In 2017, Beth Israel Deaconess Medical Center in Boston, Massachusetts announced that it would stop using race as a factor in estimated glomerular filtration rate (eGFR) calculation, a measure of kidney function. Then, in 2020, several other medical systems, including the Massachusetts General Brigham system, the University of Washington, and the University of Pennsylvania, agreed to do the same. In 2021, a task force of researchers from the American Society of Nephrology and the National Kidney Foundation recommended that other clinicians adopt the race-neutral approach. Previously, the typical practice had been for doctors to calculate eGFR differently for Black patients than for all other patients. But how did medical researchers initially get the idea that the bodies of Black patients function differently than the bodies of patients of other races? And why is eGFR only one of many ways that biological notions of race are embedded into medical education and practice?
Christopher D.E. Willoughby’s Masters of Health: Racial Science and Slavery in U.S. Medical Schools (UNC Press, 2022) seeks to answer these questions. Willoughby argues that medical schools in the antebellum United States were critical sites in the formation of a national medical community that shared ideas about racial science and about doctors’ authority to make claims about race. Extensively researched, the book draws its evidence from early 19th-century medical student theses, lecture notes, published books and treatises by prominent doctors and scientists, the papers of faculty members, and museum records.
The first medical schools in colonial America were the Medical Department of the University of Pennsylvania and the New York College of Physicians and Surgeons at King’s College (now Columbia University), both founded in the 1760s. Forty-five additional schools would join them by 1860. The book shows how these medical schools promoted the notion that there were biological distinctions between races as a central aspect of professional training. Graduates and faculty of the schools spread scientific racism across the country in their roles as physicians.
As Willoughby shows, scientific racism and the exploitation of Black people for medical research was neither an exclusively Southern or Northern phenomenon. Instead, the national and sometimes international medical community created by universities and promoted through journals, textbooks, and other widely read publications transcended sectional boundaries. Southerners, many of whom were from slaveholding families, studied at Northern medical schools and frequently returned to Southern states to practice medicine. In the 1850s, Willoughby says, most graduates of the University of Pennsylvania’s medical school were from Southern states, with similar demographics at Jefferson Medical College, also in Philadelphia. Even during the Civil War, many Southern students continued to attend Northern medical schools, and some physicians sent letters to each other across the Mason-Dixon line expressing their desire to maintain their professional relationships after the war ended. While these doctors may have had different opinions about slavery, they had shared ideas about scientific racism and about the importance of the “white male fraternity” of physicians.
Willoughby also describes the increasing popularity of the theory of polygenesis among doctors, who marshaled scientific authority to express racial ideologies about the body in ways that endure to the present. In the late eighteenth and early nineteenth centuries, many physicians had subscribed to the theory of monogenesis—the idea that all humans derived from the same origin— and rejected polygenesis—the idea that races had distinct origins and were different species—as conflicting with the biblical origin story. By the 1850s, however, the circulation of texts such as Josiah Nott and George Gliddon’s Types of Mankind and the discussion of polygenesis as a subject of study in universities made the theory much more widely accepted by doctors and medical students, even though, Willoughby notes, it had critics outside of the medical community. While polygenesis appealed to slaveholders as a justification for slavery, holding pro-slavery politics was not required to accept and promote the theory; students learned this idea from faculty members at Northern medical schools as much as in their Southern hometowns. The belief that race was biological and that racial difference was important to science and medicine was a critical aspect of medical education, expressed through lectures, experimentation, theses, and faculty publications.
Building on Foucault’s notion of the “clinical gaze,” Willoughby introduces his own concept, “the clinical-racial gaze,” which he argues “combined the racial gaze of the slaveholder with the clinical gaze of the anatomist.” Doctors advanced their authority by presenting themselves as experts on the nature of the body and on race as embodied. They increasingly emphasized quantitative data and used specialized instruments, such as the craniometer and the microscope, to present their findings as precise and scientific. Occasionally, they even testified at trials as medical experts to prove or disprove an individual’s claim about racial identity.
Faculty members and students also experimented on Black people, both living and dead. The idea that Black and white people were different species did not prevent medical schools from using the bodies of Black people for teaching and research purposes. Willoughby provides several examples of medical faculty members and students conducting painful and degrading experiments on people of color. Additionally, as other scholars have shown, the growing importance of dissection in medical education created a demand for corpses, leading to illegal grave robbing. While medical schools dissected cadavers from a variety of sources, including the bodies of poor whites, they typically encountered less public resistance when they robbed graves that held Black people. Furthermore, the relatively high presence of African Americans in almshouses from which medical schools often sought bodies contributed to the schools’ access to the cadavers of Black people. Willoughby points out that although Southern medical schools marketed themselves as having ample access to cadavers, obtained because of slavery, the practice of body snatching and the racial disparity in whose bodies were snatched originated in Northern cities. Northern medical schools also welcomed cadavers from Southern states, reinforcing Willoughby’s focus on the racial exploitation of medical education as something national, as opposed to regional.
As part of their demonstration of mastery over the body, medical schools established museums in which they displayed human remains. These museums functioned as teaching and research collections and increased institutional prestige. Willoughby writes, “U.S. medical schools constructed their racial pedagogy through global networks of grave robbers,” as universities drove demand for human specimens to analyze for racial differences. Among the most famous of these are the Warren Anatomical Museum, donated to Harvard in 1847, and the notorious crania collection of Samuel Morton, a graduate of the University of Pennsylvania and faculty member at the Pennsylvania Medical College, a now-defunct medical school in Philadelphia. Students were taught “to think of the human body as an object.” Analyzing, experimenting on, and displaying bodies and body parts were central aspects of medical education and how physicians created and demonstrated their professional expertise. Many of these institutions still hold the human remains collected during this period.
As the imperial influence of the United States grew, the networks became even more expansive. Physicians and race scientists such as Morton had crania and other specimens shipped to them from all over the world. Doctors also developed theories that people of different races were suited to different climates, allowing ideas about racialized medicine to transcend national boundaries.
Willoughby mentions at various points that the medical students and professors about whom he writes were white men, most of whom were interested in maintaining racial and gender exclusivity in their profession. The book briefly discusses Harvard’s 1850 admission of three Black students, including Martin Delany, before the school forced the men out after protests from white students. Some greater attention to medical schools’ admissions policies and internal debates about whether to admit Black students could have enriched the book, adding information about how faculty and students thought about race in relation to their medical education and training.
As many institutions examine their relationships to slavery and its legacies, including the impact of racial science on contemporary medical care, Masters of Health will be an important resource to readers interested in the history of the university, the history of medicine, and intellectual history. The book also raises important implications for medical and scientific education, including the ways in which contemporary professional training continues to include biological notions of race.
- The author of this review was previously affiliated with the University of Pennsylvania, including as an Affiliate Postdoctoral Fellow of the Penn Medicine and the Afterlives of Slavery Project, where Willoughby has been a Visiting Fellow. ↑
- Willoughby, 182. ↑
- Willoughby, 49. ↑
- Willoughby, 127. ↑
- Willoughby, 79. ↑
- Willoughby, 101. ↑