Doctoring Freedom: The Politics of African American Medical Care in Slavery and Emancipation

By Gretchen Long

For enslaved and newly freed African Americans, attaining freedom and citizenship without health for themselves and their families would have been an empty victory. Even before emancipation, African Americans recognized that control of their bodies was a critical battleground in their struggle for autonomy, and they devised strategies to retain at least some of that control. In Doctoring Freedom, Gretchen Long tells the stories of African Americans who fought for access to both medical care and medical education, showing the important relationship between medical practice and political identity.
Working closely with antebellum medical journals, planters' diaries, agricultural publications, letters from wounded African American soldiers, WPA narratives, and military and Freedmen's Bureau reports, Long traces African Americans' political acts to secure medical care: their organizing mutual-aid societies, their petitions to the federal government, and, as a last resort, their founding of their own medical schools, hospitals, and professional organizations. She also illuminates work of the earliest generation of black physicians, whose adult lives spanned both slavery and freedom. For African Americans, Long argues, claiming rights as both patients and practitioners was a political and highly charged act in both slavery and emancipation.

• Language: English
• Publisher: The University of North Carolina Press
• Release date: Oct 22, 2012
• ISBN: 9780807837399

Gretchen Long

Gretchen Long is associate professor of history at Williams College.

Book preview

DOCTORING FREEDOM

The John Hope Franklin Series in African American History & Culture

Waldo E. Martin Jr. & Patricia Sullivan, EDITORS

DOCTORING FREEDOM

The Politics of African American Medical Care in Slavery and Emancipation

Gretchen Long

The University of North Carolina Press

Chapel Hill

This book was published with the assistance of the John Hope Franklin Fund of the University of North Carolina Press.

©2012 THE UNIVERSITY OF NORTH CAROLINA PRESS

All rights reserved. Designed by Sally Fry and set in Arnhem by Rebecca Evans. Manufactured in the United States of America. The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources.

The University of North Carolina Press has been a member of the Green Press Initiative since 2003.

Library of Congress Cataloging-in-Publication Data

Long, Margaret Geneva.

Doctoring freedom : the politics of African American medical care in slavery

and emancipation / by Gretchen Long.

p.; cm. — (John Hope Franklin series in African American history and culture)

Includes bibliographical references and index.

ISBN 978-0-8078-3583-8 (cloth : alk. paper)

ISBN 978-1-4696-2833-2 (pbk. : alk. paper)

ISBN 978-0-8078-3739-9 (ebook)

I. Title. II. Series: John Hope Franklin series in African American history and culture.

[DNLM: 1. African Americans—history—United States. 2. Delivery of Health Care—history—United States. 3. History, 19th Century—United States. 4. History, 20th Century—United States. 5. Physicians—history—United States. WZ 80.5.B5]

362.108996′073—dc23    2012010855

for my parents

Contents

Acknowledgments

Introduction

ONE When the Slaves Got Sick

Antebellum Medical Practice

TWO Sickness Rages Fearfully among Them

A Wartime Medical Crisis and Its Implications

THREE We Have Come Out Like Men

African American Military Medical Care

FOUR We Have Come to a Conclusion

to Bind Ourselves Together

African American Associations and Medical Care

FIVE No License; Nor No Deplomer

Regulating Private Medical Practice and Public Space

SIX By Nature Specially Fitted for the Care of the Sufferer

Black Doctors, Nurses, and Patients after the War

Conclusion

Notes

Bibliography

Index

Acknowledgments

Julie Saville, Tom Holt, Amy Dru Stanley, and Ken Warren helped me to shape what grew from an unfocused interest in medical care and African American history into a book manuscript. Julie Saville’s questions helped me to connect this project with phenomena in the wider Atlantic world. Ken Warren’s patience with a historian who wanted to write about fiction has been a consistent and comforting force. Amy Stanley’s vigorous inquiries and insightful critiques have strengthened my scholarship. Tom Holt has been a model adviser. He took on this project and revealed a true interest in and knowledge of American medical history. Conversations and correspondence with him have helped me to see the need to rework my arguments and to see the value in opening up an interesting question even when the answer remains elusive. His own imaginative work on African American history and his sensitivity to nuance provided me and many others with a valuable framework in which to ground our own inquiries.

