In March of 1864, a Massachusetts nurse named Rebecca Lee Crumpler became the first Black woman to graduate from an American medical school. Not long afterward, she headed for the South, where 4 million people had just been set free. She took a job with a federal office called the Freedmen’s Bureau Medical Division. She was one of about 120 doctors assigned the task of looking after the health of the entire emancipated population—which was dying at a stunning rate in the throes of a smallpox epidemic, rampant malnutrition, and inadequate shelter.
Crumpler’s post was a Freedmen’s hospital in Richmond, Virginia, where she was subjected to intense discrimination by her colleagues. “Doctors snubbed her, druggists balked at filling her prescriptions, and some people wisecracked that the MD behind her name stood for nothing more than ‘mule driver,’” according to an Ebony article from 1964. The hospital was also, in a sense, set up to fail. The entire idea of the Freedmen’s Bureau Medical Division was seen by some American leaders as a waste of time. Black people, they believed, were uniquely vulnerable to smallpox, syphilis, and other contagious diseases. “No charitable Black scheme can wash out the color of the Negro, change his inferior nature, or save him from his inevitable fate,” one Ohio congressman said in arguing against the bureau’s creation.
Crumpler left the South in 1869, but she didn’t abandon it. She just changed strategy. In 1883 she bypassed the white medical system altogether and published a book of medical advice targeted at mothers and nurses—on things like nutrition, breastfeeding, how to treat burns, and how to prevent cholera. She called it A Book of Medical Discourses in Two Parts, and she hoped it might end up “in the hands of every woman.”
Some writers have compared Crumpler’s book, which was unusual for its time, to an early version of Our Bodies, Ourselves. The historian Jim Downs argues it was also an implicit “rebuttal to the prevailing idea” that Black people were physiologically doomed—because it focused on what Crumpler called “the possibilities of prevention.” The book is anything but a polemic, but there are a few lines toward the end of the introduction that feel like a subtweet of the entire racist medical establishment: “They seem to forget that there is a cause for every ailment,” she writes, “and that it may be in their power to remove it.”
Sadly, American medicine didn’t get the message. One year after Crumpler died, in 1896, a statistician working for the Prudential Life Insurance Company named Frederick L. Hoffman published a book called Race Traits and Tendencies of the American Negro. Drawing on statistical analysis of numerous data sources, Hoffman set out to prove once and for all that free Black people were dying off not because of social conditions but because of their “inferior vital capacity.” He concluded that they were bound for extinction (and were therefore uninsurable at anything but the highest rates).
Hoffman’s work, and its so-called extinction thesis, quickly became pillars of American scholarship; white contemporaries swooned over his tables and tables of data. But a few people swiftly pointed out that Hoffman’s actual analysis of all that data was a hot mess. One of them was a 28-year-old researcher named W. E. B. Du Bois. (He showed, among other things, that white people in some European cities were dying at higher rates than American Black people were.)
As a young academic, Du Bois believed that American authorities discounted the social conditions of Black life simply because they did not see them clearly enough. So he set out on a mammoth and unusual study of his own—one that would be as deeply investigated and tightly focused as Hoffman’s had been high-handed, sloppy, incurious, and shallow.