Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

Washington’s book is split into three parts, with Part 1, “A Troubling Tradition,” focusing on the relationship between Black Americans and American medical institutions in the country’s early years. In the first chapter, Washington provides an overview of the state of medicine in the American South, with a particular focus on the scientific and medical views of enslaved people. Washington argues that “antagonism reigned between African Americans and their physicians” from America’s conception (26).

The state of medicine in the 18th and 19th centuries was rudimentary compared to contemporary medical standards. Germs and bacteria had yet to be discovered, meaning that scientific understanding of what caused disease was poor. Accordingly, disease treatments often caused more harm than good, and medicines were frequently composed of harmful chemicals such as cocaine and opium. The Antebellum American South was an especially disease-ridden area due to its climate and the mixing of “the pathogens of North America, Europe, and Africa” (27).

Enslaved people were given no say in their health care, and all medical treatments were instead decided upon by the enslavers and physicians. As a result, medical decisions for enslaved people were based less on caring for their health than guaranteeing their “soundness” for work, ensuring the highest possible profits for the enslaver. In some instances, enslavers allowed enslaved people to die rather than seek treatment, as the owners would rather receive money from a life insurance policy payout than pay a physician to treat them. Enslaved people recognized that the white physicians were not acting in their best interest, and they frequently hid their illnesses and sought traditional African treatments instead.

The treatments that physicians prescribed enslaved people were based on “scientific racism” (32)—a set of beliefs that sought to manipulate scientific practices to prove the inherent inferiority of Black people. Advocated by such scientists as Samuel A. Cartwright, scientific racism argued that Black people evolved separately from white people, developing lesser mental and physical skills in the process. Cartwright and others viewed slavery as a benevolent institution, as they believed Black people needed “white supervision” (36) in order to live. White physicians treated enslaved people based on the assumption that they were “physically inferior and were liars, malingerers, hypersexual, and indolent” (35). Physicians often prescribed poor or dangerous treatments to enslaved people, incorrectly believing that Black individuals’ bodies were physically different. Likewise, scientists incorrectly assumed that Black people had physical immunity to diseases such as malaria and heatstroke, often ignoring the symptoms of such diseases as a result.

In “Profitable Wonders,” Washington describes some of the various experiments white doctors subjected enslaved people to in the Antebellum South. Washington opens the chapter with the story of John Brown, an enslaved person owned by Doctor Thomas Hamilton. Hamilton purchased Brown because he wanted to experiment on him to find a cure for heatstroke. These experiments bordered on torture and included forcing Brown to sit for hours in a pit of burning embers. In Washington’s view, Brown’s painful ordeals were characteristic of how doctors exploited the bodies of Black people in the Antebellum South.

White doctors’ abuse of enslaved people’s bodies was influenced by the beliefs of scientific racism, which portrayed Black bodies as particularly suitable for scientific experiments. Many doctors believed that Black people were incapable of feeling “pain or anxiety” (58), leading to the doctors performing physically intense experiments that they would never performed on white patients. While enslaved people were sometimes asked to agree to their participation in medical experiments, Washington argues that this form of consent would not match today’s more rigorous standards of “informed consent” (55), which requires the physician to thoroughly explain the experiment and its potential dangers to all research subjects.

Washington then discusses James Marion Sims, a doctor who practiced on plantations in Alabama. One day, Sims was called to treat Anarcha, a 17-year-old enslaved woman. After a failed painful childbirth, Anarcha developed a condition called vesicovaginal fistula, in which small openings form in the skin between the vagina and the rectum. Vesicovaginal fistula was a common condition in 19th-century America and frequently left women permanently damaged. Sims decided to devote himself to finding a cure for the condition and purchased 11 enslaved women to experiment on.

