Illustration: Escaped slave John Brown
The next installment of the New York Times’s new series commemorating the 400th Anniversary of the arrival of the first slaves at Jamestown is out. It looks at the influence of slavery on medicine in America, which continues to the present day. Written by Linda Villarosa, who directs the journalism program at the City College of New York. Below are some excerpts from the article:
The excruciatingly painful medical experiments went on until his body was disfigured by a network of scars. John Brown, an enslaved man on a Baldwin County, Ga., plantation in the 1820s and ’30s, was lent to a physician, Dr. Thomas Hamilton, who was obsessed with proving that physiological differences between black and white people existed. Hamilton used Brown to try to determine how deep black skin went, believing it was thicker than white skin. Brown, who eventually escaped to England, recorded his experiences in an autobiography, published in 1855 as “Slave Life in Georgia: A Narrative of the Life, Sufferings, and Escape of John Brown, a Fugitive Slave, Now in England.” In Brown’s words, Hamilton applied “blisters to my hands, legs and feet, which bear the scars to this day. He continued until he drew up the dark skin from between the upper and the under one. He used to blister me at intervals of about two weeks.” This went on for nine months, Brown wrote, until “the Doctor’s experiments had so reduced me that I was useless in the field.”
Hamilton was a courtly Southern gentleman, a respected physician and a trustee of the Medical Academy of Georgia. And like many other doctors of the era in the South, he was also a wealthy plantation owner who tried to use science to prove that differences between black people and white people went beyond culture and were more than skin deep, insisting that black bodies were composed and functioned differently than white bodies. They believed that black people had large sex organs and small skulls — which translated to promiscuity and a lack of intelligence — and higher tolerance for heat, as well as immunity to some illnesses and susceptibility to others. These fallacies, presented as fact and legitimized in medical journals, bolstered society’s view that enslaved people were fit for little outside forced labor and provided support for racist ideology and discriminatory public policies.
Over the centuries, the two most persistent physiological myths — that black people were impervious to pain and had weak lungs that could be strengthened through hard work — wormed their way into scientific consensus, and they remain rooted in modern-day medical education and practice. In the 1787 manual “A Treatise on Tropical Diseases; and on The Climate of the West-Indies,” a British doctor, Benjamin Moseley, claimed that black people could bear surgical operations much more than white people, noting that “what would be the cause of insupportable pain to a white man, a Negro would almost disregard.” To drive home his point, he added, “I have amputated the legs of many Negroes who have held the upper part of the limb themselves.”
These misconceptions about pain tolerance, seized upon by pro-slavery advocates, also allowed the physician J. Marion Sims — long celebrated as the father of modern gynecology — to use black women as subjects in experiments that would be unconscionable today, practicing painful operations (at a time before anesthesia was in use) on enslaved women in Montgomery, Ala., between 1845 and 1849. In his autobiography, “The Story of My Life,” Sims described the agony the women suffered as he cut their genitals again and again in an attempt to perfect a surgical technique to repair vesico-vaginal fistula, which can be an extreme complication of childbirth….
Recent data also shows that present-day doctors fail to sufficiently treat the pain of black adults and children for many medical issues. A 2013 review of studies examining racial disparities in pain management published in The American Medical Association Journal of Ethics found that black and Hispanic people — from children with appendicitis to elders in hospice care — received inadequate pain management compared with white counterparts.
A 2016 survey of 222 white medical students and residents published in The Proceedings of the National Academy of Sciences showed that half of them endorsed at least one myth about physiological differences between black people and white people, including that black people’s nerve endings are less sensitive than white people’s. When asked to imagine how much pain white or black patients experienced in hypothetical situations, the medical students and residents insisted that black people felt less pain. This made the providers less likely to recommend appropriate treatment. A majority of these doctors to be also still believed the lie that Thomas Hamilton tortured John Brown to prove nearly two centuries ago: that black skin is thicker than white skin.
This disconnect allows scientists, doctors and other medical providers — and those training to fill their positions in the future — to ignore their own complicity in health care inequality and gloss over the internalized racism and both conscious and unconscious bias that drive them to go against their very oath to do no harm.
The centuries-old belief in racial differences in physiology has continued to mask the brutal effects of discrimination and structural inequities, instead placing blame on individuals and their communities for statistically poor health outcomes. Rather than conceptualizing race as a risk factor that predicts disease or disability because of a fixed susceptibility conceived on shaky grounds centuries ago, we would do better to understand race as a proxy for bias, disadvantage and ill treatment. The poor health outcomes of black people, the targets of discrimination over hundreds of years and numerous generations, may be a harbinger for the future health of an increasingly diverse and unequal America.
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