Invisible Black Women: Medical Bias and the Silencing of Enslaved Black Women in 18th- and 19th-Century British West Indian Medical Discourse

Abstract

This article examines the historical roots of medical neglect experienced by Black women, focusing on the 18th- and 19th-century British West Indies. During this period, White male physicians constructed racialized and gendered frameworks of disease that excluded enslaved Black women from diagnosis, care, and medical legitimacy. Positioned not as patients but as reproducers and laborers, their suffering was either pathologized or dismissed. Drawing on medical treatises and plantation manuals, this article argues that enslaved Black women were relegated to a space of medical liminality: recognized as reproductive laborers but denied clinical legitimacy or voice. It advances three key arguments. First, it explores how physicians framed Black women as morally deficient and biologically inferior, blaming their behavior for illness. Second, it shows how reproductive outcomes like miscarriage and abortion were weaponized to portray Black women as lacking maternal instinct. Third, it examines how female-only diagnoses, such as Chlorosis, excluded Black enslaved women, even when they presented similar symptoms. Instead, they were assigned stigmatized conditions, like “dirt-eating,” reinforcing assumptions of biological difference and unworthiness of care. By tracing this history, the article reveals the foundations of contemporary racial disparities in women’s healthcare. It concludes by linking these colonial ideologies to current maternal health outcomes, where Black women in the United States still face disproportionate rates of medical dismissal and death. This legacy underscores the urgent need to confront the historical frameworks that continue to shape how Black women are treated in medicine today.

“Giving birth to my baby, it turned out, was a test for how loud and how often I would have to call out before I was finally heard.” Serena Williams, Elle [1].

In 2017, Serena Williams, one of the most recognizable and powerful athletes in the world, nearly died after giving birth. Despite knowing her own medical history and correctly identifying symptoms of a life-threatening blood clot, hospital staff repeatedly dismissed her concerns. She had to fight to be taken seriously. Williams’s story is not an anomaly. It reflects a broader and enduring pattern: even the wealthiest, most visible, and highly educated Black women remain vulnerable to systemic medical neglect. This marginalization has deep historical roots. Black women have been medically underserved for centuries, a reality that extends far beyond the modern healthcare system. Williams’s experience of being dismissed by medical staff reflects a broader and long-standing pattern. For instance, in maternal health, where Black women suffer fatal post-birth complications at significantly higher rates than White women. In response to these alarming disparities, the US Centers for Disease Control and Prevention launched the “HEAR HER” campaign, which seeks to raise awareness about urgent maternal warning signs and encourage medical professionals to listen to and act on the concerns of pregnant and postpartum patients of color [2].

This experience is rooted in a much longer history of racialized and gendered medical treatment. This article examines how these patterns took shape in the 18th- and 19th-century British West Indies, where enslaved Black women were not only physically exploited through forced labor and reproduction, but also silenced and disregarded within the emerging medical discourse. White male European physicians working on plantations consistently cast enslaved Black women as morally corrupt and inherently inferior to White women. These physicians further embedded these social prejudices through the construction of racialized and gendered frameworks of disease that erased enslaved Black women from care. As a result, enslaved Black women were relegated to a space of medical liminality. They were not seen as patients, but as reproducers and laborers. Their symptoms were pathologized or ignored, their pain disbelieved, and their voices silenced. They were bodies to be used, not individuals to be heard.

To understand the roots of these present-day disparities in Black women’s health, we must examine the historical development of racial and gender bias in Western medicine. These patterns were shaped, in part, by medical practices in the 18th- and 19th-century British West Indies, where the medical treatment of enslaved Black people reflected broader colonial hierarchies of racialized, gendered, and socio-economic control.¹ The medical neglect of enslaved Black women during this period was not an isolated failure of care but part of a system that placed little value on their lives and well-being.² These hierarchies shaped not only colonial laws and institutions but also diagnostic categories, treatment priorities, and clinical decisions. Physicians working on West Indian plantations often interpreted the symptoms of enslaved Black patients through the lens of racialized and gendered stereotypes, adjusting medical knowledge to support the colonial order. As a result, medical ideas about disease were used to justify unequal treatment of enslaved Black people, in particular, enslaved Black women, thus casting them as biologically different, morally deficient, and undeserving of care.³

This article argues that Black women’s medical invisibility today is rooted in historical patterns of exclusion embedded in early clinical thinking. Drawing on historical analysis of published medical treatises and plantation manuals, this article traces how White male physicians shaped a hierarchy of care that routinely excluded enslaved Black women. First, it explores how these physicians portrayed enslaved Black women as morally inferior to White women by depicting them as less chaste, less maternal, and attributed their increased disease susceptibility to their social behaviors. Second, it examines how stereotypes of moral deficiency were reinforced by promoting the belief that enslaved Black women were more likely to induce abortions and lacked maternal tenderness. Third, this article examines how the construction of female-specific diseases, such as Chlorosis and Of the Whites, systematically excluded enslaved Black women from diagnostic categories and denied them appropriate medical treatment. The intersection of social prejudice and medical bias relegated enslaved Black women to a liminal space, rendering them medically invisible in medical literature and reinforced long-standing assumptions that their suffering was either imagined, exaggerated, or unworthy of attention.

