Medical apartheid The dark history of medical experimentation on Black Americans from colonial times to the present

Review by Choice Review

The legality of African American slavery in the US until the Civil War is the basis for the rabid segregationist policies that the American medical establishment followed until recently. Washington's documentation of the egregious treatment that black Americans received from physicians, hospitals, pharmaceutical companies, and government at all levels justifies the use of the term apartheid in her title. In addition to the Tuskegee Study, which is now widely known, Washington (independent scholar) provides rampant examples in which African Americans unwillingly have been used, as objects, for new surgical techniques, drug testing, nuclear radiation absorption, biased psychological testing, sterilization, and cadavers. In short, first-class white Americans benefited from medical experimentation on second-class African Americans. Medical Apartheid is well documented, and the author usually defines specialized terms in the text. In a few instances an expected footnote is not provided. The author overuses the guideline concerning the percentage of blacks in the US population when evaluating the composition of small experimental groups. An epilogue indicates the improved state of ethical standards in medical research for all Americans today. Summing Up: Recommended. All libraries; all levels. R. D. Arcari University of Connecticut School of Medicine

Copyright American Library Association, used with permission.

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Review by New York Times Review

IN April 1721, sailors arriving from Barbados set off a smallpox epidemic that raged in Boston for a year. Cotton Mather, the powerful Puritan minister, advocated using pus from a smallpox scab to infect another person, producing a mild case and long-term immunity to the "speckled monster." Mather first learned about inoculation from an African slave and from reports of the practice in Turkey. For years, he had repeatedly failed to persuade any physician to try it. But on June 26, 1721, Zabdiel Boylston, a physician, administered pus to his 6-year-old son and two of his slaves, an adult and child. All three experienced mild cases and quickly recovered. By the time the epidemic subsided, Boylston had inoculated 244 people, six of whom died - a death rate of 2.4 percent, compared with 14 percent for the nearly 6,000 Bostonians who acquired smallpox naturally. As Boylston's use of slaves highlights, African-Americans have participated in biomedical research from the outset. In "Medical Apartheid," Harriet Washington charges that they have also too often been abused and exploited by a racist medical establishment. This history, she argues, goes far beyond the infamous Tuskegee syphilis study, in which African-American sharecroppers, under the sponsorship of the United States Public Health Service, were for 40 years subjected to various procedures and prevented from getting penicillin treatment - despite the fact that determining the course of the disease, the putative goal of the study, had already been accomplished. "Researchers who exploit African-Americans," Washington writes, "were the norm for much of our nation's history, when black patients were commonly regarded as fit subjects for nonconsensual, nontherapeutic research." Renty, a slave, photographed in 1850 as part of a study intended to show that blacks and whites were from different species. Washington, a Journalist and former ethics fellow at Harvard Medical School, tells some harrowing stories, and claims that throughout the 19th century, medical schools disproportionately used blacks in live surgical demonstrations. In more recent times, she writes, they have been disproportionately enrolled in risky, nonbeneficial research in gynecology, oncology, surgery, pediatrics, infectious disease and genetics. While the worst excesses are a thing of the past, blacks are still "at greater risks than whites of being conscripted into ... research without giving their consent." There have been superb studies of individual cases of exploitation, particularly James H. Jones's masterful 1981 history of Tuskegee, "Bad Blood." Yet we lack a comprehensive history of the role of African-Americans in research. Unfortunately, "Medical Apartheid" is not that book. Washington's polemic fails in two ways. First, it fails to place the experience of African-Americans in a broader social, historical, scientific and ethical context, comparing it with that of research participants more generally. Second, the book is so riddled with exaggerations, distortions, contradictions, errors and confusions as to be untrustworthy. The history of medical research in America has seen tragedies and triumphs, instances in which exploitation occurred and others in which measures were taken to minimize it. For example, in his yellow fever research of 1900-1, Walter Reed delineated many safeguards, including auto-experimentation (members of his Yellow Fever Board would themselves be research subjects), a signed contract with participants (fore-runner of today's informed-consent documents) and a prohibition against doing research on children until after it had been successfully completed on adults. Amazingly, the only person to die in this very high-risk research was Jesse Lazear, a white medical school graduate and a member of the board. Since Tuskegee and other scandals, further safeguards have been enacted, including the establishment of independent review boards charged with ensuring that research is scientifically valid, that participants give informed consent and that the benefits outweigh the risks. While not perfect, these safeguards have minimized the risk of abuse. Still the question remains: Why have some researchers exploited certain groups? For Washington, the answer comes down to one thing: skin color. "The racial homogeneity of American medical researchers," she writes, "lies at the very heart of the problem." Doubtless, many American researchers in the past were - and some current ones may still be - racist. But this explanation is simplistic. Risky research - whether beneficial or not - has often relied on various vulnerable populations, including the elderly, soldiers, prisoners, the mentally disabled and orphans of all races and creeds. Yes, African-Americans have been exploited, but they have not been singled out exclusively or even predominantly. In the so-called Jewish Chronic Disease Hospital