Thesis: In the Antebellum South, as American medicine modernized, white physicians identified black people as vulnerable targets to meet the growing demand for human specimens. Black people’s social inferiority and the prevailing scientific racist belief provided a strong “justification” for white physicians’ overt medical practices on them. While economic incentives for slave owners and physicians played a role, racist ideology and black people’s inferior slave status primarily drove the prevalent use of black bodies in medical experiments in the Antebellum South.
Of all the forms of inequality, injustice in health is the most shocking and the most inhumane,” remarked American medical ethicist Harriet A. Washington in Medical Apartheid. During the Antebellum South, black people played a significant but unjust role in medical education and surgical practice—as “clinical material.” Antebellum-Era medical journals have documented southern white physicians’ extensive reliance on black patients for clinical demonstrations, experiments, and anatomical dissections. Medical experimentation on black subjects led to significant medical breakthroughs, profoundly shaping modern American medicine and saving numerous lives. Notably, Alabama surgeon Dr. J. Marion Sims, revered as the “father of modern gynecology,” developed groundbreaking surgical techniques to enhance women’s reproductive health through experimental operations on enslaved black women. Contrary to prevailing beliefs of black people’s inherent inferiority, people assumed that medical knowledge acquired from experimentation on black bodies could be applied to Caucasians. While the use of black people for medical experimentation and demonstration was not a deliberate, organized conspiracy by southern white physicians and slave owners, a pattern emerged within the social and scientific context of the time, revealing the racial attitudes harbored by white southerners toward black people. The widespread acceptance of black people’s social and biological inferiority, supported by flawed scientific racist theories, provided the motivation and opportunity for white physicians to exploit black bodies without social constraints. As the modernization of American medicine created public expectations for physicians to acquire professional medical training, they identified black people as vulnerable targets to meet the growing demand for human specimens. The widely accepted belief in black subordination served as a seemingly robust justification for white physicians’ overt medical practices on black people. While economic incentives for slave owners and physicians also played a role, racist ideology and black people’s inferior slave status primarily drove the prevalent use of black bodies in medical experiments in the Antebellum South.
Slavery in the Antebellum South
The history of slavery in North America predates the establishment of the United States. Throughout the seventeenth and eighteenth centuries, the trans-Atlantic slave trade thrived as European colonists in North America relied on enslaved Africans for cheap and abundant labor. In the American South, where an insatiable demand for slave labor grew, slavery became deeply embedded in the culture and profoundly influenced the region’s economy and society. Following the pivotal Act to Prohibit the Importation of Slaves in 1808, which outlawed the international slave trade, slaves from older slave states like Virginia, Maryland, and the Carolinas became subjected to domestic slave trade.
In American history, the Antebellum Period lasted from the end of the War of 1812 to the onset of the Civil War in 1861. During this time, the South was characterized by a deeply entrenched system of slavery and the culture it fostered. White landowners imposed forced labor on plantations upon enslaved black people, whose lives were marked by brutal treatment, such as harassment, torture, family separation, and imprisonment, as punishments for any acts of defiance. The quality of life for slaves was remarkably low, with meager food, inadequate shelter, and a lack of personal belongings. These factors, along with the demanding labor conditions, caused frequent illness and death among the enslaved population. Ironically, due in part to the prohibition of the international slave trade, enslaved people were encouraged to reproduce, as each child brought the potential for increased wealth for slave owners who treated them as mere commodities.
Medical Development in the Antebellum South
During the seventeenth and nineteenth centuries, American medicine reflected a narrow understanding of disease and the rudimentary training of medical practitioners. The slaves and southern white physicians shared a primitive medical world that lacked recognition of the microbial nature of diseases. Effective treatments for prevalent diseases were scarce. Surgical procedures were excruciatingly painful without reliable anesthesia, making many surgeries impossible. Public-health institutions were sparse, feeble, and rising temporarily during outbreaks of diseases such as yellow fever or smallpox and subsiding from neglect once the crisis was resolved. Due to the absence of basic public-health measures, epidemics of infectious diseases frequently raged unchecked.
