Read the book excerpt following the review-- Another aspect of the demand for Reparations is the multicentury medical torture and abuse in the name of "Science" that Blackfolk had to endure and resist. Finally, a book is published that helps begin the documentation of this normalized racist misuse of "the Science of Healing." As you can see these experimentations and variations on medical torture PREDATE the Nazi's horrendous works. In fact, they came to the US to study how it's done... and went on to "improve" upon these horrible forms of experimentation and abuse (which- inturn- came back to the US after WWII to be further "perfected" in this nation's prisons and among Black and poor people. Thank you, Sista Harriet Washington for your fine research that brings to the public a well researched work that exposes the depth and breadth of medical racism. (See her interview at www.democracynow.org)
January 23, 2007
By DENISE GRADY
The most notorious medical experiment in American history was surely the Tuskegee syphilis study, in which 400 black men with syphilis were left untreated for 40 years, from 1932 until 1972, so government doctors could study the course of the disease. The experiment ended only because a journalist exposed it, igniting a firestorm of public outrage over its racism and cruelty. By then, as many as 100 of the men had already died of syphilis.
Tuskegee was just part of a pattern of experimental abuse, one of many shameful chapters in what Harriet A. Washington calls “the long, unhappy history of medical research with black Americans.”
Ms. Washington, a journalist and research scholar in ethics, writes in “Medical Apartheid” that this history has left blacks with an ugly legacy of distrust for research and even treatment, and that it is a lingering stain on the history of medicine.
She does not oppose medical research or blacks’ inclusion in it. On the contrary, she calls research “utterly essential,” and blacks’ participation necessary. “African-Americans,” she writes, “desperately need the medical advantages and revelations that only ethical, essentially therapeutic research initiatives can give them.”
But first, she argues, the air must be cleared. She is certainly the one to do it. She has unearthed an enormous amount of shocking information and shaped it into a riveting, carefully documented book.
Blacks have been forced to undergo painful, risky experimental surgery, dosed with radiation and singled out for experiments aimed at finding brain abnormalities linked to violence. They have been falsely assumed to feel pain less than whites and to require higher X-ray doses for a readable film.
One of the worst offenders was James Marion Sims, a 19th-century surgeon who has been venerated as a selfless benefactor of women for devising ways to repair severe vaginal injuries that can occur in childbirth.
Sims honed his skills by performing scores of painful operations on the genitals of black slaves. His early attempts so often failed that he operated on one young woman 30 times. The women had to be held down during the excruciating operations. Though ether was available, Sims refused to use it, insisting it was not needed. But when he had refined the surgery enough to offer it to white women, he always gave them ether.
To the question of whether it is fair to judge people like Sims by the ethical standards of a later era, Ms. Washington replies that he violated the ethical codes of his own day.
Reprehensible behavior continued into the 20th century. Often, the so-called research performed on blacks had the trappings of science but was meaningless, poorly designed and based on specious theories. People must have known better, but apparently chose not to think about it.
“In the South,” Ms. Washington writes, “rendering black women infertile without their knowledge during other surgery was so common that the procedure was called a ‘Mississippi appendectomy.’ ” But the same was true in the North, as recently as the 1970s, when unnecessary hysterectomies were often done on poor black and Puerto Rican women to give doctors in training a chance to practice their skills.
Some of Ms. Washington’s arguments are less convincing than others. She questions the “significance” of two black men’s being selected as the first subjects to test the AbioCor artificial heart in 2001 and 2002. But was it significant?
Since two of the first six subjects were black, she notes that they made up 33 percent of the test subjects, “almost three times their representation in the population,” and suggests that blacks were used disproportionately to test a device that, if ever approved, would probably be too expensive for most minorities. Ultimately, 14 people tested the AbioCor, but she never gives the complete racial breakdown. From her account, it’s hard to figure out what was going on.
In another venture onto thin ice, Ms. Washington calls for “more exhaustive studies” of an experimental AIDS vaccine that initially appeared to protect blacks and Asians, but not whites. But when the data were closely analyzed, the first finding did not hold up: the vaccine did not work for anybody. Even so, Ms. Washington implies that the vaccine did have promise for minorities but was abandoned purely because it did not help whites. If there is evidence to justify sinking more money into this vaccine, she does not provide it.
But this is an important book. The disgraceful history it details is a reminder that people in power have always been capable of exploiting those they regard as “other,” and of finding ways to rationalize the most atrocious abuse. The victims are declared defective, violent, hypersexed or a drain on the community. The medical tinkering is for their own good, and the greater good of society.
The worst abuses in this country may be a thing of the past, but history has a way of repeating itself. Ms. Washington warns that Africa and other poor regions are becoming the next venue for exploitative studies by foreign governments, universities and drug companies, which may use their citizens to develop medicines and other treatments that those nations will never be able to afford.
