A closer look

Medical Care and the Health of Enslaved People

How did the medical care available to enslaved people on southern plantations reveal many of the contradictions inherent in the slave system?

by Gretchen Long, Williams College

Health and medical care of enslaved workers goes to the heart of the many contradictions and brutalities that underlie the system of slavery in the United States. On the one hand, white society did not, through legal statutes or social attitudes, acknowledge the humanity of enslaved people. Black people were bought and sold as property with no protection for their families, marriages, or physical safety. Unsurprisingly, enslaved people had worse health outcomes and worse care than whites. This was reflected in everything from infant mortality statistics to the recorded height and weight of African American men when they enlisted in the Union Army. On the other hand, enslavers wanted the people they owned to stay healthy, strong, and able to reproduce. Their reasons were nearly entirely financial—healthy laborers turned more profit than sick ones. Healthy babies grew into healthy workers who could be sold for profit or put to work. Furthermore, white people's ideas about medical care were often predicated on beliefs about racial difference and biological inferiority. Black people themselves, realizing that any care that whites extended to them was wrapped up with realities of financial gain and loss, created their own system of care largely administered and disseminated by Black women.

Malnutrition, Illness, and Mortality

Enslaved people’s health suffered from the very beginnings of the slave trade. Africans captured and sold in west and central Africa endured a long, dangerous trek to the African coast, followed by the “Middle Passage,” an ocean journey that took weeks. Deaths from illness, dehydration, diarrhea, malnutrition, and exposure, as well as suicide, were high. Depending on the length of the journey and the conditions on board, captains often lost 25 percent of their human cargo. On small farms and large plantations, in city centers and in small towns, enslaved African Americans lived under conditions that resulted in high mortality. Cabins for enslaved people were poorly constructed; wood fireplaces and smoky air led to respiratory problems. Monotonous diets gave rise to malnutrition. Most enslaved workers lacked adequate clothing or proper shoes. Enslaved women suffered high maternal mortality, and Black children died more often and earlier than white. The agricultural and domestic labor that most enslaved workers performed left many injured and disabled. Enslavers who published runaway slave ads in the eighteenth and nineteenth century dwelled on enslaved persons’ physical descriptions—hoping to aid in their identification and capture. Inadvertently, these ads provide a glimpse of enslaved African Americans' medical history. Ads describe runaways scarred by smallpox and with missing fingers and toes from dangerous labor in sugar mills and lumberyards. Women often had burns from irons and stoves or from being branded for punishment or identification.

Enslavers’ Attitudes

Certainly, enslavers wanted their human property to stay healthy, but they were seldom willing to pay much for it, or to consider humanitarian concerns. Some enslavers hired doctors, or tended to enslaved people themselves, using a mix of patent medicines from medicine chests. Others gave precise instruction to their “negro nurses” and trusted them to follow their directions. Some planters couched physical violence in the language of medicine, suggesting “a good dose of leather” to a enslaved individual who complained of illness.

For some enslaved people, “medical care” at the hands of white doctors and enslavers merged into medical experimentation and horrific abuse. J. Marion Sims, a white doctor in Alabama, was among the most notorious practitioners of such experimentation. Believing that Black women were not particularly sensitive to pain, Sims performed dozens of experimental gynecological surgeries on enslaved women without anesthesia. Sims also compelled enslaved women to assist him in his medical experimentation as well as serve as subjects of the experiments. While the work was not voluntary, these women learned and practiced (and were practiced upon) the emerging field of gynecological medicine and were critical to significant medical breakthroughs in treating complications of childbirth. Despite Sims’s unethical and cruel practices, his work was esteemed by white medical professionals. Other white doctors throughout the South used enslaved workers as assistants, drivers, and all-around helpers. Even in death, Black people were useful to the white medical professionals, as their bodies were used in medical schools for dissection.

J. Marion Sims: Gynecologic Surgeon, from “The History of Medicine”

This painting depicts the work of Dr. James Marion Sims and his colleagues. In the nineteenth century, Sims, a white doctor from Alabama, performed dozens of experimental gynecological surgeries on enslaved women without anesthesia. Sims also compelled enslaved women to assist him in his medical experimentation as well as serve as subjects of the experiments. The painting is the only known representation of Lucy, Anarcha, and Betsey, three enslaved women whom Sims operated on. The imagined scene suggested Sims’s prestige as the “father of gynecology” and a future president of the American Medical Association; but it ignores the terror experienced by Lucy, the enslaved woman seated in the center. The image was painted in the 1950s by American artist Robert Thom, as part of a series dedicated to “Great Moments in Medicine.”

Source: https://exchange.umma.umich.edu/resources/41241/view

Protest at J. Marion Sims Statue

This image shows protestors demanding that New York City remove a statue honoring J. Marion Sims. In the nineteenth century, Sims, a white doctor from Alabama, performed dozens of experimental gynecological surgeries on enslaved women without anesthesia. Sims also compelled enslaved women to assist him in his medical experimentation as well as serve as subjects of the experiments. A statue of Sims stood in New York’s Central Park, across from the New York Academy of Medicine, for over a century, showing the enduring esteem granted to Sims by his professional colleagues. After years of protests, in 2018 the statue was removed.

Source: Howard Simmons/New York Daily News, August 20, 2017, https://www.nydailynews.com/new-york/manhattan/protesters-slam-nyc-statue-doctor-experimented-slaves-article-1.3426690.

African American Community Health Practices

In contrast to enslavers and white doctors, African Americans developed their own systems of medical care. Often practicing in the privacy of their cabins, enslaved people drew on their knowledge of local flora and healing practices to make medicines and provide care. Enslaved Blacks relied on community knowledge about the relationship of environment to health, much of it with roots in West African tradition. They used plants—both cultivated and wild—to prepare teas, salves, and medicines for all manner of ailments. Small gardens provided nutritious food, particularly vegetables that built up the immune system and supplemented meager rations provided by enslavers. Enslaved women played a particularly powerful role in enslaved communities as healers and midwives. The motivations and logic for this care stood apart from the economic calculation that undergirded the care provided by white doctors and enslavers. Much of this care took place without the knowledge and approval of white enslavers, and the medical knowledge that was passed down and shared among families formed an important part of enslaved people's culture and community. Black people, using a mixture of spiritual practices and home-made medicines, tended to the mental and emotional health of their families as well, a need that white doctors and overseers did not bother with.

Reflection Questions

What do runaway ads, posted by enslavers in the eighteenth and early nineteenth centuries, reveal about the health and living conditions experienced by enslaved people? What do they tell us about the relationships between enslavers and enslaved people?

What do documents, including images, demonstrate about the ways that whites in the nineteenth century viewed African Americans?

What were some of the contradictions inherent in the medical care that enslavers provided to their enslaved workers? What are some of the larger forces (ideological, economic, psychological) that gave rise to these contradictions?

The vast majority of enslaved people were illiterate. What sorts of medical knowledge and education did they have? How does this help us understand the idea of education?

Black women took charge of much of the medical care on plantations. How do you think this shaped gender roles and power in the Black community?

Additional Reading

Gretchen Long, Doctoring Freedom: The Politics of African American Medical Care in Slavery and Emancipation (Chapel Hill: University of North Carolina Press, 2012).

Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (Athens: University of Georgia Press, 2017).

Sharla Fett, Working Cures: Healing, Health, and Power on Southern Slave Plantation (Chapel Hill: University of North Carolina Press 2002).

Related Chapters

The Spread of Slavery and the Crisis of Southern Society, 1836-1848