Plantation physicians constructed these medical distinctions based on deeply entrenched assumptions that Black women were biologically different from White European women. Even when symptoms matched those of White female patients, enslaved Black women were often dismissed or given less attention. Instead of receiving comparable care, enslaved Black women were framed as less delicate, more resilient, and thus more capable of enduring pain and illness without intervention. The result was a pattern of exclusion and neglect that contributed to the “medical othering” of Black women; a systematic denial of their need for care, based on racialized assumptions about their bodies and capacity for suffering. In doing so, physicians reinforced racialized and gendered distinctions between White and Black female patients, allocating sympathy, diagnosis, and treatment according to “race” and ideas of femininity rather than medical need.

White male physicians working on 18th-century West Indian plantations drew upon deeply entrenched social and economic hierarchies to construct medical distinctions that upheld racialized and gendered inequality.⁴ Their published works reinforced a patriarchal and burgeoning White supremacist worldview by codifying these hierarchies into an order of care that placed White European men at the top, followed by White European women, enslaved Black men, and finally enslaved Black women. As will be discussed later, these texts frequently contrasted enslaved Black women with the idealized feminine expectations of White European women. Enslaved Black women were portrayed as inherently less virtuous and more disease-prone with their health conditions routinely attributed to a presumed lack of chastity, morality, or cultural behavior. Enslaved Black women also confronted the escalating racial biases prevalent within the White, European male-dominated medical establishment. While White women’s ailments were often met with concern and clinical attention, enslaved Black women’s suffering was routinely dismissed or reframed to fit racialized medical narratives that downplayed their conditions as less significant or less worthy of care than those of White women. The persistent moral and medical devaluation of enslaved Black women, juxtaposed with the perceived fragility and worthiness of White women, reinforced Black women’s systemic invisibility and justified their neglect in both historical and contemporary medical contexts.

Constructing the Reproductive Deviance of Enslaved Black Women

By the mid-18th century, White male physicians and colonial officials in the British West Indies were actively constructing a racialized narrative of Black women’s reproductive health. This narrative framed them as morally deviant, biologically deficient, and thus undeserving of care. Physicians practicing in the West Indies were publishing commentary on perceived racialized health differences. For example, James Grainger, a Scottish-born physician who practiced medicine on the island of St. Christopher [3], authored a medical essay on the “more common West-India diseases.” He warned of the “great risque” involved in purchasing African women from the “Ibbo country,” claiming they “often labour under incurable obstructions of the menses, whence proceed barrenness, and many disorders” [4]. While seemingly incidental, assertions like this helped institutionalize the idea that Black women were inherently incurable and thus, less deserving of medical care. Grainger further asserted that “fewer Negresses die in child-bed, or from its consequences (not one in 300) than white women” [4, p.16]. He then generalized that “Black women are not as prolific as the white inhabitants, because they are less chaste, and more liable to incurable obstructions of the monthly discharge” [4, p.14-5]. Grainger believed that Black women were not as “fertile” as the “white inhabitants,” because of their supposed moral failings, and because of this they suffer more often from incurable reproductive issues. Yet, according to Grainger, Black women were not as susceptible to maternal complications during or after birth. Statements like these reinforced the belief that Black women were both biologically different and morally deficient. Such beliefs were not confined to medical texts but permeated broader colonial thought. In 1792, the House of Lords questioned John Grant, a former agent and Chief Justice of Jamaica, regarding disorders that may have been contributing to the decline of the island’s enslaved population. Grant placed blame on enslaved Black women, stating they did not “breed so much as the labouring class in Europe.” He attributed this to “premature and licentious intercourse,” “night ramblings,” prolonged breastfeeding, and the practice of “procuring wilful abortions” [5]. These narratives helped shape a racialized framework of reproductive health and innate behaviors that excused medical neglect and justified disparities in care.

