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A historical discussion about diseases defined along racial lines is an important part of examining the origins of concepts and ideologies of race. First, the association of particular diseases with certain racial groups was a central part of the project of identifying the so-called immutable differences between blacks and whites, particularly in the United States. Comparative anatomy and morbidity and mortality statistics are only some of the ways in which differences between whites and blacks were usefully delineated. Second, the notion of racial disease factored heavily into initiatives to prevent racial mixing. Therefore, an examination of racial disease is important in understanding how the threat of miscegenation was historically understood and articulated. Third, racial diseases are an ideal site for exploring the constantly shifting meanings and definitions of race, as the association of diseases with certain races often required the shifting of boundaries within and between racial groups. Finally, an examination of racial diseases is helpful in identifying how gender bears on the construction of racial difference. While African Americans were generally targeted as a source of disease in the United States, the bodies of men and women were differentially involved in the construction of racial difference, not to mention differentially affected by these constructions.

The discussion that follows centers on notions of racial disease primarily developed in the United States during the nineteenth and early twentieth centuries. This is an ideal period of focus because information is readily available and notions of race were crystallized and demonstrated in a variety of ways during this time.


Medical language and research played an important role in constructing and reinforcing racial difference. Attributing certain diseases to particular racial groups helped to create and reinforce existing social beliefs in racial difference and in the immutable fixity among races. In addition to diagnostic methods, the linking of certain diseases to certain racial groups by medical scientists was accomplished through the use of analogy and metaphor. Nancy Leys Stepan, in Race and Medicine: The Role of Analogy in Science (1993), states that analogies were used to create relationships between previously unrelated elements. In the case of racial disease, a naturalized association between blackness and certain illnesses was constructed. Metaphors were used for the same purpose, allowing for the explanation of cultural elements in biological terms. It is important to note that these are the same methods social authorities use to promote these ideas. This underscores the point that scientific practices and knowledge reflected existing social and political ideas.

The metaphor most central to this project was that of blood. Anthropological research such as that conducted by Audrey Smedley in Race in North America: Origin and Evolution of a Worldview (1999) indicates that since the sixteenth century, blood was central to the belief in the heredity of social status. While not yet associated with physical traits or a “racial” type, this notion of blood suggested a fixity of difference in social qualities believed to be transmitted biologically. Arguably, this implication contributed to blood becoming a fundamental element of kin, character, and biological identity beginning in the eighteenth century. Therefore, when racial and physical traits became prominent in scientific and social thinking, the physical, cultural, and social differences between racial groups were also tied to differences in blood. The differences between whites and blacks in terms of physical, intellectual, and cultural characteristics reflected a difference in blood as well. This logic was useful in reinforcing notions of biological difference beyond physiognomy, which helped to lay the groundwork for the numerous publications, research projects, and public discussions that began in the nineteenth century about Negroes’ susceptibility to and propensity for certain diseases. As a result, certain diseases came to be labeled as “Negro diseases.”


It is important to note that the discourse around Negro diseases developed concurrently with discussions about the place of the formerly enslaved in U.S. society. This is because it was feared that blacks, without being properly confined within the institution of slavery, would fall into a state of poor health and behavior that would have a negative effect on the existing social order and threaten the safety of the white population. Scientists and physicians were called upon to explain and resolve this “Negro problem.”

In keeping with existing studies that typed the Negro as the lowest in the hierarchy of humankind on the basis of physical traits, it was generally accepted that the health of African Americans was better in bondage than in freedom. Historians such as Tara Hunter, in To ‘Joy My Freedom: Southern Black Women’s Lives and Labors After the Civil War (1997), note that many physicians studied the effects of emancipation on Negro health and found that after the Civil War, blacks showed a susceptibility to insanity, typhoid, syphilis, alcoholism, idiocy, and tuberculosis. Therefore, freedom caused blacks’ mental, moral, and physical deterioration, and many believed it would lead to the extinction of African Americans. In large part, this argument was substantiated by results of comparative morbidity and mortality studies.

