The service of African Americans in defense of the Union during the Civil War required African American nurses, doctors and surgeons to heal those soldiers. In the nation's capital, these brave healthcare workers created a medical infrastructure for African Americans by African Americans. Preeminent surgeon Alexander T. Augusta fought discrimination, visited President Lincoln, testified before Congress and aided the war effort. Washington's Freedmen's Hospital was formed to serve the District's growing free African American population, eventually becoming the Howard University Medical Center. These physicians would form the National Medical Association, the largest and oldest organization representing African American doctors and patients. Author Heather M. Butts recounts the heroic lives and work of Washington's African American medical community during the Civil War.
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About the Author
Heather Butts, JD, MPH, MA, is an integration of science and practice (ISP) instructor and faculty advisor of the part-time health policy management students at Columbia University Mailman School of Public Health, where she teaches bioethics and public health law. She also serves as an adjunct professor in health law and bioethics at St. John's School of Law. She is a co-founder and board member of the non-profit H.E.A.L.T.H for Youths, Inc., which focusses on college readiness and preparation. Dr. Hugh Butts completed his medical training at the Columbia University Psychoanalytic Clinic for Training and Research in 1961 and was appointed a psychoanalyst in 1967. He has been the associate director of the department, and chief of the Psychiatric Inpatient Service and Day Hospital, director of the Bronx State Hospital and first deputy commissioner of the New York State Department of Mental Hygiene. Dr. Butts is currently in private practice in New York City where he resides.
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African American Healthcare Providers and Patients In D.C. Prior to the Civil War
While the majority of African American healthcare providers' D.C. stories began during the war, some of them had contact with the city before the conflict. This chapter examines those providers as well as the overall state of African American healthcare before the war, particularly in D.C.
Washington, D.C., was an interesting town prior to the Civil War. In 1830, over half of the African Americans in Washington, D.C., were free. By 1850, free African Americans outnumbered enslaved African Americans by two to one. D.C. had "black codes" regulating the conduct and opportunities that were available to free African Americans.
The first black codes were instituted in 1808 and involved curfews that resulted in fines of five dollars. Unpaid fines resulted in individuals being whipped. Black codes increased in harshness in 1812 when fines increased to twenty dollars and unpaid fines were punished with six months' jail time. African Americans in D.C. were subject to 10:00 p.m. curfews and morality laws, such as being unable to gamble, play cards or curse in public. African Americans in D.C. had very few political rights, could not testify against whites in court and had to carry documents confirming their status as free individuals at all times. In 1821, additional codes were imposed on free African Americans. Black codes hindered but did not prevent a number of African Americans from prospering as restaurant owners and merchants. Others worked at a variety of trades and service occupations, including bricklayers, painters, shoemakers, nurses and physicians.
The D.C. Compensation Act of April 16, 1862, ended slavery in D.C. and freed over 3,100 enslaved individuals. The act also reimbursed slave owners and offered newly freed slaves money to emigrate to other countries. In 1800, 25 percent of D.C.'s population was African American, and the vast majority of them were enslaved. Slaves also earned freedom in D.C. through the death of slaves' owners who granted freedom in their wills. These numbers grew with time, and as African Americans labored on projects like building the White House and Capitol, they were able to buy their freedom and live in D.C. as free men and women. Thousands of slaves fled to D.C., and consequently, the Contraband Camp in D.C. was established. Historian Jill Newmark described the hospital:
On a parcel of swampy land in northwest Washington, D.C. bounded by 12th, 13th, R and S streets, NW, a tented camp and hospital once stood that served thousands of escaped slaves and black soldiers during the Civil War. Known as Contraband Camp, it contained one of the few hospitals that treated blacks in Washington, D.C. during the war and whose staff including nurses and surgeons, were largely African American.
According to Elizabeth Keckley, dressmaker and confidante to first lady Mary Todd Lincoln:
They came with a great hope in their hearts, and with all their worldly goods on their backs ... the north is not warm and impulsive. The bright joyous dreams of freedom to the slave — faded — were sadly altered in the presence of that stern, practical mother, reality. Poor dusky children of slavery, men and women, of my own race — the transition from slavery to freedom was too sudden for you.
Among the issues faced by free African Americans were 10:00 p.m. curfews and morality laws seeking to legislate their behavior. With the influx of so many African American "contrabands" to Washington, D.C., shelters were constructed, first on Capitol Hill, then the U Street Corridor and eventually in Arlington County. Services such as education and healthcare began and recruitment of service members took place.