Rather than recognizing their own roles, or those of plantation owners and overseers, in creating unsafe birthing and recovery environments, prevailing racialized hierarchies and medical ideologies led White physicians to attribute high infant mortality rates to enslaved mothers, reinforcing racialized stereotypes of maternal negligence and incompetence. Grainger noted that, “their children too more frequently perish, within ten days or a fortnight after their birth, than those of white people” [4, p.14-5]. So while enslaved Black women were supposedly more likely to survive childbirth, their children were not. Robert Thomas, another physician working on West Indian plantations in the 1780s, recommended that every estate include a hospital with proper ventilation, a boarded floor, and a “separate apartment…for the accommodation of lying-in women.” He criticized the practice of allowing new mothers to recover in their own homes, claiming these were “frequently in such bad repair, from their own neglect and inattention.” Thomas blamed newborn deaths on “exposure to cold and currents of air” and improper umbilical cord care. Thomas noted other “evils” that attributed to the deaths including “improper things brought to them by their friends, the chance of their being neglected by being at such a distance from the manager, and the probability of their going abroad sooner than what is proper” [6]. Thomas infantilized these new mothers by implying they required constant supervision, suggesting that both they and their “friends” (other enslaved people) were incapable of making safe decisions and would inevitably endanger the newborn without oversight. This framing not only denied Black women autonomy over the care of their newborns but also reinforced a broader racialized stereotype of irresponsibility and incompetence. Moreover, the health of the mother was deprioritized, as her primary value within the plantation economy was tied to her ability to reproduce and sustain the enslaved labor force. By insisting on managerial oversight, Thomas positioned White male authority as essential to safeguard infant health, further reinforcing physicians’ deep-seated distrust in the judgment and competence of enslaved Black women.

Physicians explained high infant mortality rates among enslaved populations by blaming enslaved mothers, while ignoring the unsanitary and hazardous conditions of plantation childbirth that made newborns particularly vulnerable to infections like “locked jaw.” Grainger stated that many newborns died within the first 2 weeks of life, attributing the cause to “the locked jaw, or, as it is called by the West Indians, the jaw falling” [4, p.15]. Thomas echoed this, noting that “negro children are more apt to be attacked with it [Jaw-Fall] than white ones…it carries off several in the first month of their birth” [6, p.321]. Tetanus, or “lockjaw,” is caused by Clostridium tetani spores commonly found in soil, feces, and on unsterile tools. In plantation hospitals, likely with dirt floors and unsanitary conditions, newborns were especially vulnerable when nonsterile instruments were used to cut the umbilical cord, or when contaminated hands and materials came into contact with the umbilical stump.⁵ These observations illustrate how physicians racialized Black infant and maternal health outcomes by shifting blame onto enslaved Black women rather than acknowledging the structural neglect that endangered them and their children.

Medical authorities in the West Indies routinely weaponized scientific discourse to reinforce racialized and gendered hierarchies, especially in matters of childcare and nursing. While enslaved Black women were commonly expected to nurse their own children or serve as wet nurses for others, White women were explicitly warned against hiring a “negro or mulatto” nurse. Physicians, such as Robert Thomas, issued highly racialized and gendered warnings, portraying Black women’s bodies as inherently diseased and morally suspect, and thus potentially unfit for the intimate care of White infants. Although Thomas acknowledged that “it is a duty incumbent on every mother to suckle her child, provided her health will admit of it, and she has a plentiful supply of milk,” he admitted that “very few [white] ladies in the West-Indies” did so, believing it “wears out the constitution” [6, p.308]. These women, he noted, typically “resign the discharge of this office to some negro, or mulatto woman.” Still, Thomas warned against entrusting their White infants to Black women “without a strict examination, by some person properly qualified to judge whether or not she is perfectly healthy.” He argued Black women may carry diseases in their blood, “such as the yaws, leprosy, or a venereal taint; as all this race of people give themselves up to an unlimited prostitution.” He concluded that, “many children have fallen victims to this pernicious custom, and many have sucked in diseases which have rendered them a loathsome object throughout life” [6, p.315]. In this passage, Thomas not only portrayed Black women as sexually immoral and irresponsible with their own health but also accused them of permanently harming White children, suggesting that their very bodies posed a threat to White society. This rhetoric laid the foundation for broader claims that enslaved Black women were not only unfit to care for others’ children but also unfit to care for their own, despite the persistent criticism they faced for nursing their children “too long.”

The contrasting medical treatment of pregnant enslaved Black women and White European women was clearly illustrated in medical literature describing the care needed during pregnancy. In 1803, Dr. Collins published Practical Rules for the Management and Medical Treatment of Negro Slaves, in the Sugar Colonies. In this treatise, he noted that although pregnant enslaved Black women were “attacked with sickness at the stomach, and vomiting,” they generally required no treatment because they “commonly endured [the symptoms] without complaint.” It is likely that these women managed their symptoms using their own knowledge and traditional remedies; however, Collins’s assumption reflects the dismissive and tone-deaf attitudes of White male physicians on the plantation. He further asserted that if a pregnant “negro” woman did complain, caregivers should “make a shew of doing something to satisfy the negro,” because “medicine cannot effect, the imagination, more powerful, may be able to accomplish” [7]. This othering attitude minimized enslaved Black women’s experiences of illness to imagined or exaggerated suffering, leading Collins to advocate, essentially, for the use of placebos rather than offer proper medical treatment.

