Race and medical practice in kansas city's free dispensary

Bulletin of the History of Medicine

Volumn 82, Issue 4, 2008, Pages 820-847

  Crenner, Christopher ^a  

^a UNIVERSITY OF KANSAS SCHOOL OF MEDICINE   (United States)

Author keywords

African americans; Dispensary; Jews; Kansas city; Medical practice; Patient records; Race; Scientific racism

Indexed keywords

AFRICAN AMERICAN; ARTICLE; HEALTH CARE DELIVERY; HEALTH DISPARITY; HISTORY; HUMAN; JEW; RACE; SOCIAL PSYCHOLOGY; SOCIAL WELFARE; UNITED STATES;

AFRICAN AMERICANS; ALMSHOUSES; CONTINENTAL POPULATION GROUPS; DELIVERY OF HEALTH CARE; HEALTH STATUS DISPARITIES; HISTORY, 20TH CENTURY; HUMANS; JEWS; KANSAS; MISSOURI; PREJUDICE; UNITED STATES;

EID: 60749103429     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (77)

1. Six volumes of handwritten patient records from the Free Dispensary are in the Archives of the University of Kansas Medical Center, Kansas City, Kansas. These volumes are part of a large, uncataloged collection of patient records. I use the following system to reference them: vol. A, 6 February 1910-15 October 1910, pp. 1-262 [Surgical and Venereal]; vol. B, 26 October 1910-1 April 1912, pp. 1-231 [Surgical and Venereal]; vol. C, 21 September 1907-8 March 1912, pp. 1-191 [Medicine]; vol. D, 20 September 1910-16 February 1912, pp. 1-108 [Medicine]; vol. E, 16 September 1907-31 January 1910, pp. 1-293 [Pediatric]; vol. F, 4 September 1906-14 January 1910, pp. 1-582 [Surgical and Venereal]. The entries by Hissem, Teachenor, and Brownlee appear in Dispensary, vol. A, pp. 9-21, and vol. D, p. 4.
2. Research on these records was conducted with approval from the Human Subjects Committee of the University of Kansas Medical Center after a full review (HSC No. 9963). For the purposes of this analysis I accepted racial designations as they were given in these documents and have avoided the practice of placing quotations marks around the terms. I have typically substituted present-day terminology in my discussion, but I capitalized racial terms in the style of the time when referring to them collectively as a system of classification, partly for consistency with terms used similarly in the time, such as Irish, Jewish, and American. We know that senior medical students at the University of Kansas School of Medicine in 1910 would have been considered white on the basis of the policy of the school in that period.
3. For the relationship of black health and urban migration
4. See Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill: University of North Carolina, 2001), pp. 25-54. On the Exodusters
5. See Nell Irvin Painter, Exodusters: Black Migration to Kansas After Reconstruction (New York: Alfred Knopf, 1977). For migration to Kansas City and urban, racial politics
6. See Sherry Lamb Schirmer, A City Divided: The Racial Landscape of Kansas City, 1900-1960. (Columbia: University of Missouri Press, 2002), who also discusses the Exodusters on pp. 27, 30-31. A nice review of the cultural development of the city can be found in Nathan W. Pearson, Jr., Goin' to Kansas City (Urbana: University of Illinois Press, 1987).
7. Reform-minded anxieties about the city's black citizens are sharply expressed in Asa Martin, Our Negro Population: A Sociological Study of the Negroes of Kansas City, Missouri (Kansas City, Mo.: Franklin Hudson Publishing, 1913). For a survey of the rise of eugenics,
8. See Daniel J. Kevles, In the Name of Eugenics: Genetics and the Uses of Human Heredity (Cambridge: Harvard University Press, 1995); and for a direct statement of its relation to racial science,