Meanwhile, European medicine underwent transformative changes. Following the French Revolution, Paris emerged as a hub of groundbreaking medical advancements, signifying a shift from medieval to modern medicine known as “Paris Medicine.” The Paris School of Medicine led a conceptual revolution in understanding diseases, laying the foundation for the “germ theory” and revolutionizing medical knowledge. Under the influence of the Paris School, medical education and research became hospital-based. It was during the mid-nineteenth century that the wave of medical modernization finally crossed the Atlantic to the United States, shaping the future of American Medicine.
Still, nineteenth-century American hospitals fell far behind the antiseptic, high-tech, and ethics-obsessed modern institutions of scientific medicine. With scarce effective medications and the absence of external federal agencies to regulate hospitals and safeguard patients’ interests over physicians’ priorities, there was a lack of transparency and oversight, creating a deep-seated sense of distrust among the American public toward medical facilities.
Section I: The“hospital movement” raising the demand for “clinical material”
European influence fostered a spirit of clinical inquiry and scientific experimentation, creating a high demand for human specimens in medical schools and hospitals in the American South. The rising popularity of clinical medicine caused a shift away from unprofessional medical training, raising public expectations for anatomical knowledge and scientific skills among medical students. Historian Todd L. Savitt noted, during the mid-nineteenth century, inspired by progressive ideas of the Paris School of Medicine, the American public began questioning the effectiveness and safety of traditional treatments such as bleeding, purging, and cupping. Consequently, medical students and physicians were expected to undergo specialized training and gain practical clinical experience. This increased the need for “clinical material”—hospitalized patients or cadavers—to facilitate anatomy education, experimentation of new techniques, and autopsies critical to understanding diseases’ effects on the human body. However, finding and maintaining an adequate supply of “clinical material” was challenging, as American hospitals in the nineteenth century were not widely sought after as they are today.
American hospitals were particularly notorious for a practice known as “clinical display,” where “clinical material” was subjected to medical observations by professors and students for education and training. During these displays, patients and their illnesses were thoroughly examined and questioned, often including speculation about their sexuality and sexual experiences. Therefore, “clinical display” often made patients feel disrespected and that their privacy was invaded. Besides passive displays, physicians also utilized “clinical material” for invasive surgical techniques, aiming to pioneer new techniques, display surgical acumen, or enhance their reputation. As “clinical display” expanded to include more hands-on practice and demonstration, patients’ lives were at risk in physicians’ pursuit of medical knowledge. Since the public understood that hospitals prioritized instruction and experimentation for students and physicians over patient care, wealthier white Americans with private physicians and financial support avoided hospitals, recognizing the potential cruelty involved.
Consequently, the relentless pursuit of medical advancement in America led medical institutions to target black people, predominantly enslaved, as a readily available source of “clinical material.” In the fierce competition for students, southern medical schools advertised their programs in newspapers, medical journals, circulars, and magazines. A key selling point was the abundance of “clinical material” for surgical demonstrations and anatomical dissections. The Medical College of South Carolina boasted about its availability of cadavers and “the great opportunities for the acquisition of anatomical knowledge.” Its boast that “the object of the faculty is to collect as many interesting cases as possible, for the benefit and instruction of their pupils” takes on special meaning as surgery at the school was performed only on black people. Similarly, the Savannah Medical Journal promoted the “abundant clinical opportunities for the studying of disease” offered by their Negro patient census at the Savannah Medical College. To this end, many southern medical schools established hospitals exclusively for black patients and advertised for offering medical care of low or no cost to sick and aged slaves in rural newspapers, encouraging slave owners to send in patients. Consequently, black patients became the primary source of “clinical material” and the sole victims of the competitive race among medical institutions for reputation and prospective students.
Besides medical schools, physicians like Dr. J. Marion Sims sought “clinical material” to showcase their discoveries and immortalize their medical success in medical journals, aiming to establish their academic careers, promote their practices, and enhance their reputations. Sam, a forty-two-year-old black slave on a plantation in rural Alabama, once was a productive laborer before developing cancer of the lower jawbone. Eager to return Sam to profitable work, his owner sent him to Sims, who performed the surgery in a teaching clinic to a group of medical students and potential protégés and hoped to document the operation in a medical publication. Sam’s case exemplifies physicians’ need for patients to demonstrate their skills and clinical success, a demand fulfilled by black patients. Therefore, as American medicine modernized, the demand for abundant human specimens for training and demonstration arose due to increased expectations for physicians. While the risks of being utilized as “clinical material” deterred white people from seeking medical care from hospitals, schools and physicians turned to black patients instead.