Robert Thomas similarly addressed the treatment of pregnant enslaved Black women in his writings. He recommended that once a woman was 3 to 4 months into her pregnancy, she should be “employed in doing some slight work, such as weeding canes, and picking small bundles of grass.” By the 7th or 8th month, however, he advised that “no duty whatever should be required from them.” Despite this seeming concession, Thomas’s language reveals a deep mistrust of enslaved women in their final trimester of pregnancy. He remarked, “I mention this as an indulgence which ought to be granted to them by way of encouragement to them to go out of their full time, and not from conceiving that moderate exercise is by any means improper for pregnant women, as I am decidedly of the contrary opinion, being fully sensible, that the leading too sedentary a life is often the cause of much mischief to them” [6, p.xxi]. Here, Thomas framed “rest” not as a necessary component of prenatal care but as a strategic “indulgence.” It was presented as a reward granted to incentivize enslaved Black women to carry their pregnancies to term. This paternalistic logic reveals his primary concern: not the well-being of the pregnant woman, but the successful reproduction of future enslaved laborers. His comment that a sedentary lifestyle causes “much mischief” reflects a broader belief that enslaved Black women might exploit leniency, thus requiring ongoing regulation and suspicion. Rather than affording pregnant Black women rest as a medical necessity, Thomas characterized their condition as something to be managed for the benefit of the plantation economy. This exposes how even apparent acts of compassion were deeply rooted in control, surveillance, and the commodification of Black reproductive labor. Both Collins’s and Thomas’s statements underscore the dismissiveness that reinforced the standard of care provided to enslaved people. These physicians viewed them not as patients in need of healing but as property to be managed. Enslaved Black women were viewed primarily as producers of future laborers. They were valued not for their well-being, but for their reproductive utility, which was essential to sustaining the exploitation of Black people’s labor during this period.

In contrast, medical treatises from the same period directed at the care of pregnant White European women reflected a markedly different level of care and concern. For example, the Edinburgh Practice or Physic, Surgery, and Midwifery (1803) recommended that pregnant White women “should live a regular temperate life; moderation in eating and drinking should now be very carefully observed, and every thing that has any tendency to disagree with the stomach should be avoided” [8]. British midwifery texts, typically written for the care of middle- to upper-class White female patients, emphasized preventing miscarriages and carefully managing the discomforts of pregnancy to promote maternal health. In 1785, Alexander Hamilton, a professor of midwifery at the University of Edinburgh, advised dietary adjustments such as “moderate use of wine,” or an opiate “after a very restless night.” Conditions such as heartburn, diarrhea, “unnatural cravings,” and fainting were also thoughtfully discussed in detail, each accompanied by suggested treatments [9]. These treatises reflect the comparatively delicate and attentive care afforded to many White women, underscoring the stark disparity in how maternal health was approached for enslaved Black women, whose discomforts were often dismissed or ignored entirely.

While every precaution was taken to prevent miscarriages in White woman, physicians claimed that Black women intentionally sought to terminate their pregnancies, allegedly motivated by the belief that “pregnancy [was] an evil.” By the early 1800s, the stigma attached to enslaved Black women being careless with their bodies and its functions was very common in both medical treatises written by physicians with experience on plantations. Dr. Collins wrote in his plantation manual, “Abortions, excited by the art of the negro herself, arise from her considering pregnancy as an evil, and children as incumbrances” [7, p.156]. Most White physicians viewed miscarriages in enslaved Black women with suspicion, accusing them of intentionally ending their pregnancies. This assumption reinforced the belief that Black women lacked maternal instinct and saw children as a burden, while disregarding the very real possibility that some sought to spare their offspring from the brutal realities of plantation life.

Abortion, Maternal Tenderness, and Racialized Disease Categories

Robert Thomas’s disease descriptions othered enslaved Black women by casting them as morally deficient and incapable of maternal tenderness, thereby reinforcing their exclusion from White feminine norms. His entry on Of the Whites, described the illness as a “discharge of thin mucous matter from the parts of generation” [6, p.288], referring to a vaginal infection. However, Thomas imposed a clear moral judgement on Black women and othered them through his extended description of the disease. He wrote, “the disease is very often met with among negroes, from the frequent abortions they designedly bring upon themselves, in order to prevent their having the trouble of rearing their offspring, to which they are seldom bound by the same times of maternal tenderness and affections that white women are” [6, p.288]. Once again, the assumption that enslaved Black women did not want children because they were purportedly not “maternal” ignored another critical reality of enslaved life: the pervasive threat of rape perpetrated by White men. This erasure reflects a broader reinforcement of blaming enslaved Black women for reproductive outcomes shaped by coercive and violent conditions. Thomas’ use of the word “frequent” not only underscored how common he believed abortion to be among enslaved Black women but also implied a moral failing; a lack of self-control and responsibility he viewed as inherent to Black women.

