Harriet A. Washington - Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present

CONTENTS

For Ron DeBose, my husband,
with undying love and gratitude

When I began working at the institute, I recalled my adolescent dream of becoming a medical research worker. Daily I saw young[white] boys and girls receiving instruction in chemistry and medicine that the average black boy or girl could never receive. When I was alone, I wandered and poked my fingers into strange chemicals, watched intricate machines trace red and black lines upon ruled paper. At times I paused and stared at the walls of the rooms, at the floors, at the wide desks at which the white doctors sat; and I realizedwith a feeling that I could never quite get used tothat I was looking at the world of another race.

RICHARD WRIGHT, 1944

The wrongs which we seek to condemn and punish have been so calculated, so malignant and so devastating that civilization cannot tolerate their being ignored because it cannot survive their being repeated.

CHIEF U.S. PROSECUTOR ROBERT JACKSON, OPENING STATEMENT, NUREMBERG DOCTORS TRIAL, DECEMBER 9, 1946

INTRODUCTION

The American Janus of Medicine and Race

Science without conscience is the souls perdition.

FRANOIS RABELAIS, PANTAGRUEL

On a sylvan stretch of New Yorks patrician upper Fifth Avenue, just across from the New York Academy of Medicine, a colossus in marble, august inscriptions, and a bas-relief caduceus grace a memorial bordering Central Park. These laurels venerate the surgeon James Marion Sims, M.D., as a selfless benefactor of women. Nor is this the only statuary erected in honor of Dr. Sims. Marble monuments to his skill, benevolence, and humanity guard his native South Carolinas statehouse, its medical school, the Alabama capitol grounds, and a French hospital. In the mid-nineteenth century, Dr. Sims dedicated his career to the care and cure of womens disorders and opened the nations first hospital for women in New York City. He attended French royalty, his Grecian visage inspired oil portraits, and in 1875, he was elected president of the American Medical Association. Hospitals still bear his name, including a West African hospital that utilizes the eponymous gynecological instruments that he first invented for surgeries upon black female slaves in the 1840s.

But this benevolent image vies with the detached Marion Sims portrayed in Robert Thoms J. Marion Sims: Gynecologic Surgeon, an oil representation of an experimental surgery upon his powerless slave Betsey. Sims stands aloof, arms folded, one hand holding a metroscope (the forerunner of the speculum) as he regards the kneeling woman in a coolly evaluative medical gaze. His tie and morning coat contrast with her simple servants dress, head rag, and bare feet.

The painting, commissioned and distributed by the Parke-Davis pharmaceutical house more than a century after the surgeries as one of its A History of Medicine in Pictures series, takes telling liberties with the historical facts. Thom portrays Betsey as a fully clothed, calm slave woman who kneels complacently on a small table, hand modestly raised to her breast, before a trio of white male physicians. Two other slave women peer around a sheet, apparently hung for modestys sake, in a childlike display of curiosity. This innocuous tableau could hardly differ more from the gruesome reality in which each surgical scene was a violent struggle between the slaves and physicians and each womans body was a bloodied battleground. Each naked, unanesthetized slave woman had to be forcibly restrained by the other physicians through her shrieks of agony as Sims determinedly sliced, then sutured her genitalia. The other doctors, who could, fled when they could bear the horrific scenes no longer. It then fell to the women to restrain one another.

I wanted to reproduce Thoms painting on the cover of this book, or at least in the text, but when I asked permission of its copyright holder, Pfizer Inc., the company insisted on reviewing the entire manuscript of this book before making a decision. As an independent scholar I could not acquiesce to this, and I used another cover image. When I renewed my request to use the image within the text, Pfizer agreed to base its decision upon reading this chapter and an outline of the book.

The Pfizer executives apparently were uncomfortable with what they read, because they refused to grant permission to reproduce this telling image or even respond to my query after I supplied the requested chapter and outline. This act of censorship exemplifies the barriers some choose to erect in order to veil the history of unconscionable medical research with blacks.

Betseys voice has been silenced by history, but as one reads Simss biographers and his own memoirs, a haughty, self-absorbed researcher emerges, a man who bought black women slaves and addicted them to morphine in order to perform dozens of exquisitely painful, distressingly intimate vaginal surgeries. Not until he had experimented with his surgeries on Betsey and her fellow slaves for years did Sims essay to cure white women.

Was Sims a savior or a sadist? It depends, I suppose, on the color of the women you ask. Marion Sims epitomizes the two facesone benign, one malevolentof American medical research.

Of all the forms of inequality, injustice in health is the most shocking and the most inhumane. In 1965, Martin Luther King, Jr., spoke these words in Montgomery, Alabama, at the end of the Selma to Montgomery march that had been attended by the black and white physicians of the Medical Committee for Human Rights. King had invited the doctors not only to give medical succor to injured marchers but also to witness the abuse suffered at the hands of segregationists. With these almost unnoticed words, King ushered in a new era in civil rights, because as Delegate to Congress Donna Christian-Christensen, M.D., chair of the Congressional Black Caucus Health Braintrust, has declared, Health disparities are the civil rights issue of the 21st century. Thus Dr. Kings alarm over racial health injustice was prescient, and were he alive today, his concern would be redoubled. Mounting evidence of the racial health divide confronts us everywhere we look, from doubled black infant death rates to African American life expectancies that fall years behind whites. Infant mortality of African Americans is twice that of whites, and black babies born in more racially segregated cities have higher rates of mortality. The life expectancy of African Americans is as much as six years less than that of whites.

Old measures of health not only have failed to improve significantly but have stayed the same: some have even worsened. Mainstream newspapers and magazines often report disease in an ethnocentric manner that shrouds its true cost among African Americans. For example, despite the heavy emphasis on genetic ailments among blacks, fewer than 0.5 percent of black deathsthats less than one death in two hundredcan be attributed to hereditary disorders such as sickle-cell anemia. A closer look at the troubling numbers reveals that blacks are dying not of exotic, incurable, poorly understood illnesses nor of genetic diseases that target only them, but rather from common ailments that are more often prevented and treated among whites than among blacks.