9. Elazar Barkan, The Retreat of Scientific Racism: Changing Concepts of Race in Britain and the United States Between the World Wars (New York: Cambridge University Press, 1992), pp. 66-134. A valuable alternative debate on racial sciences is examined in Mitchell B. Hart, Social Science and the Politics of Modern Jewish Identity (Stanford: Stanford University Press, 2000), pp. 74 -95 (eugenics), pp. 96-138 (medicine). A clear survey of medical support for white racial ideology appears in George M. Frederickson, The Black Image in the White Mind: The Debate on Afro-American Character and Destiny, 1817-1914 (Hanover, N.H.: Wesleyan University Press, 1987), esp. pp. 228-55; cf. the opening chapter on race, eugenics, and medicine in Alexandra Minna Stern, Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America (Berkeley: University of California Press, 2005), pp. 27-56. On the local medical debate in Kansas City,
10. See, e.g., John W. Kyger, "On the Decadence of the American Race," Kansas City Medical Index-Lancet, 1902, 23(3): 125-29.
11. For specific writers of the time on medical science and racial ideology, see Frederickson, Black Image (n. 4), pp. 229, 248, and 252; for general framing of the issue, see Keith Wailoo, "Genetic Marker of Segregation: Sickle Cell Anemia, Thalassemia, and Racial Ideology in American Medical Writing, 1920-1950," Hist. Philos. Life Sci., 1996, 18 : 305-20. For the distinctions among white southern proposals for race relations in the wake of the collapse of Reconstruction, see C. Vann Woodward, The Strange Career of Jim Crow (New York: Oxford University Press, 1966), pp. 44-45.
12. Charles Rosenberg, "Social Class and Medical Care in 19th-Century America: The Rise and Fall of the Dispensary," in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. Judith Walzer Leavitt and Ronald L. Numbers (Madison: University of Wisconsin Press, 1985), pp. 273-86.
13. Council on Medical Education and Hospitals, "Dispensary Service in the United States," JAMA, 1922, 79 : 464 -75, quote on p. 465.
14. Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), pp. 152-90.
15. University of Kansas, Fortieth Annual Catalogue of the University of Kansas for the Year 1905-06 (Lawrence: State Printing Office, 1906), pp. 321-23; University of Kansas, Fortieth Annual Catalogue of the University of Kansas for the Year 1911-12 (Lawrence: State Printing Office, 1912), pp. 307-14. Operating outside the merger for a brief period was the University Medical College of Kansas City, which also prominently advertised its free dispensary facilities in its cataloge: University Medical College Announcement, 1901-1902 (Kansas City, Mo.: Union Bank Note Co., 1902), p. 11; in the collections of the Archives of the University of Kansas Medical Center, Kansas City, Kansas.
16. Dr. Goldman's records are contained in Dispensary (n. 1), vol. E, pp. 1-293.
17. Dispensary (n. 1), vol. D, p. 32.
18. Dispensary (n. 1), vol. F, p. 356; vol. A, p. 167.
19. See, e.g., Dispensary (n. 1), vol. E, pp. 66 and 270.
20. Dispensary (n. 1), vol. F, pp. 483 and 169, respectively; vol. C, p. 2.
21. Dispensary (n. 1), vol. F, pp. 370 and 208, respectively; vol. C, p. 140; vol. B, pp. 80 and 63, respectively.
22. Dispensary (n. 1), vol. B, p. 202.
23. Elizabeth Lunbeck, The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America (Princeton: Princeton University Press, 1994), pp. 121-26. Dispensary (n. 1), vol. F, pp. 364 -577, in records from January through December 1909. The designation as Irish in one complete volume of medical records seemed to apply only to men, with women bearing Irish surnames classified as White. Classification as Irish in this volume seemed to trigger special attention to the excessive use of alcohol: Dispensary, vol. C, pp. 4, 9, 121, 146, and 148.
24. Two introductory medical textbooks of the period found on the shelves of the library in the University of Kansas School of Medicine are Hobart Amory Hare, Practical Diagnosis: The Use of Symptoms in the Diagnosis of Disease, 3rd ed. (Philadelphia: Lea Brothers, 1898) and John H. Musser, A Practical Treatise on Medical Diagnosis for Students and Physicians, 2nd ed. (Philadelphia: Lea Brothers, 1898).