In the “Causes” section of the same disease, Thomas continued to racialize the diagnosis by separating the causes he attributed to enslaved Black women and so-called “delicate” women. He listed the main causes as, “Every thing that occasions a relaxation of the parts…difficult and tedious labours, repeated miscarriages, immoderate flows of the menses…and evacuations of all kinds, are the general causes.” Thomas ended this section by specifying that, “Delicate women that are of lax fibres, and those who remove from cold climates to become inhabitants of warm ones, are frequently afflicted with the whites” [6, p.288]. Two aspects of this section stand out. First, Thomas used the phrase “frequent miscarriages” referring only to “delicate” women. Second, Thomas used the phrase “frequent abortions” when describing “negro” women in the main description of the disease but excluded any reference to Black women in the “Causes” section. While the terms “miscarriage” and “abortion” were used interchangeably in 18th-century medical dictionaries, Thomas and other physicians in this same environment, assigned distinct meanings by racializing the terminology.⁶ Thomas used the term “miscarriage” to describe the unintended loss of a pregnancy in the “Causes” section, including a description of “Delicate women that are of lax fibres” (a phrase referring to middle- to upper-class White European women). This contrasts with his use of the term “abortion” to describe the intentional termination of a pregnancy when referring to enslaved Black women. Through this rhetorical strategy, Thomas not only racialized the causes of vaginal infections but also weaponized medical language to reinforce racialized and gendered hierarchies. By redefining otherwise interchangeable medical terms, he pathologized Black women’s reproductive behaviors as deliberate and deviant, while simultaneously framing White women’s pregnancy losses as natural and blameless.

Moreover, Thomas presented the illness of “delicate women” as the result of environmental change (specifically, the transition from cold to warm climates) rather than any personal failing.⁷ Thomas used the term “delicate” exclusively to describe White European women of the middle and upper classes. A dictionary published in 1783 defined “delicate” as “Fine…Beautiful; pleasing to the eye…Polite; gentle of manners [and] Soft; effeminate; unable to bear hardships” [10]. This definition directly tied the term to contemporary ideals of European femininity, class privilege, and Whiteness. By using the term “delicate,” he racialized and gendered the causes of the disease and implicitly excluded Black women from this framework of femininity. His reference to women who moved from, “cold climates to become inhabitants of warm ones,” clearly referred to White European women, who were believed to develop certain diseases, such as Of the Whites, more often in tropical environments. In contrast, enslaved African women were not believed to be susceptible to such environmental factors as their bodies were supposedly more suited to life in tropical climates.

Medical discourse during the 18th and 19th centuries deployed the language of femininity to reinforce both racialized and socio-economic hierarchies, systematically excluding enslaved Black women from prevailing ideals of womanhood. Physicians like Thomas held enslaved women responsible for their own illnesses. These conditions were attributed to presumed moral failings and innate biological deficiencies. Central to this exclusion was the construct of “delicacy”— a term reserved for middle- to upper-class White women, whose identities were socially and medically framed around fragility, vulnerability, and dependence. These women were understood to require protection and care, a framing that legitimized extensive medical intervention. In contrast, enslaved Black women were viewed solely through the lens of utility: their bodies were constructed as laboring and reproductive machines, inherently robust, and undeserving of nuanced care or medical sympathy. While poor White women might be excluded from the category of delicacy due to socio-economic status, Black women were categorically denied access to this framework because of deeply embedded assumptions about racialized differences. The result was a medical logic that positioned vulnerability, and therefore eligibility for care, as a privilege of socio-economic and racialized status, one entirely inaccessible to Black women.

Through this rhetoric, Thomas constructed a medical divide, based on assumptions of morality, between White and Black women, reinforcing broader ideologies of racialized and gendered difference and maintaining the social and economic stratification of the period. Even under the “Treatment” section of the disease, the language Thomas employed clearly referred only to White women. In the final paragraph of the section, he wrote, “Women that are afflicted with the Whites should not indulge in an [sic] use of warm relaxing liquors, nor laying on feather-beds; they should rise early, go into a cold bath, and afterwards take gentle exercise before the sun becomes too powerful. Their food must consist of such things as are light and nutritive” [6, p.290-91]. The recommendations offered here were clearly not intended for the treatment of an enslaved Black woman. It was written for a woman of leisure, one who had the privilege of avoiding strenuous labor, the means to regulate her diet, and the time to prioritize rest and self-care. In contrast, enslaved Black women were required to engage in physically demanding labor from sunrise to sunset and had neither the resources nor the autonomy to implement such a treatment plan. The rest of the treatment section further emphasized this exclusivity, listing care instructions such as, “Astringent injections” to be administered morning and night, prescriptions to be taken “three of four times a day,” and directions for “the parts…to be kept very clean, by bathing them two or three times a day” [6, p.289-90]. These were not realistic or accessible options for enslaved women who lacked both medical support and personal time. Instead of acknowledging these structural limitations, physicians dismissed Black women’s suffering, attributing their symptoms to moral failings rather than medical need. In doing so, they effectively relocated Black women to a medical and social liminal space: one in which their pain was ignored, their conditions left untreated, and their bodies rendered invisible within dominant frameworks of Western medical care.

