Medical education reform efforts and failures of U.S. medical schools, 1870-1930

The dramatic decline in the number of US medical schools in the early twentieth century has been traced to a medical education reform movement that gained momentum after the Civil War. The major parties to reform-the universities themselves, the Association of American Medical Colleges (AAMC), state licensing boards, the American Medical Association (AMA), and Flexner-had different interests and strategies, however, and scholars have continued to debate the impact each had on the decline. To isolate the independent effects that the temporally intertwined forces for reform had on medical school failures, this study applies statistical survival analysis to an extensive and unique data set on medical schools operating in the United States between 1870 and 1930. Contrary to the views of some scholars, the results indicate that schools closed in response to critical evaluations published by the Illinois State Board of Health in the nineteenth century and the AMA and Flexner in the twentieth century. Additionally, the results indicate that schools were less likely to have failed if they adopted certain reforms implemented at leading schools or joined the AAMC, and were more likely to have failed if their state's licensing regulations mandated lengthier premedical and medical training.     

The Tuskegee Syphilis Study and the scientific concept of racial nervous resistance

In 1932, the U.S. Public Health Service began a study of untreated syphilis among black men in Macon County, Alabama. This project, later known as the Tuskegee Syphilis Study, became one of the most notorious ventures of twentieth-century medicine. Much has been written on it. Historians have suggested that scientific racism strongly influenced the study. But specific links between earlier racial science and the scientific conduct of the study have remained unexplored. The examination in this paper of the concept of a racially determined resistance to syphilis in the nervous system establishes such a link. Discussion of nervous resistance to syphilis appeared in the medical literature in the early twentieth century as a conjecture about the natural inferiority of blacks. White physicians used the concept to interpret racial differences in neurosyphilis as evidence of the rudimentary development of the brain. A small community of African American physicians joined other national experts in syphilis who chose to explain apparent racial differences through alternate mechanisms. But the scientific advisors to the Tuskegee Syphilis Study favored the concept of a racial resistance to neurosyphilis and steered the early design of the study to help to elucidate it. The Tuskegee Syphilis Study was an examination of untreated syphilis, but it also became a demonstration of a putative racial characteristic of syphilis long considered evidence of the natural inferiority of blacks. An examination of the concept of racial nervous resistance and its influence on the research in Macon County helps to define the influence of scientific racism on this notorious medical study.     

“The producers on the one side,and the capitalists on the other”: Labor Reform,Slavery, and the Career of a Transatlantic Radical

Abstract

Through exploring the neglected career of John Campbell, an Irish-born Chartist refugee who ascended to a leadership role in the antebellum American labor movement, this article seeks to shed light on how revolutionary upheaval in Europe, debates over immigration, and sectional conflict affected working-class politics. Focusing on the period 1848 to 1851, and tracing Campbell's rapid evolution from a radical opponent of slavery to an ardent supporter of black subjugation, I argue that labor historians need to pay closer attention to shifting local and national contexts to understand the racial politics of labor agitators. Yet even as Campbell's views changed, his commitment to a producerist vision remained constant; by 1851 he had simply added people of African descent to a list of “idle” nonproducers who lived off the labor of workingmen. His proslavery twist on producer ideology suggests historians of antebellum social relations may need to go beyond interrogating the racial dimensions of artisan republicanism to gain a fuller understanding of the variety of working-class attitudes to race.     

The business of ethics: gender, medicine, and the professional codification of the American Physiotherapy Association, 1918-1935

The history of codes of ethics in health care has almost exclusively been told as a story of how medical doctors developed their own professional principles of conduct. Yet telling the history of medical ethics solely from the physicians' perspective neglects not only the numerous allied health care workers who developed their own codes of ethics in tandem with the medical profession, but also the role that gender played in the writing of such professional creeds. By focusing on the predominantly female organization of the American Physiotherapy Association (APA) and its 1935 "Code of Ethics and Discipline," I demonstrate how these women used their creed to at once curry favor from and challenge the authority of the medical profession. Through their Code, APA therapists engaged in a dynamic dialogue with the male physicians of the American Medical Association (AMA) in the name of professional survival. I conclude that, contrary to historians and philosophers who contend that professional women have historically operated under a gender-specific ethic of care, the physiotherapists avoided rhetoric construed as feminine and instead created a "business-like" creed in which they spoke solely about their relationship with physicians and remained silent on the matter of patient care.     

