Historical Context

Historical
Context

While Perspectives of Change focuses on the history of Harvard Medical School, its faculty, students, trainees, and alumni, as well as on the history of medicine in Boston, the context of American history provides background and connection to the project.

1619-1799: The First Enslaved Africans in the American Colonies to Abolition of Slavery in Massachusetts

In August 1619, a Portuguese ship carrying 20 enslaved Africans landed in Port Comfort, part of the British Colony of Virginia. Historians estimate that between 12 million to 12.8 million Africans were forcibly moved from Africa across the Atlantic during the Transatlantic slave trade from the 16th to the 19th century.

The first medical school in the United States was founded in 1765 at the College of Philadelphia by John Morgan and William Shippen Jr. The school is now the University of Pennsylvania’s Perelman School of Medicine.

After the American Revolution, Massachusetts abolished slavery, but there is no definitive date or moment when slavery was abolished because it was slowly phased out in the state.  Prior to the 1780s, a person could be freed from slavery by manumission, by buying their freedom, by suing for freedom, or by running away. A group of slaves petitioned the colonial government for freedom after the Revolutionary War without success, but two court battles in response to the Massachusetts Constitution led to the end of slavery in Massachusetts.

See “African Americans and the End of Slavery in Massachusetts,” Massachusetts Historical Society, for more information: http://www.masshist.org/endofslavery/index.php?id=61.

The Three-Fifths Compromise was reached among state delegates during the 1787 Constitutional Convention. It determined that three out of every five slaves was counted when determining a state’s total population for legislative representation and taxation. Before the Civil War, the Three-Fifths Compromise gave a disproportionate representation of slave states in the House of Representatives.

1800-1865: Antebellum Period Through the Civil War

James McCune Smith was born into slavery in 1813 in New York City. He gained emancipation in 1827, and attended the University of Glasgow in Scotland where he earned his bachelor’s degree, master’s degree, and medical degree. He returned to New York to set up his own medical practice in 1837.

Elizabeth Blackwell (1821-1910) earned her medical degree from Geneva Medical College in 1849, thus becoming the first woman to receive an MD from an American Medical School.

Roberts v. Boston was an 1850 court case which was cited by Plessy v. Flerguson, upholding the “separate but equal” standard. Benjamin F. Roberts, an African-American man, sued the city of Boston after his daughter, Sarah C. Roberts, was denied admittance to whites-only schools in her neighborhood. The Supreme Court of Massachusetts heard the case, and ruled in favor of Boston.

The Fugitive Slave Act was passed by the United States Congress in September 1850. It required that all escaped slaves must be returned to their masters, and that citizens of Free states must not hinder the activities of Federal marshals in capturing escaped slaves.

Dred Scott v. Sandford was a landmark decision of the Supreme Court upholding that the Constitution of the United States was not meant to include American citizenship for black people.

Dred Scott, who was born into slavery in Virginia around 1795, sued Irene Emerson for his freedom in 1846. Scott argued that he and his wife should be granted freedom because they had lived in Illinois and the Wisconsin Territory (where slavery was prohibited) for several years. Scott v. Emerson was tried in 1847 in Missouri. Evidence presented by Emerson was ruled to be hearsay, and in a retrial, the jury ruled in favor of Scott’s freedom. Emerson appealed the verdict, and the Missouri Supreme Court struck down the lower court ruling, arguing that Missouri did not have to defer to the laws of free states.

In 1853, Scott sued for his freedom under federal law. Emerson had moved to Massachusetts, and transferred Scott to her brother, John F. A. Sanford. Scott lost in federal court, and appealed to the Supreme Court. In 1857, the Supreme Court found that Scott, nor any other person of African descent, could claim citizenship in the United States and therefore could not bring suit in federal court. It also voided ordinances and acts that imparted freedom or citizenship to non-white people in territories.

Despite losing his suit, Scott and family were manumitted on May 26, 1857.

