Dr Alexander Augusta sought medical education in Canada but became a medical educator in America after the Civil War

Efforts to address racism within Canadian medical education and develop antiracist curricula should be grounded in historical context.¹ It is important to understand the current underrepresentation of Black and other racialized faculty members at Canadian medical schools as a result of active discriminatory policies. The life of Alexander Thomas Augusta (1825 – 1890) demonstrates the importance of teaching trainees about the effects of racism within Canadian medical education. We discuss the relevance to medical education of the decade Augusta spent in Toronto (1853 to 1863). Although Augusta needed to come to Canada for his medical training, he became a medical educator in the United States and not in Canada.

Augusta’s remarkable life and career have been described in academic papers and books that focus on his role during the American Civil War and his life afterward. He was the first African American surgeon commissioned in the Army, ultimately achieving the rank of brevet lieutenant colonel.² After the Civil War, he served as assistant surgeon in charge of the Freedman's Hospital in Washington, DC, where he may have been the first Black hospital administrator in the country.² He was later appointed a faculty member at Howard University’s medical school as the first Black faculty member in the country.² With full military honours, he was the first African American to be buried at Arlington National Cemetery.² Augusta achieved all this despite racism that forced him to learn to read in secret and resulted in being underpaid by the military, thrown off a trolley, barred from the American Medical Association, and passed over for academic promotion.²

Descriptions of his life describe his time in Toronto as a refuge from racism in the United States. Most mention that Augusta studied medicine at Trinity College, which is federated within the University of Toronto, after being refused admission to medical school in the United States. Some descriptions indicate that Augusta was “the head of Toronto City Hospital (now Toronto General Hospital).”³

He completed his medical training in 1856 but, for reasons that are unclear, it seems he was not formally granted his degree until 1860 according to both the register of graduates and his alumni card at the University of Toronto. Augusta likely never “headed” the Toronto General Hospital and, in fact, there are no records indicating that he ever worked at the Hospital. The Toronto General Hospital’s minute books for Augusta’s time in Toronto that would document him working there are not available, and no other available documents indicate that he led the hospital. If Augusta, or any other Black person, was appointed to head the Toronto General Hospital, it likely would have been noteworthy. The belief that Augusta worked at Toronto General Hospital might be related to the fact that some sources refer to the House of Industry as “Toronto City Hospital”⁴ and some have apparently confused this with Toronto General Hospital.³

While it was reported that Dr Augusta held a senior role at the House of Industry in Toronto or that he led it, records of that institution indicate that Augusta was an ad hoc Assistant Medical Attendant. Prior to 1858, several physicians including Norman Bethune, Augusta's instructor, provided medical care to residents. At the January 1859 Board Meeting, a letter from Augusta requesting payment for his service was read to the Board who agreed to pay him 12 pounds. At the February meeting a letter from Augusta acknowledging the payment was also read into the record of the Board. At that same February meeting, the Board discussed the death of the Medical Officer, a Dr. Russell, and potential replacements. Augusta was not among the candidates for the position that paid 50 pounds. So it seems that while Augusta did provide care to disadvantaged people at the House of Industry, he never held a senior role and his pay derived for his presumably part-time work was a fraction of the salary for the Medical Officer role – a position that was difficult to fill. Instead of practicing within a larger institution, Augusta opened a “new drug store” on Yonge street while he was completing his training.⁵ After finishing his training, according to the city directories, he opened a practice as a surgeon across the street from the drug store.⁶

Augusta was president of the Association for the Education of Coloured People in Canada. This organization helped ensure children had supplies and other supports needed to succeed at school.⁷ When Manitoulin Island was suggested as a segregated colony in 1857, Augusta drafted a petition calling for the resignation of the proponent of the racist policy that was aimed at deterring immigration to Ontario (that was called West Canada at the time).^4,8 Augusta criticized John Prince for promoting an “American agenda” and being influenced by southerners. In an 1863 speech at an anti-slavery society meeting Augusta pointed out that “the South had many friends in this country, and even emissaries in this very city.”⁸

Slavery was outlawed in Canada just 20 years before Augusta’s arrival, and yet, 30 years after Augusta’s death Black people were banned from studying medicine at Queen’s University in Kingston, Ontario.⁹ Policies such as the ban on Black medical students at Queen’s University, coupled with better opportunities for Black physicians in medical schools like Howard University, contributed to a deficit of Black faculty members at Canadian medical schools. We can only speculate what Augusta might have accomplished as a medical educator in Canada and how he could have supported the next generations of physicians. One of Augusta’s mentees, Anderson Ruffin Abbott (1837-1913), though born in Canada, also found success in the United States. Abbott became a licensed physician in Canada and also served in the Civil War.³ Abbott attended Buxton Mission School that was started for formerly enslaved people and that was supported by Augusta. Abbott would go on to advocate for integrated schools in Chatham, Ontario before returning the United States to become the medical superintendent of a hospital in Chicago. Although slavery was abolished in Canada before the United States, ironically both Augusta and Abbott were only able to hold leadership positions in the United States. Since Augusta was a physician who supported the education of Black children in Canada and mentored Dr. Abbott, it is likely that he would have embraced the opportunity to teach and mentor physicians in a Canadian medical school.

Medical educators who ground the history of Canadian medical education in frameworks such as critical race theory can support antiracist medical curricula.¹⁰ Medical trainees should be taught about the history of racism within Canadian medical schools and how that history helps explain current disparities. Medical curricula even today perpetuate myths about biological difference between different “races” although race is a social construct and so the focus should be on the health effects of racism.¹¹ Undoing the effects of racism on medical curricula should be informed by Canada’s history. Change can be inspired by courageous trailblazers such as Dr. Augusta who had the determination to fight racism more than a century ago.

Conflicts of Interest

The authors have no competing interests. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Funding

This work was supported with funding from the Canada Research Chairs program, the Department of Family and Community Medicine at the St Michael’s Hospital, the Department of Family and Community Medicine at the University of Toronto, and the Faculty of Medicine at the University of Toronto.