Section II: Black people’s social inferiority making them vulnerable targets
Black people’s powerless slave status rendered them particularly vulnerable to being used as “clinical materials.” After visiting Baltimore in 1834, English sociologist Harriet Martineau remarked, “The bodies of colored people exclusively are taken for dissection because the whites do not like it, and the colored people cannot resist.” This reflects that many white Americans strongly opposed anatomic dissections and postmortem examinations due to religious beliefs and societal perceptions. During the Antebellum Era, prevalent religions, including Christianity, Judaism, and Islam, held views on death that affirmed the dignity and sanctity of the human body. Consequently, dissection was considered blasphemous. Christian doctrine, for example, emphasized the resurrection of the human body on the Last Day and its worthiness of respect, incurring religious sentiment against human dissection by physicians. Furthermore, in the eighteenth century, dissection was primarily used as a threat and punishment for crimes rather than a method to study human anatomy. Medical educator Dr. Frederick C. Waite summarized, “Many Americans considered dissection a degrading and sacrilegious practice, an act to be inflicted on an outcast as punishment—much like the medieval rite of drawing and quartering a criminal.” Therefore, besides the risk of exposure and invasion of privacy, religious beliefs and negative public perceptions of dissection exerted significant social pressures on physicians, preventing them from using the bodies of decent members of society for experimentation and deterring most white Americans from sacrificing themselves for medical science.
In the nineteenth century, most U.S. states enacted “bone bills” that permitted medical schools to take unclaimed bodies from hospitals and poorhouses for dissection. While families and friends of deceased white patients prevented physicians from taking their bodies, black people, predominantly slaves, were defenseless of their bodies after death. Samuel Clossy, New York City’s first anatomy professor, discovered in the 1760s that dissecting a white person carried substantial risks, whereas dissecting a black person was largely a matter of finding a body. Clossy admitted that he and his students “could not venture to meddle with a white subject” due to their reputation in the community, but they had no reservations about dissecting “a black or Mulatto.” Early anatomists recognized that dissecting racial minorities’ bodies protected them from public outrage and controversy due to the social stigma surrounding dissection because black people were deemed inferior to be regarded as equal social members as white people. Savitt also noted, “Blacks were considered more available and more accessible in this white-dominated society…[they] were legally invisible because of their slave status.” Historical records indicate that slaves were medically neglected and abused, with the courts uninterested in safeguarding their safety and health. Therefore, black people’s powerlessness and inferior social status as slaves afforded little safeguard for their deceased bodies, which were demanded for medical dissection due to persistent shortages of cadavers.
Moreover, slave owners, possessing complete control over their slaves’ medical care and procedures, exhibited little concern if their bodies were subjected to experimentation or dissection. Dr. Henry M. Dowling of Virginia encountered little difficulty obtaining permission for an autopsy on a twelve-year-old slave girl suspected of having worms because her owner was “a gentleman of intelligence, and unaffected by the vulgar prejudices entertained on this subject…” Sometimes, even sympathetic physicians, reluctant to operate on protesting slaves, had no right to refuse the operation because they were legally obligated to follow the wishes of slave owners rather than the slaves. The subordinate slave status completely stripped slaves of any control over decisions regarding their bodies, and slave owners often eagerly sent their slaves to physicians in the hope of curing their illnesses and returning them to the plantations to resume work and generate profits.