case of 1963, for instance, prominent researchers injected live cancer cells into nursing home residents, some of whom were Holocaust survivors, to determine whether the immune systems of sick individuals could identify and eliminate foreign cancer tissue as those of healthy people do - a classic case of "nonconsensual, nontherapeutic experimentation." Today, probably the research with the highest risk and lowest benefit to participants is Phase I cancer research, which tests experimental cancer drugs to determine the highest tolerable dose for subsequent studies. More than 85 percent of participants of such research are white and two-thirds have college educations. A more plausible explanation can be traced to the fact that, as the medical historian David Rothman has argued, medical research - especially in the decades after World War II - was "unabashedly utilitarian." The government and pharmaceutical industry invested substantially to develop vaccines, antibiotics and other drugs, and to assess radiation and other toxicities. Enrolling vulnerable people in research was justified as providing a way they could contribute to society. As Walsh Mc-Dermott, one of the most prominent academic physicians of the past century, put it at a 1967 colloquium: "We have seen large social payoffs from certain experiments in humans. ... We could no longer maintain, in strict honesty, that in the study of disease the interests of the individual are invariably paramount." This was not just the view of scientists but also of much of the public; many guardians of the institutionalized children in the safety test of Jonas Salk's polio vaccine, for example, said they felt honored to have their children be part of the risky research. Thankfully, few researchers (or parents) would express such views today. But they reveal the mind-set of those who could accept, even if they did not themselves commit, exploitative research. Despite its many footnotes and its claim to be meticulously researched in long-ignored archives, "Medical Apartheid" is suffused with undocumented assertions and factual errors. Consider this typical claim: "Of the first 251 experimental inoculations of smallpox by Dr. Zabdiel Boylston in predominantly white Brookline, Massachusetts, all but one of the subjects were black." In fact, according to Boylston's own 1726 report, he inoculated 244 people, of whom 12 were identified as black, 4 as Native American and 12 as servants and others of unspecified race. The rest, including Boylston's six children, were white. Another example, from Washington's introduction: "Within recent years," she writes, the Office for Protection From Research Risks has "suspended all research at such revered universities as Alabama, Pennsylvania, Duke, Yale and even Johns Hopkins. Many studies enrolled only or principally African-Americans." But research at Pennsylvania and Yale has never been suspended by that agency (which is now called the Office for Human Research Protections) or any other federal regulator; at Alabama, only some research was restricted. More importantly, the suspensions at the other institutions had nothing to do with concerns over minority enrollment. At Johns Hopkins, for instance, research was suspended for three days in 2001 following the death of a healthy, white 24-year-old volunteer in an asthma study. At Duke, where research was suspended for five days in 1999, the problems mainly involved record-keeping and other technical aspects of the monitoring of consent. Throughout the book, Washington blurs the distinction between "experimentation" and routine medical care and public health measures, recounting ordinary events as if they were shockingly unethical research practices. The chapter "The Black Stork," for example, hardly mentions research at all. Instead, Washington condemns the distribution of contraceptives to young black women by Planned Parenthood and others, whose practices she links to eugenics. Similarly, the chapter on infectious disease opens with the story of an African-American man who was legally detained to ensure he took his tuberculosis medication. Whatever the ethics of this particular case, it concerns quarantine practices, not research. (Patients who follow treatment only erratically contribute to the rise of dangerous drugresistant strains.) Washington then seems to dismiss directly observed therapy, in which patients must be watched ingesting a complex sequence of medication daily, as yet another of the "inequitable policies" - blacks have a 300 percent greater risk of contracting tuberculosis than whites - that have "shaped the uncomfortably close relationship between African-Americans and infectious disease." In a discussion of how "medical sadism" has been exported to Africa, Washington writes that "third world women subjects of thalidomide trials for leprosy and AIDS were not warned of the horrible birth defects the drug can cause." As with many of Washington's inflammatory claims, there is no citation. And her implication that third world women bear the brunt of this, research is simply wrong. Of the six controlled clinical trials of thalidomide for leprosy (which were actually conducted between 1965 and 1971), those in Israel, Venezuela, Malaysia and the United States enrolled men or postmenopausal women, while trials in India, Mali, Somalia and Spain enrolled only men. Furthermore, one of the largest longitudinal studies of thalidomide for leprosy did not single out third world women at all but was done in the United States, Canada and United States territories. Washington says that she wrote "Medical Apartheid" in order to help close the "health gap" that afflicts African-Americans - a gap she blames in large part on the untrustworthiness of the medical establishment, which leads many blacks to avoid care. The gap is certainly real: today, blacks die younger than whites, have substantially higher infant mortality rates and receive fewer medical services. Documenting the history of medical research involving black Americans is a necessary and worthy project, but a book as rife with errors and confusions as this one will neither help reduce health disparities nor protect against future exploitation. The history of medical abuse of blacks, Washington charges, goes far beyond the infamous Tuskegee study. Ezekiel Emanuel is an oncologist and chairman of the department of clinical bioethics at the National Institutes of Health. He is co-editor of the forthcoming book "Ethical Issues in International Biomedical Research."