25. Dispensary (n. 1), vol. D, p. 78.
26. Ibid.
27. Dispensary (n. 1), vol. D, p. 21.
28. Dispensary (n. 1), vol. D, p. 44.
29. The textbooks cited above from the Medical School library were similarly restrained on the topic of racial differences in the physical examination, only occasionally acknowledging its relevance, and then in the examination of the skin: see e.g., Hare, Practical Diagnosis (n. 18), p. 201, on the skin of "the white race"; cf. Musser, A Practical Treatise (n. 18), p. 69.
30. Dispensary (n. 1), vol. D, p. 38.
31. Dispensary (n. 1), vol. C, p. 187.
32. Dispensary (n. 1), vol. A, p. 52.
33. Dispensary (n. 1), vol. D, p. 38 and 39; vol. A, p. 53.
34. See Dispensary (n. 1), vol. E, p. 270, for an example of a note partly written by a student that includes race surrounded by a long run of notes before and after written by Goldman himself, omitting race. The records in 1907 have more student entries, but increasingly in 1908, Goldman took over these notes. An early, perhaps unique, slip by Goldman in which he inserted "col[ored]" into a note that he signed appears on p. 20. For early instances in which the students categorized pediatric patients as "Hebrew," see pp. 37 and 42; in this context it is worth noting the occasional references to Jewish patients by Goldman's colleagues in denigrating terms, as, e.g., a "Heb[rew]" who was "an hysteric old woman," vol. D, p. 43.
35. John S. Haller, Jr., Outcasts from Evolution: Scientific Attitudes of Racial Inferiority, 1859-1900 (Chicago: University of Illinois Press, 1971), pp. 40-68.
36. Frederick L. Hoffman, Race Traits and Tendencies of the American Negro (New York: Macmillan, 1896). For a discussion of Hoffman's writings in the larger context of racial science, see Frederickson, Black Image (n. 4), pp. 249-53. Although Hoffman is frequently cited for this early essay, he wrote prolifically on a variety of subjects unrelated to race.
37. W. T. English, "The Negro Problem from the Physician's Point of View," Atlanta Journal-Record of Medicine, 1903, 5: 459-72, quote on p. 462.
38. The outpatient venereal disease clinics at Johns Hopkins Hospital in the 1920s hosted a team of physicians who produced multiple papers documenting major clinical differences geniin syphilis in white and in black patients, which they ascribed to specific biological racial differences: Ernest L. Zimmerman, "A Comparative Study of Syphilis in Whites and in Negroes," Arch. Derm. Syphilol., 1921, 4 : 75-88; Thomas B. Turner, "The Race and Sex Distribution of the Lesion of Syphilis in 10,000 Cases," Bull. Johns Hopkins Hosp., 1930, 42 : 159-84.
39. English, "Negro Problem" (n. 31); Editorial, "Genital Peculiarities of the Negro," Atlanta Journal-Record of Medicine, 1903, 4: 842-44;
40. William Lee Howard, "The Negro as a Distinct Ethnic Factor in Civilization," Medicine (Detroit), 1903, 9: 423-26;
41. E. M. Hummel, "The Rarity of Tabetic and Paretic Conditions in the Negro," JAMA, 1911, 56: 1645-46;
42. Hunter McGuire and G. Frank Lydston, "Sexual Crimes Among the Southern Negro: Scientifically Considered," Va. Med. Mon., 1893, 20: 105-25;
43. Daniel David Quillian, "Racial Peculiarities as a Cause of the Prevalence of Syphilis in Negros," Medical Era (St. Louis), 1911, 20: 416-18. Medical opinion did not remain insulated within the journals, being cited in the daily newspapers to support such causes as the use of surgical castration as an alternative to lynching:
44. Philip Dray, At the Hands of Persons Unknown: The Lynching of Black America (New York: Modern Library, 2003), pp. 130, 144 -45.