Additionally, slaves faced heightened health risks due to harsh working conditions, inadequate nutrition, and exposure to environmental pathogens and parasites. The poorly constructed slave shacks exposed them to respiratory infections, while their immune systems, unfamiliar with North American microbes and weakened by malnutrition, rendered them susceptible to fatal diseases such as pneumonia and tuberculosis. Officials from the Medical College of the State of South Carolina acknowledged that they had little trouble filling beds at their newly established infirmary, as “the slave population of the city, and neighboring plantations, is capable of furnishing ample materials for clinical instruction.” Owing to a slave population “peculiarly liable to surgical diseases requiring operations for their relief,” students at the school observed various operative procedures. Exploiting their vulnerable health, physicians at these institutions conveniently acquired slaves without prompting public unrest or resistance. Therefore, due to their marginalized social status and lack of power, slaves were deemed ideal candidates for serving as “clinical material.” Collaborating with slave owners, medical institutions held the authority to dictate the fate of slaves, guaranteeing a steady supply of sick slaves for medical demonstration and practice.
Section III: Scientific racism justifying experimentation on black people
Prevalent beliefs of scientific racism justified white physicians’ overt medical operations on black people. At times, the Caucasian race was widely considered biologically superior within American society. Medical professor Samuel Cartwright told the Medical Association of Louisiana, “The excess of organic nervous matter, and the deficiency of cerebral…impart to the negro a nature not unlike that of a newborn infant of the white race.” Cartwright further asserted that black people resembled children and their anatomical structures made them “[unfit]…for the responsible duties of a free man” but destined “for a state of dependence and subordination.” The American school of ethnology, advocated by influential physicians like Cartwright, solidified the ideology that black people were slaves by nature. In the Antebellum South, physicians like Cartwright, referencing so-called “scientific evidence,” maintained that black people were physiologically distinct from white people, making them destined for servitude. Scientific racism permeated the southern culture so profoundly that succeeding generations of Antebellum-Era physicians justly viewed black people as mere demonstration materials and experimental subjects.
Furthermore, Cartwright asserted that black people were “difficult to bleed, owing to the smallness of their veins.” This widespread belief that black people were less likely to bleed and experience pain offered physicians a seemingly legitimate justification for experimenting on them. Dr. Sims, for instance, performed surgical operations on enslaved black women without anesthesia, noting that white patients often exhibited less endurance than black patients. He remarked in his medical notes, “The pain was so terrific that Mrs. H. could not stand it and I was foiled completely.” In contrast, a 1950 biography of Sims suggested that slave women endured his gynecological experiments “with amazing patience and fortitude—a grim stoicism which may have been part of their racial endowment.” As Sims’ medical success propelled him to prominence, his practice profoundly influenced that of other southern physicians and reinforced the baseless racist belief in black people’s higher pain tolerance. Dr. Charles White, another physician, made similar observations, remarking that “[black people] bear surgical operations much better than white people and what would be the cause of insupportable pain for white men, a Negro would almost disregard.” Dr. James Johnson, London Medical and Chirurgical Review editor, went so far as to claim that “[black] people will bear anything with nearly if not quite as much impunity as dogs and rabbits.” Johnson’s comparison between black people and common experimental animals reflected prevailing racial attitudes in the Antebellum South, indicating a general perception of black people as disposable beings.
Scientific racism profoundly impacted black people’s status within the U.S. healthcare system. Southern scientists claimed exclusive authority to study and interpret black people’s medical and intellectual characteristics. These theories, “presented as research findings, explained by scientific theories, and promulgated by whites…provided medical and scientific justifications for slavery.” Historians have observed that “Racism tainted...biomedical sciences from their early beginnings…precursors of scientific racism had profound and nefarious health and health care effects on enslaved Africans.” Exploiting science’s perceived objectivity and credibility, scientific racism aimed to “prove” black people’s inherent inferiority and legitimize racist attitudes and behaviors. Since black people arrived in the United States as slaves, scientific racism has negatively impacted their health outcomes and the treatment they received from the healthcare system. As southern physicians heavily relied on the black population for medical experimentation and demonstration, widely accepted and “validated” scientific racist beliefs justified and perpetuated their practices.
