Excavating the Truth About Medical Racism From the American Medical Directory—Spinning Dross Into Gold
Authors: Harriet A. Washington
Journal: JAMA Network Open (2024)

Today we openly scrutinize medical education, policies, and practices in order to discover and purge racial biases, but this openness could not differ more from the insidious means by which early African American medical aspirants were denigrated, exiled, or barred from the profession altogether.Even basic information from the past, such as the absolute numbers of early Black physicians, remains hard to divine.Moreover, an unknown number of early Black physicians, like Harvard's William Hinton and Meharry's Eugene Nelson, 1 found it politic to conceal their race in order to escape professional marginalization.How can we hope to quantify and accurately reconstruct this important history in order to design a more equitable present and future?Chrisinger 2 masterfully addresses this historical void via elegant extractions of data and identification of patterns from one of the few extant fin de siècle data sources: the American Medical Association (AMA) American Medical Directory (AMD), which has been published continually since 1906.Chrisinger analyzed 41 828 physician entries of the AMD, replete with demographic data, to emerge with information about the early days of our nation's Black physicians.These data can illuminate the early stages of racial inequities because until 1940, the AMD designated Black physicians, over their objections, with a stigmatizing "col."notation, for "colored." 2 This noxious racial labeling contributed to the further exclusion of Black physicians from medical training, practice, and professional communities, including from equitable insurance rates and from AMA constituent societies. 2In the hands of Chrisinger, the racial labeling now illuminates the real nature and extent of early medical inequity.In mining 1906 data from 18 Southern and adjacent states and Washington, DC, the study emerges with an astonishing scope of information. 2For example, it reveals inequitable access of physicians to their patients by documenting that Black physicians constituted only 1.8% of practitioners and by calculating the much greater distance between Black physicians and where they trained.The study even painstakingly correlates Black physician access with the number of regional lynchings.The insight that enabled the author to perceive a demographic gold mine in this abhorrent "col."notation is impressive, and the few questions that arise are not criticisms of the analysis but rather points to consider in future investigations.Chrisinger's excellent and nuanced portrayal is a snapshot. 2It captures early racial dynamics affecting qualified African American physicians, but not the earliest, which began with James McCune Smith sailing to Glasgow to earn his doctor of medicine degree in 1837 after being rejected by US schools.Temporal limits apply to what can be gleaned from Chrisinger's meticulous analysis of the 1906 data-especially because a mere 4 years later, as Chrisinger notes, the 1910 AMA-commissioned report by Abraham Flexner on medical education in the US and Canada 3 catalyzed a sea change in US medical education, including the shuttering of all Black medical schools except for Howard University and Meharry Medical College. 4Also, any future selection of the Southern and adjacent states listed might profitably include Pennsylvania, a Northern state whose medical culture was long imbued with Southern racial sentiments and was hostile to the medical aspirations of Black individuals.The archives of the University of Pennsylvania medical school noted, "Almost half of the 1859 student body consisted of southern men.… Medical students from below the Mason-Dixon Line formed the largest constituency of Southern sympathizers in Philadelphia."