About Medical Apartheid ...
From the era of slavery to the present day, the first full history of black America’s shocking mistreatment as unwilling and unwitting experimental subjects at the hands of the medical establishment.
Medical Apartheid is the first and only comprehensive history of medical experimentation on African Americans. Starting with the earliest encounters between black Americans and Western medical researchers and the racist pseudoscience that resulted, it details the ways both slaves and freedmen were used in hospitals for experiments conducted without their knowledge—a tradition that continues today within some black populations.
It reveals how blacks have historically been prey to grave-robbing as well as unauthorized autopsies and dissections. Moving into the twentieth century, it shows how the pseudoscience of eugenics and social Darwinism was used to justify experimental exploitation and shoddy medical treatment of blacks, and the view that they were biologically inferior, oversexed, and unfit for adult responsibilities.
Shocking new details about the government’s notorious Tuskegee experiment are revealed, as are similar, less-well-known medical atrocities conducted by the government, the armed forces, prisons, and private institutions.
Chapter 4 THE SURGICAL THEATER
Black Bodies in the Antebellum Clinic
Such [free] persons of color as may not be able to pay for Medical advice . . . [should call at the hospital]. . . . The object of the Faculty is to collect as many interesting cases, as possible, for the benefit and instruction of their pupils.
—Medical College of South Carolina advertisement
in the Charleston Courier, November 16, 1837 Sam, a forty-two-year-old laborer on a plantation in rural Alabama, had become exhausted by pain and fear. For years, an incessant racking pain in his jaw had kept him distracted days and awake nights, miserable and dejected.When his owner learned of Sam’s pain around 1838, he decided that Sam must have syphilis and applied a homemade concoction, whose only effect was to produce a painful boil on Sam’s gums. Now Sam also found it difficult to eat.He should have been a strong, productive worker in the prime of his earning power, but Sam was finding it harder and
harder to work, even in the face of cajoling and threats. By 1845, he had become worthless in the fields, and in desperation, his owner summoned a physician, who determined that Sam was suffering not from syphilis
but from osteosarcoma—a cancer of his lower jawbone. The doctor turned to a surgical colleague, Dr.Marion J. Sims, who declared to Sam’s owner that only an operation carried hope of a cure. But Sam vehemently and repeatedly refused, protesting that it would “hurt too bad.” Today, refusing to undergo an operation for a treatable cancer is a tragic mistake, because surgery is the most curative mode of therapy for cancer. Today, anesthetics, antiseptics, and antibiotics banish or at least mitigate the twin nightmares of surgical pain and infection. However, Sam’s cancer predated the common use of effective anesthesia and of sterile technique. Purgatorial pain was certain and a fatal infection all too likely. What’s more, the disfiguring surgery might have been futile, because only superficial, visible cancers were discovered during this era.
Not until Wilhelm Roentgen discovered X rays in 1895 could physicians view the body’s interior without invasive surgery.No imaging techniques allowed doctors to identify an internal cancer, and it could have spread internally through the long years when Sam was being erroneously treated for syphilis.
Sam’s version of events is not recorded, so we don’t know whether more than a fear of pain caused him to balk at surgery. But we do know that Sam might by this time have acquired a low opinion of Western medicine’s ability to help him, thanks to the original misdiagnosis and iatrogenic injury. If Sam had gotten wind of Sims’s dismal surgical statistics, his famed fondness for forced experimentation on captive patients, or of his penchant for taking shoemakers’ tools to black infants’ skulls, Sam’s opinion of Sims’s skill would have sunk low indeed. But he would not have dared to openly voice doubts about Sims’s abilities, so refusing treatment because of “the pain” may have been a canny dodge.
However, Sam was enslaved, so the decision was left not to him but to his owner, who was eager to return his slave to profitable work. Sam was sent to Montgomery despite his loud and constant protests.
Sims, for his part, stonily declared himself “determined not to be foiled in the attempt” to operate. Sims had decided not only to operate upon Sam but also to perform the surgery in a teaching clinic for a medical audience of students and potential protégés. He hoped to immortalize the operation in a medical publication, and no mere slave would frustrate this bid for medical glory.
But when the two adversaries met, Sims was all smiles. He kindly inquired into the slave’s health and graciously invited Sam to have a seat. The barber’s chair into which Sam had been welcomed had been surreptitiously fitted with wooden planks, and as soon as Sam was seated, five young physicians bounded forward to restrain him with straps about his thighs, knees, ankles, abdomen, chest, shoulders, arms,wrists, elbows, and head. Sam, Sims noted, “appeared to be very much alarmed!”While he was being immobilized, ten medical students and fifteen interested “others” filed in to watch as Sims operated for forty minutes to remove a large section of Sam’s lower jawbone, sans anesthesia. When he finished, the surgeon noted with satisfaction that his surgical innovation had “proved its practicality . . . whether the patient is willing or not.” The editors of the New Orleans Medical and Surgical Journal enthused that they were “pleased to record this highly creditable achievement of a Southern surgeon.”
After he recuperated, Sam apparently lost no time in escaping into rural Alabama again, certainly with a redoubled aversion to Western medicine. There is no evidence that Sims ever saw Sam again, but his medical report took this parting shot: “Sam’s mouth is always open in a wide grin.”
