Our nation’s founding documents and the Pledge of Allegiance detail the principles that supposedly define the United States of America: equality, liberty, and justice for all. But history has shown that these privileges did not and do not apply to everyone, especially people of color. African Americans have been systemically mistreated, and this lack of dignity for Black lives includes the absence of proper medical treatment. Described by Dr. Martin Luther King Jr. as “the most shocking and the most inhuman form” of inequality, health care injustice is an issue that impacts Black Americans to this day.
The history of the blatant medical mistreatment of Black people in what would later become the United States of America dates back to the early 16th century. During the Middle Passage, enslaved people were taken from dungeons to overcrowded ships to be transported to the burgeoning colonies. Before the journey began, captives were medically examined; those who did not fit the qualifications or had unsuitable preexisting health conditions were not taken aboard the ship.
The journey was excruciating. Enslaved people endured cramped, unsanitary conditions at sea on a voyage that could take up to three months. In a narrative, shared by Project Gutenberg, by a formerly enslaved man named Olaudah Equiano who survived the Middle Passage, he described the circumstances the captives experienced: “The closeness of the place, and the heat of the climate, added to the number in the ship, which was so crowded that each had scarcely room to turn himself, almost suffocating us. This produced copious perspirations, so that the air soon became unfit for respiration, from a variety of loathsome smells, and brought on a sickness among the slaves, of which many died, thus falling victims to the improvident avarice, as I may call it, of their purchasers. This wretched situation was again aggravated by the galling of the chains, now become insupportable; and the filth of the necessary tubs [large buckets for human waste], into which the children often fell, and were almost suffocated.”
Severe overcrowding on the ships made it easier for communicable diseases and illnesses to spread, including dysentery, smallpox, and severe diarrhea. Additionally, there was rampant abuse of power by the heads of the ships. Given their unchecked authority, they constantly raped and assaulted enslaved persons on board. Medical professionals were also on board, but their main directive was to attend to the slaves’ health so they’d be maintained as a lucrative investment, not actually caring for them as human beings.
Many enslaved people died from disease or suicide (by jumping off the ship due to “fixed melancholy” or starving themselves and refusing to eat provided rations). Unfortunately, when the ships reached their destination, the conditions were no better for those who survived the journey.
After arriving on American plantations, following the treacherous Middle Passage, enslaved people were again exposed to numerous diseases, such as hookworm, malaria, and yellow fever. As Harriet A. Washington documented in her book Medical Apartheid, the South’s unforgiving, humid climate made it easier for certain illnesses to proliferate. Most owners felt that it was their responsibility to care for the laborers they kept as property, but it cost them a lot of money to bring in a competent medical professional with many years of experience. Because of this financial strain, owners would only call on Southern physicians in the 11th hour for the sole purpose of keeping an enslaved person alive for their labor.
When sought out by owners, medical professionals did not take a tempered approach to treatment, often using dangerous remedies, including substances like arsenic and mercury, that could be deadly and frequently caused horrendous side effects. According to Washington, physicians had little incentive to treat the slaves compassionately and humanely because they approved of slavery just as the masters who employed them did. Physicians were especially prone to administering substances that would force enslaved persons to “[violently] release bodily fluids” in accordance with misconceived notions about curing a plethora of diseases and illnesses via induced vomiting.
Furthermore, owners often ignored reports of medical issues, claiming that enslaved people were “malingering” or making excuses so that they could get out of laboring. Black pain was dismissed or deemed invalid, and legitimate medical issues were written off as excuses. This pattern has endured.
As slavery was perpetuated in the United States, medical experimentation also expanded. Some of the most recognizable examples of experiments on enslaved people, particularly women, were conducted by the “father of modern gynecology,” James Marion Sims, MD. Dr. Sims became well-known in the South for his solution to the troublesome issue of vesicovaginal fistula, an opening between the bladder and vagina that results in urinary incontinence. He was seen as a trailblazer in the field of gynecology for this accomplishment, but he came to make this discovery by using violent measures on enslaved women. From 1845 to 1849, 11 enslaved women with vesicovaginal fistula were experimented on by Dr. Sims. Scholars know only the first names of three women he treated: Anarcha, Betsy, and Lucy. Dr. Sims himself wrote about the “agony” of Lucy, who contracted blood poisoning during an experimental procedure.
Experimentation on Black people persisted into the 20th century. In Macon County, Alabama, the Tuskegee Syphilis Study lasted from 1932 to 1972. Researchers targeted a group of 600 Black men, many of whom were Southern sharecroppers or tenant farmers who were typically tied to the land they worked, having leased it from a landlord to eventually exchange as payment a share of the crops they produced. The study’s researchers told subjects that they were trying to treat a condition called “bad blood,” an umbrella term that, in the region at the time, was used for diseases such as anemia and syphilis.
In truth, though, the researchers wanted to understand how untreated syphilis affected Black men. Of the men studied, 201 did not have syphilis and about 399 men did have it; the former set was used as a control group in the study. Although penicillin was an established treatment for syphilis by this time, the men were never offered access to the medication to cure their disease. As a result of the researchers not treating these men for syphilis, about 128 of them died, plus 40 of their wives; 19 of their children were born with a congenital form of the disease.
A more recent example of shocking health disparities in the US came during the COVID-19 pandemic. Over most of the pandemic, Black, Native American, and Hispanic people experienced higher rates of infection and death than white people, according to the Kaiser Family Foundation’s research. One example of how race-based notions potentially impact patient health is the use of spirometers, devices that measure an individual's lung capacity. These medical instruments are programmed to assume a 10-15% smaller lung capacity for Black patients. Because of this assumption, which is not always accurate, physicians are more likely to misdiagnose Black patients, resulting in patients who miss out on necessary treatments.
As an article in the Lancet medical journal pointed out, “Currently, there is no known major genetic locus that varies by race that can explain racial disparities in lung function; however, body proportions, socioeconomic status, and occupational hazards clearly influence capacity. These factors should be measured directly, rather than using race as a rough proxy.”
The stereotypes about Black lung capacity date back to the 1700s, when Thomas Jefferson said that enslaved persons and white people had a “difference of structure in the pulmonary apparatus.” Over 100 years later, in the Civil War era, a study deemed African Americans to have a lesser lung capacity when compared with white Americans, based on a comparison of Black and white soldiers. And this is just one example. Black women are more likely to die during childbirth than white women, even when adjusted for income, and many medical trainees still believe that “Black people’s nerve endings are less sensitive than white people’s.”
To prevent further health injustices, like the one Dr. King spoke of decades ago, it is imperative to be educated on the history of the United States. By learning about the past, we can start to unlearn our racial biases and create a more just world.
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