Practice and Protest: Early Black Physicians and the Competing Demands of Professional Life and Racial Activism
Author: Brian Powers, Institute of Medicine, Washington DC
This article is from special contributor, Brian Powers at the Institute of Medicine in Washington DC. The portion featured here is from the chapter entitled, “Emerging Amidst Tumult: Black Physicians and the Professional Demands of the Antebellum Era.”
Although the field of African-American history has risen to prominence in the last half century, an understanding of the contribution of early American black physicians has yet to be fully realized. Neglect of this unique group leaves a gap in our understanding of the evolution of African-American involvement in the professional world and inhibits us from understanding fully the nature of black leadership and activism in the antebellum era. In the decades before the Civil War, the medical world that African Americans attempted to enter was in a state of transition. Rather than being forced into parallel institutions, antebellum black physicians were able to join a mainstream American medical profession that was undergoing its own debate over the nature of professionalism and, as a result, had not yet developed the mechanisms for systematic exclusion of blacks. Race added a complicating factor for black physicians attempting to navigate this tumultuous professional climate, rendering their experience more difficult than that of their white counterparts. At a time when the majority of African Americans were enslaved, the broader racial realities evidenced by black success in the medical profession were not lost on these practitioners. Consequently, an astounding proportion of early black physicians took up practice not only as doctors, but also as ardent activists and abolitionists. Attempting to forge a professional identity in the antebellum era, these physicians were forced to grapple with the simultaneous, and often competing, demands of professional life and racial activism.
Although underdeveloped, the experience of black physicians is not wholly absent from the historical record. At the turn of the twentieth century, scholars such as John A. Kenney and Kelly Miller began to investigate the history of black physicians, focusing their studies on the formation of black medical schools such as Howard and Meharry, the organization of the National Medical Association, and influential black physicians. For these scholars, the formation of separate institutions was the genesis of the racial divide in medicine. Several decades later, a new generation of scholars revisited the topic. Hebert Morias, Dietrich C. Reitzes, Helen Walker, and others all sought to understand contemporary discrimination in the medical profession by tracing its evolution through history. Much like their predecessors, these historians focused on the separate institutions formed after the Civil War as well as contemporary discriminatory policies in order to explain racial disparities in medical education.
As these historians analyzed the history of blacks medical professionals, they neglected an important group. By concentrating on the development of black medical institutions following the Civil War, they left the experience of antebellum black physicians almost entirely unexamined. In the works of scholars such as Miller, Morias, and Walker, these physicians receive little more than a passing mention or a brief treatment in an introduction. The little we do know about these physicians is largely the result of work by William Montague Cobb, who, in the early 1950s, wrote a series of brief biographies of African-American physicians practicing in the antebellum era. Although the work of Cobb and a few others who followed in his footsteps was instrumental in establishing the existence of important antebellum black physicians, the content of these biographies never extended far beyond what could be termed “professional antiquarianism.” This work achieved the important task of preserving some early black physicians in the historical record, but it failed to move beyond the scope of chronicling individuals. To date there has been no attempt to integrate and analyze the experiences of black doctors in the antebellum North.
The historical neglect of antebellum black physicians is not entirely surprising. Compared to the years after the Civil War, fewer blacks engaged in medical practice in the antebellum era. As a result, there is considerably less information available about these individuals. While this may have limited previous examination of this cohort, close analysis of medical school records, city directories, newspapers, and manuscript collections reveals over thirty African-American physicians practicing in the North before the Civil War. These individuals, for whom biographical sketches are available in the Appendix, are the subjects of this study. Although certainly not an exhaustive list of all blacks who tried their hand at medical practice in the antebellum era, the information uncovered about their lives permits the integrated and comprehensive examination of the experience of early black physicians that follows.