Frederick Hoffman, a nineteenth-century statistician for the Prudential Insurance Company, reviewed the results of censuses and doctors’ and army surveys to put forth his extinction hypothesis in “Race Traits and Tendencies of the American Negro,” published in 1896. Hoffman’s statistical evidence suggested that the Negro was susceptible to many illnesses and constitutionally unfit for survival, and thus was destined to die out. Specifically, he argued that emancipation had allowed blacks to fall into immoral living habits resulting in a decline in their vital capacity and corresponding increase in their susceptibility to disease, especially tuberculosis and other respiratory diseases. He further argued that misguided efforts such as the educational work of philanthropists played a key role in their demise. According to Hoffman, these efforts were misdirected because Negro mortality is an indication of racial traits: “It is not in the conditions of life, but in the race traits and tendencies that we find the causes of excessive mortality” (p. 95).

Responses to Hoffman’s extinction hypothesis were mixed. Many of the refutations, some from white researchers, were based on the fact that his primary data sources were incomplete and included inadequate information on African Americans. African American scholar Kelly Miller pointed out these shortcomings in his “Review of Hoffman’s Race Traits and Tendencies of the American Negro” (1897). In addition, he argued that Hoffman did not give enough weight to environmental conditions as an influence on Negro health and mortality. W. E. B. Du Bois also refuted Hoffman’s conclusions on these grounds in a 1906 paper titled “The Health and Physique of the Negro American.” Du Bois stressed the difficulty of racial classification and accepting a monolithic image of the race. Regardless of the agreement or disagreement with Hoffman’s extinction hypothesis, labeling diseases in terms of race was generally accepted during this period, almost always involving the exaggeration or misinterpretation of statistics.

The following discussion provides examples of three diseases labeled as “Negro diseases” in the nineteenth and early twentieth centuries. Each highlights the utility of examining racial diseases.

Syphilis . Siobhan Somerville, in Queering the Color Line: Race and the Invention of Homosexuality in American Culture (2000), notes that beginning in the nineteenth century, sexuality was used as a primary means for establishing racial difference and the hierarchy between whites and blacks. Negroes were thought to possess an excessive sexual desire that was seen as a threat to white society. As such, blacks were especially prone to venereal disease. As with other diseases, the high incidence of syphilis was attributed in part to emancipation. Some doctors, such as H. L. McNeil in “Syphilis in the Southern American Negro” (1915), determined that while virtually free of disease as slaves, over 50 percent of all free Negroes were prone to venereal disease. This in turn caused the high numbers of stillbirths that caused the population to dwindle, as well as increased criminal behavior and insanity. These exaggerations aided in the demonization of blacks as a threat to white society and in predictions of their extinction.

There are two important gender dimensions to the construction of syphilis as a “Negro disease.” One particular feature of blacks’ hypersexuality doctors noted was black males’ desire for white women, something thought to be specific to the Negro racial character. Neither syphilis nor the hypersexuality of black men was seen as a threat to black women because they were also characterized as hyper-sexual. While black males were the focus of discussions regarding syphilis, the examination of black female bodies provided the historical basis for establishing sexual differences that reflected racial differences. Specifically, Cuvier’s nineteenth-century anatomical study of Sarah Baartman, outlined in “Account of a Dissection of a Bushwoman” by Flower and Murie (1867), also known as the “Hottentot Venus,” initiated the practice of locating the boundaries of race through the bodies of African women. African women’s (and later African American women’s) bodies were characterized in terms of excess, especially the sexual organs, which supposedly placed her body outside the boundaries of normalcy. Her anatomy was explained by her characteristically unladylike hypersexuality. Therefore, black women were also marked as sexually deviant and diseased in their “natural” state.

