Medical Apartheid

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present is a 2007 book by Harriet A. Washington. It is a history of medical experimentation on African Americans. From the era of slavery to the present day, this book presents the first detailed account of black Americans' abuse as unwitting subjects of medical experimentation.

Medical Apartheid

Paperback edition cover
Author	Harriet A. Washington
Audio read by	Ron Butler
Language	English
Subject	Unethical human experimentation in the United States
Genre	Non-fiction
Publisher	Doubleday
Publication date	9 January 2007
Publication place	United States
Media type	Print, e-book
Pages	512 pp.
ISBN	978-0385509930

Medical Apartheid won the 2007 National Book Critics Circle Award for Non-fiction. Washington's work helped lead to the American Medical Association's apology to the nation’s black physicians in 2008 and the removal of the James Marion Sims statue from Central Park in 2018.

Synopsis

Medical Apartheid traces the complex history of medical experimentation on Black Americans in the United States since the middle of the eighteenth century. Harriet Washington argues that "diverse forms of racial discrimination have shaped both the relationship between white physicians and black patients and the attitude of the latter towards modern medicine in general".

The book is divided into three parts: the first is about the cultural memory of medical experimentation; the second examines recent cases of medical abuse and research; while the last addresses the complex relationship between racism and medicine. Some topics discussed are well-known, such as the Tuskegee syphilis experiment (1932–1972), in which African Americans with the disease were intentionally denied treatment (without being told) in order to allow the progression of the disease so it could be observed in all stages, but other episodes are less well known to the general public. The book also mentions cases of medical experimentation in Africa and their links to African-American cases.

Topics covered

Part 1

James Marion Sims

In several chapters in Part 1 of the book, Washington describes how enslaved African Americans were exploited and mistreated by doctors and used in medical experiments. One of the most infamous examples she describes is James Marion Sims, a doctor from South Carolina often considered the "father of gynecology". Washington details the misdiagnosis of the medical conditions which his patients suffered from during his medical training and the mistreatment of black enslaved women that led to his medical breakthrough.

Washington describes how Sims used black infants for tetany experiments. Sims determined through his research that the cause of tetany in the babies was a result of the movement of skull bones during birth. In order to test his theory, he took a black baby and, using a shoemaker's tools, opened the baby's brain based on his belief that black babies' skulls grew faster than the skulls of white babies, preventing their brains from growing or developing. Most of the babies died and he blamed their deaths on their supposed lack of intelligence.

The most infamous example of Sims' medical malpractice was his research on vesicovaginal fistulas. Sims acquired four enslaved women and used their bodies in order to find a cure for the complication of childbirth. Sims mistreated the women, including by making them completely undress (despite modesty standards of the time) while he and other doctors examined them. He also put the women through painful surgeries without giving them anesthesia and Washington writes, "he claimed that his procedures were 'not painful enough to justify the trouble and risk of attending the administration,' but this claim rings hollow when one learns that Sims always administered anesthesia when he performed the perfected surgery to repair the vaginas of white women in Montgomery a few years later. Sims also cited the popular belief that blacks did not feel pain in the same way as whites." Despite this, he received much fame and attention for his breakthrough. Because of his use of black women, Sims was eventually able to help white women who experienced vesicovaginal fistulas, but black women still did not have access to these treatments and many of them died from the same disease that the enslaved women helped to cure.

Exhibiting of African Americans

Washington discusses cases of Africans and African Americans exhibited in human zoos and freak shows, including famous and lesser known cases. Washington argues that "[a]round 1840, entrepreneurs realized that a market hungered for black exotica, and they took a leaf from the physicians' book by displaying blacks as medical curiosities", and that these displays were "a dramatic argument for the alien inferiority of black bodies".

Cases Washington describes include:

• Ota Benga, a Mbuti (Congo pygmy) man kidnapped by slave traders and exhibited in the 1904 Louisiana Purchase Exposition and in the Bronx Zoo. Outrage from African American newspapers and black churches helped pressure the mayor of New York City into releasing him in 1906. After his release, Benga learned English and obtained a job, but developed depression because he could not return to Africa and died by suicide in 1916.

• Sarah Baartman was a Khoikhoi woman exhibited in 19th-century Europe under the name Hottentot Venus. She was displayed in Cape Town by the man whose household she worked for, and eventually toured Europe and became a popular attraction. It is unknown to what extent she consented to be exhibited and how much of the profits she received. She died in December 1815 around age 26 of an undetermined disease. Scientist Georges Cuvier preserved her skeleton, brain, and genitalia, and they were displayed at several French museums. After a formal request from President Nelson Mandela, her remains were repatriated to her homeland in 2002.
• Joice Heth was exhibited by P.T. Barnum with the false claim that she was the 161-year-old nursing mammy of George Washington. She attracted considerable public attention and speculation. After her death in February 1836, Barnum arranged for a public autopsy in front of fifteen hundred spectators, charging admission of US$0.50. When the surgeon declared the age claim a fraud, Barnum insisted that the autopsy victim was another person, and that Heth was alive, on a tour to Europe. Barnum later admitted the hoax. Heth was likely 79-80 years old when she died. Little is known of her early life other than she was once enslaved.