Diagnostic Exclusion and Medical Erasure

Medical literature in the West Indies further reinforced racialized and gendered hierarchies through the diagnosis and treatment of Chlorosis, a disease categorized exclusively as female and distinctly White. The disease was typically characterized by symptoms such as an Obstructed Menses and a craving for non-food substances, or “deprav’d appetite,” was widely diagnosed among young White women, especially virgins. Alexander Sutherland, a Scottish physician practicing in Bath, England [11], recounted various cases of patients who benefited from the waters in Bath and Bristol. Sutherland described the case of “Miss La Chambre” a 13-year-old girl who was “the very complexion of the chalk, mortar, and other trash which she used to devour.” Miss La Chambre was diagnosed with Chlorosis and suffered from its major symptom called a “deprav’d appetite.” Women who suffered from this symptom craved non-food items such as “unripe Fruits, Vinegar, Juyce of Lemmons…[while] Others desire Earthy, Dry, and burnt things…[such as] Salt-Ashes, Chalk, and the like” [12]. Sutherland noted she had spent several weeks drinking and bathing in the Bath waters. After the treatment, “she rejoiced more at the sight of a shoulder of mutton than a handful of clay” [13]. This image of White girlhood delicately treated through restorative therapies was not unique, further illustrating how such conditions were sympathetically framed when affecting White female patients.

In his 1731 medical treatise, De Morbis Cutaneis, English physician Daniel Turner described the case of an 11-year-old White girl suffering from “short-breath’d, pale or rather of a leaden Complexion,” along with stomach pain and a “constant Palpitation.” Turner stated the girl’s mother described her as having had a “lovely, florid and beautiful Complexion,” but had deteriorated into “that of a Ghost.” Turner diagnosed the 11-year-old girl with Chlorosis after her mother told him she found a “Piece of a Scotch Cole of about two Pound Weight” in her apron pocket. On multiple occasions, in fact, the mother had found pieces of coal in her daughter’s apron pockets that she had been consuming in secret. The societal taboo surrounding consuming non-food items would have forced the girl to conceal her actions. After Turner frightened the girl with “Thoughts of Death” from consuming such items, the girl promised to stop. Turner “began her Cure” with purges and tinctures for the next 3 to 4 weeks. After her recovery, he described the girl as being “fat and lusty, and fresh-colour’d as ever” [14]. This case demonstrates not only the medical attention and narrative care afforded to White female patients, but also the emotional framing of their suffering; an illness to be treated, understood, and resolved.

In stark contrast to White women, enslaved Black women who exhibited the same symptoms were excluded from diagnoses like Chlorosis and denied any compassionate medical framing. White women were also believed to consume non-food items in order to quell their suffering from “acidities of the stomach,” young White women were diagnosed with Chlorosis and pregnant White women with Pica.⁸ However, enslaved Black women’s experiences with eating non-food items were frequently dismissed as habits, addictions, or signs of mental instability rather than recognized as legitimate symptoms of disease. Physicians who had worked on plantations explicitly gendered and racialized their descriptions of Chlorosis, categorizing it as a disease exclusive to White European women. Although they exhibited the physical symptoms of Chlorosis, enslaved Black women were systematically excluded from the diagnosis. Instead, White physicians and plantation owners applied the derogatory term dirt-eating to describe enslaved men and women who consumed non-food items like chalk, clay, or ashes.⁹ This terminology served to stigmatize the behavior in enslaved Black people, reinforcing both their social marginalization and their erasure from legitimate diagnostic categories.

Alongside this diagnostic exclusion, physicians and plantation authorities further dehumanized enslaved people by relegating behaviors like dirt-eating as signs of irrationality, moral failing, or suicidal intent. John Grant blamed dirt-eating for the decline of enslaved Black people in Jamaica, in addition to the supposed immoral behavior of enslaved Black women. Grant argued there was a, “disorder called dirt-eating; that is, eating a kind of earth, absorbent earth, which gives, as they conceive, some relief to acidities of the stomach; and I understand it to be a practice in their native country; some of the children by imitation eat dirt likewise, and a number of them perish from the cause” [5, p.20]. Among enslaved people, the behavior was derogatorily labeled dirt-eating, but physicians considered it a difficult “habit” to stop; one that supposedly resulted, most often, in death. According to slave owners, dirt-eating could easily turn into an epidemic with hundreds dying from the disease and was well known among those living in Jamaica.¹⁰