Revisiting black medical school extinctions in the Flexner era

Abraham Flexner's 1910 exposé on medical education recommended that only two of the seven extant medical schools for blacks be preserved and that they should train their students to "serve their people humbly" as "sanitarians." Addressing charges of racism, this article traces the roots of the recommendation that blacks serve a limited professional role to the schools themselves and presents evidence that, in endorsing the continuance of Howard's and Meharry's medical programs, Flexner exhibited greater leniency than he had toward comparable schools for white students. Whether his recommendations to eliminate the other five schools were key factors in their extinction is addressed here by examining 1901-30 enrollment patterns. Those patterns suggest that actions of the American Medical Association and state licensing boards, combined with the broader problem of limited premedical educational opportunities for blacks, were more consequential than was the Flexner report both for the extinction of the schools and for the curtailed production of black doctors.     

Lincoln,Race, and the Spirit of ’76

Abstract

This essay examines how Lincoln dealt with race, slavery, and emancipation in antebellum America. It argues that despite a few controversial statements and policies regarding black Americans, Lincoln sought to preserve the American union and its system of self-government by reclaiming the ideals of the Declaration of Independence. Unlike U.S. Senator Stephen A. Douglas, who exploited white bigotry in his promotion of local “popular sovereignty” as a solution to the slavery controversy, Lincoln highlighted the natural rights of blacks as a way to prevent the spread of slavery and thereby save what he would later call “the last best hope of earth.”     

‘From motives of generosity,as well as self‐preservation’: Thomas Branagan,Colonization, and the Gradual Emancipation Movement

The idea of colonizing free blacks in areas distant from white settlement has had a long history in the American antislavery movement. A decade before the American Colonization Society formed in 1817, an Irish immigrant in Philadelphia, Thomas Branagan, argued that creating a black settlement in the newly‐acquired Louisiana Purchase territories would encourage slaveholders to emancipate their bondspersons while also saving white society from a number of ills he associated with a biracial society, most notably racial mixing, poverty and violence. Branagan’s plan never gained acceptance, but the idea of sending free blacks to the American West to encourage emancipation did catch the attention of gradual emancipationists associated with the American Convention of Abolitionists. This group considered a similar scheme as the lesser of two evils once the Colonization Society began its campaign to send America’s blacks “back” to Africa. Neither plan met with success, but their existence reveals an important link between colonization and the early antislavery movement.     

Responding to the second ghetto: Chicago's Joe Smith and Sin Corner

World War Two and its aftermath transformed Chicago's African American community. The Great Migration entered a second and more intense phase as black migrants flooded into Northern cities. This massive relocation of Southern blacks resulted in the expansion and reformulation of Chicago's ghettoes on both the West and South Sides of the city. The question of a response to this Second Ghetto from African Americans themselves presents itself. White politicians, cultural elites and businessmen still controlled the city and could impose their will on its neighborhoods simply redrawing ghetto boundaries to reflect the new realities of the postwar era. The strange case of Joe Smith and Sin Corner sheds some light on black agency in the 1950s. The African American middle class had resources it commanded to try and protect itself from racial injustice. These resources, however, were based on class privileges not enjoyed by most in the African American community.     

Patriot Graves: American national identity and the Civil War dead

The Civil War was America’s defining conflict, the war that made the nation and the fulcrum for the development of American national identity in the later nineteenth and early twentieth centuries. Yet the role that the Civil War dead played in this process has only begun to be explored. Although the monuments raised to honor the dead, along with the battlefields on which they fought, attract considerable interest, the cemeteries constructed to inter them have been integrated into the landscape – literal and figurative – of the American nation so fully that the need they answered, the manner of their development, the form they took, and their longer‐term symbolic message has been relatively neglected. Yet the Civil War dead were a crucial – indeed, the crucial – component in the construction of American national identity. Although scholars interpret American attitudes toward the Civil War dead within the context of the mourning rituals of the antebellum era, the war required, and produced, a different approach to death, for which antebellum precedent had ill‐prepared Americans. Removed from its antebellum religious and societal framework, death in the Civil War acquired a new and more potent national meaning that not only validated American nationalism through warfare, but anticipated the response to fallen soldiers in future European conflicts.     