Dissection and Grave Robbing

As the number of medical schools in the United States increased and as science and medicine evolved, demand for cadavers for doctors to dissect increased. Laws in some states allowed medical schools to use the remains of those at the bottom of society's hierarchy—the unclaimed bodies of poor persons and residents of almshouses, and those buried in potter's fields for anatomical study. Doctors also turned to hiring men to carry out grave robberies. According to Washington, the majority of bodies used for dissection were of African Americans.

Washington describes the 1989 discovery beneath the Medical College of Georgia for thousands of bones once used for dissection. Approximately 75% of the bones belonged to African Americans, despite the nearby population only being 42% African American.

Also discussed is the Negroes Burial Ground (now known as the African Burial Ground National Monument), New York's earliest known African-American cemetery; studies show an estimated 15,000 African American people were buried there. The revelation that physicians and medical students were illegally digging up bodies for dissection from the burial ground precipitated the 1788 Doctors' Riot.

Tuskegee Syphilis Study

One of the most infamous examples of the medical mistreatment of African Americans Washington discusses is the Tuskegee Syphilis Study, which was a study conducted between 1932 and 1972 by the United States Public Health Service and the Centers for Disease Control and Prevention on a group of nearly 400 African American men with syphilis. The purpose of the study was to observe the effects of the disease when untreated, though by the end of the study medical advancements meant it was entirely treatable. The men were not informed of the nature of the experiment and by the end of the study, 28 patients had died directly from syphilis, 100 died from complications related to syphilis, 40 of the patients' wives were infected with syphilis, and 19 children were born with congenital syphilis.

A public outcry ensued after newspapers broke the story in 1972, and Senator Edward Kennedy called Congressional hearings and the CDC and PHS appointed an ad hoc advisory panel to review the study. As a result of the panel's investigation, the study was ended and new laws regulating human experimentation were passed. For Medical Apartheid Washington conducted new interviews with panel members, and members shared for the first time publicly discord behind the scenes of the investigation. Several members felt they were not given enough resources and the scope of their investigation was too limited. Panel members also shared with Washington that chairperson Dr. Broadus Butler steered the panel toward a softer version of the final report that removed references to intentional racism on the part of the study doctors, that he convinced the panel to destroy tapes of some of their interviews.

The study is often cited as a reason for African Americans' distrust of the medical system. However, Washington writes:

"[b]y focusing upon the single event of the Tuskegee Syphilis Study rather than examining a centuries-old pattern of experimental abuse, recent investigations tend to distort the problem, casting African Americans' wariness as an overreaction to a single event rather than an understandable, reasonable reaction to the persistent experimental abuse that has characterized American medicine's interaction with African Americans".

Part 2

In Part 2 of the book, Washington discusses experiments in the 20th century done on individuals who did not give informed consent and were often in vunerable positions. Cases she discusses include experiments done on incarcerated individuals, with a focus on one of the most famous examples, Holmesburg Prison; experiments on juvenile boys with the goal of identifying so-called violent genes; and human radiation experiments done on people who were seeking other medical care. In these cases, not only black people were part of the experiments, but Washington argues that they were disproportionately targeted and that they were more often selected for more dangerous experiments.

Awards & Reception

Medical Apartheid won the 2007 National Book Critics Circle Award for Nonfiction. It also won a PEN/Oakland Award, BCALA Nonfiction Award, and Gustavus Myers Outstanding Book Award. It was selected as one of Publishers’ Weekly Best Books of 2006.

Medical Apartheid received generally favorable reviews. In their starred review, Publisher's Weekly wrote "Washington is a great storyteller, and in addition to giving us an abundance of information on "scientific racism," the book, even at its most distressing, is compulsively readable". Kirkus Review called the book "sweeping and powerful". For The New York Times, Denise Grady was more mixed, writing "[s]ome of Washington's arguments are less convincing than others", but adding, "this is an important book. The disgraceful history it details is a reminder that people in power have always been capable of exploiting those they regard as "other," and of finding ways to rationalize even the most atrocious abuse".

See also

• The Plutonium Files
• Acres of Skin
• List of medical ethics cases
• Compulsory sterilization in the United States
• Medical racism in the United States
• Unethical human experimentation in the United States