Copyright 2007 The New York Times Company
Excerpted from Medical Apartheid by Harriet A. Washington Copyright © 2007 by Harriet A. Washington. Doubleday, a division of Random House, Inc.
Medical Exploitation on the Plantation
Celia’s child, about four months old, died last Saturday the 12th. This is two negroes and three horses I have lost this year. –DAVID GAVIN, 1855
Frederick Gardiner, a peripatetic Mormon physician, left among his travel memoirs an impression of the nineteenth–century slave markets of Washington, D.C.:
There are a great number of Negroes, nearly all of whom are Slaves. And on different Streets are large halls occupied as Marts or stores, for the sale or purchase of Slaves. . . While I have been looking at one of these places on Gravier Street, Two Gentlemen have arrived, one of whom I have Seen in the Saloon, he is a young Planter and come to purchase a girl to take care of his children, or whatever duties he may think proper to impose upon her. The other person is a Doctor whom he has brought with him for the purpose of examining her. They pass along the front of the row in company with the agent or Salesman. As they move forward One is called upon to stand up, then another while a passive examination is made. Then finally he discovers a bright mulatto, who appears about 16 years of age and is quite good looking. She is ushered into a private room where she is stripped to a nude condition and a careful examination is made of all parts of the body by the Dr. and is pronounced by him to be sound. The money is then paid and she is transferred to her new owner…I have heard that the Masters beat and scourge them most cruelly. But I have not seen anything of the kind, nor do I believe that it occurs very often. For the southern people as a class are Noble minded kind hearted people, as can be found in any country…And moreover it would be against their own interests, to brutally treat their Slaves. As no planter desired to have sick negroes on his hands. According to my judgment so far as my experience extends, I believe that the Negroes as a class, are far more humanely treated and taken care of, Than are the laboring classes of European countries (1).
Enslavement could not have existed and certainly could not have persisted without medical science. However, physicians were also dependent upon slavery, both for economic security and for the enslaved “clinical material” that fed the American medical research and medical training that bolstered physicians’ professional advancement. Gardiner’s vignette suggests the integral role of medicine in enslavement and repeats a key belief—that slave owners and physicians shared an interest in preserving the slave’s health, “as no planter desired to have sick negroes on his hands.” But although medicine was essential to enslavement, the apparent solicitude for the health of slaves was not all it seemed. Rather, the medical interests of the slave were often diametrically opposed to the interests of his owner and of American physicians. From the first, antagonism reigned between African Americans and their physicians.
Between the seventeenth–century advent of African settlers to North America and the end of the nineteenth century, the slave and the physician shared an unrecognizably primitive medical world. The “germ theory” that revealed the microbial nature of much disease and led to the first grand waves of disease cures was still well in the future: The existence of pathogens (2) such as bacteria, viruses, and fungi was unsuspected. Almost no effective treatments existed for prevalent diseases until the eighteenth century. Until the late 1830s, the lack of effective anesthesia made the few common surgical procedures horribly painful and all others impossible.
Between the seventeenth and nineteenth centuries, medicine in the United States reflected a narrowly limited understanding of disease and a rather cursory training of medical practitioners. Public–health institutions were few, feeble, and ephemeral, rising momentarily with epidemics of yellow fever or smallpox and subsiding from neglect after the crisis resolved. Even the simplest public–health measures—hand washing and antiseptic techniques, clean water, sound, pathogen–free housing, an untainted food supply, sewage management, and quantitative disease reporting were all in the future. Because there were only a few effective disease therapies and no antibiotics, epidemics of yellow fever, malaria, tuberculosis, and other infectious diseases frequently raged unchecked. In the early 1700s, this mirrored the situation in England and the rest of Europe, but medicine on the Continent began to undergo modernizing changes, although these were very slow to cross the Atlantic. Europe began to embrace public–health measures and medical advances such as widespread vaccination, scientific medical education, and the rise of the hospital, but American progress lagged behind, especially in the insular South.
The point of this chapter’s unflattering précis of nascent American medicine is not to castigate it for its primitivism, but to put blacks’ historical aversion to medical care into context, for most antebellum blacks were subjected to southern medicine.
The South was a particularly unhealthy region and was home to 90 percent of American blacks, the majority of whom were enslaved until 1865. The first blacks arrived in the colonies in 1619, and by 1700 there were only about 20,000 blacks. But as the slave trade flourished, 20,000 more blacks arrived each year. Although 30 percent of transported slaves died in the nightmare of the Middle Passage, there were 550,000 chattel slaves in the United States by 1776, when blacks constituted 20 percent of the U.S. population. By 1807, slave importation was legally prohibited throughout the country, and by 1860, the nation’s four million enslaved blacks had a value equivalent to four billion dollars today. In some states, the black population completely comprised slaves: Alabama, for example, forbade the presence of free blacks.
