Lecture Seven: The African American Medical Experience 1800's

Excluded from the AMA and from orthodox medicine, African American doctors had to find their own way in the late 1800's.  Virtually no African American doctors existed in the early century, but that changed in the Civil War, especially with the advent of Howard University and then a sprinkling of other medical schools that trained black doctors.  How the African American medical community grew and prospered by essentially engineering an alternate medical landscape is something often overlooked by medical historians, and yet is crucial to understand white orthodoxy, the medical racial script, and the posturing of the AMA.  Ironically, most African American doctors upheld the most foundational tenants of orthodoxy and worked well with white doctors, but were shunned by organized medicine, medical schools, and remained excluded from most medical institutions.  

Transcript

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I want to talk a little about race, especially in the mid-1800s to the late 1800s, because it's really important to this whole story and it's often neglected. It is certainly has a chapter in the AMA that we'll talk about. And this is gonna be a long talk, so I apologize in advance because I'm actually very passionate about this. It's what I wrote my thesis on, and I find it to be something that is not well understood by most people who study medicine. Um, so let's start with 1847. That was the year of the founding of the AMA, and in New York City, um, there was um a move by many of the founders of the AMA who were from New York to create a medical society that was in line with the AMA's version of orthodoxy. And they called it the New York Academy of Medicine, NYAM, which exists today just outside of um Central Park. I went to visit it, went through their archives, uh, really impressive place. But um in 1847, they were founding. And the way they found it is to have some of the most prominent doctors in New York be appointed as fellows. And those fellows then picked members of the NYAM. And the deal with the AMA was if you were a member of good standing in a local medical society, then you would have automatic approval to join the AMA. That was the way things were. So one of the first people that several of the fellows picked was a incredibly prominent doctor named James McCune Smith. He was a surgeon in New York City, he was the founder and chief surgeon of a hospital for orphan children. He had an amazing education. He was educated in Glasgow Medical School, trained in several of the most prominent hospitals in France, uh, author of several scientific articles in Scotland and throughout Europe. And he was truly um someone beloved by the doctors in New York City. The um when his uh when he came up for um being picked to this new academy, he was universally rejected. And the Committee on Admissions wrote, quote, the committee finds no objection to the recommendation of James McCune Smith of New York for resident fellowship in the academy from any want of professional testimonials, medical status, or a moral character, but believes that the agitation of the question in the Academy at this early stage of its existence would perhaps disturb the existing Union of Harmony, which is one of the leading objects of its organization as set forth by the Constitution without any corresponding advantage for it. It is therefore ordered that the subject be laid on the table for further consideration. So reading through the archives of the New York Academy of Medicine, it's fascinating because Dr. Smith and some of the people who supported him wrote letters back and forth. Uh it was um it was ugly for quite uh several months. Dr. Smith wrote um, quote, hadn't any agitation in view in nominate the people who nominated him hadn't any agitation in view in the first having affected, the second having offered to make the nomination on purely professional grounds. What agitation referred to clearly was the color of Dr. Smith's skin. He was black. And he trained in Scotland because no American medical school would take him. In fact, he was the first African-American medical doctor to practice in the country. His articles, nonwithstanding, um, his his status, his approval, despite months and months of haggling, uh it was not allowed, and his nomination was not only stopped, but the New York Academy of Medicine basically defrocked all the people who nominated him. His own career continued. Uh, he still worked in New York. But after that time, because of the uh authority of the New York Academy of Medicine, although he published medical articles more than almost anyone else in the city, um, he wasn't allowed to present them at any uh um Academy functions, other white doctors had to present them. And it's interesting, in in 2018, uh the New York Academy of Medicine offered membership to Dr. Smith posthumously, um, giving it to his family. 