The Civil War, also referred to as the War of the Rebellion, was fought from 1861 to 1865 between the North (the Union) and the South (the Confederacy). The war was fought over the enslavement of black people in America. A monument to Harvard Medical School's Union Soldiers and Sailors who gave their lives for freedom, hangs in Harvard Medical School's Gordon Hall and reads:

"To the Memory of the Graduates and Members of the Medical School of Harvard University who fell in the Army and Navy of the United States during the War of the Rebellion.

Erected by the Class of 1869-70

  • John Lawrence Fox
  • Charles Henry Wheelwright
  • Samuel Lee Bigelow
  • Edward Hutchinson Robbins Revere
  • William Henry Heath
  • Samuel Foster Haven
  • Robert Ware
  • Lucius Manlius Sargent
  • Ira Wilson Bragg
  • jJohn Edward Hill
  • Dixi Crosby Hoyt
  • Henry Sylvanus Plympton
  • Edward Bromfield Mason
  • John Fletcher Stevenson
  • William Borrowe Gibson
  • Neil K Cunn
  • James Witchman
  • Eugene Patterson Robbins
  • Henry Livingston Dearing
  • Nathaniel Bowditch
  • Oliver Dean Root"

During the Reconstruction era from 1865-1877, following the Civil War, Confederate States were required to take an oath of loyalty to the Nation and to abolish slavery, in order to be admitted back into the Union.  Northern “carpetbaggers” and federal troops occupied the South to protect the Civil Rights of African Americans. The Freedmen’s Bureau, established in 1865 and abolished in 1872, provided assistance to emancipated slaves, while Southern states passed “black codes” to restrict the rights of emancipated former slaves. Reconstruction saw the rise of black participation in politics, including the House of Representatives, and the US Senate, as well as the rise of the Ku Klux Klan and other organizations and tactics to intimidate, threaten, and harm, African Americans.

Amendment XIII to the United States Constitution abolished slavery and involuntary servitude, except as a punishment when a person has been convicted of a crime. In 1868, Amendment XIV gave black people equal protection under the law and in 1870, Amendment XV granted black men the right to vote.

1865-1895: Reconstruction Through the Rise of Jim Crow

The Civil Rights Act of 1875 was a United States federal law enacted during Reconstruction. It was designed to protect all citizens in their civil and legal rights, and was the last major piece of legislating related to Reconstruction passed by Congress.  The act forbid discrimination in hotels, trains, and other public spaces. It was declared unconstitutional in 1883, as discrimination was not authorized by the 13th or 14th Amendments of the Constitution.

Jim Crow Laws were state and local laws enforcing segregation in the United States. Enacted in the late 19th and early 20th centuries, and enforced through 1965, these laws mandated segregation in public facilities like schools, restrooms, restaurants and drinking fountains in former Confederate States, and included transportation like interstate buses and trains. Segregation of public schools was declared unconstitutional by the Supreme Court of the United States in Brown v. Board of Education, and the remaining Jim Crow laws were overruled by the Civil Rights Act of 1964 and the Voting Rights Act of 1965.

Medical professional associations and societies are necessary for professional development. They also offer opportunities to collaborate, develop professional relationships, present papers, and learn techniques and treatments.

In Massachusetts, black physicians could join the Massachusetts Medical Society (MMS), established in 1791. MMS accepted its first black physician, John Van Surly DeGrasse, in 1854. Dr. DeGrasse’s papers are in the Degrasse-Howard Papers at the Massachusetts Historical Society

Although state and local medical societies could choose to accept members of color, many did not. The American Medical Association (AMA) delegated membership decisions to the state level until the 1960s.

The AMA, founded in 1847 as a national medical association, was created amid a climate of racial tension and debate over the institution of slavery. The AMA did not overtly disallow physicians of color from becoming members, but incidents at the 1870 and 1872 national meetings led to a policy that effectively excluded African American members.

