Where have we been: Part 2: Dawn of Hospital-Based Research

“I call ’em body snatchers quick they come to fetch ya? With an autopsy ambulance just to dissect ya.”

-Public Enemy “911 Is a Joke” (1990)

As I was thinking about this post, I was reminded of the Public Enemy song, “911 Is a Joke”. The premise of the song was an attempt by the socially-conscious rap group to highlight the issues with rescue services in the late 1980’s and early 90’s in New York City. Allegedly, emergency services were not reliable or timely in their response time in the lower socio-economic areas of the city, leading to preventable death and injuries in the African-American community. Yet, within the narrative, the group also articulated the perception that many still held that the deaths were intentional in order to create a readily available pool for the “body snatchers” to generate cadavers for their research. Ultimately, the root cause of the delays was associated with the security concerns that first responders had. However, this still illustrates that a resounding impact of a community often abused, bypassed, overlooked, neglected and offered second-rate care by the U.S. medical system. This trend didn’t follow the rise of any musical genre, or the rhyme of any lyrics, but was actually initiated in the late 1890s and carries with it a palpable, resounding impact on the community almost a century later.

With the founding of the Johns Hopkins Hospital in 1889 and the creation of the Johns Hopkins Medical School in 1893, we ushered in a new era in US medicine. Funded primarily by the philanthropic efforts of financier Johns Hopkins, the hospital was one of the first large facilities dedicated to providing health services to the poor. Ahead of its time, Hopkins was progressive for the period in providing services—albeit segregated—to people of color across the wider Baltimore community. In parallel, the founding of Johns Hopkins Medical School (JHMS) at the turn of the century represented a new standard for medical training in this country. Before the introduction of Hopkins’ rigorous medical training program, the requirements for training physicians were minor, consisting of inconsistent trade school training and apprenticeships. Prior to this period, there was no nationally accepted standard for medical training. JHMS became the first U.S. medical school to establish a bar on entry requirements that included clinical research, introducing the training concept of “clinician-scientist“. In order to understand disease etiology and progression, the implication of this new clinical standard and respected medical institution was the increased requirement for research subjects achieved through autopsies and viable candidates made available for dissection.

As described by Harriet A. Washington in Medical Apartheid, the need for subjects for anatomical dissection drove researchers to look to the African-American community for an answer. And it was not their opinion that was sought. The commonly held perception by societal standards was that Negroes were expendable humans, if deemed human at all. The term “night doctors” was coined as a result of those researchers who would steal African-American bodies from graves for their research under the cover of night. It was even suggested that “night doctors” intentionally killed potential subjects in order to have fresh specimens for their research. Large research hospitals like Johns Hopkins and the University of Pennsylvania even justified any subsequent autopsies and dissections of blacks as payment for medical services they received prior to death. It was such a common occurrence in the 19^th century that black families grew to expect bodies to be missing from their gravesites shortly following their funerals. Unfortunately, there is not a significant amount of written history documenting this phenomenon, as many African-Americans in the antebellum period still were unable read, or at least pretended not to, in order to avoid potential consequences. However, through oral history and anecdotal evidence, African-Americans were acutely aware of the grave-robbing atrocities and stories of blacks being snatched from the streets never to be heard from again.

Considering the level of medical racism rampant during this period, African-Americans became increasingly reluctant to utilize medical services, particularly in the large, hospital setting. As previously discussed, their iatrophobia, or fear of doctors, mounted as a physician’s motive was always in question. It was simply difficult to discern whether their interest in preservation of life outweighed their desire to identify viable research candidates. Unfortunately, this fear led to a reluctance of blacks to pursue standard medical treatments in favor of home and herbal remedies or waiting until their discomfort was unbearable. What took root at the time was a perception among minorities that large hospitals and teaching institutions were not places of healing, but where one would only go as a last resort. One’s chances were seen as 50/50, to either die inside those walls or become a ‘guinea pig’ for their medical research, or both. Ironically, one can see the connection in the African-American community today. There remains a disinclination to seek preventive care and to participate in modern clinical research—both of which ultimately do more harm to minorities and undoubtedly contribute to persistent and debilitating health disparities across the spectrum of disease.

FEEDBACK: What’s your take? Comments are welcomed!

• Is medicine unjustly vilified for past indiscretions committed for the good of all?
• Does the medical profession (including clinical research) promote the persistent hegemony that ultimately bites itself in the butt?
• Do we have any hope of reversing the beliefs and positions on both sides any time soon?