2018, mind you, that's when they finally allowed uh him in. So that that's kind of the state of medicine. Um, but that is very uh uh very characteristic of what happened during the rest of this century. I went through a lot of archives from medical societies. The the um Massachusetts Medical Society actually accepted an African-American doctor in 1854, whose name was uh John Van Surly de Grasse, who was the grandson of the French naval commander Admiral de Grasse, who won at Yorktown, and he graduated from Maine medical school in 1850 and then studied in France, and he's considered the first American trained doctor. Massachusetts Medical Society kind of viewed him as a white guy because he apparently had a very white complexion and did not accept any other African American doctors, nor is there evidence that he ever was accepted into the AMA. Uh the Maryland Medical Society, whose um uh archives I went through, uh, stipulated in its constitution that only gentlemen could become members, and the definition of gentlemen uh was men who are white, and that was gentlemen. It was all code back then. No one would outwardly state that they would not accept people based on the color of their skin. You never found this in the AMA, you never found this in any medical societies. It was words like agitation, words like gentlemen, uh, that prevented these places from accepting African Americans. But again, the medical racial script was very clear about this: that African Americans were inferior and were not capable of being doctors. It was that simple. There's no evidence the AMA even considered uh allowing any African-American doctors into its ranks of the couple that were in the country before the Civil War. Um, the Civil War itself was was interesting in terms of how it affected the AMA. Obviously, that its large Southern membership disappeared, and um both Northern and Southern doctors continued to speak with each other. In fact, the the AMA, even up to the Fort Sumter, kind of denied that there was any sectional conflict between doctors, even if it was there in the country. Um, biographer Martin Morris Fishbein writes, quote, throughout the nation there was great turmoil, but there's nothing in the discussions of the American Medical Association at the time indicating any thought that war was impending. The basic questions leading to the war were not discussed. And they never discussed race. You will not find anything about race in the AMA transactions during this time and almost forever. They continued to believe that orthodoxy united doctors under a single orthodox dogmatic rubric, which included the medical racial script banning black doctors. Um, Christopher Willoughby writes that, quote, the strength of physicians and racial scientists' professional identity was able to withstand the deadliest war in U.S. history. Because orthodoxy didn't acknowledge sectional conflict, because the AMA dogma um was that medical science was uh uniform and did not have sectional uh differences. They all believed in the same thing. Even those who believed slavery should be um eliminated, did not believe that African Americans were anything other than a different race of people. That was simply medical science and dogma at the time. And that is kind of punctuated by the fact that during the Civil War, uh many extremely prominent um uh medical researchers in the North, uh, including people who were who are from Massachusetts, um, like there's a man named Dr. Russell, uh, who was an extreme abolitionist. But during the war, he used the opportunity to study black bodies, did dissections, tried to determine why they were immune to certain diseases and prone to other diseases, completely accepting the difference in physiology between black and white people. And there's a guy who was fighting for the North as an abolitionist. It just was never in contention in the medical community. However, you know, the the war clearly affected the AMA because it lost half its people. And in 1864 and 1865, um Nathan Davis took over as its president trying to heal the organization. He wrote, quote, let us hope that time is not far distant when we may again offer to our Southern brethren the hand of professional fellowship, which is our privilege to extend to you this day. Soon after the war, the AMA elected uh Alabamian William Baldwin as its president, who gave a very conciliatory lecture. Um and slowly uh the Southerners returned. But something that disrupted the entire landscape of Orthodox medicine also occurred during the Civil War, and that was opportunities given to African Americans. At this time, uh a few medical schools did admit an occasional African-American doctor, but rarely allowed them to matriculate. Harvard, for instance, accepted African-American applicants based on arrangement with the American Colonization Society, whereby any African American doctors who graduated were obligated to emigrate to Liberia. However, even under these conditions, no African Americans earned a degree from Harvard as the backlash from white professors and students proved too steep a barrier for them and the institution to surmount. Yale and Dartmouth each graduated one African-American doctor, both of whom had affluent roots, and one of whom passed as a white man. Few schools in Ohio, new schools and Iowa graduated African-American doctors at the start of the Civil War due to the paucity of white applicants and the fact that no more doctors were needed in the war. By the time the war was over, there were 10 African American doctors in the country, all of whom fought in the war for the Union, but none of whom, other than one early on, who was offered a commission. It was felt that you could not have African American doctors presiding over white, even nurses. It just wasn't allowed. So they were considered uh helpers at best. Um one of these guys was Alexander Augusta, who became very important later. He was educated in Canada. Um, he was the first one to apply for medical post, and and Sercura War Stanton gave him a commission. Uh, but the white doctors and nurses from the north, mind you, fighting for the freedom of African Americans, refused to work under him. Um, said one biographer, Augusta's qualifications were not under attack by these white surgeons. What they objected to was a black man's position as a ranking medical officer. But these ten doctors became incredibly important