Published On February 9, 2022
In June of 1869, three Black physicians brought their applications to the Medical Society of the District of Columbia. They were looking to become members of a local professional organization—the kind of body that was, increasingly, gatekeeping who could work in medicine. At the time, the MSDC consisted entirely of white men.
The American Medical Association had been founded in 1847, in part to bring ethics and standards to the profession. Membership to the AMA brought legitimacy, access to admitting privileges and other perks, but it was contingent on belonging to a more local society. Those local societies had leeway in deciding whom to admit, and the Washington D.C. Society chose to turn down the Black applicants. The battle that ensued led to a shameful episode, one that still echoes through the medical profession. As one Society member, Samuel C. Busey, later noted, “the disturbance….was the most angry, turbulent, and widespread of any that has occurred.”
One of the men rejected was Major Alexander Thomas Augusta, a physician of extraordinary bravery and talents. He had learned to read and write in secret from an Episcopalian priest, since it was illegal to educate Black people in the state of Virginia. Despite his extraordinary intelligence, Augusta was denied entry to the University of Pennsylvania’s medical school. He was able to procure some private tutoring from a sympathetic faculty member before traveling to more tolerant Toronto to get his medical degree and practice.
When the Civil War broke out, Augusta returned to the United States to enlist, moved by the chance to help enslaved Black people. The Army Medical Board denied him a post as “a person of African descent,” but Augusta wrote to Abraham Lincoln himself. Wheels turned and he got the job, becoming the first African American medical officer in the U.S. Army.
But the wartime violence he experienced came, all too often, from his own side. Augusta was punched in the face while in uniform on a Baltimore train platform; an angry mob ripped off his epaulettes, shouting, “Lynch the scoundrel!” “Hang the Negro!” In the Army, his white subordinates often refused to work with him.
In time Augusta was transferred to the new Freedmen’s Hospital in Washington D.C., where he became the first Black person to head a hospital. In the final year of the war, Lincoln invited Augusta and his assistant, fellow Black physician Anderson Abbott, to attend a reception at the White House. They were met by hostility from fellow guests and Abbott said that the two could not have “created more surprise if we had been dropped down upon them through the skylight.”
The end of the Civil War should have led the war hero to a quiet, distinguished practice. Instead, not being a member of the local medical society made his work impossible. AMA members refused to socialize with or provide ongoing education to nonmembers. When called to consult at a patient’s bedside, they would simply refuse to speak to Augusta, sometimes taking his patients.
Not a man to back down, Augusta co-founded an entirely new group, the National Medical Society (NMS), open to physicians of all races. The fledgling group petitioned the AMA to join. Moreover, as the group was in the nation’s capital, they petitioned Congress to revoke the white Society’s charter, on the grounds of its discriminatory policies.
A barrage of heartbreaks followed. A Senate investigation confirmed that their exclusion from the white Society had been racially motivated, and Senator Charles Sumner of Massachusetts introduced a bill to revoke the discriminatory D.C. group’s charter. Sumner, a full-throated civil rights advocate, blasted them in a scathing report, particularly one MSDC member’s comment that denying the Black doctors had been “simply a question of taste”: “Then is the Declaration of Independence ‘simply a question of taste.’ Then are human rights ‘simply a question of taste,’…it is painful to think that this pretension must bring discredit upon the medical profession in our country.” Despite Sumner’s efforts, the bill met with opposition as a “controversial matter” and went no further.
The AMA also failed to help Augusta. At the time, several societies were allowing in questionable members, such as homeopaths, who had medical qualifications that were less than sterling. The D.C. society was one of those, which the Black physicians were quick to point out. In a roll-call vote, all of the white groups with unqualified members were allowed to remain in the AMA. But Augusta’s NMS, with qualified Black members, was not allowed to join.
To add insult to injury, the AMA also voted on establishing an institutional non-discrimination policy. It lost, 106 to 60. Then the group voted once more to expunge that vote from official AMA records.
In the years that followed, Black physicians—who remained largely excluded from AMA membership—founded their own state societies in Texas, North Carolina and New Jersey. These efforts culminated with the establishment of the National Medical Association in 1895, whose members were almost all Black. It still exists today.
In 2008, the AMA apologized for policies that had excluded Black physicians for more than a century. The damage has proved lasting and hard to reverse. Only about 5% of AMA members identified as Black in 2019, and the profession at large is less integrated than many other professions, with medical school faculty roles especially dominated by white men. Even among the younger generations, only 11.3% of first-year medical students in 2021 were Black or African American, up from 9.5% the year before. Black people make up about 12% of the U.S. population.
The AMA is working with a number of other organizations to seed a more diverse pool of physicians, particularly Black men. Efforts include focused recruitment, revising medical school admissions to make them less reliant on standardized tools like the MCAT, and addressing bias in classrooms and wards. Much of the change, however, will come from the success and visibility of Black physicians, as it did for the medical colleagues of Augusta, one of whom said that the man’s service and dedication “stirred the faintest heart to faith in the new destiny of [his] race.”
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