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Medical Apartheid: The Dark History of Medical Experimentation
on Black Americans
from Colonial Times to the Present by
Harriet A.
Washington
Reviewed by Kam Williams
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The
experimental exploitation of
African-Americans is not an issue of the
last decade or even the past few decades.
Dangerous, involuntary, and non-therapeutic
experimentation of African-Americans has
been practiced widely and documented
extensively at least since the 18th
Century... The problem is growing… No other
group as deeply mistrusts the American
medical system.
These
subjects were given experimental vaccines
known to have unacceptably high lethality,
were enrolled in experiments without their
consent or knowledge, were subjected to
surreptitious surgical and medical
procedures while unconscious, injected with
toxic substances, deliberately monitored
rather than treated for deadly ailments,
excluded from lifesaving treatments, or
secretly farmed for sera or tissues that
were used to perfect technologies such as
infectious disease tests.
Excerpted from the
Introduction |
In taking the Hippocratic
oath, every new doctor pledges “Never to do deliberate
harm to anyone for anyone else’s interest.” However,
Hippocrates, the father of modern medicine, must be
spinning in his grave, given the rampant ethical
violations of his sacred doctrine being routinely
perpetrated by physicians in the United States.
Most people only think of
the infamous Tuskegee study of subjects with untreated
syphilis when it comes to the exploitation of blacks as
guinea pigs. But such experimentation by medical
researchers neither began nor ended with that shocking
case.
In recent years, on a
couple of occasions, I have been skeptical about
physicians I felt were doling out different brands of
medicine based on their patients’ skin color. Frustrated
because I had neither the time nor the wherewithal to
pursue my hunches, I couldn’t confront anyone or go
public based only on anecdotal evidence.
For this reason, I am so
grateful that Harriet A. Washington has written
Medical Apartheid: The Dark History of Medical
Experimentation on Black Americans from Colonial Times
to the Present. For this groundbreaking book
confirms my suspicions by addressing the disparate
methodologies currently being employed with patients
presenting the specific symptoms I had been concerned
with.
Ms. Washington, a Harvard
and Tuskegee-trained scholar in ethics and journalism,
conducted exhaustive research in order to be able to
shed light on the country’s racism in the name of
scientific research. Among the brutalities uncovered
here by the author is proof that “black women have been
systematically sterilized without their consent, and
that “the brains of African-American children as young
as six” have secretly been “surgically excised.”
She illustrates how this
disregard for the well-being of blacks began during the
days of slavery when Africans en route to the Americas
were “thrown overboard if signs of disease were found”
by the ship’s surgeon. By the conclusion of this
compelling opus, she makes it abundantly clear that just
as America has a two-tiered criminal justice system, it
has totally different quality healthcare systems when it
comes to blacks and white citizens.
So, when you encounter an
African-American who harbors a deep distrust of doctors,
that might not be paranoia but simply a sensible
survival instinct still intact.
—Kam
Williams
* * * *
* Other Reviews
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.
The product of years of prodigious research into
medical journals and experimental reports long
undisturbed,
Medical Apartheid reveals the hidden
underbelly of scientific research and makes
possible, for the first time, an understanding of
the roots of the African American health deficit. At
last, it provides the fullest possible context for
comprehending the behavioral fallout that has caused
black Americans to view researchers—and indeed the
whole medical establishment—with such deep distrust.
No one concerned with issues of public health and
racial justice can afford not to read Medical
Apartheid, a masterful book that will stir up both
controversy and long-needed debate.
—Publisher, Random House
* * * *
*
Washington’s book is a rallying call for change within
the medical and African American communities. While
doctors must understand their black patients’ fears of
exploitation, African Americans, Washington writes,
“cannot afford passivity.” Increased participation in
ethically designed medical studies would not only be a
boon to African Americans suffering from serious
diseases but would also lead to better preventive care
in general. As she concludes, “Physicians, patients, and
ethicists must…understand that acknowledging abuse and
encouraging African Americans to participate in medical
research are compatible goals.”
—Amaya
Rivera,
Mother Jones
* * *
* *
Given the history
presented in Medical Apartheid, it is no surprise that
some African Americans continue to regard the medical
system with apprehension, despite more stringent
safeguards enacted by the federal government in the
1970s. Washington attributes this outlook, which she
calls iatrophobia, to the seeds of distrust sown
in black communities by the Tuskegee scandal and a
history of lesser-known mistreatment.
Washington, a visiting fellow at Chicago's DePaul
University, intends that
Medical Apartheid serve a socially
therapeutic—if not cathartic—function. Laying bare these
atrocities, her logic goes, will foster healing and
frank but necessary conversation. Clearing the air may
encourage a better informed African American public to
participate in clinical trials.. . . . Precisely because
Washington's account of racially stratified medical
exploitation is so gripping, it may be difficult for the
public to muster enthusiasm to enter clinical trials, no
matter their cultural background. And with the
experimental research burden shifting from Americans of
African descent to Africa itself (which Washington calls
a "continent of subjects"), Asia, and Latin America,
where some cavalier researchers are seeking more
plentiful and pliant subjects, readers may be more
convinced than ever of the durability of the medical
color line. ?
—Alondra Nelson,
Washington Post
* *
* * *
Harriet A. Washington
Medical Apartheid: The Dark History of Medical
Experimentation
on Black Americans from Colonial Times
to the Present
* * *
* *
Chapter 1
SOUTHERN DISCOMFORT: Medical Exploitation
on the Plantation
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.
Source:
Random House
posted 8 February 2007 |