to the formation of a separate um African-American medical world. And a lot of that happened after the Civil War when the Union created Howard University, and as part of Howard University was a medical school that was designed to train African-American doctors and trained lots of them. The driving force for this school was a doc a white doctor named Robert Rayburn. Um, he taught at Georgetown. Uh, he rejected biologic differences between the races. He was one of the orthodox doctors who did. And interestingly, he was also a prominent AMA member uh who um was part of their admissions committee, something that would come into play later. Other schools started to prop up too. Mahirney College in Tennessee received a lot of money from uh Northern white benefactors to train African-American doctors and by the Maherney family. Um, all in all, um, about 12 African-American medical schools came into being during these years after the Civil War. Some of them, uh, like Howard, publicly financed, most of them privately financed by uh altruistic white people. And a few uh what are called proprietary schools, which were very common among white people too, where people had a pay to enter, that the students had a pay to enter. Something much more difficult when uh most African Americans who went to medical school this time still had to have full-time work. So, two of the most prominent African-American doctors, uh Dr. Purvis and Augusta, we talked about Dr. Augusta. Dr. Purvis also served in the uh Civil War uh and and actually uh received accommodation. Uh, they, along with Dr. Rayburn, who is their sponsor, decided to seek membership in the uh uh Washington, D.C. Medical Society, MSCD. Dr. Rayburn pushed for membership of not only these two doctors, but other African-American doctors who were at Howard University. And this created a maelstrom of protest. The DC Medical Society was closely linked to the AMA, and many members were in both. And as one biographer of this society writes, um uh this time was the most angry, turbulent, and widespread of any that has ever occurred. The society rejected these doctors' admission and actually kicked Rayburn out, and they did not at all point to race. So you could read through their archives too, no mention of race. It's all that they felt that they were performing quackery and that they were consorting with homeopaths, something that Rayburn proved was not the case. These early African-American doctors, and you could read their writings, which I've done, are clearly uh embracing the Orthodox mindset purported to be spit out by the AMA, obviously rejecting the uh medical, the medical racial part of it. But that was, remember, the the script was not part of the AMA uh overtly. It was a it was a very um buried part of the AMA's dogma. So on the surface, they extend were absolutely consistent with the AMA Code of Ethics and believed everything the AMA did. They were orthodox doctors, they hated homeopaths, they hated all these other alternative doctors. They were the perfect candidates to be part of the AMA and part of this uh uh Maryland, uh sorry, DC medical group. So after the rejection, uh Rayburn actually took this to Congress. Um, Senator Sumner uh uh tried to get their charter revoked. He writes, quote, in my opinion, these white oligarchs of the uh D.C. Medical Society ought to have notice, and I give them notice now that this outrage shall not be allowed to continue without remedy if I could obtain it through Congress. He tried to pass a law to get the uh MSDC to admit the doctors or to lose their sancture from Congress. Remember, uh they were in D.C. and they got their money from Congress, but uh these were constantly tabled, even by the Republicans. So in 1870, this this AMA doctor, Rayburn, who was also head of the admissions to the AMA, tried to get these doctors admitted directly to the AMA. And he wrote that the AMA's code of ethics stipulated that all regular medical doctors, all orthodox medical doctors could join if they were not guilty of conspiring with uh uh with other alternative medicine doctors, other quacks. What would the AMA do in this situation? Um historian Douglas Haynes writes, quote, in response to the new possibilities for blacks in medicine, the AMA took steps to vigorously police the racial boundaries of the national profession. Now, the AMA could never use race as a reason they were rejecting these doctors. It just uh was not something the AMA ever did then or subsequently. And it was just felt, especially after the Civil War, this would be a huge mistake, uh, even though racism was alive and well in the country. Um in fact, uh in 2008, uh 2008, the AMA apologized for his actions in 1870, um de uh deified, not deified, but uh demonized its founder, Nathan Davis, removed its statues from AMA headquarters, removed any mention of him in AMA archives that was at all positive, and blamed him for this. And he was partially responsible, but again, this was not a one-man show. Uh it's very easy to demonize one person, but this was something that the AMA had in its core principles, this idea of the medical racial script. And you can't blame uh just one guy for it. This was partially, you know, remember, soon after the Civil War, you're not going to antagonize the Southern members and disrupt the unity of the medical profession, which is in part glued together with the medical racial script. And if you have a chance, read the transactions of the 1870 meeting. It's really the only time race is discussed in AMA transactions, and it was a wild romp with people just attacking each other. I mean, at the end of the day, um there was a majority report written by Nathan Davis