The Passenger Cases Reconsidered in Transatlantic Commerce Clause History

The Supreme Court's 5–4 decision in the Passenger Cases (1849) overturned two Northern states' taxes on poor foreign immigrants. The Court's eight opinions disputed whether destitute transatlantic immigrants arriving in U.S. ports were legally and constitutionally “persons” like fugitive slaves fleeing the South, free African Americans residing in the U.S.‐Canadian borderlands, and black seamen working on ships entering Southern ports. The eight opinions issued in the case, as Charles Warren noted, raised fundamental constitutional questions concerning whether U.S. congressional or state authority was exclusive or concurrent over persons moving in interstate and international business, reflecting wider sectional struggles fostering the Civil War. ¹ More recently, Mary Bilder and others examined connections among indentured contract labor, race‐based American slavery, and the Court's antebellum Commerce Clause decisions to establish that foreign immigrants were commercial objects subject to regulation through the Constitution's Commerce Clause. ² Southerners and Northern pro‐slavery supporters argued, however, that fugitive slaves and free blacks crossing interstate and international borders were “persons” who could be regulated or altogether excluded under state police powers. ³     

Eugenics as Indian removal: sociohistorical processes and the de(con)struction of American Indians in the southeast

Although research on the history of the eugenics movement in the United States is legion, its impact on state policies that identified and defined American Indians has yet to be fully addressed. The exhibit, Our Lives: Comtemporary Life and Identities (ongoing until September 21, 2014) at the National Museum of the American Indian provides a provocative vehicle for examining how eugenics-informed public policy during the first quarter of the twentieth century served to "remove" from official records Native peoples throughout the Southeast. One century after Indian Removal of the antebellum era, Native peoples in the American Southeast provide an important but often overlooked example of how racial policies, this time rooted in eugenics, effected a documentary erasure of Native peoples and communities.     

African Americans’ scheme to diffuse the Chinese “threat,” 1865–1882

ABSTRACT

How to deal with Chinese immigrants was an explosive issue in America in the latter half of the nineteenth century. Most people advocated exclusion, while many were active abusers of Chinese on a daily basis. African Americans were not immune to this controversy. Some followed the lead of whites in bullying Chinese either physically or discursively, becoming cooperators of white agitators. Others protested American discrimination against Chinese and demanded full equality for those immigrants. In between cooperators and protesters was a third, understudied group of blacks. They did regard Chinese as a problem but opted for a dilution of the so-called menace through peaceful and restrained means. Adding to the complexity of black reactions to the Chinese presence, these diffusers’ voices enriched the content of the black inclusion/Chinese exclusion racial configuration.     

Dispossessing Massa: Fugitive Slaves and the Politics of Slavery After 1850

This article investigates how Norwegian immigrants expressed their sense of belonging during the antebellum period. By focusing on the concept of “belonging” rather than “adjustment,” the article attempts an interpretation sensitive to how antebellum immigrants themselves perceived the process of adaptation to American society. The Civil War is usually referred to as a sort of watershed in Norwegians' adjustment to American society, and consequently scholars have downplayed the extent to which antebellum Norwegian immigrants expressed belonging in the United States prior to the Civil War. Identifying three main categories of expressions of belonging available to antebellum Norwegian immigrants – namely land ownership, place attachment, and settler ideology – the article concludes that even if these immigrants did not readily identify themselves as Americans, they became firmly attached to their new home.     

Black Swan/White Raven: the racial politics of Elizabeth Greenfield’s American concert career, 1851–1855

In 1851, the former slave turned singer Elizabeth Greenfield traveled from her home of Philadelphia to Buffalo, New York, to pursue a career as a concert singer. This article explores the terms and reception of Greenfield’s tours of the northern United States and Upper Canada in the early 1850s, where she performed before predominantly white audiences. While white critics celebrated Greenfield in highly racialized terms as an untrained natural wonder, black activists like Frederick Douglass focused on the racist management of her career and criticized Greenfield for the segregation of her concerts. Told through analysis of reviews and promotional literature, the story of Greenfield’s early career makes visible the race and gender politics operating at the intersection of popular entertainment and black movements for racial uplift and equality in the antebellum North.     