Copyright (c) The New York Times Company [October 27, 2009]

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Review by Booklist Review

The shameful history of the physical and medical misuse of African Americans began long before the infamous Tuskegee experiment of the 1930s. Washington, a medical journalist, offers the first and only comprehensive history of medical experimentation on and mistreatment of black Americans. Starting with the racist pseudoscience that began when whites first encountered Africans, Washington traces practices from grave robbing to public display of black albinos and the Hottentot Venus, and theories from eugenics to social Darwinism, which have attempted to justify views of racial hierarchy and mistreatment and even enslavement of blacks. Washington draws on medical journals and previously unpublished reports that openly acknowledged racial attitudes and experimentation, protected by the fact that the public and the media rarely read or understood such reports and often shared similar feelings on the subject. Washington also details a litany of medical abuses and experimentation aimed at black men in the military and in prison, as well as women and children, all without proper notification or consent. This is a stunning work, broad in scope and well documented, revealing a history that reverberates in African Americans' continued distrust of the medical profession. --Vanessa Bush Copyright 2006 Booklist

From Booklist, Copyright (c) American Library Association. Used with permission.

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Review by Publisher's Weekly Review

This groundbreaking study documents that the infamous Tuskegee experiments, in which black syphilitic men were studied but not treated, was simply the most publicized in a long, and continuing, history of the American medical establishment using African-Americans as unwitting or unwilling human guinea pigs. Washington, a journalist and bioethicist who has worked at Harvard Medical School and Tuskegee University, has accumulated a wealth of documentation, beginning with Thomas Jefferson exposing hundreds of slaves to an untried smallpox vaccine before using it on whites, to the 1990s, when the New York State Psychiatric Institute and Columbia University ran drug experiments on African-American and black Dominican boys to determine a genetic predisposition for "disruptive behavior." 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. It covers a wide range of topics the history of hospitals not charging black patients so that, after death, their bodies could be used for anatomy classes; the exhaustive research done on black prisoners throughout the 20th century and paints a powerful and disturbing portrait of medicine, race, sex and the abuse of power. (Dec. 26) (c) Copyright PWxyz, LLC. All rights reserved

(c) Copyright PWxyz, LLC. All rights reserved

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Review by Kirkus Book Review

Medical ethicist and journalist Washington details the abusive medical practices to which African-Americans have been subjected. She begins her shocking history in the colonial period, when owners would hire out or sell slaves to physicians for use as guinea pigs in medical experiments. Into the 19th century, black cadavers were routinely exploited for profit by whites who shipped them to medical schools for dissection and to museums and traveling shows for casual public display. The most notorious case here may be the Tuskegee Syphilis Study, in which about 600 syphilitic men were left untreated by the U.S. Public Health Service so it could study the progression of the disease, but Washington asserts that it was the forerunner to a host of similar medical abuses. Among her numerous examples is the radical brain surgery performed by a University of Mississippi neurosurgeon on African-American boys as young as six who were deemed aggressive or hyperactive, a procedure he recommended for urban rioters after Watts. And the abuses are not all buried in the distant past: During a 1992-1997 study of the biological basis of violent behavior conducted by the New York State Psychiatric Institute and Columbia University's Loewenstein Center, researchers intimidated parents of black juvenile offenders into permitting them to administer the dangerous drug fenfluramine to the offenders' younger brothers. African-Americans' reproductive rights have been trampled on; soldiers, prisoners and children have been coerced into becoming subjects of experiments without therapeutic value to themselves; the federal government and private companies have utilized unwitting blacks in large-scale experiments with radiation and biological weapons, she asserts. While the worst abuses have been eliminated, Washington concludes, African-American skepticism about the medical establishment and reluctance to participate in medical research is an unfortunate result. One of her goals in writing this book, aside from documenting a shameful past, is to convince them that they must participate actively in therapeutic medical research, especially in areas that most affect their community's health, while remaining ever alert to possible abuses. Sweeping and powerful. Copyright ©Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