and a minority report written by Rayburn. And the minority report clearly said these are orthodox doctors of the highest caliber, and you have no reason not to admit them. In fact, it goes against your code of ethics to not admit them. Whereas Davis, um, again, not using any racial language at all. And by the way, it's very doubtful that Davis was a Southern sympathizer during the Civil War. He he called secessionists such horrible things that I don't want to repeat them in this lecture, um, although he was friendly with a lot of Southern doctors, but he he never used racial words. Instead, he accused Rayburn and the African-American physicians of ethical violations, of um of being consorting with homeopaths. And by allowing members of the uh DC Medical Society to vote, they barely voted down these doctors, but they also not only excluded these doctors, but kicked out Dr. Rayburn and his colleague Dr. Cox from the AMA for also consorting with homeopaths. And after this, quote, Dr. Cox endeavored to speak, but amidst cries of sit down was forced to desist. It was a wild show in the AMA during this year. And ultimately, these people were shut up. In an article written in the AMA Journal in 1985, Herbert Nickens writes, quote, the solution was simple. The black physicians were not to be excluded. The organization of which they were all members was to be denied admission. Thus, at once the colored men and the hostile fraction could be dispensed with without having to discuss race. Rayburn showed up two years later, um, even though he was not a member, and pushed again. Uh, and finally, um, the AMA changed rules in 1874 and actually allowed only one medical society per state and city, and that medical society essentially was the one pick that would not allow African Americans in. It's interesting, too, that in um 1871, the AMA president, whose name was still S-T-I-L-L-E, and he was really good friends with Rayburn and helped write the minority report, disparaged what happened in 1870. Um, he suggests that, quote, the colored physician and even his white representative was refused admission upon that the proposal is an outrage to the association and a personal insult to many of its members is deplorable. He's actually considered a hero for saying this, but what's what's not stated is what he said about women. He said, on a quote, quote, on the whole, then we believe that all experience teaches that women, a woman is characterized by a combination of distinctive qualities, of which the most striking are uncertainty of rational judgment, capriciousness of sentiment, fickleness of purpose, and indecision of action, which totally unfit her for professional pursuits. The ignorance, the inexactness, the untrustworthiness, the unbusiness like ways of women are appalling. And especially in the practice of a scientific art, it nevertheless may be true and probably is so that she usually displays a strange ignorance to the logic of reason and a profound contempt for the logic of facts. This was the guy who's considered a hero. Because he pushed back a little on the 1870 decision. And by the way, after that little one-sentence quip uh saying bad things about the AMA, race was never brought up again. That was it. Done. Soon after that, Rayburn and Cox, and also the leader of the homeopaths, Dr. Verde, worked with Washington and took over the Washington Health Department and tried to set up a national medical university that would allow African Americans and teach both homeopathic and orthodox medicine. But in the end, Congress voted that down as well. But these guys remained in charge of the DC Health Department for many, many years and allowed African American doctors to work in the department. But what was much more interesting about this time period when you read about it is that African Americans didn't care. It was such a weak and ineffectual organization. Nobody cared if they were members or not. And so now we had 12 or so African-American medical schools. We had some organizations that would accept them. And now we had black doctors, and they were starting to be trained in large numbers during these years. It wasn't easy being an African-American doctor, especially in the South, but there were places for them. A lot of communities, even in the South, invited African American doctors in to take care of African American patients, at least as an outpatient. Hospitals were controlled by the whites, and very few African Americans were allowed in anything but African American hospitals, which also started to grow during this time and were sponsored by a lot of northern philanthropic groups as well as African Americans themselves. So now they could be trained in hospitals and they were taking care of African-American people in hospitals. It was extremely rare for them to take care of white people. They also established medical societies in almost every state. And those medical societies allowed them to come together as a group to present papers and to uh establish themselves as a professional class, which they did. Toward the end of the 1800s, there were well over a thousand African-American doctors. And interestingly, uh that that number would not grow until maybe the year 2000. In the readings, I have readings by Dr. Thomas Burton in Ohio, who was um was one of the early African-American doctors and talks a lot about uh what it was like to practice. It was not easy. And Dr. Edward Purry, who wrote a 450-page memoir, I'm not asking you to read the whole thing, but I do have some stuff in there, which because it's really interested, he graduated from Mahirney and began a uh a career in Missouri. He said when he started practicing, people