Sims built a wooden shack for the women to live in and began to operate on them. In the Antebellum South, white women would never have undressed in front of a doctor nor displayed their genitalia. Sims, however, forced the enslaved women to get completely naked and then display themselves for his observation. After studying the women’s genitalia, Sims decided to attempt to cure their vesicovaginal fistula by suturing the openings shut. Each of Sims’s operations, however, was a failure, as the surgical wounds became infected and reopened. Sims forced the women to undergo his surgeries without anesthesia, even though ether was frequently used as an anesthetic at the time. After five years of operating on enslaved people, Sims developed a method of using silver for the sutures. The usage of silver led to a successful operation, and Sims earned recognition and praise for his discovery from the American medical community. However, a few of his contemporaries, including his medical assistant, criticized him for what they saw as exploitative practices.

In this chapter, Washington moves away from medical investigations on enslaved people to the exhibition and display of Black bodies in popular culture. Washington describes a variety of Black individuals—some former enslaved people, others captured native Africans—who were made to exhibit their bodies for public entertainment in circuses and other venues. Washington argues that “the boundary separating popular display from medical display was a porous one” (79). She describes how the use of Black bodies for entertainment and theatrical purposes helped popularize scientific theories that viewed Black people as physically inferior to whites.

Often, 19th-century exhibitions of Black bodies argued that Black people occupied a lower rung on the evolutionary ladder and had physically more in common with animals than white humans. Such a theory was characteristic of “polygenism” (91), which held that different races evolved separately from each other and that Black people were an entirely different species from whites. When Saartje Baartman, a captured woman from the Khoi tribe in South Africa, was put on display in 18th-century London, her exhibitors presented her as a “missing link between human and ape species” (83). Baartman’s gender and sexuality were particularly emphasized in her exhibitions, and she was given the nickname “Hottentot Venus.” At the time, many scientists believed that African women were inherently promiscuous and oversexualized, and they were eager to observe Baartman’s genitalia to prove their theories. Washington characterizes this as “regular violations that alternated between rape and the most intimate of medical examinations” (84). After several years of circus-like displays, Baartman developed an alcohol addiction and died at 27. After her death, scientist Georges Cuvier dissected Baartman’s corpse, extracting her genitalia and brain as scientific specimens.

Washington turns to the story of P. T. Barnum, a successful circus leader in 19th-century America. Barnum got his start as a showman when he purchased Joice Heth, a formerly enslaved elder. After claiming Heth was 161 years old and the former nurse of George Washington, Barnum received a surge in media attention, much of which was devoted to determining whether Heth’s age was a hoax. In response, Barnum agreed to let Heth be publicly autopsied following her death, asserting that the autopsy would confirm Heth’s advanced age. The resulting autopsy was a “bloodily invasive circus” (88), and although Heth’s age was revealed to be a lie, Barnum received even greater notoriety from the spectacle.

Barnum went on to create exhibitions of so-called “white negroes” (94)—Black individuals who appeared to be turning white. Washington notes that such individuals’ supposedly “white” appearance could have been due to a number of reasons, from medical conditions such as albinism or vitiligo to interracial sexual relationships. Various scientists and doctors conjured a number of theories to explain the perceived change in race, with some arguing that the physical transition was caused by Black people’s adoption of Western culture. For many scientists, however, the existence of white-passing Black people was a deeply troubling phenomenon, as it called into question their medical theories about the evolutionary difference between Black and white people. In turn, some scientists became determined to locate racial difference inside Black bodies rather than relying on skin color alone as the marker of race.

In “The Surgical Theater,” Washington turns her attention to the role that Black people—both enslaved and freed—played in the growing number of teaching hospitals in 19th-century America. Hospitals were a relatively new phenomenon, taking the place of one-year medical schools as the educational standard for physicians. Most individuals who could afford to do so hired private doctors to treat their illnesses, though they expected these doctors to have years of training working at a public hospital. Most hospitals almost exclusively treated America’s lower classes: poor white people, freed Black people, and enslaved people. As hospitals required a constant influx of “clinical material” with which to train their numerous students, Black patients were frequently forced to have their treatments serve as demonstrations for training doctors.