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CHAPTER 1 SOUTHERN DISCOMFORT Medical Exploitation on the Plantation Celia's child, about four months old, died last Saturday the 12th. This is two negroes and three horses I have lost this year . -DAVID GAVIN, 1855 Frederick Gardiner, a peripatetic Mormon physician, left among his travel memoirs an impression of the nineteenth-century slave markets of Washington, D.C.: There are a great number of Negroes, nearly all of whom are Slaves. And on different Streets are large halls occupied as Marts or stores, for the sale or purchase of Slaves. . . While I have been looking at one of these places on Gravier Street, Two Gentlemen have arrived, one of whom I have Seen in the Saloon, he is a young Planter and come to purchase a girl to take care of his children, or whatever duties he may think proper to impose upon her. The other person is a Doctor whom he has brought with him for the purpose of examining her. They pass along the front of the row in company with the agent or Salesman. As they move forward One is called upon to stand up, then another while a passive examination is made. Then finally he discovers a bright mulatto, who appears about 16 years of age and is quite good looking. She is ushered into a private room where she is stripped to a nude condition and a careful examination is made of all parts of the body by the Dr. and is pronounced by him to be sound. The money is then paid and she is transferred to her new owner...I have heard that the Masters beat and scourge them most cruelly. But I have not seen anything of the kind, nor do I believe that it occurs very often. For the southern people as a class are Noble minded kind hearted people, as can be found in any country...And moreover it would be against their own interests, to brutally treat their Slaves. As no planter desired to have sick negroes on his hands. According to my judgment so far as my experience extends, I believe that the Negroes as a class, are far more humanely treated and taken care of, Than are the laboring classes of European countries (1). Enslavement could not have existed and certainly could not have persisted without medical science. However, physicians were also dependent upon slavery, both for economic security and for the enslaved "clinical material" that fed the American medical research and medical training that bolstered physicians' professional advancement. Gardiner's vignette suggests the integral role of medicine in enslavement and repeats a key belief--that slave owners and physicians shared an interest in preserving the slave's health, "as no planter desired to have sick negroes on his hands." But although medicine was essential to enslavement, the apparent solicitude for the health of slaves was not all it seemed. Rather, the medical interests of the slave were often diametrically opposed to the interests of his owner and of American physicians. From the first, antagonism reigned between African Americans and their physicians. Between the seventeenth-century advent of African settlers to North America and the end of the nineteenth century, the slave and the physician shared an unrecognizably primitive medical world. The "germ theory" that revealed the microbial nature of much disease and led to the first grand waves of disease cures was still well in the future: The existence of pathogens (2) such as bacteria, viruses, and fungi was unsuspected. Almost no effective treatments existed for prevalent diseases until the eighteenth century. Until the late 1830s, the lack of effective anesthesia made the few common surgical procedures horribly painful and all others impossible. Between the seventeenth and nineteenth centuries, medicine in the United States reflected a narrowly limited understanding of disease and a rather cursory training of medical practitioners. Public-health institutions were few, feeble, and ephemeral, rising momentarily with epidemics of yellow fever or smallpox and subsiding from neglect after the crisis resolved. Even the simplest public-health measures--hand washing and antiseptic techniques, clean water, sound, pathogen-free housing, an untainted food supply, sewage management, and quantitative disease reporting were all in the future. Because there were only a few effective disease therapies and no antibiotics, epidemics of yellow fever, malaria, tuberculosis, and other infectious diseases frequently raged unchecked. In the early 1700s, this mirrored the situation in England and the rest of Europe, but medicine on the Continent began to undergo modernizing changes, although these were very slow to cross the Atlantic. Europe began to embrace public-health measures and medical advances such as widespread vaccination, scientific medical education, and the rise of the hospital, but American progress lagged behind, especially in the insular South. The point of this chapter's unflattering précis of nascent American medicine is not to castigate it for its primitivism, but to put blacks' historical aversion to medical care into context, for most antebellum blacks were subjected to southern medicine. The South was a particularly unhealthy region and was home to 90 percent of American blacks, the majority of whom were enslaved until 1865. The first blacks arrived in the colonies in 1619, and by 1700 there were only about 