This comparatively small number of antebellum black physicians likely explains their absence from the studies of scholars concerned with the growth of the black professional class after the Civil War. In their minds, black physicians who practiced before the Civil War were merely “occasional or exceptional individuals” who never constituted a professional class. This is a hasty conclusion. Although antebellum black physicians lacked professional organizations, separate colleges, and significant numbers, they nonetheless formed an emerging professional class. In antebellum Philadelphia, for example, local directories, census information, and newspaper clippings reveal a concentration of blacks engaged in the medical field. By 1856, Philadelphia was home to six African-American physicians who operated medical practices within the city. Not only did a noticeable number of blacks practice medicine, some began to forge professional alliances. Between the years of 1849 and 1851, at least three African Americans operated medical and dentistry practices on the same block of Lombard Street. James Wilson and David Peck opened a drug store together after practicing independently in the area for several years. A similar community formed in New York City, where, by 1850, there were nine black physicians and three druggists engaged in practice. Although medical professionalization among African Americans may have intensified after the Civil War, the process had its roots in the urban centers of the antebellum North.
Black involvement in the medical profession, however, did not occur outside the broader antebellum context, both professional and racial. The professional experience of antebellum black physicians was very much a product of the unique state of American medicine before the Civil War. In the first half of the nineteenth century, the medical field was drastically different from the highly professionalized and regulated guild of today. Owing to a lack of restrictions and regulations on practicing medicine, there were no formal strictures preventing blacks from engaging in the practice of medicine. The rich body of scholarly inquiry that surrounds the evolution of the American medical profession has described a complex process involving the interplay of social, political, and scientific factors. However, for the scope of this paper, it is only necessary to identify a few of the overarching trends in order to be able to appreciate the tumultuous climate into which antebellum black physicians entered.
In the early 1800s, professional credibility as a physician was defined primarily within the social sphere. Thus, continuing a trend from the colonial era and the early republic, the principal requirement for practicing medicine was not formal training, but experience. Rather than depending on years of formalized instruction, medical education in America initially served as a supplement to the standard practice of apprenticeship. Under this system, prospective doctors obtained the bulk of their knowledge through years spent in the offices of established physicians. While university education, official license, and membership in a medical association were valued within higher circles of physicians, only experience was necessary for a physician to be a respected practitioner in his community.
Professionalization of American medicine would not occur until the educated medical elite could consolidate medical authority within itself, a process impeded in the antebellum United States by a variety of factors. Chief among them was the inability to control the number of individuals practicing medicine. As long as experience remained the sole arbiter of credibility as a physician, the ranks of the profession swelled. In order to restrict entry into the profession, a regulatory system such as medical licensing was necessary. Banding together to form medical societies, elite physicians secured an early victory in establishing licensing laws in most states. Amidst the democratic and egalitarian climate of the Jacksonian era, however, medical licensing became identified with monopolies and self-interested intellectual elites and failed to secure popular or legal traction. Signaling their failure to regulate entry into the profession, all states but one repealed their licensing laws by the 1840s.
As the expansion of the market made medicine a reliable source of profit, formally trained physicians redoubled their efforts to entrench their position among American practitioners. Since medical licensing failed to achieve the desired goal, formally educated physicians began to tout medical school degrees as badges of credibility. Medical schools still served as a supplement to apprenticeships, which were often pre-requisites for admission, but degrees conferred the sanction of institutional credibility. Consequently, the number of students seeking to obtain degrees increased. This demand for institutional medical education, combined with the potential profits associated with operating a medical school in this era, led to a proliferation of proprietary medical colleges. Apprenticeships, and even self-instruction, were still viable sources of medical experience, but within a profession flooded with aspiring physicians, a medical degree offered an edge in an increasingly competitive environment. The result of this unconsolidated professional environment was a field where practitioners were extremely varied in their training and education. Although myriad sub-classifications existed, antebellum medical professionals generally fell into one of two broad classifications: “regular” or “irregular.” Regular physicians received formal training at medical schools in the orthodox techniques of heroic medicine, such as bleeding, leeching, cupping, and purging. Irregular physicians, on the other hand, gained medical knowledge through informal channels, either through apprenticeship or self-instruction.