At the 1870 meeting of the AMA, the all-white Medical Society of the District of Columbia challenged the authenticity of the integrated Washington D.C. National Medical Society, claiming that it had been founded to undermine the Medical Society. The Washington D.C. National Medical Society maintained that it incorporated because the Medical Society of the District of Columbia would not accept physicians of color as members. During the meeting, the issue of two societies was debated, and the Washington D.C. National Medical Society members were excluded from membership in the AMA. John L. Sullivan, a physician from Massachusetts, proposed that the AMA adopt a policy of racial non-discrimination but his proposal was tabled after the meeting.

After another attempt to seat an integrated medical society delegation at the AMA’s 1872 national meeting, a policy was enacted in 1874 to change the structure of seating medical societies at the national convention. While in the past any medical society, school, or institution could send a delegation to the national convention, now state and local societies would determine which societies would be officially recognized by the AMA, and only one society was allowed to represent a given region. This policy excluded most African American members because many local societies practiced racial exclusion.

In response, several integrated medical societies were founded on a local level, including the Medico-Chirurgical Society of the District of Columbia, the Lone Star State Medical, Dental, and Pharmaceutical Association of Texas, the Old North State Medical Society of North Carolina, and the North Jersey National Medical Association.

After years of attempts by black physicians around the United States to integrate the AMA, the National Association of Colored Physicians, Dentists, and Pharmacists was created in 1895 in Atlanta, Georgia. The Association changed its name to the National Medical Association (NMA) in 1903. In 1908, the NMA began to publish the Journal of the National Medical Association. The credo of the organization, as laid out by the journal’s first editor Dr. C.V. Roman, is:

“Conceived in no spirit of racial exclusiveness, fostering no ethnic antagonism, but born of the exigencies of the American environment, the National Medical Association has for its object the banding together for mutual cooperation and helpfulness, the men and women of African descent who are legally and honorably engaged in the practice of the cognate professions of medicine, surgery, pharmacy and dentistry.”

For more information on the history of the National Medical Association, see Dr. Karen Morris’s thesis The Founding of the National Medical Association.

For a timeline on African American Physicians and Organized Medicine from 1846-1968, visit: https://www.ama-assn.org/sites/default/files/media-browser/public/ama-history/african-american-physicians-organized-medicine-timeline.pdf.

1896-1959: “Separate But Equal” to Brown v. Board of Education

Plessy v. Ferguson was an 1896 Supreme Court Case that upheld the constitutionality of racial segregation laws for public facilities if those facilities were of equal quality. The court case was brought by Homer Plessy, a person of 1/8 black heritage and resident of New Orleans who purposefully violated the city’s Separate Car Act of 1890. His suit argued that separate but equal accommodations for black and white passengers was unconstitutional. The Supreme Court issued a 7-1 decision against Plessy.

In 1904, the American Medical Association created the Council on Medical Education to evaluate and restructure medical education. Abraham Flexner, an educator and reformer who published The American College: A Criticism in 1908, was hired to study American medical schools. The 1910 Flexner Report examined medical education and suggested reform for medical colleges, which included increasing standards, partnering with hospitals for clinical training, and closing schools that could not afford to update and maintain facilities. The Flexner Report drastically changed medical education, especially for African American physicians. Flexner recommended coeducation of men and women in medical schools, but believed that black physicians should be trained to serve black communities. Prior to the report, there were over 20 black medical schools in the Unites States. Within a decade only two remained: Howard University College of Medicine in Washington, D.C., and Meharry Medical College in Nashville, Tennessee.

For more information about the Flexner Report, see Abraham Flexner and the Black Medical Schools by Todd Savitt. The Flexner Report is available online through the Carnegie Foundation Archives.