20,000 blacks. But as the slave trade flourished, 20,000 more blacks arrived each year. Although 30 percent of transported slaves died in the nightmare of the Middle Passage, there were 550,000 chattel slaves in the United States by 1776, when blacks constituted 20 percent of the U.S. population. By 1807, slave importation was legally prohibited throughout the country, and by 1860, the nation's four million enslaved blacks had a value equivalent to four billion dollars today. In some states, the black population completely comprised slaves: Alabama, for example, forbade the presence of free blacks. The South was the nadir of the American medical experience, visited by a deadly triple confluence--the pathogens of North America, Europe, and Africa. This unholy trinity yielded a bewildering array of unfamiliar infectious diseases, such as hookworm, types of malaria, and yellow fever, incubated by a subtropical climate that was hospitable year-round to pathogens that could not thrive in the colder North. Even familiar European illnesses flared anew in strangely virulent forms, abetted by the hot, marshy climate, poor sanitation, and a public-health vacuum. Although the South harbored a highly visible affluent class, the region's relative poverty led to a dearth of medical care and a host of unrecognized nutritional-deficiency diseases. So did enslavement. A dramatically misunderstood set of disease etiologies led to the adoption of heroic remedies calculated to kill or cure. Through the eighteenth century, Western medicine was not only misinformed but dangerously so. Caustic medicines of the period often contained metabolic poisons such as arsenic, or calomel, (3) a compound of mercury and chlorine that was used as a purgative. Many other remedies contained highly toxic substances such as mercury and addictive Schedule II narcotics, including the opiates laudanum, (4) opium, and morphine, as well as cocaine derivatives. These medicines addicted, sickened, or killed outright; they also could trigger chemical pneumonitis, or progressive lung injury, if inhaled during a bout of iatrogenic , or physician-triggered, vomiting. No studies seem to have been done on this point, but such lung injuries may have helped to account for slaves' higher death rate from respiratory disease. Induced vomiting was an everyday event because the common denominator of medical techniques in this period was the violent release of bodily fluids. Copious bleeding, blistering, and the induction of violent diarrhea were standard therapies. Harsh laxatives or "draughts" such as calomel or jalap (5) produced copious diarrhea, which leached nutrients, water, and electrolytes from the body. They also invited painful bedsores, which were open to infection unchallenged by antibiotics. These crude therapies were not only unpleasant but debilitating to ill persons and even to the strong and healthy. Arsenic, for example, produced not only the intended vomiting and diarrhea but also a wide range of other problems, including fainting, heart disease, disorders of the nervous system, gangrene, and cancers (6). Mercury's very serious effects included injury to the nervous system, profound mental deficits, hair and tooth loss, kidney and heart disease, lung injury, and respiratory distress. Mercury crossed the placental barrier and concentrated in breast milk, contributing to the high black infant-death and birth-defect rates (7). Such ministrations were often fatal. The 1799 death of George Washington, hastened by a copious bloodletting the debilitated former president could ill afford, is perhaps the best-known example of a patient finished off by the misguided heroics of eighteenth-century medicine. However, whites of the slave-owning class enjoyed better initial health, better nutrition, and less exposure to environmental pathogens and parasites than did enslaved blacks. Slave owners did not suffer from overwork and exposure, so they were better able than slaves to withstand the rigors of bloodletting. Sensing this, many physicians and scientists discouraged bloodletting for slaves. Thomas Jefferson, statesman and amateur physician-scientist, wrote unequivocally, "Never bleed a negro." (8) But in their everyday practices, physicians didn't listen. Dr. Lunsford Yandell wrote, "On March 16, 1833 I was called before sunrise to visit a Negro woman. I took from her twelve ounces of blood...I waited about fifteen minutes when she had a severe convulsion." (9) Such techniques as cupping (the use of heated glass jars to create a partial vacuum that drew blood upward to the skin's surface or through an incision in the skin) and trephination (the therapeutic drilling of holes in the skull) were risky for pampered, well-nourished adults living in relatively healthy environments. But they were fatal attentions for sickly, undernourished, and exhausted slaves and for their children, who were at even higher risk of succumbing to anemia or dehydration. Enslaved African Americans were more vulnerable than whites to respiratory infections, thanks to poorly constructed slave shacks that admitted winter cold and summer heat. Slaves' immune systems were unfamiliar with, or naïve to, microbes that caused various pneumonias and tuberculosis. Parasitic infections and abysmal nutrition also undermined blacks' immunological rigor. Before antibiotics