This project would have been impossible without the remarkable Freedmen and Southern Society Project at the University of Maryland. The tireless and careful work of the editors and staff there has resulted in the archive to which I turned time after time. Leslie Rowland, editor at the Project, scholar, and teacher, has been an exemplary mentor. She welcomed me to Maryland, answered my questions, pointed me toward (and away from) sources, read my work, and gave me practical feedback. I am in awe of the Freedmen and Southern Society Project’s work and look forward to returning as I begin other scholarly endeavors.

I was lucky to have many friends and relatives in Chicago who pulled hard and encouraged me all along the way. They also helped me to revel in the richness of the nonacademic parts of my life. The health workers at the Chicago Women’s Health Center first showed me the power that good medical practice can bestow on people who have been socially marginalized. I received immeasurable support from friends on the playground of the Murray Language Academy. I relied upon my family in Chicago, particularly Chris Long and Newton Ellison Long, to talk about the African American experience and to help me draw out the role of medical practice in African American history. Newton Long did not live to see the completion of this project, but the interest he showed in it and his ability to connect its questions to broader themes in American society were nourishing. Charles Long has encouraged and challenged me in my scholarly work. His impatience with my pace spurred me on to completion.

After a move to Williams College, I accumulated even more scholarly debts. A fellowship from the Newberry Library allowed me to return to Chicago for some weeks to research and write. The dean of the faculty at Williams and the Oakley Center there provided grants that released me from teaching duties at key moments. A generous fellowship from Harvard’s W. E. B. DuBois Center for African and African American Studies enabled me to continue my research at the center. I was fortunate to have Amber Moulton as a research assistant there. I am grateful to Henry Louis Gates for his presence as a lively interlocutor and to Susan Reverby for sisterly and scholarly support during that year and beyond. Pat Sullivan, whom I met at the DuBois, generously encouraged me to pursue publishing at the University of North Carolina Press. It would have been impossible for me to accept the DuBois fellowship without the incredible generosity and hospitality of Amy Null, Andrew Budson, and their children, Leah and Danny. They opened their home to me for many months. I am blessed to count them as friends.

Many friends and colleagues have read drafts of this work, provided comments, and kindly pointed out errors, making the work stronger. I am particularly grateful to Laurie Green, Quincy Mills, Adam Biggs, Tess Chakkalakal, Merida Rua, Guillaume Aubert, Peter Starenko, Todd Savitt, and Neville Hoad. I am grateful to Sharla Fett and Keith Wailoo, manuscript readers for the University of North Carolina Press, who took this work seriously and offered extraordinarily insightful suggestions for making it better. I also owe a debt to my colleagues in the history and Africana studies departments at Williams College as well as to Lori DuBois and Emery Shriver, reference librarians. Kenda Mutongi has been particularly generous, reading drafts and offering insights, challenges, and friendship in equal measure. Paul Park read the entire manuscript, and his honest critiques helped me find my way.

Joyce and John Rossitter have been a marvelous support, stepping forward when I needed to devote days and nights to research and writing. My brother, Nathan Kellar-Long, and his family have given me unwavering support and love. My own parents, Jerome and Patricia Long, have encouraged me in this project from the beginning. Their belief in the value of intellectual inquiry and their demonstrations of social responsibility have meant more to me than I can express. Patricia Long has served simultaneously as babysitter, copyeditor, and coconspirator extraordinaire, particularly over the last year when my full-time teaching duties, mothering, and writing threatened to overwhelm. I could not have reached this point without her. My paternal grandparents, Diamond Geneva Long and Samuel Preston Long, died before I was born. They and their parents lived through some of the period that this book covers. Had they had access to better medical care and social justice, I might have been able to know them.

My husband, David, has provided the finest example of true intellectual curiosity. His challenges to the basic tenets of my research projects have strengthened them immeasurably. This pales, however, next to his affection. My children, Thalia, Jacob, and Leo, have lived and grown alongside this project. Their good cheer and engagement with the world around inspires me.