The National Association for the Advancement of Colored People was founded on February 12, 1909, by a group of activists including W.E.B. Du Bois (the first African-American to earn a doctorate at Harvard), Ida B. Wells, Archibald Grimke, Mary Church Terrell, Henry Moskowitz, Mary White Ovington, William English Walling, Florence Kelley, Oswald Garrison Villard, and Charles Edward Russell. The organization held its first conference on May 30, 1909, and at its second conference on May 30, 1910, members named the organization the National Association for the Advancement of Colored People and elected its first officers. The organization was incorporated in 1911 with the mission:

To promote equality of rights and to eradicate caste or race prejudice among the citizens of the United States; to advance the interest of colored citizens; to secure for them impartial suffrage; and to increase their opportunities for securing justice in the courts, education for the children, employment according to their ability and complete equality before law.

The Boston Branch was established at the 1911 meeting, and was the first branch of the organization.

The “Tuskegee Study of Untreated Syphilis in the Negro Male” began in 1932. The Public Health Service and the Tuskegee Institute partnered to study syphilis in hopes of justifying treatment programs for black people. Participants in the study were unaware of the parameters of the study and was conducted without informed consent. The 600 men in the study, 399 infected by syphilis, 201 without, were told they were being treated for “bad blood,” and were not given proper treatment to cure their illness.

The study went on for 40 years, and participants were still not given treatment even after penicillin became the standard treatment for syphilis. In 1972, an Associated Press story broke, and the study was terminated. The Center for Disease Control and the Public Health Service appointed an ad hoc advisory panel to review the study, finding that although the men agreed to certain terms of the experiment, they were not informed of the study’s actual purpose. The NAACP filed a class action lawsuit on behalf of study participants and their descendants, and the US government paid $10 million and agreed to provide free medical treatment to surviving participants and family members infected as a consequence of the study.

The study led to the establishment of the Office for Human Research Protections and federal regulations requiring institutional Review Boards for the protection of human subjects in studies.

On August 13, 1946, the Hill-Burton Act was signed into law by President Harry S. Truman. The bill, known formally as the Hospital Survey and Construction Act, was a Truman initiative that provided construction grants and loans to build hospitals where they were needed and would be sustainable. The Hill-Burton Act particularly impacted the South, where many of the facilities utilizing Hill-Burton funds were built, but the law codified the idea of “separate-but-equal” in hospitals. While outright discrimination against black patients was not allowed, separate-but-equal facilities were built where black and white patients were segregated by race.

After the NAACP spearheaded several lawsuits aimed to eliminate discrimination in hospitals, in 1963, a federal court challenge overturned the “separate-but-equal” aspect of Hill-Burton. The act influenced hospital desegregation by denying funds to segregated institutions

For more information on the Hill-Burton Act, see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448322/, The Hill-Burton Act and Civil Rights: Expanding Hospital Care for Black Southerners, 1939-1960 by Karen Kruse Thomas and https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-era-when-bipartisanship-led-to-health-care-transformation.

Executive Order 9981 abolished discrimination “on the basis of race, color, religion or national origin” in the United States Armed Forces. It was signed by President Harry S. Truman on July 26, 1948, and led to ending segregation in military schools, hospitals and bases.

In 1954, the Supreme Court unanimously ruled that “separate educational facilities are inherently unequal” and violate the Equal Protection Clause of the Fourteenth Amendment.

In 1951, a class action suit was filed against the Board of Education of the City of Topeka, Kansas, by thirteen black parents on behalf of their twenty children after attempting to enroll the children in white-only public schools. The District Court ruled in favor of the Board of Education, citing Plessy v. Ferguson, before being heard before the Supreme Court.

1960-1978: The Civil Rights Movement and Upholding Affirmative Action

The Medical Committee for Civil Rights (MCCR) was created by Walter Lear after attending the 1963 Imhotep Conference on Hospital Integration. Lear decided to protest segregation in medical facilities at the American Medical Association conference held in Atlantic City, New Jersey, and enlisted other doctors to join him. A group of 20 protesters picketed the AMA conference, calling for a stand against discrimination and segregation in all medical facilities. The AMA responded to the protests by discrediting the protesters for obscuring the achievements in medical science presented at the conference and insisting that any qualified person could join the AMA, but also acknowledging that it would not interfere with local groups who did not allow physicians of color to join.

