CHAPTER 1
SOUTHERN DISCOMFORT
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.