In many ways, this fractured professional climate, wherein both irregular and regular practitioners enjoyed professional success, worked to the advantage of aspiring black physicians. Since no institution regulated entry into the profession, there were no formal mechanisms for excluding blacks. If black physicians could, through education, apprenticeship, or self-instruction, develop the skills necessary to attract sufficient patients, they could become successful physicians. Consequently, aspiring black physicians followed various paths into the medical field. Self-taught healers such as James Still and David Ruggles developed their medical techniques from practice, experimentation, and widely available medical literature. Other physicians, such as James Wilson in Philadelphia, were unable to receive official medical degrees, but apprenticed with white physicians. Finally, men such as David Peck and James McCune Smith, raised in urban black enclaves, received strong elementary and secondary educations that, in conjunction with progressive admissions policies, allowed them to attain medical degrees from prominent universities. As opposed to the years after the Civil War, when the black experience in medicine would diverge from that of the white mainstream, in the antebellum North black physicians were products of the same medical climate and therefore embodied the same trends and characteristics as their white counterparts.
Although participating within the same medical system as whites, the racial climate of the era rendered the experience of black physicians unique. Black physicians in the antebellum North were acutely aware of the implications of their success on race relations. African-American doctors, such as university-trained James McCune Smith and Martin Delany, used their status as physicians to critique publicly theories of scientific racism and the natural inferiority of blacks. Early black practitioners appreciated that they were emerging professionals within the medical field, but also that their privileged standing positioned them as representatives of their race. This underlying current of representativeness resonates deeply with existing historical analysis on antebellum black activism. Patrick Rael has linked this issue of representativeness to the idea of racial synecdoche – a process by which the actions of individual African Americans (the parts) signify broader racial realities (the whole). Typically used by whites in a negative vein (e.g., an African-American indigent or criminal being used to discredit the entire race), black leaders sought to achieve the opposite by promoting their individual successes to demonstrate the capabilities of their race. Consequently, many of these antebellum black physicians assumed activist and abolitionist activities, hoping to promote their own educational and professional stature in the public sphere.
These central themes – practice and protest – defined the professional experience of early black physicians and, as such, constitute the core of this study. The first section examines the professional experience of African-American physicians and the way in which various social and economic factors shaped the professional trajectories of aspiring black physicians. Chapter 1 focuses on regular physicians, whereas Chapter 2 addresses their counterparts who, unable to gain access to formal education, received instruction through irregular channels. Together, these chapters depict a wide spectrum of experiences in education and practice and elucidate how the nature of the antebellum medical climate combined with personal circumstance to shape professional experience. The subsequent section delves into the realm of protest, examining early black physicians’ nuanced relationship with racial activism. Chapter 3 establishes the varied degree to which early black physicians shifted their energies towards activism, while probing the ideological link between professional success and antebellum black protest rhetoric. Chapter 4 extends the analysis of this relationship, elucidating the way in which varied social circumstances as well as experience in the medical profession shaped each physician’s decision on how best to balance the competing demands of professional life and racial activism. Finally, the Conclusion examines the way in which the relationship between practice and protest that formed during the antebellum years evolved as the black medical profession matured following the Civil War.
Several important findings emerge from this analysis. In the realm of practice, the unconsolidated nature of the antebellum medical profession created opportunities for aspiring black physicians. Without a regulated and formulaic path towards medical education, African Americans followed a variety of routes into careers as practitioners. The result was a group of early black physicians with varied personal backgrounds, medical training, and methods of practice. Black entry into the professional realm was not devoid of its racial context, and black physicians appreciated how their professional success meshed with the ideological tenets of antebellum black activism. However, while ideologically compatible, the competitive antebellum medical environment created a situation in which physicians could not divide their time between clinical responsibilities and other endeavors. Thus, while their professional success placed them in a privileged position to speak and write on behalf of their race, professional obligations prohibited sustained engagement in the arena of public protest. As each physician attempted to reconcile these competing demands, a nuanced interplay between the very factors that rendered the group so heterogeneous – family background, education, and experience in practice – dictated the degree to which early black physicians shifted their energies away from practice and towards a career in activism.
 John A. Kenney, The Negro in Medicine (Tuskegee: Tuskegee Institute Press, 1912); Kelly Miller, “The Historic Background of the Negro Physician,” Journal of Negro History 1, no. 2 (April 1916): 99-109.