DOCTORING FREEDOM

Introduction

What about the colored doctor? . . . with the hospital, and the diamond ring, and the carriage, and the other fallals? asks Colonel McBane, a vicious white supremacist in Charles Chesnutt’s 1901 novel, The Marrow of Tradition. McBane and his two cronies, upset about the rising position of African Americans in their small southern city, are making plans to run a number of prominent black men out of town. They decide quickly to expel the editor of the black paper and the black real estate agent, who have championed civil rights. Disposing of the colored doctor, laden with trappings of wealth, proves more contentious. Dr. Miller is a well-trained surgeon who has opened a nursing school and a hospital for African Americans in the city. In contrast to McBane, General Belmont, a moderate, objects to targeting Miller, saying, I shouldn’t interfere with Miller. He’s a very good sort of a negro, doesn’t meddle with politics, nor tread on any one else’s toes. His father was a good citizen, which counts in his favor. He’s spending money in the community too, and contributes to its prosperity. McBane, however, is not satisfied. A violent man who embodies racial hatred and will later lead a genocidal campaign against the town’s African American population, he responds, That sort of nigger, though, sets a bad example. They make it all the harder to keep the rest of ’em down.¹

Not merely a novelist and short story writer, Charles Chesnutt was an astute observer of American race relations, an essayist, a public intellectual, and a cultural critic. His decision to focus on medical culture in his turn-of-the-century novel allowed him to explore a wide variety of themes. In The Marrow of Tradition, we encounter both folk medicine and advanced surgeries performed by African American practitioners. We learn about black patients receiving medical care from African American doctors and nurses at a black-run hospital. Through the novel’s plot and characters, we confront the simultaneous limits and potential of modern medical expertise.

If Chesnutt had looked backward fifty years or so from 1901 and examined those years in detail, he would have found a turbulent period in African American medical and political history. In 1850, the vast majority of African Americans spent their entire lives enslaved in the rural South, and an array of laws granted their white owners control over their bodies. This control extended beyond labor to sexual access and to medical treatment that could include decisions about everything from amputations to whether to rely on allopathic or homeopathic practitioners. A separate system of medical care operated concurrently, however—one largely controlled by slave healers. White medical authorities often dismissed this system as conjuring or superstition, but slaves relied on it for both physical and emotional healing. The Civil War and emancipation simultaneously upended both of these systems of care along with African American enslavement. White planters were no longer responsible for laborers’ bodies, and neither law nor custom dictated what they should provide. At the same time, slave communities and kinship networks that had sustained African American healers were largely disrupted by the chaos and upheavals in the wartime South. For African Americans, ownership of their own bodies translated into new responsibilities of providing and procuring care for those bodies.

The health care situation of the newly emancipated African Americans was, like many aspects of African American life, so dire that white observers often saw it as worse than slavery. The ex-slaves, however, did not see it that way. Both under slavery and after, their idea of health involved more than doses of medicine and splinting of bones; it represented choice in these matters, autonomy in caring for their own families, and opportunities for some to become healers themselves. Finding themselves in a chaotic situation in terms of medical care and public health, African Americans showed a keen awareness of themselves, not only as free persons but as deserving patients, competent healers, and new citizens of the United States. They often brought this political awareness to bear on the problem of medical care. The chaos and widespread absence of health care after emancipation eventually opened a space for African Americans to assert political will and self-determination. Their efforts and achievements affected not only their own sense of personhood and political rights, but their place in American society.

In Doctoring Freedom, I trace the history of the place of African Americans in the nation’s medical landscape from the late antebellum period through the first decade of the twentieth century in order to examine their new responsibilities. In the antebellum era, slaves and their owners as well as white political and medical leaders all realized that medicine was an area fraught with struggle. These actors did not always agree on questions as basic as the purpose of medical care for black people. Medical questions sparked debate over the worth and purpose of African Americans’ bodies and the labor those bodies could produce. Often, masters had expected their slaves to surrender their bodies completely to them. Of course, many slaves resisted medical notions that saw their bodies simply as means to labor production. Using folk medicine, slaves nurtured medical traditions that placed the relief of physical suffering above the return of bodies to productive labor. Medical control, a heavily contentious issue in the master-slave relationship, produced a radically different political resonance for a wide variety of antebellum historical actors. Slaves, slave owners, abolitionists, proslavery theorists, and free blacks in the North all employed the use and abuse of medicine as they argued for political agendas and strove to build politically coherent communities.

