the United States.(Cooper Owens, Deirdre, 2017) After Sims left the South for New York, he sold the hospital to his former assistant Nathan Bozeman, a fellow slave owner who continued to operate it as a gynecological hospital experimenting on a primarily slave population.(Cooper Owens, Deirdre, 2017)

The clinical work that took place in these hospitals depended on physical restraint of patients. Cooper Owens reads white doctors’ own writing for the moments where their clinical descriptions of restraining enslaved women during childbirth and surgery contradict the same physicians’ published claims that Black women were impervious to pain.(Cooper Owens, Deirdre, 2017) Following Stephanie Camp, Cooper Owens treats the slave hospital as a “geography of containment,” a site where slaveholders enacted bodily restraint over enslaved patients.(Cooper Owens, Deirdre, 2017) At Sims’s 1883 funeral, the obstetrician William Waring Johnston eulogized Sims’s enslaved patients as “humble negro servitors” who had brought “their willing sufferings and patient endurance” to his research, a framing that converted patients with no capacity to consent into voluntary participants. Informed consent did not exist for slave patients.(Cooper Owens, Deirdre, 2017)

Specific cases give the institutional pattern its surface texture. In August 1819, Nanny, a Columbia, South Carolina, enslaved woman, lay in agony for sixty hours unable to give birth naturally; Dr. Charles Atkins removed one stillborn twin by hand and the other, the next day, with his surgical blade, even though her plantation community had warned that her body was “too delicate” to bear children.(Cooper Owens, Deirdre, 2017) In April 1850 in Augusta, Mary, a twenty-eight-year-old enslaved woman with irregular menstrual cycles, visited Dr. Paul Eve, who excised what his team claimed was the first successfully removed cancerous uterus in the United States; she died three months later.(Cooper Owens, Deirdre, 2017) John Peter Mettauer of Virginia performed repeated experimental fistula surgeries on a twenty-year-old enslaved woman over four years, using lead sutures, and blamed his failures on her ongoing sexual activity, which she had little power to refuse.(Cooper Owens, Deirdre, 2017)

Enslaved Women as Obstetric Subjects and Knowledge Sources

The same population that supplied the experimental subjects also produced the field’s working knowledge of women’s reproductive medicine. On the Glover plantations of Colleton County, South Carolina, enslaved women diagnosed with prolapsed uteri were transitioned from field hands into long-serving plantation nurses for fifteen years between 1844 and 1859, while those whose conditions made them unprofitable were sold off, an integration of gynecological diagnosis into the management of slave labor itself.(Cooper Owens, Deirdre, 2017) Frances Kemble’s 1838-39 journal of her Georgia plantation documented enslaved women’s lying-in conditions, including a granny midwife who reportedly tied a cloth around laboring women’s throats nearly to suffocation as part of her birthing practice, an episode that records both the inadequacy of the conditions and the existence of an internal Black obstetric tradition with its own methods.(Cooper Owens, Deirdre, 2017)

The medical apparatus of slavery also recognized, in legal cases, what its public ideology denied. In August 1831 in Christ Church Parish, South Carolina, Dr. R. S. Bailey was called to treat a young enslaved girl who had been raped and sodomized so violently she could not urinate for a week, and his medical journal report gave clinical visibility to a crime the law would not recognize.(Cooper Owens, Deirdre, 2017) In 1859 a Mississippi court explicitly declared that “the crime of rape does not exist in this State between African slaves,” treating the violation of an enslaved woman as merely assault and battery.(Cooper Owens, Deirdre, 2017) The split between what medicine could see and what law would protect ran the full length of the antebellum period.

White antebellum society structured medical authority around two poles, white women’s maternal domestic authority and white men’s professional training authority, both of which were systematically denied to enslaved women. Black healers therefore had to construct a third category of authority grounded in spiritual empowerment and community recognition.(Fett, Sharla M., 2002) Cooper Owens’s argument is that the field of American gynecology was built on the labor of women working inside that third category, even as the published medical literature credited the white surgeons.