and sterile technique, surgery was an often-fatal affair. Unaware of the connection between bacteria and infection, surgeons operated in their street clothes and with dirty hands in filthy environments, such as the shacks that served as "slave hospitals." Even minor incisions or injuries could proceed to life threatening infections with frightening rapidity. Southern medicine of the eighteenth and early nineteenth centuries was harsh, ineffective, and experimental by nature. Physicians' memoirs, medical journals, and planters' records all reveal that enslaved black Americans bore the worst abuses of these crudely empirical practices, which countenanced a hazardous degree of ad hoc experimentation in medications, dosages, and even spontaneous surgical experiments in the daily practice among slaves. Physicians were active participants in the exploitation of African American bodies. The records reveal that slaves were both medically neglected and abused because they were powerless and legally invisible; the courts were almost completely uninterested in the safety and health rights of the enslaved (10). The practice of hiring slaves out further endangered enslaved workers by removing much of an employer's incentive to keep the slave healthy and safe. Some humane plantation owners were careful to choose less risky work venues, but a great danger of slave death or disability was inherent in some forms of mining, tobacco production, rice farming, and most plantation work. In these settings, the slave's possible death became part of his owner's commercial calculations. Ominously for blacks, the owners, not the enslaved workers, determined safety and rationed medical care, deciding when and what type of care was to be given. Because professional attention was expensive, most owners dosed their own slaves as long as they could before calling in physicians, who usually saw slaves only in extremis, as a last resort. In clinical notes, medical journals, and memoirs, physicians consistently decried the planters' tendency to rely upon the cheaper ministrations of overseers, slaves, and mistresses in order to save expense. Physicians' records also expressed disgust at the conditions in which enslaved workers were kept. Historian Richard Shryock observed in 1936: "Of all critics, the Southern physician was perhaps in the best position to report on the physical and moral treatment of the slaves. When he stated, as he sometimes did, that Negroes were overworked and underfed, he can hardly be suspected of antislavery bias since he was the friend of the planter who employed him. As a matter of fact, he usually approved of the institution." (11) Planters' own records and slave narratives corroborate physicians' complaints that planters provided professional medical care only when they deemed it necessary to save the slave's life--often too late. Owners also restricted access to medical care by routinely accusing sick blacks of malingering. Slave narratives and planters' records reveal that an owner faced with a sick slave was likely to believe the illness was feigned. In her excellent and nuanced history, Working Cures: Healing Health and Power on Southern Slave Plantations , Sharla Fett describes how, in 1859, slave owner William Massie resentfully recorded that his eighty-year-old slave "Patty" had just died "of I know not what disease...She has been saying she was sick for near a year and always pretended to be sick." No doctor was ever summoned to investigate, and not even Patty's death seems to have exonerated her from charges of malingering (12). The enfeebled Patty was no longer valuable in the fields or as a "breeder," so the nature of her sickness was inconsequential. Owners relied upon doctors to tell them whether slaves were malingering, but physicians were less than objective. Dr.W. H. Taylor, called in consultation for an enslaved man, prefaced his assessment with the phrase "remembering that simulation was a characteristic of his race" (13). Doctors and owners wrote articles in which they shared medical ruses and techniques calculated to get blacks, healthy or not, back into the fields. Dr. M. L.McLoud even wrote his master's thesis on the fraudulent illnesses of slaves (14). He shared an incident in which he had accidentally administered an overdose of ammonium carbonate, (15) a corrosive white powder that was often used as smelling salts, to a slave shamming an epileptic fit. The burning sensation shocked her into abandoning her performance, and McLoud, like many other doctors, began to advocate such veiled medical violence when confronted with questionable illness in slaves (16). But masters also responded to suspected malingering or prolonged illness with frank abuse. Thomas Chaplin wrote in his planter's journal, "Mary came out [of the sick house] today or rather was whipped out." Owners and physicians also blurred the therapeutic line by referring jocularly to whipping as "medicine" for malingering slaves. One complaining woman was " treated with a cowskin or hickory switch to scourge her" [emphasis added]; other doctors recommended that an owner apply "9 drops of essence of rawhide" or "oil of hickory" (17) to the back of a sick slave. From the Hardcover edition. Excerpted from Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

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