During the Civil War, the physical suffering of African Americans as slaves, refugees, military laborers, and enlisted soldiers was laid bare to the public. African Americans, fleeing plantations where they had been enslaved, appeared at Union army camps, often in need of medical treatment but also ready to labor, looking for protection and some measure of freedom. As observers and participants recounted the physical conditions of African Americans in the midst of this war, white medical staff and African American soldiers found that the hospital setting provided a unique place for reflections about freedom. African American soldiers, as they lay wounded or ill in army hospitals, dictated eloquent, misspelled appeals to President Abraham Lincoln in which they demanded medical care for themselves and their families as part of their due as soldiers and soon-to-be citizens.

After emancipation, medical care continued to appear in discussions of labor and politics. Black people continued to resist any system that denied them autonomy in accessing medical treatment. African American patients and practitioners found themselves in a new medical landscape—one newly shaped both by scientific discovery and by a government that was in the process of recognizing and defining their citizenship. During this time, African American medical culture developed in a variety of significant ways. Understandably, many freedpeople developed conflicting attitudes toward health and healing. While some continued to rely on the folk medicine that had served as an effective survival mechanism during slavery, a few aspired to become practitioners of modern medicine. The latter hoped to move toward a medical culture where African Americans could attend quality medical schools and practice medicine in hospitals and dispensaries. African Americans also desired modern scientific care for themselves and their families and found imaginative ways to raise collectively the funds to establish medical and nursing schools as well as hospitals. Black doctors began to publish research and findings in black medical journals.

These black medical schools and journals have a specific historical significance beyond their pathbreaking existence and the opportunities they provided to aspiring black doctors. They serve as proof of a shift in African Americans’ sense of themselves within professional medical culture and modern science. In the first generations after freedom, African Americans tried to move away both from the folk traditions of slavery and from dependence on white largesse. This shift, however, would necessitate a new trust in science and medical authority.

In African American communities, the progression toward citizenship and the transition to modern medicine were beset with obstacles both ideological and logistic. Life expectancy for African Americans lagged well behind that of white southerners, as the former fell victim to diseases and to the effects of poor sanitation and nutrition. Many lacked cash to pay for medicines, doctors, or hospital fees, yet they needed bones set, wounds cleaned and cared for, infections cured, and pain relieved. For free African Americans, throwing themselves on the mercy of their employer, municipal government, or nation-state often meant accepting labels of dependency and degeneracy. However, even without cash funds or relationships with white masters to call upon, African American individuals and communities mobilized the resources that freedom had bestowed to procure medical care. Organizing themselves into brotherhoods and associations, they found ways to provide their members funds for medical expenses. In their election of officers, public parades, and pooling of resources to provide medical care for themselves and for indigent African Americans, members of these societies took active roles in philanthropy, self-reliance, and citizenship. They simultaneously became sites in which to display nascent patriotism. In making decisions about medicine, medical treatment, and medical education, African Americans, both enslaved and free, deployed the same skills they used in more traditionally political forums—balancing self-interest with the longer-term interest of their community, deciding who belonged to their community and who did not, and negotiating with different white actors for funds, treatment, and recognition from the U.S. government.

Indeed, the clinic, the hospital, and the dispensary were important arenas of African Americans’ postemancipation political action, just as were the more widely investigated arenas of the schoolhouse, the church, the polling place, and the cotton field. Keenly aware of their own roles, whether as citizens, as Union soldiers, or as medical professionals, African Americans pressed for their rights to health care, to dignified treatment, to quality medical training, and to the opportunity to practice medicine. The routines of a modern hospital, lack of adequate care in a Union army camp, or an employer’s intolerance of absence from work could be reminders of conditions under slavery or of white supremacy more broadly. Black people creatively asserted themselves as independent, discerning, and deserving patients under all of these conditions. These were political acts. In articulating their medical needs, organizing their finances, and demanding quality medical care, African Americans attempted to carve out a tolerable place for themselves in American medical culture—a culture that had for decades been instrumental in denying them rights and personhood.