Black patients in hospitals were frequently subjected to invasive questioning about their lives and bodies, often being inappropriately asked about their sexual practices. Medical institutions were not secretive about their desire for and use of Black patients for experimentation, and hospitals frequently advertised requests for enslavers to bring their sick enslaved people to the hospital. Similarly, when hospitals advertised to potential students, many boasted about the number of Black patients on which students could learn and practice new surgical techniques.

While some physicians were critical of this exploitation, many surgeons were openly flippant about respecting the rights of Black patients. Many surgeons would perform unnecessary surgeries on Black patients, such as amputations or castrations, to demonstrate proper surgical technique to their pupils. These surgeons failed to ask for the Black patients’ consent and frequently performed the surgeries without anesthesia, as they incorrectly believed that Black people could not feel pain in the way white people did. The results of these surgical experiments were frequently published in medical journals that were read exclusively by fellow white male doctors, with little regard for the privacy of the Black subjects. Washington closes her chapter by arguing that this disregard for medical ethics in treating Black patients led to student surgeons developing a lack of empathy for their Black patients. In Washington’s view, hospital practices in the 19th century taught doctors that Black people were not human but rather “expendable” material suited for doctor’s experimentation.

One of the key tenets of the growing “hospital movement” in 19th-century America was that doctors had to base their medical decisions on scientifically proven therapies. Accordingly, doctors were increasingly expected to have dissected a human corpse, so as to have detailed knowledge of the anatomy of the human body. Few individuals, however, willingly consented to have their bodies used for dissection following death, and hospitals continually struggled to find enough corpses to supply their students. They began to use the bodies of Black people—especially enslaved people, who had no legal rights over the usage of their bodies. Hospitals began employing “resurrectionists,” individuals who would visit Black cemeteries at night and dig up corpses. These resurrectionists were frequently also Black, as the white staff at hospitals did not want to be associated with such blatant criminal activity. In several instances, these resurrectionists were caught, leading to a media outcry over the graverobbing. However, while the Black resurrectionists were sent to jail for their graverobbing, the white doctors who paid them frequently received no punishment.

In the 19th century, practices of dissection and autopsy were seen as particularly ghastly by Black and white people alike, as it was interpreted as a mutilation of the human body. Black people were particularly disgusted by the idea of dissection as they saw it as a way that racism and the institution of slavery held power over their bodies, even after death. Black people frequently avoided hospitals out of rumors that the medical staff would purposely kill them to use their cadavers. While white doctors dismissed such fears, Washington argues that the reality was that 19th-century hospitals almost exclusively made use of Black cadavers in their teaching. As hospitals across the country were in constant need of corpses for dissection, many white individuals decided to overlook the dubious means by which Black corpses were obtained, as they would prefer Black bodies be dissected over white ones.

In addition to dissection, many Black corpses were later put on display, whether as stuffed corpses or as skeletal remains. Although these displays were intended to serve as teaching aids, they were frequently made without the individual’s consent. Washington further notes that many anatomists and other surgeons would pose for photographs alongside dissected Black corpses. In Washington’s argument, such images of white physicians next to mutilated Black bodies communicated in similar ways as photographs of lynchings, reminding Black individuals that “whites could torture them, murder them, and defile their bodies with impunity” (136).

In the decades before the Civil War, many in the South were starting to become aware that slavery was a dying institution. The North boasted a strong enough economy that it did not have to rely on slavery as the South did, and many in the North viewed the South’s theories of scientific racism to be a manipulation of science with the sole purpose of justifying slavery. Many in the South were growing fearful of a future where Black people were free, as well as the growing number of multiracial “mulattoes” whose existence they saw as threatening the racial hierarchies in Southern society. Slavery’s supporters found the seemingly objective justification for slavery they were looking for in the form of the 1840 US census.

At first glance, the 1840 census seems to indicate that slavery was of greater benefit to Black people than freedom. According to the census, free Black people in the North suffered from lower life expectancy and much higher rates of mental health conditions than enslaved Black people in the South. Slavery advocates such as Senator John C. Calhoun used this data to argue that freedom was too difficult a burden for Black people to deal with and that the help of white enslavers kept enslaved people in better health. Two different doctors—the white Dr. Edward Jarvis and the Black Dr. James McCune Smith—each produced analyses of the census that proved the census’s data was full of errors and poor calculations. However, Calhoun refused to accept their analyses, and the myth that slavery kept Black people healthy and happy persisted for decades.

