Black and Blue. John Hoberman
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and doctors who feared the black population in the South as an infectious “reservoir of disease,” due to the ravages of tuberculosis and syphilis, were primarily concerned about protecting the health of their own racial community. As the chief health officer of Savannah, Georgia, warned in 1904, it was necessary to reduce disease among blacks, because “in doing this we protect ourselves.”17 “They knead our bread and rock our babies to sleep in their arms, dress them, fondle them, and kiss them,” a physician from Florida reminded the American Public Health Association in 1912; “can anyone doubt that we may not escape this close exposure?”18 The Southern white population did, in fact, escape the feared consequences of their close exposure to their black servants; widespread fears of infection proved unfounded. But the hysterical element inherent in this sort of white thinking about black disease has manifested itself in various forms up to the present day.
For decades afterward, the stereotype of the irresponsible “Negro patient,” whether sullen and recalcitrant or ignorant and docile, served to rationalize the black man's subordinate status and relieve both the white physician and society at large of the responsibility for taking on “Negro” medical problems as a serious social project. Doctors' judgments about perceived black immorality prompted them to turn their backs on the Negro patient: “Some physicians of the day were overtly judgmental and spoke of blacks as having earned their illnesses as just recompense for wicked life-styles.”19 Over the past century the razor-slashed, shot-gunned, and overdosed black men and women who have come staggering into hospital emergency rooms after their bouts of Saturday night mayhem have left behind a racial stigma in the minds of the many doctors who have treated them. The tardiness and medical noncompliance of the far greater number of black people who simply do not trust white medical institutions have persuaded many medical personnel that efforts to promote black health face insuperable obstacles. In his classic study of the Tuskegee experiment, James H. Jones points out: “Private physicians had long agreed that the [syphilis] problem was serious, but most despaired of being able to do anything about it, preferring instead to exchange stories on the difficulties of treating black patients.”20 Over the past two decades the medical establishment has adapted to the challenge of widening “racial health disparities” by embracing epidemiological research and clinical studies while omitting the most candid accounts of difficult patients. These publications dress up medical suffering and hardship, as well as failed doctor-patient relationships, in a psychological and sociological jargon that excludes or strictly limits any deeper (and necessarily historical) discussion of racially biased ideas and behaviors among medical personnel.
MEDICAL VULNERABILITY AND RACIAL DEFAMATION
African Americans, including physicians, have long had their own reasons not to draw special attention to their health problems. The medical defamation of black people by whites in positions of authority has taken many forms over the past two centuries and has done incalculable damage to race relations in general and to black confidence in a medical system that has always been controlled by whites. In addition, medical folklore about blacks has played a major role in the history of American racism and its campaign to stigmatize black people as both immoral and inherently inferior.
During the era of slavery, the campaign of defamation aimed primarily at justifying plantation slavery on physiological and psychological grounds. Slave owners and the plantation physicians who served them found it convenient to talk about black slaves' “efficiency as laborers in [a] hot, damp, close, suffocating atmosphere—where, instead of suffering and dying, as the white man would, they are healthier, happier and more prolific than in their native Africa.” This physiological rationale for putting slaves into the heat of the cotton fields was accompanied by a psychological rationale—regarding the slaves' deficient willpower—that justified keeping them under the control of whites.21 An elaborate system of racist ideas about black anatomy and physiology gave chattel slavery an ostensibly scientific foundation and remained influential well into the twentieth century.
The most destructive defamatory campaign lasted for decades after emancipation and portrayed blacks as a disease-ridden and biologically degenerate race. A 1915 article in the Southern Medical Journal, to choose from one of many examples, called the Negro “a hive of dangerous germs, perhaps the great disease-spreader among the other subspecies of Homo sapiens.”22 Predictions that syphilis and tuberculosis would eventually bring about their extinction were common before and after the turn of the century. In his influential Race Traits and Tendencies of the American Negro (1896), Frederick L. Hoffman had welcomed the news that contemporary rates of “constitutional and respiratory diseases” would henceforth limit the growth of the black population. “It is sufficient to know,” he writes, “that in the struggle for race supremacy the black race is not holding its own….”23 Many African Americans were thus made aware that millions of whites, including some doctors, were looking forward to their extinction as a race.
The Social Darwinism of this era constantly evoked the idea of a racial competition that African Americans were fated to lose. In the context of this deadly serious contest, black medical problems became nothing less than harbingers of racial extinction. Constant reports of high rates of syphilis among blacks reinforced folkloric ideas about their sexual immorality that attained the status of dogma for many white physicians and further intensified black hostility toward the medical profession. “It is the prevailing opinion,” one doctor writes in 1915, “that practically every negro who has reached middle life is syphilitic, an opinion which finds support in the exceedingly lax moral standards of the race.”24 Here is the heritage of medical defamation that makes today's African Americans reluctant to protest against the legacy of medical racism by declaring, “Look how sick we are!”
Public discussions of black medical inferiority forced black leaders, and black doctors in particular, into the position of having to defend the biological integrity of the “race” and even the capacity of Negroes to benefit from medical therapies—a campaign that persists up to the present day in the case of certain medications. The Urban League's official publication declared in 1924, for example, that “the Negro possesses 'biologic fitness'” and, contrary to the belief of some white doctors, is also capable of responding to the treatment for pulmonary tuberculosis.25 In 1932, a white member of the American Social Hygiene Association welcomed “the willingness of Negro leaders to face statistics relative to actual health conditions. A few years ago the Negro was inclined to interpret statements and figures regarding syphilis and gonorrhea as a racial indictment.”26 Black people understood that defamatory claims about black sexual behavior were poisoning race relations and alienating black people from white doctors.
Describing the medical problems of black people without causing offense has been a long-standing problem. A black physician writing in the Urban League magazine in 1941 strives for balance by acknowledging the seriousness of the “Negro health problem” while refusing to accept the familiar claims about the sickliness of his people. “The health of the Negro is a problem,” he writes, “but, before submitting proof, let us define the premise. The health of the Negro, as used by the intelligent and honest observer and narrator is not by assertion or implication a derogatory statement. Certainly, it is not intended to place undue emphasis upon his susceptibility to disease or his maladjustment in the complex pattern of American life.” The challenge for Dr. Roscoe C. Brown of the U.S. Public Health Service was to confront two ideological adversaries. On one side were the white doctors who made a policy of exploiting black health problems to promote the idea of racial inferiority and the ideal of segregation. On the other side were those of his fellow blacks who resented public discussions of the state of their health and favored “a more euphemistic and optimistic declaration of racial parity in health status and life expectancy.”27 In 1945 the first African American physician to earn a masters degree in public health, Dr. Paul B. Cornely, struck a blow for the medical integration of all Americans by declaring that “there is [no] such an entity as a 'Negro Health Problem,' for the health achievements and problems of this racial group are merely expressions of the total health situation of the country.”28 A decade later Cornely was able to report some incremental progress in the desegregation of an American medical system that was still refusing to embrace racial integration.29 But the era of real militancy