The character of African Americans’ discussions of health care has long been largely invisible to scholars of this period. Not only were the majority of African Americans illiterate during this time, but conversations and debates about sickness and health tend to be private and not preserved for posterity. Such conversations happen when a community or family is under stress—from a contagious disease or epidemic or from witnessing the illness or injury of a loved one. Because medical needs at such times tend to be immediate and personal, it is easy to miss the political implications of medical treatment. However, recorded interviews and written evidence do exist of, for example, slaves’ decisions about medical care, discussions alongside the sickbeds of members of the Colored Troops, African Americans’ meetings to organize mutual help in paying doctors’ bills, and deliberations about establishing their own medical schools.

Discussions that white historical actors had about African Americans’ health care and its implications, whether during slavery, the Civil War, or in the emancipation era, usually did not concern only medicine or science. Science and medicine were so entangled with ideas about racial difference and labor that most slave owners, white doctors, army officers, Freedmen’s Bureau agents, and employers of freedpeople could not think about African American health, illness, and cures in what we might consider exclusively clinical terms. In medical forums such as journals, Freedmen’s Bureau documents, diaries of northern reformers, and physicians’ private correspondence, men and women debated competing ideologies regarding the proper place of African Americans in the political and social order. White physicians and observers often viewed the responses of black people to sickness and cures as a barometer of their adjustment to slavery or freedom. Within these sources, however, when white observers describe African Americans’ responses and conversations with medical personnel, it often becomes clear that although they were excluded from formal debates about their health care and its significance, African American patients, both slave and free, did all they could to control their own treatment, aware of the potential consequences of reliance on slave owners and, later, on the state.

Slaves seldom left behind written testimony about major events in their daily lives, much less their experiences with healers, doctors, and the world of medicine in general. To trace slaves’ experiences with white practitioners, I draw on evidence in antebellum medical journals, planters’ diaries, and agricultural publications. To recapture what I can of slaves’ own accounts, I use the Works Project Administration (WPA) narratives, trying to remain mindful of the pitfalls of this collection. Slave narratives, both well known and obscure, have also been useful in this task. Abolitionists, both white and African American, also had insights on slaves’ physical health, and many of their writings have found their way into my chapters.

During the Civil War, the reading public as well as federal officials in Washington learned about the physical suffering of African Americans through government reports, charity organizations, journalists, and photographers. Newspapers, fundraising appeals, private letters, and even fiction and poetry by white authors are some of the sources that provide a fractured portrait of African Americans’ health, illness, injury, and death.

Many of my sources on African Americans’ experience during the Civil War and just after it, be they military and Freedmen’s Bureau reports, letters from African American soldiers and civilians, orders and observations from doctors, or correspondence from African American mutual aid societies, are drawn from the remarkable Freedmen and Southern Society Project at the University of Maryland. The Project, which gleans documents relating to emancipation from the National Archives, has published five volumes of primary source material thus far. None of the volumes and few sections within them are devoted explicitly to medicine. However, health, illness, and medicine had such far-reaching implications in the lives of black laborers, soldiers, and refugees that discussions and debates about hospitals, treatments, physicians, and billing appear in general orders, protests, complaints, leases, and contracts. For example, the latest volume in the series Land and Labor 1865 focuses on that one tumultuous year and the diversity of agricultural labor arrangements. The labor contracts reproduced in this volume reveal that payment of medical expenses remained unsettled in this first year of freedom.

In addition, the Project’s archive in College Park holds a wealth of unpublished material valuable to scholars of the Civil War era. The letters and testimonials from African American men and women in this collection, often addressed to President Lincoln or the commissioner of the Freedmen’s Bureau, General Oliver Otis Howard, are a particularly rich source. For example, I drew heavily from this unpublished material in using correspondence from and about three disparate African American doctors in 1866. While historians of slavery have explored the lives of enslaved healers and their role in plantation communities, and other historians have done extensive research on black medical professionals in the early twentieth century, the experiences of black doctors in the 1860s have been less examined in the literature.² The lives of the three doctors that I focus on all spanned slavery, the Civil War, and freedom. All three drew on their antebellum experience as doctors in building a medical practice during emancipation. In the earliest years of freedom, under radically different circumstances, all petitioned the federal government for assistance in maintaining their medical practices. The doctors’ appeals to the Freedmen’s Bureau and the War Department reveal how these men attempted to blend medical and state authority in their pursuit of professionalism.