Within two months of the protest, the MCCR grew from a small group of activists to over 200 members and participated in the March on Washington for Jobs and Freedom. In 1968, the AMA changed its bylaws to allow the Judicial Council the authority to expel local societies that discriminated against members of color.

Soon thereafter, the MCCR collapsed under debts but a new organization, the Medical Committee for Human Rights (MCHR), was created to support Freedom Summer in Mississippi.

To learn more about the Imhotep Conference on Hospital Integration, see The Journal of the National Medical Society: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2641236/?page=1

The 1964 Civil Rights Act is a landmark case that outlaws discrimination based on race, color, religion, sex, or national origin. It also prohibits unequal application of voter registration requirements, racial segregation in schools, employment and public accommodations.

"David Barton Smith, professor emeritus at Temple University, argues that 'Medicare was a gift of the civil rights movement,' which infused the country with a quest for racial justice and progressive reform. Medicare could only be used to desegregate hospitals because of the Civil Rights Act of 1964, one of the greatest legislative victories of the civil rights, which banned discrimination in any facilities receiving federal funding."

Before Medicare was signed into law by President Lyndon B. Johnson in 1965, the health care system was one of the most definitive aspects of racial inequality in the country. Up until that time, this health care system devalued the lives of black patients and created an almost universal distrust among black Americans for the medical establishment and for a federal government that was principally responsible for hospital construction, medical research, and medical education.

With the advent of Medicare, the federal government created an expansive agency of health advocacy for black patients, providing funding for thousands of elderly black patients that had previously been unable to secure or afford medical care. Medicare also required that hospitals meet national standards of health, safety and civil rights. The legislation created a powerful and necessary enforcement mechanism through federal inspectors who ensured that hospitals receiving Medicare funds were desegregated. It ensured that communities of color knew that these facilities were available to all. Across the nation, hospitals were required to prove that they did not racially discriminate against patients, doctors, nurses or hospital employees.

For a more complete discussion of this key element of equal access in medicine and health care, the following resources are recommended:
https://www.usnews.com/news/articles/2015/07/30/desegregation-the-hidden-legacy-of-medicare  

David Barton Smith. The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America's Health Care System. Nashville: Vanderbilt University Press, 2016.

Executive Order 11246 established requirements for non-discriminatory practices in hiring and employment by government contractors. The executive order was signed by President Lyndon B. Johnson on September 24, 1965. It also required contractors to implement affirmative action plans to increase the participation of minorities and women in the workplace.

There are two amendments to Executive Order 11246: Executive Order 11375 added the category “sex” to anti-discrimination provisions, and Executive Order 13672 changed “sexual orientation” to “sexual orientation, gender identity.”

The Voting Rights Act of 1965 is a landmark piece of federal legislation that prohibits racial discrimination in voting. It was signed into law by President Lyndon B. Johnson and Congress amended the Act five times to expand its protections.

The Association of American Indian Physicians was founded in 1971 by a group of fourteen American Indian and Alaska Native physicians. The group wanted to establish an organization to provide support and services to American Indian and Alaska Native communities. The primary goal of the organization is to improve the health of American Indian and Alaska Natives. Adoniram (Don) Van Bowen, Harvard Medical School’s first American Indian graduate, Class of 1976, served as President of the organization from 1983 to 1984.

Title IX of the Education Amendments Act is a federal civil rights law that protects people from discrimination based on sex in education programs or activities that receive federal funding. To learn more about Title IX at Harvard University, visit: https://titleix.harvard.edu/about-us.