Section IV: Economic incentives driving medical experimentation on black people
However, in Medical Apartheid, Harriet Washington identified the economic incentives contributing to Antebellum physicians and slave owners’ conspiracy to perform medical experimentation on black people. In the nineteenth-century slave markets of Washington, D.C., described by Mormon physician Frederick Gardiner, “no planter desired to have sick negroes on his hands.” With the abolition of the international slave trade, slave owners sought to maximize their profits by sending old, sick, and futile slaves to infirmaries and hospitals, where the cost of feeding, housing, and treating their slaves would be covered. If the slaves died, owners were spared the burial expense, as hospitals retained the bodies for dissection or experimentation. Alternatively, if the slaves recovered, owners could continue profiting from their labor and reproduction. To ensure a steady supply of patients for clinical instruction, the Medical College of the State of South Carolina’s hospital waived professional charges for lodging and treating slaves, while charging white patients, exemplifying the mutual economic interests between slave owners and physicians. Therefore, while medical institutions publicly requested slaves as “clinical material,” slave owners willingly obliged, seeking to avoid the burden of caring for sick slaves and benefiting if the slaves happened to recover and regain their working capacity.
Moreover, trading slaves between medical institutions and slave owners proved financially lucrative for physicians, who, along with the owners, played a vital role in sustaining these slave markets for medical purposes. Southern white physicians often purchased slaves specifically for experimentation, aiming to achieve significant breakthroughs, showcase clinical operations for public demonstration, and advance their medical careers. This pursuit of medical success held the promise of fame and fortune, prompting physicians to seek slaves for experimentation. Former slave Martha Griffith Browne recounted that Dr. Mandy’s kind-hearted wife “did not believe in slavery, yet she dared not speak against the ‘peculiar institution’ of the South. It would injure the doctor’s practice, a matter about which she must be careful.” While physicians’ reputations and prosperity relied on the availability of slaves for experimentation, they were driven by a positive feedback loop to acquire even more slaves in their quest for greater fame and fortune.
Many physicians, including Sims, were themselves slave owners who purposefully bought and raised slaves for experimentation. From 1844 to 1849, Sims experimented exclusively on enslaved black women to find a cure for vesicovaginal fistula (VVF), a common obstetrical condition threatening enslaved women’s ability to perform hard labor and their reproductive capacity. Sims experimented on fourteen slaves with VVF, including 30 experiments on a seventeen-year-old girl called Anarcha. Sims wrote in his memoir that besides Anarcha, Betsy, and Lucy, he “ransacked” the country and found “six or seven cases of [VVF] that had been hidden away for years…”After years of engagement in medical experimentation, Anarcha, along with Betsy, Lucy, and approximately nine other unidentified women, was eventually cured of VVF and remained working in Sims’ hospital. Sims’ ultimate success in developing effective surgical techniques for VVF brought him tremendous fame and fortune.
Sims’ practices were common among elite white physicians, supported by both the medical community and slave owners. Since gynecological conditions like VVF posed a significant threat to enslaved women’s reproductive health, physicians extensively experimented on enslaved women to improve their reproductive outcomes and ensure the sustainability of slavery. Before being sold, enslaved women underwent gynecological examinations by physicians to assess their value and determine whether they would be a profitable investment. Historian Deirdre C. Owens, the author of Medical Bondage, explained that most physicians experimented on slaves to protect and increase slave owners’ economic interests while enhancing their professional skills. “Slavery, medicine, and capitalism were intimate bedfellows,” remarked Owens. As the abolition of the international slave trade increased the reliance on domestic slave births, enslaved women’s fecundity and the birth of healthy slave offspring became crucial for perpetuating American slavery. This economic imperative drove the growth of gynecology as a medical specialty, aiming at maintaining black women’s reproductive health and preventing potential financial losses for slave owners. Consequently, experimentation on enslaved women flourished in the Antebellum South. Hence, physicians’ pursuit of fame and fortune, slave owners’ desire to maximize profits, and the necessity of perpetuating slavery all fueled the economic motivations behind medical experimentation on slaves.