This book adds to a growing and exciting historiography on African American slavery and emancipation. Many scholars have touched on medicine in their explorations of this time period, but few have explored medical culture as an independent topic—a lens through which to understand larger issues of racial hierarchy, freedom, and African American political life. Many of the canonical works on slavery and slaveholding do discuss health and healing on plantations, whether as work done by slaves, overseers, or masters. Slaves’ life expectancy has also come up in work on the economics of slavery.³ Two authors, Todd Savitt and Sharla Fett, have written books devoted to health and healing among slaves in the rural South. Savitt’s work, Medicine and Slavery, is a medical history text and skillfully investigates slaves’ diets and living conditions as well as the beliefs of white antebellum doctors and slave owners to sketch out a medical portrait of slaves. Fett’s Working Cures moves away from what she calls the biomedical model to explore the cultural and spiritual significance of healing on slave plantations.⁴

Historians interested in African American institution building have examined the founding of African American churches, schools, banks, life insurance companies, and small businesses throughout the South in the aftermath of the Civil War. With a few notable exceptions, less attention has gone to the development of medical infrastructure.⁵ Todd Savitt, in a series of articles published together in Race and Medicine in Nineteenth-and Early-Twentieth-Century America, takes the most thorough look to date at black medical institutions, both medical schools and hospitals, from Reconstruction until the turn of the twentieth century. Scholars of the Civil War and medicine have delved into African Americans’ medical conditions during that conflict. The most recent and satisfying of these is Margaret Humphreys’s Intensely Human.⁶

Unlike most of these books, Doctoring Freedom is not a medical history in which the reader will learn about specific illnesses that African Americans fell victim to during slavery and freedom. Nor is it an institutional history that focuses on the development and significance of black hospitals, medical associations, or nursing schools. Rather, it is African American history that attempts to incorporate a holistic exploration of African American medical culture from slavery through the Civil War and Reconstruction and into the turn of the century, an exploration that is most centrally concerned with medicine’s relationship to African American culture and politics.

Doctoring Freedom is roughly chronological. The first four chapters deal explicitly with slavery and the Civil War. The first chapter explores the role of health and medicine in slavery and to a lesser extent in the abolition movement. Chapters 2 and 3 turn to the experiences of African American military laborers, contraband, and soldiers during the Civil War. These people often brought their medical concerns to army officials, Freedmen’s Aid agents, and charity workers in camps. Often their ideas about their place in medical culture reveal how they saw themselves in relation to the state. Chapter 4 investigates brotherhoods and associations that African Americans organized during freedom. These groups often helped their members pay for medical expenses and organized charitable activities as well.

Chapters 5 and 6 differ in purpose and scope from the earlier ones. Both are situated in the postwar era; slavery and the Civil War exist only in the recent past. The chapters explore how the entwined legacies of racial hierarchy and medical culture that African Americans had lived under during slavery and the war continued to shape the emancipation era for black doctors and patients. These final chapters move away from the episodic framework and narrow in on material, in the case of Chapter 5, and broaden out from it in the case of Chapter 6. Chapter 5 undertakes a close reading of correspondence from and about three disparate African American doctors. Chapter 6 takes up the experiences of African Americans as patients, medical students, and doctors from the end of the war through the early twentieth century.

The primary documents that Doctoring Freedom draws on hail from a wide geographic area. The bulk of the sources and historical actors that the book examines originate in the southern United States. There are notable exceptions: The urban centers of New York, Philadelphia, and Washington, D.C., are also home to institutions, hospitals, agencies, and people that help tell this story. While medical care and theories about racial difference as well as the African American experience varied from place to place, this project attempts to connect common themes and relationships between African American experience and medical culture.

By the first decade of the twentieth century, African American doctors, having obtained degrees, mostly from small black medical schools, strove to join the ranks of respectable, professional physicians. Their work as doctors marked them as men of science and as bona fide members of the African American professional and cultural elite. Like Chesnutt’s Dr. Miller in The Marrow of Tradition, they may have, in McBane’s words, made it all the harder to keep the rest of ’em down.

McBane’s diagnosis of the threat Miller and other colored doctors posed to white supremacy told only half of the story, however. Surely, black doctors in the twentieth century and healers, enslaved and free, in the nineteenth did make it hard