Many plantation owners and managers in Jamaica saw dirt-eating as a disgusting habit of enslaved people done to spite the slave owners and plantation managers because the enslaved person would likely be unable to work due to their illness. In 1788, John Hunter, a surgeon and anatomist, argued that enslaved Black people began the “habit” of dirt-eating because of their “discontent with their present situation, and a desire of death in order to return to their own country, for they are well aware that it [consuming “dirt”] will infallibly destroy them.” He wrote that “Dirt-eaters” could “seldom or ever be corrected of this unnatural practice,” and the “habit” could kill an enslaved person in 10 days, but noted, “they often drag on a miserable existence for several months, or even one or two years.” Hunter compared “Dirt-eaters” to that of alcoholics and stated that their attachment to consuming “dirt” was greater than “dram-drinkers [and] their pernicious liquor” [15]. Hunter’s assertion that dirt-eating was a willful, suicidal act reveals how physicians pathologized enslaved Black people. By pathologizing the behavior, physicians deflected attention away from structural violence, malnutrition, or cultural transference, and instead blamed the individual as unable to control their behavior.¹¹ This dehumanizing interpretation allowed them to avoid responsibility for plantation conditions while also rationalizing the medical abandonment of enslaved people.

The “habit” of dirt-eating was not formally pathologized as a medical condition until the 1790s, when it was reclassified as a distinctly “Black-only” disease called Cachexia Africana. Although the symptoms closely mirrored those of Chlorosis, including consuming non-food items as a defining characteristic, physicians maintained separate diagnostic categories to preserve rigid racialized distinctions. This segregation was not simply incidental; it served to uphold a medical framework where disease classification, diagnosis, and treatment were contingent on gendered ideals and socio-economic status. Notably, enslaved Black women were systematically excluded from both diagnostic categories. They were not considered appropriate candidates for a diagnosis of Chlorosis, a condition reserved for White European women. Nor were they consistently included in diagnoses of Cachexia Africana; a category often focused on enslaved Black men’s presumed lack of self-control. This exclusion rendered Black women medically invisible, effectively denying them recognition as legitimate sufferers of illness and, by extension, access to the care afforded to White women.

Robert Thomas provides a clear example of this exclusion. In his writings, he acknowledged that enslaved Black women could present with the classic symptoms associated with Chlorosis. However, rather than diagnosing them with Chlorosis, he directed readers to the more general category of Obstructed Menses. Despite the generic label, this section of his treatise was clearly written with White women in mind, based on its language, tone, and prescribed treatments. This diagnostic redirection reflects a deeper unwillingness within the medical community to see Black women as physiologically or morally comparable to White women. Furthermore, Chlorosis was framed as a disease of delicacy and refinement, as physicians argued that it “frequently arises among those in higher stations of life,” while young women “among the lower class of people, who use sufficient exercise and enjoy the fresh, open air, are seldom visited with [Chlorosis].” Such statements, similar in the description of Of the Whites, not only racialized and gendered the condition but also aligned it with a particular socio-economic status, further reinforcing the exclusion of enslaved Black women. They were denied the assumption that their suffering might stem from gynecological or constitutional causes. Instead, their symptoms were attributed to mental instability, bad habits, or moral failure, explanations that served to medicalize Whiteness while pathologizing Blackness.

This exclusion extended beyond diagnostic labels and also revealed the racialized logic of care through the treatment itself. White women presenting with symptoms of Chlorosis were met with an extensive treatment plan designed to support both physical recovery and emotional well-being. This often included a nutritious diet, rest, gentle exercise, and social stimulation. These recommendations not only assumed the physical fragility of the patient but also her worthiness of individualized care. In contrast, when Pica appeared in enslaved Black women, it was called dirt-eating and rarely interpreted as a symptom of a diagnosable disease. Instead, it was cast as an irrational or even dangerous behavior, one that the individual was expected to overcome without medical support. When Pica appeared in pregnant enslaved Black women it was considered a condition they could manage independently. This reflects broader racialized assumptions that Black women were neither in need of nor deserving of the same medical attention as White women. Physicians assumed that Black women were both emotionally and physically equipped to manage such symptoms independently, if they deserved care at all. For example, Thomas addressed the behavior under a separate heading, “OF DIRT-EATERS,” where he differentiated between enslaved men and women. He wrote that “when the disease takes place in young [Black] women that are obstructed, the remedies recommended under the Obstructed Menses, must be made use of” [6, p.206-07]. Here again, the enslaved Black female patient exhibited both a desire to consume non-food items, or dirt-eating, and Obstructed Menses, but was not considered for a diagnosis of Chlorosis. Instead, she was redirected to a generalized section that ignored the full constellation of her symptoms and denied her a more precise diagnosis. This not only stripped her of diagnostic legitimacy but also ensured she would not receive the same nuanced treatment that a White woman might for the very same condition.

