The Myth of Innate Racial Differences Between White and Black People’s Bodies: Lessons From the 1793 Yellow Fever Epidemic in Philadelphia, Pennsylvania

Abstract

In this commentary, I take up the question of why beliefs in fundamental, innate racial differences between Black and White people’s bodies persist in medical discourse, despite evidence to the contrary.

I locate the origin of some of these beliefs in the infamous yellow fever epidemic that struck Philadelphia, Pennsylvania, in 1793. During that early public health crisis, White physicians and lay people erroneously thought that Black people were immune to yellow fever because of their race. I then highlight the efforts of Philadelphia’s Black leaders during the epidemic—namely Absalom Jones and Richard Allen—to challenge the belief in fundamental and innate differences between Blacks and Whites.

I conclude by asking us to consider how the false belief that there is something peculiar about Black people’s bodies has become a feature, not an aberration, in the production of medical knowledge. Indeed, I point out how medical experimentation in the 20th century and in the marketing of new drugs in the 21st century have been buttressed by this persistent yet incorrect assumption that innate racial differences exist.

Mentions of slavery and the shadow that its legacy has cast on the medical, public health, and allied health professions in the United States have crept into national discussions on racial disparities in health outcomes, treatment, and access to health care. This is clearly illustrated by the 2016 study on racial bias in pain assessment by Hoffman et al. published in the Proceedings of the National Academy of Science.¹ Some of the study’s findings include widespread beliefs among White medical residents and lay people “that blacks have thicker skin than do white people or that black people’s blood coagulates more quickly than white people’s blood.”^1(p4298) Hoffman et al. point out the longevity of beliefs that hold Blacks and Whites to be fundamentally and biologically different. Their study suggests that these beliefs have their roots in claims made by “scientists, physicians, and slave owners alike to justify slavery.”^1(p4297) More to the point, they acknowledge how unethical medical experiments, such as the 40-year Tuskegee Study of Untreated Syphilis in the Negro Male that was conducted by US Public Health Services, were premised on these false ideas.¹

Explicitly naming how these beliefs have harmed people who identify as Black or African American is a step toward realizing equity in health and health care. However, it is worth noting that these damaging views about innate racial differences were not solely the product of slavery apologists—one need not have been aligned with slavery to believe in the myth of innate and fundamental racial differences—a point I discuss at length. Focusing too much on slavery and the bald racism associated with it creates the illusion that these beliefs are aberrations—unfortunate and rare relics of a bygone era. As the historical record and contemporary medical discourse reveal, these beliefs are not aberrations; they are built into the ethos of medical knowledge production.

We continue to inhabit a milieu in which people’s bodies are marked as different because of their race. Race, as it is constituted by superficial bodily traits like skin color, has emerged as the most obvious sign of difference. Furthermore, race has been viewed as a proxy for deeper innate difference—its inexactness notwithstanding.^2–4 When racial disparities are studied and reported on, questions often arise about whether there might be something innate in Black people’s bodies that make them different from White people’s bodies. This approach encourages scrutiny of Black people’s bodies, their habits and customs, etc., and arises from an assumption that Black people are indeed different in comparison with other races. Instead, we might consider viewing disparities as a function of how Black people’s bodies have been regarded by the medical profession—shifting our efforts away from trying to understand what might be different about a Black person’s body to trying to understand the contexts in which that body exists.

OF DISEASE AND RACIAL DIFFERENCES

In addition to identifying racial disparities and combating inequities in health care and medical treatment, we should consider reflecting on the genealogy of damaging ideas about innate racial difference. Doing so, as a means of gaining greater clarity about why these ideas persist and perhaps where they came from in the first place, might help halt their spread. Re-examining the now infamous yellow fever epidemic that struck Philadelphia, Pennsylvania, in 1793 is instructive in this regard. Many firsthand accounts of the epidemic reveal a widely held view that Black people were naturally immune to yellow fever because of their race (they were not). A smaller number of accounts challenge that view. One source, in particular, penned by two of Philadelphia’s well-known, free, Black abolitionists, Richard Allen and Absalom Jones, underscores how people of African descent engaged in discussions about racial difference (see “A Narrative of the Proceedings of the Black People During the Late Awful Calamity in Philadelphia, in the Year 1793” (p. 1336 in this issue of AJPH).