It was in the face of this that healthcare issues, with respect to African Americans, surfaced. Many of these issues had their inception in slavery and in the transition for African Americans from a system of servitude to a status of freedom. This transition was more difficult for some than others and particularly difficult in a city such as Washington, D.C.
Healthcare of African Americans in D.C.
The toll that slavery took on both the slaves that endured the system and those who propagated it is incalculable. Information on the health of African Americans before the war is available by looking at the health of African Americans who enlisted in the war. It is critical to understand the health status of African Americans prior to the war in order to understand their health outcomes during the war.
According to English legal academic and author Edward Strutt Abdy, who visted Washington in the 1830s:
One day I went to see the slave pen — a wretched hovel "right again" the Capitol, from which it is distant about half a mile, with no house intervening ... At a small window above, which was unglazed and exposed alike to heat of summer and the cold of winter, so trying to the constitution, two or three sable faces appeared, looking out wistfully to while away the time and catch a refreshing breeze; the weather being extremely hot.
The hardships that African Americans had to endure while living in slavery through the 1850s took a physical and psychological toll on their health. Additionally, as African American slaves in Washington, D.C., became older and sicker, their utility lessened, and they were often reduced to begging for money to earn their keep. The usefulness of a slave was in his or her ability to be productive, and that meant being as healthy as possible, under the circumstances.
Factors such as a poor living standard, the amount and level of work and the lack of access to healthcare led to high mortality rates for slaves. According to the 1850 census, the average age of death for African Americans was 21.4 years as opposed to 25.5 years for whites. In 1860, 3.5 percent of slaves and 4.4 percent of whites were over the age of sixty.
All experiences slaves had with a doctor or nurse were under the control of their owner. Physicians often had a contract with the slave owner to care for all the slaves on a plantation. The most obvious difference between healthcare for whites and slaves was that slaves did not have control over their own bodies. Moreover, the slave "body" was the economic engine that kept the southern economy in place. It was up to the slave owner to decide, in conjunction with the doctor, the medical course of treatment for that slave. Slaves had to report all illnesses to their owners. This, in turn, created an interesting paradox where slaves who became ill would often try to self-medicate with herbs or roots. If the illness persisted, they were forced to tell their owner of the sickness and that they had self-medicated. This would often be an indication to the owner that the slave had little interest in his or her own health or the health of his or her children. Exacerbating the healthcare problems for many slaves was that they lived in close quarters and were exposed to parasites, bacteria, human waste and garbage.
It is important to chronicle the healthcare of slaves during slavery because it is within this context that many intergenerational disease processes were inherited from African Americans in the 1800s, both for free African Americans and slaves. Under this umbrella of healthcare of slaves, we can transition to examine healthcare for African Americans during the Civil War.
It does appear that there was a cohort of African Americans, namely older slaves, that had, if not better, at least comparable health outcomes to their white counterparts. There are several reasons for this. First, older slaves were those who had been able to avoid deadly childhood and midlife illnesses and life-threatening accidents. They might have developed a healthcare-coping mechanism that allowed them to successfully reach old age. If a slave reached a mature age, it was financially wise to keep the slave healthy and alive, either for work or sale. Slaves also developed mechanisms of keeping older slaves healthy.
The psychological impact of slavery cannot be denied. The lack of mental health services for African Americans in the 1800s has led to a "legacy of neglect" for African Americans' mental health issues today. This, coupled with the psychological trauma that African Americans went through during slavery, led to generational tension with mental health and treatment. During the 1800s, the main mental health diagnoses for all individuals were melancholy, mania, dementia and idiocy. For slaves however, drapetomania and dysaethesia aethiopicia were the diagnoses of choice.
Drapetomia, characterized by being sulky and dissatisfied, often "resulted" in slave escape and runaway situations. Many of these diagnoses were premised on the notion that slaves were unjustifiably dissatisfied with their place in life and irrationally decided to run away from a perfectly good slave master and home where they were taken care of.
Dysaethesia aethiopicia was defined as mischief, poor work habits or destruction of property. According to Tony Lowe, while environmental factors were attributed to mental health issues of whites in the 1800s, social inferiority and biological defects were the etiology many attributed to African Americans' mental health issues. Some doctors even suggested that slavery helped to ameliorate such inherent mental health issues. The stigma attached to slaves, coupled with a need to justify the institution, led to such notions.
The slave narrative entitled The Life of Gustavus Vassa tells the story of how slave masters neglected and cruelly treated slaves.