In 1978, the Supreme Court of the United States ruled that race could be one of several factors in college admission policy, but that specific racial quotas were illegal. The case was brought to the Supreme Court after Allan P. Bakke sued the University of California, Davis. The school had rejected Bakke twice, and he challenged the constitutionality of the school’s affirmative action program. California Supreme court ruled the program was a violation of white applicants’ rights, and ordered the school must admit Bakke. The U.S. Supreme Court accepted the case, and ultimately ruled in favor of affirmative action.

1979-today:

The Americans with Disabilities Act is a civil rights law prohibiting discrimination against people with disabilities in all public and privates places that are open to the general public, and in all parts of public life, including employment, education, and transportation. To learn more about Harvard University’s Disability Resources, visit: https://accessibility.harvard.edu/.

The National Hispanic Medical Association (NHMA) was established in 1994 in Washington, DC. The organization was announced at a White House Press Conference in December 1993 with President Bill Clinton, First Lady Hillary Rodham Clinton and ten medical association leaders. NHMA’s founders were physicians who attended the White House Health Care Reform Task Force meetings in 1993 and 1994, advocating for Hispanic health issues.

Today, the organization represents the interests of 50,000 Hispanic physicians in the United States. To learn more, visit: http://www.nhmamd.org/about/about-nhma/.

Grutter v. Bollinger was a landmark case of the Supreme Court concerning affirmative action in student admissions. A prospective student to the University of Michigan Law School, Barbara Grutter, alleged that she was discriminated against on the basis of race after she was denied admission to the school. Grutter argued that she was rejected because the Law School used race as a predominant factor, giving some minority applicants a greater chance of admission than students with similar credentials from majority groups. The defendant of the case was President of the University of Michigan Lee Bollinger.

Ultimately the Supreme Court upheld that an admissions process that favors underrepresented minority applicants does not violate the Fourteenth Amendment’s Equal Protection Clause so long as the process also takes into account other credentials on an individual basis for every applicant.

The Patient Protection and Affordable Care Act are the first part of the comprehensive health care reform law signed by President Barack Obama on March 23, 2010. The second part, the Health Care and Education Reconciliation Act, was signed on March 30, 2010. The law provides rights and protections that make health coverage more fair and easy to understand, along with subsidies to make it more affordable. The law, the most significant regulatory overhaul of health insurance coverage since the passage of Medicare and Medicaid in 1965, also expanded the Medicaid program to cover more people with low incomes.

The health care law is sometimes known as “Obamacare”.

Fisher v. University of Texas is a Supreme Court case concerning the affirmative action policy of the University of Texas at Austin. The suit, initially brought by Abigail Fisher and Rachel Michalewicz in 2008, alleged that the University of Texas at Austin discriminated against both women on the basis of their race in violation of the Equal Protection Clause of the Fourteenth Amendment. Michalewicz withdrew from the case in 2011.

The original Supreme Court hearing of the case took place between 2011 and 2013, and in 2014, ruled in favor of University of Texas at Austin to use race as part of a holistic admissions program. In 2015, Fisher again challenged University of Texas at Austin’s admissions policy, and in 2016, the Supreme Court upheld that the race-conscious admissions program is legal under the Equal Protection Clause.

In 2014, Harvard College was sued by the group Students for Fair Admissions (SFFA), founded by Edward Blum, an anti-affirmative action activist. Blum and SFFA have a history of litigation targeting civil rights protections. The lawsuit alleged that Harvard College discriminated against Asian American applicants based on their race.

In 2019, Federal Judge Allison D. Burroughs ruled in favor of Harvard, upholding Harvard’s admissions policy and ruling that the University’s admissions policy does not discriminate on the basis of race, does not use racial quotas, and over-emphasize race when considering an applicant’s admissions file.

In a letter to the Harvard community following the ruling, President Larry Bacow upheld:

“The consideration of race, alongside many other factors, helps us achieve our goal of creating a diverse student body that enriches the education of every student. Everyone admitted to Harvard College has something unique to offer our community, and today we reaffirm the importance of diversity — and everything it represents to the world.”