In the 18th century, yellow fever was not yet understood as a vector-borne disease—it was, however, known as a deadly scourge of the eastern and southeastern American seaboard.⁵ While some accounts of yellow fever epidemics referenced Black victims of the disease, many White commentators fixated on Blacks’ seemingly low mortality and morbidity from the disease.⁶ Over time, the belief that yellow fever was a disease to which Black people were immune, because of their race, took hold—and such a belief became fodder for slavery apologists.⁷

In mainland North America, this belief gained traction in part because of an observation made by Charleston, South Carolina–based physician John Lining. In his posthumously published treatise describing Charleston’s 1748 yellow fever epidemic, he noted: “There is something very singular in the constitution of the Negroes, which renders them not liable to this fever.”^8(p7) Lining, well regarded among his medical peers, had observed both Black and White populations during yellow fever epidemics and was likely a credible observer. Lining may truly have encountered immune Black people (he served as a port physician in Charleston and likely saw newly arrived captured Africans), but that might have been attributable to them acquiring immunity through previous exposure, not because of their race. With a disease like yellow fever, which was endemic to parts of Western Africa (a site of embarkation for many captive Africans), the oversight about the possibility of Black people’s previous exposure proved disastrous.⁵

Lining’s claim about innate racial immunity (made only about yellow fever; he believed that Blacks and Whites shared susceptibility to other fevers) proved to be an enduring one—so enduring that it was repeated during the yellow fever epidemic that struck Philadelphia in 1793. The well-known patriot, antislavery activist, and physician Benjamin Rush not only repeated the claim but also incorporated it into the logic he used when he penned a letter to Richard Allen, a founder of the Free African Society, asking him and the city’s Black inhabitants to stay behind and help during the epidemic. Rush assured Allen that yellow fever would “pass by” people of color.⁹ Allen, after some deliberation with other leaders of the free Black community, acceded to Rush’s request only to find that Rush’s claim (and, indirectly, Lining’s claim) of innate Black immunity to yellow fever was wrong. Allen contracted yellow fever, but recovered.

The pamphlet Allen and Jones penned to refute allegations that Blacks took advantage of Philadelphia’s White inhabitations during the epidemic, stated

to this day a generally received opinion in this city, that our colour was not so liable to the sickness as the whites. We hope our friends will pardon us for setting this matter in its true state. The public were informed that in the West Indies and other places where this terrible malady had been, it was observed the blacks were not affected with it. Happy would it have been for you, and much more so for us, if this observation had been verified by our experience.^10(p15)

Here is one of the earliest written accounts from Blacks vigorously and publicly refuting false ideas about their bodies. Rush would go on to admit his error in a publication about yellow fever published several years after the epidemic, but he adopted the view that even if Black people suffered from yellow fever, they suffered less than Whites. “The disease was lighter in them, than in the white people,” Rush wrote. “I met with no case of hemorrhage in a black patient.”^11(p73) Rush’s backtracking did little to stop people from believing in innate Black immunity to yellow fever, as this view would continue to circulate well into the 19th and even 20th centuries.¹²

Philadelphia’s 1793 yellow fever epidemic is instructive for revealing how people, even those to whom slavery was an anathema, could propagate harmful statements about Black people’s bodies. Rush’s opposition to slavery did not necessarily mean that he viewed Black and White people’s bodies physiologically equal. This view is evident in his assessment of Blacks suffering from yellow fever. It is even clearer in his 1799 essay, “Observations Intended to Favour a Supposition That the Black Color (As It Is Called) of the Negroes Is the Leprosy.”¹³ Aside from literally pathologizing Black people’s skin, Rush listed a host of rationales for why Black people were Black, complete with broad generalizations about Black people’s bodies—“The big lip, and flat nose so universal among the negroes, are symptoms of the leprosy.”^13(p293) The desire to see and explain innate racial difference was hard to shake.