45. See Dispensary (n. 1), vol. A, pp. 1-262, 218 patients, and vol. B, pp. 1-231, 189 patients; and vol. F, pp. 1-582, 572 patients. Among the other racial terms appearing were American and Mo[issouri?]. These patients, with embarrassing and stigmatized conditions, may have found care at the Free Dispensary appealingly anonymous. Black patients might especially appreciate that a constantly rotating group of white students and physicians would have little association with the surrounding North End neighborhood. The other local options for African American patients were established black physicians nearby, one of whom had a private medical office near the dispensary on Independence Avenue. But within a small and close-knit community, such news might spread easily. Medical commentators of the time commented on a similar behavior among white men with syphilis, who sought care from black physicians:
46. H. H. Hazen, "Syphilis in the American Negro," JAMA, 1914, 63 : 463-66, quote on p. 464. See also Thomas J. Ward, Jr., Black Physicians in the Jim Crow South (Fayetteville, Arkansas: University of Arkansas Press, 2003), p. 150.
47. Dispensary (n. 1), vol. B, p. 46.
48. See a further example of speculation on genital difference including issues of the foreskin related to venereal disease in Eugene R. Corson, "Syphilis in the Negro," American Journal of Dermatology and Genito-Urinary Diseases, 1906, 10: 240-47.
49. See, cf., observations such as "tonsils about normal," "lungs normal," "liver about normal," or even less commonly, the emphatic "no abnormality": Dispensary (n. 1), vol. B, p. 13; vol. A, p. 231; vol. B, p. 12; vol. A, p. 18.
50. Dispensary (n. 1), vol. B, pp. 34, 123, and 88, respectively; vol. A, p. 190.
51. Normal finding occurred in one of thirty-four examinations for phimosis among White patients and in four of fifty-nine examinations for phimosis among black patients, which is not significantly different by Fisher's exact test. Among the abnormalities purported to affect black male genitalia were an unusually long foreskin and the rare condition called varicocoele. I found mention of a long foreskin in 12% (four of thirty-four) of physical examinations of white patients with venereal disease and in 15% (nine of fifty-nine) of examinations of black patients, a nonsignficant difference according to Fisher's Exact Test. One white man and one black man were found to have varicocoele. On these specific racial differences, see "Genital Peculiarities" (n. 33).
52. Martin S. Pernick, A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth-Century America (New York: Columbia University Press, 1985), pp. 148-67, and especially on African Americans, pp. 154 -60.
53. Howard, "Ethnic Factor" (n. 33), p. 424; "Genital Peculiarities" (n. 33), p. 843. Notorious published correspondence between the president of the American Medical Association and a Chicago surgeon gave sustained arguments for surgical castration and "penile mutilation" as a means for preventing the rape of white women by blacks: McGuire and Lydston, "Sexual Crimes" (n. 33).
54. Dispensary (n. 1), vol. F, pp. 94 and 201. Cf. another entry on "anesthesia" for a local farmer described as colored who had excision of an infected cyst "under local anesthesia (drunk)," vol. F, p. 322.
55. Dispensary (n. 1), vol. F, pp. 522, 422, 441, 104, 409, and 516, respectively.
56. Dispensary (n. 1), vol. F, p. 516.
57. I found only four instances in which dispensary physicians identified their treatments as "placebo" treatments. In two cases, the patients were identified as colored; in one case, the racial designation is illegible; and in the final case, the racial designation is absent, although the street address locates the patient in a largely black neighborhood: Dispensary (n. 1), vol. F, pp. 83, 133, 128, and 100, respectively. The racial composition of neighborhoods on the basis of census data appears in Schirmer, A City Divided (n. 3).
