A 1995 report from the Centers for Disease Control (CDC) indicated that at that time African-American women were more than three times more likely to die in childbirth than their white counterparts. That figure has not changed significantly since then. Even today, black infants are more than twice as likely to die than white infants. Disparities go beyond issues of pregnancy and childbirth. A number of studies have found that patients of color are less likely to receive the same quality of medical care as whites – even when all other factors, such as coverage, ability to pay and general health are equal.
In order to understand why this disparity exists, it is necessary to face our history, particularly in connection with race, slavery and medicine. One place to start is with the story of Dr. James Marion Sims (1813-1883), sometimes hailed as the “Father of Modern Gynecology.” Aside from being the inventor of the vaginal speculum (a device used by gynecologists to the present day), he is best known as the inventor of a surgical technique for repairing a condition known as obstetric fistula, an injury often occurring during childbirth in which the bladder leaks urine into the vagina. While hailed by medical historians for his contributions, what is less known is that Sims used African-American slave women as subjects for his cruel and usually painful experiments.
It is a disturbing history that is outlined in the book Medical Apartheid, by medical ethicist Harriet Washington. She points out, “As African-Americans, we’ve been abused for so long, consistently by the system, why should we trust it?” She says that iatrophobia – “fear of the healer” – among African-Americans is the result of the long history of abuse and victimization by the medical profession, which advanced medical knowledge through inhuman experimentation on blacks – in many cases, without their knowledge.
Since the beginning of American history in the early 17th Century, plantation owners were the primary employers of physicians. These doctors were hired to examine slaves at auctions in order to determine the state of their health. They were also expected to treat sick and injured slaves in order to protect their employers’ investment. Things changed after 1808, when Congress passed a law banning the importation of slaves from Africa. This resulted in slave owners putting increased pressure on black women to become breeding stock.
During the 1830s, the rise of the Abolition Movement led to the development of a new branch of medicine, known as “Negro Medicine.” In reality, this was pseudo-science used primarily to justify the “peculiar institution” and provide both scientific and biblical “proof” that blacks were of an “inferior” race. It was at this time that Sims and others began their medical experiments on slave women. Many of these experiments were little better than those done by the infamous Dr. Josef Mengele during the Second World War. One medical journal of the time described an experiment in which boiling water was poured over a subject’s legs simply to determine if she was capable of feeling pain.
During the late 1840s, Sims was busy performing experimental surgeries on a teenage slave named Enarca and eleven other black women. Over a two-year period, Enarca was subjected to thirty of Sims’ experimental procedures. Eventually, Sims’ colleagues abandoned him and were no longer willing to assist him – so Sims enlisted the help of his other experimental “subjects.” Although anesthesia had been introduced a year before Sims began his experiments, he decided against using it because of a belief, prevalent at that time, that blacks did not feel pain or fear. In his 1848 work, The Natural History of the Human Species, author Charles Hamilton Smith wrote, “The American dark races bear with indifference tortures insupportable to a white man” – suggesting that dark skin inured them to pain.
If that seems shocking to us here in the 21st Century, consider a recent study from the University of Virginia, which found that even today, “black Americans are systematically undertreated for pain relative to white Americans.”
Such experiments did not end with Dr. Sims – nor was he the only one to conduct such studies. Starting in 1932, there was an infamous study, known as the “Tuskegee Study of Untreated Syphilis in the Negro Male,” which continued until 1972. Subjects signed up believing they were being treated for rheumatism or gastrointestinal disorders. Instead, they were studied to learn about the progression of the disease, and were never treated – even though penicillin was available.
By the mid-20th Century, pro-sterilization laws aimed at blacks were on the books in more than half of the states – and in some cases, sterilization was forced. In 1961, civil rights leader Fannie Lou Hamer was admitted to a Mississippi hospital for a minor operation. While there, doctors performed a hysterectomy on her without her consent. The practice of sterilizing black women without their knowledge or consent was so common that Hamer referred to it as a “Mississippi appendectomy.” Such practices were not confined to the South; many teaching hospitals in the New York City had an “unwritten policy” of performing hysterectomies on poor African-American and Latina women, and such operations were done well into the 1970s throughout the country.
It is small wonder that African-Americans tend to be suspicious of health care institutions – and the problem is exacerbated by another disturbing trend: fewer blacks are choosing medicine as a career.
Some argue that it is unfair to judge people like James Marion Sims and his contemporaries by the standards of our ostensibly more enlightened era. After all, they were products of their time and their culture, and they didn’t know better – right? Wrong. Ms. Washington says, “I didn’t judge the practitioners based on our own ethics. I judge them based on the ethics of their time. It was not acceptable back then – we just did not hear from the people who protested against it.”
Sadly, the legacy of those bad old days continues to persist. Today, a bronze statue of Dr. J. Marion Sims honoring his “contributions” stands at the entrance of New York City’s Central Park – ironically, part of East Harlem, a traditionally African-American neighborhood. This past summer, protesters gathered in front of the 125-year-old statue, demanding its removal. Considering that other relics such as the Confederate flag and other Confederate monuments have been coming down in recent years, the City of New York would do well to follow suit – but so far, municipal leaders have refused to remove the statue.