LEARNING FROM THE PAST

We can take comfort that medical discussions about race and racial disparities no longer proceed along these lines. However, we still need to exercise caution in how we talk about racial disparities in health. To be clear, it is appropriate and necessary to evaluate a variety of individual characteristics, even race, when assessing health outcomes, but how we do that makes all the difference. Without explicitly naming racism as a possible factor in explaining poor health outcomes for racial minorities, we run the risk of framing health disparities in such a way that draws our attention to the bodies of those suffering under the disparities rather than drawing our attention to why the disparities exist in the first place.

For example, when the Centers for Disease Control and Prevention’s (CDC’s) Web site notes, “Racial disparities persist. The risk of pregnancy-related deaths for black women is 3 to 4 times higher than those of white women,” it correctly identifies a glaring health problem facing Black women.¹⁴ While the CDC and public health officials suggest elsewhere that racial discrimination and the chronic stresses associated with it might be responsible for this startling figure, neither racism nor discrimination are named explicitly as possible contributing factors for this grim statistic. The word “racism” does not appear on the CDC Web site in the discussion of pregnancy-related deaths. Explicitly identifying racism and systemic discrimination against Black women in this context as potential factors correlated with their high maternal mortality shifts our attention to larger structural problems both inside and outside the realm of medicine and away from any potential innate biological reason for the disparity. Identifying the problem with a comparison is a step in the right direction; however, more can be done to signal a deep appreciation of how Black women have to navigate a society with structural racism built into it.

Indeed, how we invoke racial comparisons or racial disparities in medical discussions matters. This is particularly important when one considers that claims about innate racial difference have emerged under the guise of righting past wrongs. For example, in 2005, the Food and Drug Administration (FDA) approved a combination of isosorbide dinitrate and hydralazine hydrochloride (BiDil), which carries the distinction of being the first FDA-approved drug for people who self-identity as Black or African American. Despite the support for BiDil from Black physicians, many of whom hailed its approval as a step toward improving the lives of Blacks with congestive heart failure, the drug’s marketing and history remains problematic. BiDil’s creators originally presented the drug to the FDA for use in the general patient population, but it failed to gain approval because of statistical issues with early trials; thus, it did not start its career as a drug designed for Black people.¹⁵ Once approved, it was hailed as a bold step toward eliminating racial disparities. One of the drug’s developers seemed to suggest that it was unclear why BiDil worked so well in Black people; nevertheless, they were willing to go along with the idea that the unknown reason was biological, possibly innate. Despite the good that BiDil may do, its approval sanctions the dangerous idea that congestive heart failure is a different disease in Black people than in White people for biological reasons.¹⁶ Many scholars, including Susan Reverby, Pamela Sankar, and Jonathan Kahn, have pointed out that BiDil’s initial marketing suggested that there was something peculiar but also not quite well understood about Black people’s bodies that makes them respond to this drug.^17–19

When we consider the 1793 yellow fever epidemic and other past instances of incorrect assumptions about fundamental biological differences between Black and White people’s bodies, a pattern emerges—one that is not the result of a few aberrant racist claims. Much has obviously changed in how we view race now—we are more attuned to implicit bias in the health care setting. Nevertheless, the impulse to see difference rather than sameness in medical discourse and practice persists. In their 2016 study, Hoffman et al. conclude: “white laypeople and medical students and residents [held] false beliefs about biological differences between blacks and whites. . . . racial bias in pain perception is associated with racial bias in pain treatment recommendations.”^1(p4297)

These findings become even more arresting for the uncanny resemblance they bear to 18th-century views on Black people’s pain tolerance. Rush, well-meaning in his intentions, did not hesitate to share medical lore about Black people’s supposedly high pain tolerance when explaining why Black skin was attributable to leprosy: “This insensibility belongs in a peculiar manner to the negroes. Dr. Moseley says, ‘they are void of sensibility to a surprising degree. . . . They bear surgical operations much better than white people, and what would be a cause of insupportable pain to a white man, a negro would almost disregard.’”^13(p292) Here Rush repeated the words of an esteemed medical peer, Benjamin Moseley, as he made the case for innate Black insensitivity to pain. Moseley’s observation was likely politically motivated, but that does not account for why Rush cited it as evidence in his essay on Black skin as leprosy.²⁰ There are no data to suggest that Hoffman’s respondents cited Rush’s and Moseley’s medical writings as the point of origin for their wrongheaded views, and yet, somehow, they have managed to invoke an ideology of race from a bygone era.