Punitive Medicine, Feigning, and Legal Control

Medicine intersected with plantation discipline through several channels. Slaveholders used emetic and purgative medicines not only therapeutically but as instruments of punishment and surveillance: enslaved people were forced to vomit to reveal stolen food, and at least one planter exacted punishment by arranging several enslaved people in stocks and forcing them to take large doses of medicine, causing them to purge on one another.(Fett, Sharla M., 2002) This blurring of treatment and torture was structural, not incidental; it arose from the same plantation management logic that merged disease-control with labor discipline, holding enslaved people responsible for their own health problems through racialized character deficiencies — characterizing their eating habits, nighttime activities, and crowded quarters as threats to plantation health — rather than acknowledging the conditions of enslavement as the proximate cause.(Fett, Sharla M., 2002)

Plantation management also routinely suspected enslaved women of feigning illness. Enslaved women fell under double suspicion as both feigning workers and feigning patients: planters could not verify early stages of pregnancy and routinely complained of the labor lost to “female complaints,” suspecting reproductive claims of deception.(Fett, Sharla M., 2002) The inability to verify early pregnancy fueled resentment; one South Carolina planter described sick women as “either real or pretended, the latter in most cases.”

Legislatures attempted to regulate this volatile boundary between enslaved healing authority and White fear of that authority. Virginia’s 1748 law made it a capital offense for any enslaved or free Black person to prepare, exhibit, or administer medicine without slaveholder consent, on the stated grounds that enslaved practitioners had used “physic” as a cover for poisoning. The law was most actively prosecuted in the eighteenth century but remained on the books through the Civil War, with penalties moderating by 1843 to misdemeanor status for most violations. Crucially, the law’s exemptions reveal what it was actually managing: a slave who practiced with the knowledge, direction, and orders of whites was defined as a legitimate healer. Fett reads these adjustments as slaveholders’ attempt to separate the labor of enslaved healers from their autonomous authority — to harness the skill while eliminating the power it carried.(Fett, Sharla M., 2002)

The Medical Experimentation Problem

The interlocking of slavery with medical experimentation is documented in greatest detail elsewhere, including in Harriet Washington’s Medical Apartheid (see medical-experimentation), and the present page does not duplicate that detail. The point to register here is structural: the experimental relationship between southern doctors and enslaved patients was not an episodic abuse but a systemic one, and the surgical specialties that emerged from it (gynecology in particular) were built into the same structure. African American distrust of white medical institutions has deep historical roots in three centuries of medical abuse, from slave-trade inspections through Tuskegee.(Fett, Sharla M., 2002)

Postbellum Continuities

The end of legal slavery in 1865 did not end the medical patterns slavery had produced. The disproportionate use of Black bodies in dissection, in clinical teaching, and in experimental research persisted into the twentieth century (see medical-experimentation for that history). Cooper Owens argues that the antebellum framing of Black women as “medical superbodies” impervious to pain remains alive in twenty-first-century gynecology, citing studies that Black women suffer chronic pain at higher rates with less access to pain medication.(Cooper Owens, Deirdre, 2017) In the postbellum decades, the same gynecologists who had operated on enslaved women in the South began operating on poor Irish immigrant women in northern hospitals, replicating the structural pattern with a different vulnerable population (see american-gynecology).

Conflicting postwar narratives of plantation health care extended the antebellum struggle into collective memory. African Americans with direct memories of slavery emphasized self-reliant healing and communal agency, while southern physicians, former slaveholders, and white historians propounded stories of Black dependency on benevolent white medical care with remarkable consistency from the antebellum period through the mid-twentieth century.(Fett, Sharla M., 2002)

Methodological Notes

The reconstruction of plantation healing relies on a broad source base. Fett’s evidence draws on slave narratives and hundreds of WPA interviews conducted between 1920 and 1940; on herbal, illness-narrative, and folklore collections gathered from southern African Americans; and on the physical artifacts of healing practices, medicine bowls, birthing beads, and conjure kits, that remained in the earth long after their users passed on.(Fett, Sharla M., 2002) Cooper Owens’s reading of nineteenth-century medical journals supplements that base by mining the published record of white physicians for what they could not help recording about restraint, pain, and enslaved nurses’ surgical knowledge, even as their ideology framed those nurses as servitors.

Fett’s conclusion distills the core argument: enslaved communities on cotton, tobacco, and rice plantations created a relational vision of health, rooted in African conceptions of the self as constituted by interpersonal relationships, that defined well-being as more than the material worth of individual bodies.(Fett, Sharla M., 2002) Health was not merely the absence of disease but an arena in which enslaved African Americans and antebellum planters struggled over religion, family, sexuality, and labor; persistent adherence to that relational view in the face of routine dehumanization quietly and profoundly shaped the power relations of southern plantations.(Fett, Sharla M., 2002)

The result, in both bodies of work, is an account of plantation medicine as a contested terrain rather than as a single system, with two intertwined histories, the surgeons’ history and the enslaved healers’ history, that cannot be honestly told apart.