While the Tuskeegee experiment is a well-known demonstration of these beliefs, medical research on the prevalence of syphilis among blacks conducted beforehand during the 1920s and 1930s contested these ideas. A study funded by the Julius Rosenwald fund in 1929 actually illustrated the success of mass treatment for syphilis among blacks in Macon County, Alabama, but the results were ignored. Rather, the high prevalence of syphilis in the county was interpreted as “an unusual opportunity” to conduct a natural study of the disease. This perspective reflects the generally accepted idea that blacks, in their “natural state,” were diseased. In addition, this logic contributed to the lack of consideration for socioeconomic factors when examining black health. The biological basis of the Negro had to be accepted as unchangeable. Not surprisingly, the exaggeration of statistics was central to the construction of this naturalized state. U.S. Public Health Service physicians at the helm of the Tuskegee experiment argued that “lust and immoralities, unstable families, reversion to barbaric tendencies” made blacks especially prone to venereal diseases. Allan Brandt, in “Racism and Research: The Case of the Tuskegee Syphilis Study” (2000), states that some doctors “estimated” that over 50 percent of blacks over the age of twenty-five were syphilitic. In reality, the rates of syphilis fell way below expectations. Therefore, research revealed more about the pathology of racism than the pathology of syphilis.

Tuberculosis . The high incidence of tuberculosis was also attributed to both the freedom and hypersexuality of blacks and was seen as a harbinger of their eventual extinction. However, during the antebellum period, tuberculosis was thought of as a white disease. Susan Craddock, in City of Plagues: Disease, Poverty and Deviance in San Francisco (1997), states that specifically it was a disease of standing, associated with the upper and artistic classes. Tuberculosis was transformed into a black disease only after the “quarantine effect” of slavery was removed.

In the segregated South, black female domestic workers were targeted in particular as disease vectors for tuberculosis. It was generally accepted that they infected whites (in most cases their employers) as a result of their daily movement between black and white worlds. Black women were targeted not only because of their mobility in and out of white households but also because of the stereotypes about black female hypersexuality. Whites considered black women as “naturally promiscuous” and depicted them as seducers of “innocent white boys.” Their bodies were receptacles for dangerous germs, including venereal diseases and tuberculosis. As such, they were considered a threat to white society.

Throughout the nineteenth and early twentieth centuries, medical research was constantly focused on determining whether tuberculosis assumed a unique form in the Negro. During the 1830s, U.S. physicians such as Louis Yandell (1831) published articles in medical journals about “Negro consumption,” “struma Africana,” and “Negro poisoning.” As indicated by the terms, doctors argued that this form of consumption was specific to blacks and was a more acute type than that found among whites. During the Civil War, black Union Army soldiers were subjected to batteries of tests and measurements to the end of identifying disease susceptibilities. The results of this study indicated that Negroes had an inferior lung capacity to whites. According to Hunt (1869), the Negro had a smaller “tropical lung” that could not function adequately in temperate climates. Although initial comparative research on Negro and white lungs was inconclusive, the inferior lung theory persisted into the twentieth century.

Researchers were also preoccupied with the possibility of isolating characteristics of susceptibility in the population. In keeping with the exploration of the “Negro problem,” these inquiries were made to the end of identifying how Negroes, now uncomfortably situated within U.S. society, were beings different from whites. The issues of Negro increase or decline in the population and the prospects of race mixing were also in the forefront of the minds of scientists. Whites were worried about the proximity of a race considered to be a vector for disease.

Research on tuberculosis gained renewed fervor in the wake of emancipation, as rates among Negroes increased. Marion Torchia, in “Tuberculosis Among Negroes: Medical Research on a Racial Disease, 1830– 1950” (1977), states that the statistics on Negro mortality from tuberculosis factored heavily in the prediction of Negro extinction. As with discussions of syphilis, emancipation allowed blacks to fall into immoral living habits resulting in a decline in their vital capacity and an increase in their susceptibility. However, some scholars (e.g., Holmes 1937) countered this logic by emphasizing consideration of socioeconomic factors in the prevalence of the disease. Others pointed out the misinterpretation of mortality statistics, arguing that results showed that Negro deaths from consumption fluctuated according to population density.

Research on Negro susceptibility to tuberculosis fell out of popularity in the late 1930s. By the 1950s, racial studies of tuberculosis were deemed particularly suspect in light of racial integration initiatives and the role that antibiotics played in nearly eradicating the disease.