The South was the nadir of the American medical experience, visited by a deadly triple confluence—the pathogens of North America, Europe, and Africa. This unholy trinity yielded a bewildering array of unfamiliar infectious diseases, such as hookworm, types of malaria, and yellow fever, incubated by a subtropical climate that was hospitable year–round to pathogens that could not thrive in the colder North. Even familiar European illnesses flared anew in strangely virulent forms, abetted by the hot, marshy climate, poor sanitation, and a public–health vacuum. Although the South harbored a highly visible affluent class, the region’s relative poverty led to a dearth of medical care and a host of unrecognized nutritional–deficiency diseases. So did enslavement.
A dramatically misunderstood set of disease etiologies led to the adoption of heroic remedies calculated to kill or cure. Through the eighteenth century, Western medicine was not only misinformed but dangerously so. Caustic medicines of the period often contained metabolic poisons such as arsenic, or calomel, (3) a compound of mercury and chlorine that was used as a purgative. Many other remedies contained highly toxic substances such as mercury and addictive Schedule II narcotics, including the opiates laudanum, (4) opium, and morphine, as well as cocaine derivatives. These medicines addicted, sickened, or killed outright; they also could trigger chemical pneumonitis, or progressive lung injury, if inhaled during a bout of iatrogenic, or physician–triggered, vomiting. No studies seem to have been done on this point, but such lung injuries may have helped to account for slaves’ higher death rate from respiratory disease.
Induced vomiting was an everyday event because the common denominator of medical techniques in this period was the violent release of bodily fluids. Copious bleeding, blistering, and the induction of violent diarrhea were standard therapies. Harsh laxatives or “draughts” such as calomel or jalap (5) produced copious diarrhea, which leached nutrients, water, and electrolytes from the body. They also invited painful bedsores, which were open to infection unchallenged by antibiotics. These crude therapies were not only unpleasant but debilitating to ill persons and even to the strong and healthy. Arsenic, for example, produced not only the intended vomiting and diarrhea but also a wide range of other problems, including fainting, heart disease, disorders of the nervous system, gangrene, and cancers (6). Mercury’s very serious effects included injury to the nervous system, profound mental deficits, hair and tooth loss, kidney and heart disease, lung injury, and respiratory distress. Mercury crossed the placental barrier and concentrated in breast milk, contributing to the high black infant–death and birth–defect rates (7).
Such ministrations were often fatal. The 1799 death of George Washington, hastened by a copious bloodletting the debilitated former president could ill afford, is perhaps the best–known example of a patient finished off by the misguided heroics of eighteenth–century medicine. However, whites of the slave–owning class enjoyed better initial health, better nutrition, and less exposure to environmental pathogens and parasites than did enslaved blacks. Slave owners did not suffer from overwork and exposure, so they were better able than slaves to withstand the rigors of bloodletting. Sensing this, many physicians and scientists discouraged bloodletting for slaves. Thomas Jefferson, statesman and amateur physician–scientist, wrote unequivocally, “Never bleed a negro.” (8) But in their everyday practices, physicians didn’t listen. Dr. Lunsford Yandell wrote, “On March 16, 1833 I was called before sunrise to visit a Negro woman. I took from her twelve ounces of blood…I waited about fifteen minutes when she had a severe convulsion.” (9) Such techniques as cupping (the use of heated glass jars to create a partial vacuum that drew blood upward to the skin’s surface or through an incision in the skin) and trephination (the therapeutic drilling of holes in the skull) were risky for pampered, well–nourished adults living in relatively healthy environments. But they were fatal attentions for sickly, undernourished, and exhausted slaves and for their children, who were at even higher risk of succumbing to anemia or dehydration.
Enslaved African Americans were more vulnerable than whites to respiratory infections, thanks to poorly constructed slave shacks that admitted winter cold and summer heat. Slaves’ immune systems were unfamiliar with, or naïve to, microbes that caused various pneumonias and tuberculosis. Parasitic infections and abysmal nutrition also undermined blacks’ immunological rigor. Before antibiotics and sterile technique, surgery was an often-fatal affair. Unaware of the connection between bacteria and infection, surgeons operated in their street clothes and with dirty hands in filthy environments, such as the shacks that served as “slave hospitals.” Even minor incisions or injuries could proceed to life threatening infections with frightening rapidity.
Southern medicine of the eighteenth and early nineteenth centuries was harsh, ineffective, and experimental by nature. Physicians’ memoirs, medical journals, and planters’ records all reveal that enslaved black Americans bore the worst abuses of these crudely empirical practices, which countenanced a hazardous degree of ad hoc experimentation in medications, dosages, and even spontaneous surgical experiments in the daily practice among slaves.
