Race and Medicine in Nineteenth- and Early-Twentieth-Century America (review)

Race and Medicine in Nineteenth- and Early-Twentieth-Century America shows Todd L. Savitt's highly respected prowess in telling a difficult history—a history marred by social, economic, and political conflict to this day. His multifaceted medical history of African Americans from slavery through the early Progressive years artfully melds well-known and lesser-known essays, all previously published, into four parts to reveal details of African American health, disease, and practice of medicine.

Sickle cell anemia is the starting point, beginning with what Savitt calls the "African Exchange" (p. 7). Savitt's biological expertise serves to clarify the complex scientific and social history of a life-threatening disease long ignored by medicine. Medical research attention began in the early 1900s, but only in the 1950s did medicine seriously undertake treatment of the disease. Historical misunderstandings of the disease resulted in the assumption that sickle cell carried immunity to malaria. Too facile, says Savitt. His careful history balances genetics with historical context.

Turning to health and medicine in early Reconstruction, Savitt describes an outbreak of smallpox among freedmen and -women in and around Atlanta. Moving chronologically, the inadequacies of health care for blacks following the war segue easily into medical schools for African Americans. Looking at four medical schools in the South, Savitt describes the historic need for black doctors, the concerted efforts to establish these institutions, the context of competition, prejudice, and denial of African American sickness, and the lack of medical attention paid to African Americans, with the history of determination to educate black doctors.

During the blighted years of anti-black violence and disfranchisement, the book covers several little-known black leaders in medical education. Although many historians blame the Flexner Report of 1910 for the demise of black medical schools, Savitt shows a more nuanced history. Failures to keep twelve of fourteen medical schools open came almost entirely from a lack of funding. Savitt's history also traces the professionalization of African American medicine, the creation of the National Medical Association in 1895, and two medical journals that thrived briefly only to suddenly disappear. One short-lived journal, the Hospital Herald, emerged out of a hostile environment in Charleston, South Carolina, to garner a biracial audience and to launch a long-lasting nursing school and hospital—both for and staffed by African Americans into the 1950s.

Without an explicit theoretical construct, Savitt's work interprets race relations directly as part of a history of disease defined in part by race. His approach is unlike that of medical anthropologists, for instance, who refer to sickle cell anemia to show false biological reading of race because white populations also have sickle cell anemia. In a different vein, Savitt's study begins with slavery, detailing sickle cell anemia unreported among those in bondage and exploring their susceptibility to respiratory disease as a sign of the presence of sickle cell anemia. Savitt carries the black/white framework forward into his writing about post-slavery eras. Savitt gracefully walks a tightrope in his history of propensities for disease in a population defined by race.

Race and Medicine models sensitivity but firmness in its treatment of issues of race. Revisiting his oft-cited essay on experimentation on slaves, including the widespread use of black bodies in Southern antebellum medical schools, one finds telling context for the so-called Tuskegee syphilis experiment on black men in Macon County, Alabama (1932–73), in which autopsies of these subjects' bodies was a primary motive.¹ His statement, " in a slave society . . . the subjugated will be exploited . . . Blacks acted not only as servants and laborers, but also as medical specimens" (p. 88) shows that he has uncovered the history leading to the syphilis study. Savitt's new book showcases his pioneering and ongoing contributions to the history of medicine.