One Mr. D — — told me he had sold 41,000 negroes and he once cut off a negro-man's leg for running away. I asked him if the man had died in the operation, how he, as a Christian, could answer, for the horrid act before God ... He ... said that his scheme had the desired effect — it cured that man and some others of running away.
The narrative goes on to describe the health of slaves, stating:
Another negro-man was half hanged, and then burnt, for attempting to poison a cruel overseer. Thus by repeated cruelties, are the wretched first urged to despair, and then murdered, because they still retain so much of human nature about them as to wish to put an end to their misery, and to retaliate on their tyrants! Their overseers are, indeed, for the most part, persons of the worst character of any denomination of men in the West Indies. Unfortunately, many humane gentlemen, but not residing on their estates, are obliged to leave the management of them in the hands of these human butchers, who cut and mangle the slaves in a shocking manner, on the most trivial occasions, and altogether treat them, in every respect, like brutes. They pay no regard to the situation of pregnant women, nor the least attention to the lodging of the field negroes. Their huts, which ought to be well covered, and the place dry where they take their short repose, are often open sheds, guilt in damp places; so that, when the poor creatures return tired from the toils of the field, they contract many disorders, from being exposed to the damp air in this uncomfortable state, while they are heated, and their pores are open. The neglect certainly conspires with many others to cause a decrease in the births as well as in the lives of the grown negroes.
From a public health perspective, there is a question about the health of African Americans as they entered the war. How does one quantify the level of health for this population? One way to do this would be childhood health. Another way would be by using height indicators. In A Peculiar Population: The Nutrition, Health, and Mortality of American Slaves from Childhood to Maturity, Richard H. Steckel does an exhaustive review of the height and mortality data of slaves.
In 1807, Congress passed legislation requiring ship captains to describe each slave based on name, age, sex, color and height. Because the need for good nutrition increases dramatically during adolescence, it is instructive to identify the average age of growth spurt in the slave population. It appears that the peak of the adolescent growth spurt for female slaves was 13.27 years and for male slaves 14.75 years, approximately 1–1.15 years behind that of averages for individuals, regardless of race, during that time period. It is clear that young slave children were well below the expected height levels. But there is an interesting phenomenon with slaves as they matured — they essentially made up for their height disparities in their teenage years and into adulthood.
Slaves caught up with respect to growth. By age sixteen and a half, for example, American male slaves were taller than factory workers and laboring classes in England, factory workers in Russia and German peasants.
It is provoking to think about the seeming incongruity between childhood height rates and adolescent growth spurts among slaves. Why were slave children so small? Much of this can be traced to birth rates and birth weights. Slave newborns, on average, weighed five and onehalf pounds. Once born, these infants had a poor diet after breastfeeding, which led to high infant mortality and sickness rates. If a baby made it through infancy, then he or she had to deal with a poor diet as a child. Slave masters focused on working slaves and their diets, not the children's. Slave owners did a cost-benefit analysis: If slave children made it into late childhood and early adolescence, the return on investment at that point was worth the money to the slave masters.
The focus on the laborer in the slave system influenced slaves themselves. If the thought was that the adult laborer was the modern equivalent of the "bread winner," then the entire family was invested in the health and strength of that family member, even to the detriment of younger family members. Slaves made up their height differential when they joined the labor force. This corresponds with an improved diet and the slave owner's including meat in the slave's diet once he or she became a laborer.
Unlike other societies where individuals continued to be poorly nourished through adulthood, when slaves entered the workforce, they were deemed to be a cost-benefit to their masters and, thus, deserving of a better diet, or at least a diet that included meat. This seems to have been an important factor in spurring growth among slave adolescents.
Below is a quote from Walt Whitman which manifests his views on slavery:
I say where LIBERTY DRAWS NOT THE BLOOD OUT OF SLAVERY, THERE SLAVERY DRAWS THE BLOOD OUT OF LIBERTY. After all, I may have been trained a bit, just a little bit with the New York feeling with regard to anti-slavery. The horror of slavery always had a strong hold on me. Slavery and the tremendous spreading of hands to protect it and the stern opposition to it which shall never cease, or the speaking of tongues and the moving of lips ceases. I observe the slights and degradations cast by arrogant persons upon laborers, the poor and upon African Americans, and the like. Or I guess the grass itself is a child ... a uniform hieroglyphic ... growing among black folks as among white ... large fine headed nobly formed superbly destined, on equal terms with me! Everyone who speaks his word for slavery is himself the worst slave — the spirit of freeman is not light enough to show him that all the fatness of earth were bitter to a bondaged neck — when a feast I eat corn and roast potatoes for my dinner through my own voluntary choice, it is very well and I am much content, but if some arrogant head of the table prevent me by force from touching anything but corn and potatoes then is my anger aroused. I was a decided and outspoken anti-slavery believer myself then and always but steered from the extremist, the red hot fellows of these times.