Sickle Cell Anemia. Sickle cell anemia was first discovered in 1910. The disease was recognized as a Mendelian dominant disorder specific to African Americans. Therefore, it could be spread by an individual parent who carried the trait to her or his offspring. As with the other diseases discussed, this perception of heredity and the nature of the disease reflected concerns about race mixing and the general dangers of associating with Negroes brought about by emancipation. By 1925, cases of sickle cell in whites were being reported in medical journals. Rather than leading to a broader conceptualization of the disease as affecting multiple races, these cases confirmed that the disease could be spread through miscegenation: “Its occurrence depends entirely on the presence of Negro blood, even in extremely small amounts it appears that the sine qua non for the occurrence of sickle cell anemia is the presence of a strain, even remote, of Negro blood” (“Sickle Cell Anemia” 1947, p. 33).

Keith Wailoo, in “Genetic Marker of Segregation: Sickle Cell Anemia, Thalassemia and Racial Ideology in American Medical Writing, 1920–1950” (1996), states that in the 1910s and 1920s, the development of methods to identify individuals with blood that had the potential or tendency to sickle led to statistically tying sickling to race. Physicians became heavily engaged in research to confirm that sickle cell anemia was specific to the Negro. This included sampling the blood of hundreds of individuals as well as studies of individual families. Again, because of the detection of sickling among whites, attention turned to investigating this particular problem.

Such diagnostic techniques reproduced and reflected the dominant ideology, as scientists took for granted the distinction between black and white bodies. Research was used to confine sickle cell anemia to the black body and to represent the distinctiveness between black and white bodies as a product of indisputable scientific evidence. Therefore, sickle cell was employed as a test to specify who was black and white, as well as an instrument for policing the boundaries between these groups.

Diagnosing sickling in a person presumed to be white called the true racial identity of the person into question. During the 1940s, literature on individuals who could not easily be identified as black increased. In most cases, the articles made clear that the identification of sickle cells led to a closer examination of family background. Specifically, physiognomy, geography, and genealogy were relied on to clarify the picture. Faces were examined for evidence of admixture, and genealogies were examined for places of family origin where “significant crossbreeding” between blacks and whites took place. As such, the medical practice of revealing black ancestry in apparently white individuals became commonplace. This information was used to explain sickling among whites as the result of association with blacks in the remote past. Justifying the presence of sickle cell in white populations was achieved through means such as noting the geographical proximity of a country to Africa or identifying “Negro strains” in seemingly isolated populations because of historical events, such as Hannibal’s invasion of Spain.

Ironically, at the same time that this logic reinforced racial boundaries between blacks and whites, it also led to the creation of new criteria for defining and identifying true whiteness. A new set of lines was essentially drawn around the white body rather than accepting the occur-rence of sickling in the population. In other words, medical authorities used the emergence of these cases to reveal black ancestry in people who only appeared to be white, thus refining the technique of determining who was and was not “racially pure.” As noted by Melbourne Tapper (1995), this line of thinking destabilized the notion of whiteness being solely identifiable by skin color and other physical features at the same time that it reinforced the notion of racial fixity. The necessity for shifting racial boundaries to maintain racial fixity is one of the many reasons that race was rarely defined in the literature pertaining to research on racial diseases.


Each of the three diseases discussed here reveals different elements of the historical construction of racial disease. Misconceptions about syphilis reflected the way in which racial difference was constructed through an association with abnormal sexuality. Discussions about the etiology of tuberculosis indicate, among other things, the reliance upon differential physiology in delineating racial difference. The dilemma raised in the case of sickle cell speaks to the important role that disease played in creating meaning around the concept of racial purity, as well as identifying it. All three cases illustrate how maintaining racial boundaries was privileged over disease treatment and prevention. They also underscore the fact that race, be it in the past or present, is not solely articulated on the visible surface of the body.

Arguably, this practice of seeking and finding racial difference “below the skin” factors heavily into understanding what became of racial diseases. A vast amount of research in the biological sciences over the past 35 years confirms that human diversity cannot be genetically organized into racial categories. However, the rise of genetic technologies has fostered explanations of disease associated with “inherited predisposition.” As with racial diseases, the notion of “genetic disease” is at odds with epidemiological evidence that health disparities can be attributed to social and historical factors. In addition, summaries of genetics research result in the scientific and popular press often including the use of racial groups to delineate the “increased risk” that some individuals have to certain diseases. These summaries wrongfully imply that race is both a genetic reality and useful category for understanding differences in disease frequencies between human groups (Braun 2002).

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