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Health before Civilization

Early on, many doctors followed the lead of Benjamin Rush, who argued that insanity and tuberculosis were rare among Africans and Indigenous Americans. Rush attributed Indigenous Americans’ vigor to “their principal occupations,” specifically their lives spent in “war, fishing and hunting.” A New York physician in 1847 emphasized diet: “Phthisis is almost unknown amongst the Hebrews. The Indian races and the African tribes which adhere to their primitive diet — similar to that prescribed by the wisdom of the Jewish lawgiver — enjoy the same immunity.” An 1893 essay on tuberculosis argued that “Nature when left to herself is a very wise mother.” Unfortunately, “civilization — so-called — sometimes woefully interferes with her and thwarts her evident intentions. The savage, obeying nature, lives out of doors, bathed in sunshine and fresh air. He is physically active, which compels him to breathe deeply and fully. He runs, swims, climbs; all of which exercises are excellent for producing large lung capacity and ample chest expansion. Not so, however, is it with the civilized man.” Early writings praising the health of allegedly primitive Africans and Indigenous Americans contrasted them with “civilized” White Americans.

Doctors also invoked race in examining the origins of insanity. An 1845 excerpt reprinted from the American Journal of Insanity included testimonials from several physicians. A doctor who participated in the Cherokee removals “never saw or heard of a case of insanity among them.” Joseph Cinqué and other Africans who escaped La Amistad and won freedom from slavery reported that “insanity was very rare in their native country.” Doctors offered unflattering explanations for this mental health. An 1851 address explained that the intellect of the “poor and uneducated…rusty by disuse, is less under the influence of excitement; their feelings are duller; their nerves less sensitive.…Hence it is that amongst the savage tribes, where the mind is totally uncultivated, insanity is comparatively rare.” This explanation echoes Edward Jarvis’s 1842 claim that slavery, by removing “some of the liabilities and dangers of active self-direction,” protected enslaved Africans from insanity: “If the mental powers and the propensities are kept comparatively dormant, certainly they must suffer much less from misdirection or over-action.”

Health disparities worked in both directions. If something protected Indigenous Americans and enslaved Africans against tuberculosis and insanity, something else left them vulnerable to the ill effects of alcohol. As Samuel Cartwright explained in 1853, “a nation of intemperate people will soon become extinct, if both sexes be so; short-lived, rheumatic and consumptive, if only one be. The Indian nations, one after the other, are disappearing — both sexes being intemperate.” Africans’ prospects were equally poor: “The black race, like the red, diminish faster than they multiply in the free States, Hayti, Canada, Sierra Leone, and wherever they have free access to spirituous liquors.…Their own will is too weak, with the scent of that substance in their wide nostrils, to prevent them from leaving all industrious pursuits, and the places of religious and moral instruction, for the haunts of dissipation.” Such confident, sweeping, racist generalizations appeared often, impugning not just Africans and Indigenous Americans, but also Jewish people, Catholics, Irish immigrants, Germans, and Mexican Americans. Systems of racial thought evolved over time, changing who could be included in the White elite in the United States.

The Crisis of Health and Civilization after the Civil War

White physicians asserted that any health protections that Indigenous Americans and enslaved people might have had disappeared under the pressures of “civilization.” An Illinois physician in 1863 described how tuberculosis increased among “the Red Man” when “their hunting grounds became settled by the white man” and “exterminating wars waged against them caused a scarcity of corn.”17 When a Boston doctor traveled to Barbados in 1867, he heard that rates of tuberculosis and insanity had increased after emancipation. Local physicians blamed changed diets: “Since the abolition of slavery, the diet of the blacks has probably been less nutritious than when they were not obliged to provide for themselves, consisting now chiefly of Indian meal, sweet potatoes and flying fish.”

Thomas Mays, writing in 1897, was struck by parallel increases in insanity and tuberculosis. When Black people were “precipitated into the midst of a higher civilization,” they were “unequal to the task” and fell “prey to disease”: “the brunt of the battle in this contest falls on and vitiates the brain and nervous system, since these structures are the instruments through which his efforts are chiefly made to bring himself in harmony with his changed relations. He, therefore, becomes insane and phthisical because his nervous system is undermined by and disintegrates under strains and burdens which he is unable to resist or to counteract.” This fate was not inevitable. Tuberculosis could be prevented among African Americans by impressing “the masses with the importance of leading a life similar to that (excepting slavery), which made the slave population of the South practically immune from this disease before the Civil War.” African Americans needed to adopt proper hygiene, diet, and clothing, to engage in useful labor, to shun “strong drink and other vices,” and to seek “effective medical attendance and nursing.”

Medical discourse soon polarized, with protagonists contesting the role of environment, habits, and heredity. Speaking in 1907, one doctor argued that although Indigenous Americans “are not inherently more liable to infection with tuberculosis than is a white man under like circumstances, their exceedingly filthy habits and fondness for liquor and unventilated dwellings make the mortality from phthisis great.” Heredity played “a secondary part”: “The principal cause is a man’s life habits.”

Other commentators disagreed. A Baltimore physician asserted that the “great increase in the susceptibility of the negro cannot alone be accounted for by conditions of ignorance and lack of hygienic laws, and can only be explained by assuming that in the evolution of the race it has not acquired the same powers of resistance or immunity to the germ of tuberculosis, that has been acquired by some of the white peoples.” Another doctor wrote similarly about Indigenous Americans: “Sioux Indians, who are the flower of the Indian tribes, living in a healthful climate, well fed and comfortably housed, show a death-rate from tuberculosis of more than fifteen times that of the whites…working in the virgin soil of the American Indians, the same tubercle bacilli produce a rather different and much more virulent disease.”

Heredity, however, could be malleable. Doctors theorized that races gained resistance through long exposure. Whereas susceptible Indigenous Americans resembled “non-tubercularized tropical natives,” African Americans had been “largely tuberculized while in slavery.” African Americans, however, could still contract tuberculosis because of “their unhygienic mode of life and excesses.” Despite such competing theories, assertions of racial susceptibility persisted. Army physicians studying tuberculosis data after World War II noted that “Negroes” and Indigenous Americans were over-represented: “it seems fair to conclude that they are more susceptible than the average soldiers.”