In his 1809 medical treatise, Thomas explicitly argued that enslaved Black women could not suffer from Chlorosis at all. He wrote, “Between it [Cachexia Africana] and chlorosis there is in many respects a great similarity; but they differ in this circumstance, that the latter only affects females, and that principally about the age at which menstruation ought to commence; whereas the former affects males as well as females, and is often to be met with in children of six or seven years old, as I have seen happen in various instances” [16]. In this passage, Thomas openly acknowledged the overlapping symptomatology of the two diseases, especially among young women, but insisted on maintaining their diagnostic separation. While his logic might appear consistent when applied to enslaved Black men versus White women, it breaks down when comparing Black and White female patients who shared the same reproductive anatomy and exhibited the same clinical signs. Despite this, only White women were granted the medicalized identity of the Chlorosis patient, while enslaved Black women remained outside the bounds of diagnostic sympathy. This medical exclusion was not based on biological evidence but on entrenched racialized and socio-economic hierarchies that framed White women as delicate and treatable, and enslaved Black women as pathological, untreatable, or simply undeserving of care. It was not merely a question of biology but one of belonging, who was seen as capable of illness, and thus, worthy of medical treatment.

Medical texts further racialized the condition by specifying that Chlorosis “frequently arises among those in higher stations of life.” John Leake, an English man-midwife, observed that young White women, “among the lower class of people, who use sufficient exercise, and enjoy the fresh, open air, are seldom visited with green sickness [Chlorosis], it may reasonably be presumed, that it often arises among those in a higher station of life, from want of these common benefits, and that little more than their salutary aid is necessary for its cure” [17]. This class-based framing reinforced the idea that susceptibility to Chlorosis depended not only on gender but also on Whiteness and socioeconomic status. Black women were entirely excluded from these frameworks, not even afforded the assumption that their reproductive suffering might be related to the uterus or treated with compassion. Instead, they were either dismissed entirely or treated as biologically distinct from their White counterparts.

The erasure of Black women from Chlorosis discourse was not just about diagnosis but also about the treatment they received. For White women, consuming non-food items and Obstructed Menses prompted an extensive regimen of care and emotional support, underpinned by the belief that these women were fragile and in need of nurturing. Treatments included dietary regulation, bloodletting (by opening a vein in each foot), and environmental adjustments like avoiding cold and dampness. In contrast, enslaved Black women were believed to possess bodies inherently more resilient, less sensitive, and thus, less in need of intervention.

Contemporary Legacies of Historical Medical Bias

The history of medical neglect toward Black women is not confined to the past; it continues to shape clinical encounters in the present day. The long-standing assumptions developed by 18th- and 19th-century White male physicians in the British West Indies (namely, that Black women were biologically different, morally deficient, and more capable of enduring pain) established a framework of “medical othering” that persists in today’s healthcare systems. A 2022 study titled “We’re Not Taken Seriously” starkly illustrates this enduring legacy: 92% of Black women surveyed reported not being listened to by medical staff, and 94% felt they received poorer service than White patients [18]. These women described an atmosphere marked by dismissal and a deep-seated lack of trust in medical professionals, one rooted in historical experiences of being ignored, mistreated, and devalued. Their accounts echo the same patterns of silencing and disbelief that defined medical treatment of enslaved Black women centuries earlier. One participant noted, “Older Black women…tend not to trust health officials so much because of things that happened in their past or the way they were treated.” Another put it more bluntly: “We are so marginalized—we are not listened to, we’re not taken seriously” [18, p.886].

This article has shown how that marginalization was constructed and reinforced in medical literature and plantation policy: through the systematic exclusion of Black women from diagnoses like Chlorosis, the refusal to acknowledge their pain as real or their conditions as treatable, and the racialized frameworks that pathologized Black female bodies while idealizing White ones. Physicians, like Robert Thomas and John Hunter, framed enslaved Black women as biologically suited to suffering and morally unfit for care, denying them the diagnostic legitimacy, compassion, and treatments routinely afforded to White women. These practices were not anomalies of medical ignorance, but deliberate strategies embedded in systems of racial capitalism, patriarchy, and colonial control.

Understanding this historical context is critical. The racialized health disparities that persist today (particularly in Black maternal mortality, reproductive health, and diseases like cervical cancer) are not accidental. They are the product of a medical tradition that has long privileged Whiteness as the default for care and diagnosis while rendering Black women medically invisible. The stories of enslaved Black women, their misdiagnoses, and their erasure from medical concern must be centered in our historical narratives if we are to challenge the racial biases that still define medical practice today. Only by acknowledging the deep roots of these injustices can we begin to dismantle them.

Author Contributions

VMR conceptualized the research, conducted the archival analysis, and wrote the manuscript.