58. For the history of the film and novel, see John Hope Franklin, "'The Birth of a Nation': History as Propaganda," in Race and History: Selected Essays 1938-1988 (Baton Rouge: Louisiana State University Press: 1989), pp. 10-23. An interested reader can examine the original typed manuscript of this important review, which University of California Berkeley has put online: http://www.mip.berkeley.edu/cgi-bin/cine-doc-detail.pl/cine-img?5557? 5557?1 (accessed March 2008).
59. A closely related discussion of the charismatic champion boxer Jack Johnson and his cross-race relationships appears in Dray, The Lynching of Black America (n. 33), pp. 192-96. For the film and related events in Kansas City, see Schirmer, A City Divided (n. 3), pp. 81, 122, and 127-28.
60. A grid showing the students from the class of 1911 scheduled into the sections of the Free Dispensary for 1910 appears as an appended note at the end of vol. A and omits Etling and Anderson.
61. See, e.g., Anderson's write-up on case no. 985, in volume of case histories 976-1000, Eleanor Taylor Bell Memorial Hospital, Department of Gynecology, Archives of the University of Kansas Medical Center, Kansas City, Kansas. Anderson's white male classmates were permitted to see black female patients on the same hospital gynecology service: see case no. 948, Eleanor Taylor Bell Memorial Hospital, Department of Gynecology, on the presence of John Gilliland as a student.
62. Anonymous, "Dr. Thomas Conrad Unthank: The 'Father' of Kansas City's Negro Hospital," Jackson County Medical Journal, 1932, October: 26-27; also Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York: Oxford University Press, 1995), pp. 8-10; and Schirmer, A City Divided (n. 3), pp. 66-71.
63. Woodward, Strange Career (n. 5), p. 98.
64. Dispensary (n. 1), vol. B, p. 154.
65. Gamble, Making a Place (n. 50), pp. 8-10, 165.
66. Richard Matthew Fletcher, Jr., "Surgical Peculiarities of the Negro Race," Transactions [of the] Annual Session of the Medical Association of the State of Alabama, 1898, pp. 49-57, quote on p. 51.
67. Mark M. Smith, How Race Is Made: Slavery, Segregation, and the Senses (Chapel Hill: University of North Carolina, 2006), pp. 76-95.
68. An influential statement of related ideals appears in William Osler's address to the students at the University of Pennsylvania in 1889: "Aequanimitas," reprinted, e.g., in Aequanimitas With Other Addresses to Medical Students, Nurses and Practitioners of Medicine (Philadelphia: P. Blakiston's Son, 1932), pp. 3-11. For focused historical analysis of the concept,
69. See Lynda Payne, With Words and Knives: Learning Medical Dispassion in Early Modern England (London: Ashgate, 2007). Related concepts are examined by Susan C. Lawrence, "Anatomy and Address: Creating Medical Gentlemen in Eighteenth-Century London," in The History of Medical Education in Britain, vol. 30 of Clio Medica, ed. Vivian Nutton and Roy Porter (Amsterdam: Rodopi, 1995), pp. 199-228.
70. On these two in particular, see Dispensary (n. 1), vol. B, p. 103; vol. F, p. 83.
71. On the forms of white privilege, see Elizabeth Grace Hale, Making Whiteness: The Culture of Segregation in the South 1890-1940 (New York: Vintage Books, 1999).
72. William S. Thayer, "On Some Functions of the Free Dispensary," Boston Med. Surg. J., 1913, 168: 185-88, quote on p. 186.
73. Louis Hamman, "The Use of Dispensary in the Teaching of Clinical Medicine," South. Med. J., 1923, 16: 309-12, quote on p. 312.
74. Ibid.
75. A. R. Warner, "Dispensary Abuse," JAMA, 1913, 60 : 738-41, quotes on p. 741.
76. See an analysis of this debate in Rosenberg, "Social Class and Medical Care" (n. 6), pp. 282-83.
77. The case was made for British physicians in Barkan, The Retreat of Scientific Racism (n. 4), pp. 260-66; and see a medically informed rejection of the idea of a fixed Jewish racial inferiority by the physician Maurice Fishberg, a friend and colleague of Franz Boas, discussed in Hart, Social Science (n. 4), pp. 158-68.