Whitman's attitude on slavery was further expressed in a dispatch to the Brooklyn Daily Eagle, dated March 18, 1856:
Public attention within the last few days has been naturally turned to the slave trade — that most abominable of all man's schemes for making money without regard to the character of the means used for the purpose. Four vessels have, in about as many days, been brought to the American territory for being engaged in this monstrous business! It is a disgrace and a blot on the character of our Republic and on our biased humanity! Though we hear less nowadays of this trade — of the atrocious slave hunt — of the crowding of a mass of compact human flesh into little more than its own equal in space — we are not to suppose that such horrors have ceased to exist. The great nations — our own first of all — have passed stringent laws against the slave traffic. But Brazil encourages it still. And many citizens of Europe and America pursue it notwithstanding its illegality. Still the African American is torn from his simple hut — from his children, his brethren, his parents and friends to be carried far away and made the bondsman of a stranger. Still the black hearted traitors who ply this work go forth with their armed bands and swoop down on the defenseless villages and bring their loads of human trophy, chained and gagged, and sell them as so much merchandise! The slave-ship! How few of our readers know the beginning of the horrors involved in that term! Imagine a vessel of the fourth or fifth class, built more for speed than space, and therefore with narrow accommodations even for a few passengers; a space between decks divided into two compartments, three feet, three inches from floor to ceiling — one of these compartments sixteen feet by eight, the other forty by twenty-one-the first holding two hundred and twenty-six children and youth of both sexes, the second, three hundred and thirty-six men and women and all this is a latitude where the thermometer is at eight degrees in the shade. Are you sick of the description? O, this is not all by a good sight. Imagine neither food nor water given these hapless prisoners except a little of the latter, at long intervals, which they spill in their mad eagerness to get it; many of the women advanced in pregnancy — the motion of the seas sickening those who have never before felt it — dozens of the poor wretches dying, and others already dead (and they are most to be envied!) — the very air so thick that the lungs cannot perform their office — and all this for filthy lucre! Pah! We are almost a misanthrope to our kind when we think they will do such things! Of the nine hundred Negroes (there were doubtless more) originally on board the Pons, not six hundred and fifty remained when she arrived back and landed her inmates at Monrovia! It is enough to make the heart pause its pulsation to read the scene presented at the liberation of these sons of misery. — Most of them were boys, of from twelve to twenty years. What woe must have spread through many an African American mother's heart from this wicked business! It is not ours to find an excuse for slaving in the benighted condition whose horrors we have been describing — did not facts prove the contrary. The "middle passage" is yet going on with all its deadly crime and cruelty. The slave trade yet exists. Why? The laws are sharp enough, too sharp. But who ever heard of their being put in force, further than to confiscate the vessel, and perhaps imprison the crews a few days? But the laws should pry out every man who helps the slave trade — not merely the sailor on the sea, but the cowardly rich villain and speculator on the land — and punish him. It cannot be effectually stopped until that is done — and Brazil forced by the black muzzles of American and European men-of-war cannot to stop her part of the business too. To the American young men, mechanics, farmers, etc. How much longer do you intend to submit to the espionage and terrorism of the three hundred and fifty thousand owners of slaves? Are you too their slaves and their most obedient slaves? Shall no one among you dare open his mouth to say he is opposed to slavery, as a man should be on account of the whites, and want it abolished for their sake? Is not a writer, speaker, teacher to be left alive but those who lick the spit that drops from the mouths of the three hundred fifty thousand masters? Is there hardly one free, courageous soul left in fifteen large and populous states? Do the ranks of the owners of slaves themselves contain no men desperate and tired of that services and sweat of the mind, worse than any of that service in sugar fields or cornfields.(Continues…)
Excerpted from "African American Medicine in Washington, D.C."
Copyright © 2014 Heather M. Butts.
Excerpted by permission of The History Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Foreword, by Hugh F. Butts, MD,
1. African American Healthcare Providers and Patients in D.C. Prior to the Civil War,
2. Unique Healthcare Issues of African American Soldiers and Prisoners of War,
3. African American Healthcare Providers in D.C. During the Civil War,
4. African American Healthcare in D.C. after the Civil War,
5. African American Healthcare Providers in D.C. after the Civil War,
About the Author,