Herbert M. Morias, The History of the Negro in Medicine (New York: Publishers Company, 1967); Dietrich C. Reitzes, Negroes and Medicine (Cambridge: Harvard University Press, 1958); Helen Edith Walker, Negro in the Medical Profession, Phillips-Stokes Fellowship Papers, vol. 18 (Charlottesville: University of Virginia Press, 1949). For additional work in this historiographic vein, see Midian O. Bousfield, “An Account of Physicians of Color in the United States,” Bulleting of the History of Medicine 17 (1945): 61-84, Leonard W. Johnson, “History of the Education of the Negro Physician,” Journal of Medical Education 42, no. 5 (May 1967): 439-446.
 Cobb wrote a series of biographies for the Journal of the National Medical Association over the years 1952 and 1953. Full citations can be found in the bibliography.
 Brief biographies of some prominent antebellum black physicians can be found among the entries of the American National Biography (see bibliography for complete list).
 Miller, “The Historic Background of the Negro Physician,” 106.
 Pennsylvania Society for Promoting the Abolition of Slavery, Statistics of the Colored People of Philadelphia (Philadelphia: T. Ellwood Chapman, 1856), 14.
 McElroy’s Philadelphia Directory (Philadelphia: A. McElroy) 1849-1851.
 The Christian Recorder, July 15, 1865
 Carter G. Woodson, The Negro Professional Man and the Community: with Special Emphasis on the Physicians and the Lawyer (Washington, DC: The Association for the Study of Negro Life and History, 1934), 5.
 For an excellent analysis of this process see Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1983), chs. 1-3. Other treatments include, but are not limited to, Joseph F. Kett, The Formation of the American Medical Profession: The Role of Institutions, 1780-1860 (New Haven: Yale University Press, 1968), John Duffy, The Healers: A History of American Medicine (Urbana: University of Illinois Press, 1979) and William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (Baltimore: Johns Hopkins University Press, 1985).
 John Harley Warner, “Science, Healing, and the Physician’s Identity: A Problem of Professional Character in Nineteenth-Century America,” in William F. Bynum and Vivian Nutton, eds. Essays in the History of Therapeutics (Amsterdam: Rodopi, 1991), 67-68; Starr, The Social Transformation of American Medicine, 63-4, 78.
 Warner, “Science, Healing, and the Physician’s Identity,” 67-68; Duffy, The Healers, 166-7.
 Kett, The Formation of the American Medical Profession, 8-10, 64-65; Starr, The Social Transformation of American Medicine, 30-39, 59; Duffy, The Healers, 176-7.
 Starr, The Social Transformation of American Medicine, 45; Kett, The Formation of the American Medical Profession, 12-13.
 Kett, The Formation of the American Medical Profession, 58.
 Duffy, The Healers, 170-74; Starr, The Social Transformation of the American Medical Profession, 42; Kett, The Formation of the American Medical Profession, 69-70; Geoffry Marks and William K. Beatty, The Story of American Medicine (New York: Charles Scribner’s Sons, 1973), 201-02.
 With such a varied spectrum of education and training, the attempt to force antebellum physicians into a neat dichotomy is inherently imprecise. However, the “regular”/“irregular” classification is ultimately the most inclusive and instructive. Additionally, since the differences between the sects centered around the type of instruction, the “regular”/”irregular” classification will be used concurrently, and interchangeably, with the terms “formally” and “informally” educated. For more on the classification of antebellum medical professionals, as well as a discussion of the alternative sects, see: Kett, The Formation of the American Medical Profession; Duffy, The Healers; Starr, The Social Transformation of the American Medical Profession.
 Frank A. Rollin, Life and Public Service of Martin R. Delany: Subassistant Commissioner Bureau Relief of Refugees, Freedmen, and of Abandoned Lands, and Late Major 104th U.S. Colored Troops (Boston: Lee and Shepard, 1883), 69; William Wells Brown, The Black Man, His Antecedents, His Genius, and His Achievements (New York: Thomas Hamilton, 1863), 205; Morias, The History of the Negro in Medicine, 34.
 Patrick Rael, Black Identity and Black Protest in the Antebellum North (Chapel Hill: University of North Carolina Press, 2002), 179, 185.
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