Section V: Deeply entrenched racist ideology and social bias providing the gateway to pursuing economic incentives
Indeed, economic incentives promoted the existence of slave markets for experimentation and investigation of slaves’ health conditions to preserve their working and reproductive capacities. However, these economic incentives could only be pursued with the deep-rooted racist ideology of black people’s inherent inferiority and prevailing racial attitudes that enabled physicians and the public to justify and accept the use of black people as “clinical material.” According to public health professor Kathleen Bachynski, racist beliefs provided perceived ethical justifications for physicians like Sims to conduct invasive experiments on black people. Sims began his fistula operations on enslaved women before the discovery and public demonstration of ether anesthesia in October 1846. Although anesthesia quickly gained popularity, its acceptance was not universal, with considerable opposition to its application, according to historian Martin Pernick. Thus, Sims continued his experiments on VVF patients without anesthesia, specifically choosing black women as his subjects. Bachynski noted, “Black women were considered appropriate subjects for such experiments based on the widespread belief that black people experienced less pain than white people.” Therefore, while economic motives initially prompted his research, the pervasive and misleading belief in black people’s pain tolerance provided the foundation and justification for utilizing black women as experimental subjects and ultimately contributed to Sims’ success.
In addition to false racist beliefs, enslaved women’s vulnerable and inferior slave status contributed to their exploitation as experimental subjects by southern white physicians. According to historian Sharla Fett, Sims recognized that “using white women to test such painful surgeries as might be effective against it was impossible.” Historian Walter Fisher further emphasized the crucial role of slavery, stating that “It would have been most improbable that Sims…could have established so remarkable a surgical schedule without the slave system which provided the experimental subjects.” Unlike white women, slaves “did not have to be recruited, persuaded, and cajoled to endure pain and indignity; they could not refuse,” Washington summarized. While white women from the middle or upper class had the agency to refuse Sims’ painful surgeries, enslaved women were deprived of autonomy over their bodies and compelled to obey their white masters’ will. This power imbalance and their defenselessness made them readily available and vulnerable subjects for physicians to obtain with minimal effort.
Moreover, the perception of black people as inferior to the human species exempted physicians from the social constraints regarding medical experimentation on “respectable” members of society. In the nineteenth century, social norms refrained male physicians from viewing unclothed female bodies, even for professional medical examinations. To examine women’s genitalia, “women’s doctors” relied on their sense of touch and averted their eyes. However, Sims was “constrained by no such delicacy when dealing with enslaved black women.” He required his subjects to fully undress and kneel on hands and knees to insert a speculum and examine their vaginas. When treating black patients, southern physicians disregarded the social rules that applied to white women, perceiving black people as a different and subordinate “race.” This freedom from social pressure made investigating diseases and examining female reproductive organs significantly easier for physicians. Thus, while economic incentives motivated physicians to experiment on slaves, the combination of misguided racist beliefs and slaves’ inferior status left them particularly vulnerable and powerless to resist, making them the most exploitable subjects for medical experimentation.
In the Antebellum South, black people were not only relegated to servitude but also exploited as medical specimens. As slaves occupied the bottom of the social hierarchy, they were dehumanized and powerless in a society deeply entrenched by racist ideologies. Southern white physicians exploited their vulnerability and subordinate status to perform clinical demonstrations, experiments, and dissections, practices spurned and avoided by white people. Although economic incentives facilitated the conspiracy between physicians and slave owners, the pervasive racist system in the Antebellum South made these incentives feasible, at the expense of black people. While slavery was abolished in the United States in 1865, and the American public health system gradually advanced over time, the exploitation of black people in medical research persisted. In 1932, nearly a century later, the U.S. Public Health Service, collaborating with the Tuskegee Institute, initiated the notoriously unethical “Tuskegee Study of Untreated Syphilis in the Negro Male.” In this infamous study, six hundred black men were deceived and coerced into participation, denied proper diagnosis and treatment for syphilis. They were subjected to painful experimental procedures like those in the Antebellum South. Not only was the study flawed and racist in its design, but it also became unnecessary after penicillin became a widely available treatment. Yet, it continued unabated. The mistreatment and exploitation of black people in medical experimentation did not start or end in the Antebellum South, nor did it cease with the Tuskegee Study. Regrettably, the racism that fueled these practices in the past continues to permeate the U.S. healthcare system today, leading to racial disparities in access to medical care and resources. Recent studies found many white medical students still wrongly believe black people have higher pain tolerance, making black patients less likely to receive appropriate pain medication. Although various efforts have been made to address these issues, the long history of dehumanization and medical abuse of black people highlights the considerable distance left to go in achieving equitable healthcare.
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