Slavery in black and white: the racialisation of (male) slavery in Frederick Douglass’s Narrative and/vs. Toni Morrison’s A Mercy

This article revisits Frederick Douglass’s 1845 slave narrative as illustrative of the ‘birth’ of whiteness as ideology and, in particular, of the subordination of class to race interests in antebellum America. To do so, it compares Douglass’s text to Toni Morrison’s A Mercy (2008), which traces the origins of the slave trade back to the seventeenth century, when American slavery was not fully ‘racialised’ yet. While Morrison focuses on the earliest stage of the increasing (class) animosity among different types of servants and slaves, black and white, Douglass’s nineteenth-century Narrative already reveals the explicitly racialised association of human bondage with non-whiteness. I argue that Morrison’s novel may thus be interpreted as a ‘prequel’ to Douglass, whose Narrative illustrates the increasing racialisation of slavery throughout the nineteenth century, but also elaborates on its class and gender biases. In this sense, the essay concludes that Douglass shows how the assertion by white workers, especially males, of their racial and gender supremacy over both black men and women entailed, paradoxically enough, their class subjugation, which, if not in form, ended up transforming them into virtual ‘slaves’.     

The Presidency and Political Equality

When black Americans and white Americans want the president to do different things, who wins? When low-income earners prefer different government action than do middle and high-income earners, whose preferences are reflected in presidential behavior? Recent studies show that congressional behavior often most closely follows the preferences of the white and the wealthy, but we know relatively little about presidential behavior. Since the president and Congress make policy together, it is important to understand the extent of political equality in presidential behavior. We examine the degree to which presidents have provided equal representation to these groups over the past four decades. We compare the preferences of these groups for federal spending in various budget domains to presidents’ subsequent budget proposals in those domains from 1974 to 2010. Over this period, presidents’ proposals aligned more with the preferences of whites and high-income earners. However, Republican presidents are driving this overall pattern. Democratic presidents represent racial and income groups equally, but Republicans’ proposals are much more consistent with the spending preferences of whites and high-income earners. This pattern of representation reflects the composition of the president's party coalition and the spending preferences of groups within the party coalition.     

The Death of Frank Wilson: Race,Crime, and Punishment in Post-Civil War Pennsylvania

In 1877, Frank Wilson, an African American man, was executed for murdering a white tramp in Harrisburg, Pennsylvania. This article examines the trial, punishment, and press reporting of the case in the evolving context of race and criminal justice in post-Civil War Pennsylvania. It presents three main findings. First, it documents evidence of racial discrimination and wildly disproportionate rates of African American arrest and imprisonment in Harrisburg and surrounding counties comparable to earlier research focused on the largest northern cities. Second, it shows that views on law enforcement were diverse within both white and black communities and shaped by the exigencies of local and national party politics. Third, it makes the case that African American experiences of law enforcement in northern states are better understood as part of a national criminal justice culture than in distinctively regional terms.     

An Archive of Difference: Syrian Women,the Peddling Economy and US Social Welfare, 1880–1935

Historians have scrutinised the racial classifications of Arab immigrants in the census, in immigration documents and in early‐twentieth‐century naturalisation cases. However, recent scholarship has shown that other archives – ones that do not focus on interactions with the law – reveal a different process of Arab‐American racialisation. This article contends that looking in other archival spaces, specifically the US social welfare archive, shows how ideas about gender, sexual and class difference constituted early Arab‐American racialisation. Social welfare reformers in institutional settings, including the International Institute of Boston, the National Conference of Social Work and the pages of the social work periodical The Survey, systematically linked Syrian labouring practices with notions of dependency, sexual and gender deviance, and Orientalist difference. Syrian women were racialised through their participation in the peddling economy – a network of peddlers, suppliers and domestic labourers that sustained a widespread profession of the early Syrian American community. Syrian women's labouring practices conflicted with white middle‐class femininity and posed a threat to Syrian claims of whiteness. This analysis demonstrates the centrality of gender, sexuality and class to studies of early Arab America and demonstrates how Arab migrant women's labouring practices affected their communities’ standing in the American context.     

African American workers and southern visitors at antebellum Saratoga Springs

The New York state resort of Saratoga Springs was virtually unique in the antebellum United States as a venue where slave owners, fleeing the pestilential diseases of the plantation, confronted free black workers, drawn by the easy availability of seasonal work. The interactions of this odd pairing, preserved in a few fragmentary texts, reveal a considerable degree of negotiation. Antebellum black workers at Saratoga often substituted everyday acts of rebellion for the perceived futility of open attacks on individuals or institutions of domination. If their self‐assertion did not translate into substantial economic or social gains, neither were they a particularly servile or degraded class. For Southerners, the spa was a liminal site filled with pleasurable and frightening possibilities in complete contrast to plantation life. Although planters often returned to the South confirmed in their racial and sectional fears, both groups found the resort a congenial place to experiment with new roles and new attitudes.