Physicians were active participants in the exploitation of African American bodies. The records reveal that slaves were both medically neglected and abused because they were powerless and legally invisible; the courts were almost completely uninterested in the safety and health rights of the enslaved (10). The practice of hiring slaves out further endangered enslaved workers by removing much of an employer’s incentive to keep the slave healthy and safe. Some humane plantation owners were careful to choose less risky work venues, but a great danger of slave death or disability was inherent in some forms of mining, tobacco production, rice farming, and most plantation work. In these settings, the slave’s possible death became part of his owner’s commercial calculations. Ominously for blacks, the owners, not the enslaved workers, determined safety and rationed medical care, deciding when and what type of care was to be given. Because professional attention was expensive, most owners dosed their own slaves as long as they could before calling in physicians, who usually saw slaves only in extremis, as a last resort. In clinical notes, medical journals, and memoirs, physicians consistently decried the planters’ tendency to rely upon the cheaper ministrations of overseers, slaves, and mistresses in order to save expense. Physicians’ records also expressed disgust at the conditions in which enslaved workers were kept. Historian Richard Shryock observed in 1936: “Of all critics, the Southern physician was perhaps in the best position to report on the physical and moral treatment of the slaves. When he stated, as he sometimes did, that Negroes were overworked and underfed, he can hardly be suspected of antislavery bias since he was the friend of the planter who employed him. As a matter of fact, he usually approved of the institution.” (11) Planters’ own records and slave narratives corroborate physicians’ complaints that planters provided professional medical care only when they deemed it necessary to save the slave’s life—often too late.
Owners also restricted access to medical care by routinely accusing sick blacks of malingering. Slave narratives and planters’ records reveal that an owner faced with a sick slave was likely to believe the illness was feigned. In her excellent and nuanced history, Working Cures: Healing Health and Power on Southern Slave Plantations, Sharla Fett describes how, in 1859, slave owner William Massie resentfully recorded that his eighty–year–old slave “Patty” had just died “of I know not what disease…She has been saying she was sick for near a year and always pretended to be sick.” No doctor was ever summoned to investigate, and not even Patty’s death seems to have exonerated her from charges of malingering (12). The enfeebled Patty was no longer valuable in the fields or as a “breeder,” so the nature of her sickness was inconsequential.
Owners relied upon doctors to tell them whether slaves were malingering, but physicians were less than objective. Dr.W. H. Taylor, called in consultation for an enslaved man, prefaced his assessment with the phrase “remembering that simulation was a characteristic of his race” (13). Doctors and owners wrote articles in which they shared medical ruses and techniques calculated to get blacks, healthy or not, back into the fields. Dr. M. L.McLoud even wrote his master’s thesis on the fraudulent illnesses of slaves (14). He shared an incident in which he had accidentally administered an overdose of ammonium carbonate, (15) a corrosive white powder that was often used as smelling salts, to a slave shamming an epileptic fit. The burning sensation shocked her into abandoning her performance, and McLoud, like many other doctors, began to advocate such veiled medical violence when confronted with questionable illness in slaves (16). But masters also responded to suspected malingering or prolonged illness with frank abuse. Thomas Chaplin wrote in his planter’s journal, “Mary came out [of the sick house] today or rather was whipped out.” Owners and physicians also blurred the therapeutic line by referring jocularly to whipping as “medicine” for malingering slaves. One complaining woman was “treated with a cowskin or hickory switch to scourge her” [emphasis added]; other doctors recommended that an owner apply “9 drops of essence of rawhide” or “oil of hickory” (17) to the back of a sick slave.
Excerpted from Medical Apartheid by Harriet A. Washington Copyright © 2007 by Harriet A. Washington. Doubleday, a division of Random House, Inc.
From Library Journal
Relying on prisoners' firsthand reports, Hornblum (urban studies, Temple Univ.) has written a thorough account of the questionable medical experimentation carried out in Philadelphia's Holmesburg Prison from the mid-1940s to 1974. Research on everything from cosmetics to chemical warfare agents was conducted there, often with minimal or no record keeping. Such research raises serious ethical issues. Throughout, Hornblum asks whether prisoners can give informed consent, particularly when the potential consequences of the research are not fully explained. Although most of the book centers on Holmesburg, Hornblum does cite other prisons across the country where similar practices took place before they received widespread condemnation in the 1970s. What is shocking about this is that it did not happen in the distant past but in our own generation, with the doctors involved still in practice. Frighteningly, Hornblum reveals that at the Nuremberg trials Nazi doctors cited American prison practices as a defense for their nefarious medical experiments in the camps. Essential for students of medical ethics.AEric D. Albright, Duke Medical Ctr. Lib., Durham, NC
Copyright 1998 Reed Business Information, Inc. --This text refers to the Hardcover edition.