Once the Civil War began, Black people fled the South for the free North in numbers that eventually reached more than 1 million individuals. The Union Army was tasked with caring for these newly freed Black people and built numerous camps and hospitals to house them. However, very few doctors were assigned to treat the freed Black people, and many outright refused to treat them at all. After the war, the freed Black people returned to the South, where they became ensnared by the institution of sharecropping—what Washington deems “an insidiously indirect new form of slavery” (152). Sharecropping trapped Black people in a life of deep poverty, and they were unable to afford proper health care. As a result, disease abounded in Black communities. Many white southerners at the time erroneously believed that the poor health facing Black people was caused by their innate inability to sustain themselves, rather than by poverty and a lack of proper medical care. Whereas before the Civil War white southerners believed Black people to have innately superior physiques, many white people came to believe that Black people were a dying population that would go extinct in the upcoming century.

In this chapter, Washington tells the history of the Tuskegee Syphilis Study—one of the most notorious abuses of Black people by physicians in US medical history. Throughout the chapter, Washington stresses that the Tuskegee Syphilis Study was not a singular episode of ethical misconduct; rather it was part of a long historical pattern of neglect by medical institutions.

Tuskegee is a town located in Macon County, Georgia, and in the early 20th century, it was predominantly inhabited by Black people. Making a living as sharecroppers, Macon County’s Black population lived in poor conditions nearly identical to those endured by enslaved people half a century earlier, and numerous diseases “from malaria to tuberculosis to syphilis” (159) abounded. The US Public Health Service (PHS) became interested in Macon County due to the high rates of syphilis in the population. The organization sensed an opportunity to create a study that tracked how syphilis affected and killed the human body over decades. The PHS’s experiment was motivated by racist beliefs that Black people were naturally inclined to develop syphilis due to their innate “sexual irresponsibility” (160), as well as the erroneous assumption that syphilis affected Black bodies differently from white bodies.

In order to find subjects for its study, the PHS set up clinics that offered free treatments for a disease they called “bad blood” (162). Numerous Black Macon County residents visited the clinic, and although the institute identified individuals with syphilis, the doctors did not inform the patients of their diagnosis and prescribed them treatments that they knew to be ineffective. In 1932, the doctors ultimately selected 399 syphilitic Black men to observe for the study. While these men were led to believe that they were being treated by the doctors, the doctors purposefully neglected to inform the men of their diagnosis, and they continued to withhold proper treatment for their syphilis. Local doctors were also instructed not to treat the men for syphilis. Although penicillin was discovered to be an extremely effective cure for syphilis in 1943, the PHS still declined to cure the men of their disease. A Black nurse, Eunice Rivers, was tasked with closely observing the men to help ensure that they did not accidentally receive treatment for syphilis. Rivers was also tasked with making the doctors aware when the syphilitic men died so that they could obtain their corpses and perform autopsies.

The study continued until 1972 when Peter Buxtun leaked news of the study to the media, leading to public outrage. A nine-member panel was appointed to investigate the study and determine whether it was ethically sound. The panel, half of whom were Black, declared that the study had been unethical from the start and that it should not continue. The subjects were to receive immediate treatment for their illness. Likewise, the panel advised that a national board be founded to ensure robust ethical standards are met in all human research studies. The investigation, however, was hampered by a short time frame and infighting among the participants. It was later discovered that numerous important papers relating to the Tuskegee Study were not made available to the board’s members, and some felt a deliberate cover-up had occurred. The board condemned the study, yet its final report failed to fully note the racism inherent within the experiment’s structure. News reports of the Tuskegee Study helped increase African American’s “iatrophobia” (179)—a term Washington uses to refer to Black people’s fear of medical institutions and health care.