didn't want him. He quotes a white man in town when he first arrived who states, quote, I would not care if you were to come here, but the practice among your people is done by white brethren in the profession, and it would be a mighty hard thing for a man of your age and most especially your color, to wring it from their hands. But he did, and he says, quote, the serious-minded citizens have begun to notice the significance and activities of the colored doctor. He established a very important practice. He did try to get training uh in Chicago and was accepted until they saw the color of his skin, and they could not technically reject him, but no one would talk with him. Still, he graduated. And he and many of the other African-American physicians set up all sorts of hospitals and sanctuaries and other training uh sites and were very prominent in uh local medical societies. There was a vibrant African-American medical profession growing in the United States. And guess what? None of these doctors, and I read so many biographies and articles written by African-American doctors at the time, none of them even mentioned the AMA. They didn't care. It was that unimportant. But they were strictly in the Orthodox uh fold and they did not like homeopaths or any other alternative groups. So they were a natural fit with the AMA, but they were not part of the organization, nor were they ever asked to be. Finally, in 1895, a few of them got together. The um uh Monagu Cobb was one of the original ones, and they realized uh that it was time to set up a national African-American medical organization to run parallel to the AMA, one that in which all the doctors from the country who are African American and anyone else, they invited everyone in, could join and meet annually and share articles, etc. And this became the National Medical Association. And it was, as Cobb writes, it was a loser's best alternative after a prolonged and angry uh strife, um, which essentially uh meant that, yeah, they had no other choice. Another of the founders uh, who is a prominent uh member of the ANMA for many years, John Kenny, wrote, uh, here was the enunciation of a platform which, while not pleasing to all, yet was such that the leaders of both races in the South could maintain their dignity and work side by side in the development of this section of the country. Reading through NMA journals during this time, and they started uh publishing their journals in the early 1900s, uh, and they had some amazing doctors writing for the journals. Uh, C. V. Roman was, I mean, I've read a lot of his essays, they're just absolutely amazing. And I I have I have one of his essays in in the readings. Uh, but he wrote, quote, our association is not an imitation but an evolution, not a schism, but a creation, not a negative protest against existing conditions, but a positive advance toward the adaptability to environment, which finds its highest expression in the survival of the fittest. It's important to know that the NMA was founded under the tutelage of Booker T. Washington's movement and received a lot of its funding and its leadership. And when its journal was produced, it was published at Tuskegee. And the ideals of Booker T. Washington find their way into the ideals of the NMA. And you could read a lot of the editorials, which basically say for us to survive in this world, we cannot fight white medicine. We have to coexist alongside it. We have to make compromises. We have to show the white doctors that we are as good as them, but we will never threaten them. There's more and more written like that. And it became often almost self-defeating because a lot of the people who wrote basically suggested that the problem with the advancement of African-American doctors was that they were poorly trained or they didn't follow the rules. They did not want to blame white people. It became a true mission, and some of its most prominent members stated this over and over that if we start blaming racism for this, we're gonna fail. We have to deal with the racist world in which we live and work through it. But but kind of the amazing thing is they did. Um they truly succeeded in this, and there was a flourishing African-American medical class that coexisted alongside the white medical class that practiced orthodoxy, um, that never had any interest in becoming part of the AMA, at least at this time, um, didn't care. And that was widely accepted by white doctors throughout the country just by staying in their lean, which was a hard thing to do, especially for intelligent people who understood that they should be part of the mainstream, but they also understood that they were they were building up a professional identity that was vibrant and that was uh potentially sustainable. So, this is what was going on outside the um gaze of the AMA at the time. Not once did the AMA mention the National Medical Association or any of its founders or any African-American physicians. The AMA continued to promulgate ideas of racial difference. Um, it it published a lot of articles about that, especially in the late 1800s, and we'll see that became even more prominent when the eugenics movement really struck the country uh in the early 1900s. But that didn't hurt the African-American medical class, and it did not uh get in the way of these medical schools at the time. So that's where we were by the end of the 1800s. And at that time, the AMA starts to look at itself in the mirror and realize it better do something if it wants to change this environment that was now accepting African American physicians and all sorts of alternative providers and not really gaining a foothold on its own.