Staging Disease: Treatment Under the Microscope
There were many Sams. Like circuses, clinics and hospitals had an abundance of uses for the displayed African American body. After the mid-nineteenth century, a supply of black bodies was key to the primacy of the hospital as the new center for American medical instruction and treatment. African Americans filled medical school rosters as well as circus tents, because medical teaching, training, and research utilized black bodies disproportionately, and in some southern venues, they were used exclusively.
During the 1830s, a Dr. T. Stillman ran serial advertisements in the Charleston Mercury for his infirmary, in which he principally treated skin diseases. On October 12, 1838, he made a fascinating addendum:
“Wanted: FIFTY NEGROES. Any person having sick negroes, considered incurable by their respective physicians and wishing to dispose of them [emphasis added] . . . the highest cash prize will be paid upon application as above.”
Slaves who had become too old or too sick to work supplied the bulk of hospital “clinical material.” They enjoyed no legal rights and could mount no legal challenge to their incarceration and treatment.
5 Stillman advertised his desire for blacks who suffered from disorders far beyond his own specialty, such as apoplexy, kidney disease, and stomach, intestinal, bladder, liver, and spleen disorders, as well as scrofula and
hypochondriasm. He wished to test new techniques and medications he had formulated on debilitated and chronically unhealthy blacks in the same institution where he treated paying whites. He then marketed the
medications and techniques.
Slave owners were glad to rid themselves of old, sick, and unproductive slaves.
6 It was a sage bargain on the slave owner’s part, because the hospital took over all or most of the cost of feeding, housing, and treating the unproductive slave. If the slave died, his owner was spared the inconvenience and expense of burying him, because the hospital would retain the body for dissection or experiment. If the slave recovered, the master would once again profit from his or her labor and breeding.
Moreover, the slave owner could lay claim to benevolence; after all, he was sending his old or sick slaves to a hospital for expert care. Free blacks were also vulnerable because they were easily incarcerated in jails and
almshouses for a variety of minor infractions of the many regulations governing free African Americans.
Why were blacks the chief denizens of teaching-hospital wards? In the middle of the nineteenth century, the “hospital movement” finally crossed the Atlantic from Europe. One-room, one-year medical schools based upon the stereotyped dispensing of a few dozen nostrums fell out of favor and began to close as medical training began to focus upon scientific experimentation and anatomical knowledge. The new spirit of clinical inquiry questioned heroic but ineffectual treatments such as bleeding, purging, and cupping, causing them to quickly lose their cachet. Medical students were now expected to undergo specialized training during several years, not months, on the clinical floors of hospitals. Diseases such as yellow fever, smallpox, malaria, and tuberculosis still flared into epidemics with regularity, and the dominant class of property-owning whites still relied upon private physicians to care for them and their families. However, they increasingly expected those physicians to have the professional benefit of hands-on clinical experience.
However, acquiring such experience presented a challenge because hospitals were about as popular a destination as homeless shelters are today:
No one who had a family, access to a private physician, or financial resources to rely upon was willing to enter one. American hospitals of the 1800s were very different from the antiseptic, high-tech, ethics-obsessed meccas of scientific medicine that we know today. They offered few effective medications and there were no federal agencies exerting exterior checks and balances to weigh the interests of patients against those of the hospitals’ physician owners.Without the therapeutic options, patient protections, medical advances, and knowledge that we take for PDF granted today, the hospital was less an institution for healing than a physician-centered venue for learning, training, and experimental approaches.
These were conducted on black people and on other poor, desperate people without resources.
Perhaps Thomas Jefferson said it best: “It is poverty alone which peoples hospitals . . . to be exposed as a corpse, to be lectured over by a clinical professor, to be crowded and handled by his students to hear
their case learnedly explained to them, its threatening symptoms developed and its probable termination foreboded. . . .”
The best one could hope for in hospitals and “poor clinics” was shelter from the elements and a minimum of dangerous untried treatments among the infectious. One could, however, count upon exposure to a host of iatrogenic conditions and upon being regularly displayed to students and faculty. Hospital patients also risked involuntary treatment, including unnecessary surgery, often without the benefit of effective anesthesia.Yet, the doctors-to-be and their teachers needed “clinical material”—human bodies upon which they could practice diagnosis, treatment, and, finally, autopsy and dissection. Because no one entered a hospital voluntarily, this reluctant “clinical material” emanated from the lowest rungs of society. Sick or old people cast out of workhouses, almshouses—and, in the South, plantations —filled hospitals. Clinic patients were not asked for their consent, and any physician who hesitated to operate on protesting slaves found he was legally bound to follow the wishes of not the slave but the owner. In the South, African Americans were reluctant patients, but they outnumbered poor whites in hospitals. When the city of Richmond,
Virginia, contemplated expending public funds to build a new almshouse, the professor owners of the Medical College of Virginia proposed a mutually beneficial alternative: They would take “all the sick and infirm paupers” into their infirmary and, in exchange, pay the city the funds it needed for a workhouse.
In 1848, the faculty also proposed establishing a hospital solely for blacks, thereby ensuring a supply of patients for clinical instruction, although free blacks knew enough to give hospitals a wide berth when they could. Even in the North, hospitals expected blacks to submit to research as “payment” for having been treated in charity wards; yet no amount of money could buy a black patient a bed in the private ward where well-to-do whites received care. When a black patient was admitted in error to Boston’s Massachusetts General Hospital in 1829, his doctor, George W. Otis, M.D., was severely taken