MEDICAL APARTHEID: The Dark History Of Medical Experimentation

On Black Americans From Colonial Times To The Present:    by Harriet A. Washington,  Published by Doubleday, copyright 2006, 404 pages, $27.95 

THE ETHNIC CLEANSING OF PALESTINE:  by Ilan Pappe, Published by Oneworld Publications Limited, copyright 2006,  261 pages, $27.50


The study of History, its lessons, its meanings, its relevance,  has through the centuries accumulated its share of clichés from Marx “ History repeats itself, first as tragedy then as farce” to Henry Ford “History is bunk”. No matter how clever we are we can’t hope to confront the problems and perplexities of the present and future successfully without an understanding of the past.  That’s also a cliche` but when the past we are considering is painful and disruptive to our worldview it becomes vulnerable to denial.   It is in this spirit that I consider here two outstanding books of history whose importance looms large in the present: “MEDICAL APARTHEID: The Dark History Of Medical Experimentation On Black Americans From Colonial Times To The Present” by Harriet A. Washington and “THE ETHNIC CLEANSING OF PALESTINE” by Professor Ilan Pappe.  While Washington’s book is a broad historical survey covering more than 200 years of the relationship between the medical establishment and American blacks, Pappe’s book focuses primarily on events  during the brief period from 1947 to 1949 and the birth of the state of Israel.  Both books shake the reader’s confidence in our ability to create institutions of authority that faithfully project our ethical values.    


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Harriet Washington is a medical ethicist and journalist. She has been a fellow in ethics at Harvard Medical School, at the Harvard School Of Public Health, a Knight fellow at Stanford University and a senior research scholar at Tuskegee University.  Some years ago while working on a project in a hospital in upstate New York she came across some old neglected files from the 1970’s and noticed two cases of elderly men who had similar conditions and were in need of a kidney transplant. One was white, the other black. The disparity in their treatment startled her. The former was earmarked for a transplant while the latter was being prepared for death. This was the spark that ignited Harriet Washington to begin an exhaustive research project of the historical relationship going back to colonial times between blacks and the American medical establishment.  What she brings to light should be mandatory reading for every American.

The Tuskegee experiments  on black men suffering from syphilis,  first exposed in the 1970s,  are now more or less familiar to the broader literate public, particularly after Bill Clinton issued a formal apology to the families involved in the early 1990s. In these experiments, black syphilitic men were deceived into believing that they were being given medical treatment in a program when actually they were being studied to learn more about how the disease progresses.  While the public was outraged, what was never understood or fully explored was that there was a long history behind Tuskegee. 

The relationship between physicians and blacks goes back to the beginnings of slavery when doctors were hired by slaveowners.  The interest of the slaveowner in the health of slaves was limited to the slaves’ usefulness in the process of production but that’s all.  This resulted in a quality of care where

“planters provided professional medical care only when they deemed it necessary to save the slave’s life – often too late”   pg. 30 

Through a varied assortment of archives, medical records, letters, testimonies, and documents of one sort or another Washington pieces together a depressing portrait of medicine in the old south. Beyond the generally abysmal care afforded slaves, the fact that they had no legal rights whatsoever made them prey to medical experimentation without their consent. And this is what in fact happened regularly and quite mercilessly either by the local practitioner who wanted to test his own original remedy for a simple stomachache to the more elaborate experiments conducted by some who would eventually achieve international recognition. One example was Dr. James Marion Sims a gynecologist who became famous for developing pioneering  procedures in women’s health. All of his quite painful experimentation was done on slaves. All the benefits of his research went to white women.

At the heart of ante-bellum medicine was the spector of scientific racism. This is the powerful sub-theme of the book, lurking below the surface everywhere and Washington flushes it out with skill. At the root of scientific racism was the notion that Blacks were different, a subspecies from which a whole host of dubious assumptions would flow. The famous Swedish naturalist Carolus Linnaeus categorized Africans as:

“…. ‘Homo afer’, theorizing that black men had different evolutionary forebears and had evolved along a separate evolutionary track from white men.” Pg.33  

Having established blacks as separate one could then proceed with creating notions of inferiority based on cranial size, or that they possessed other undesirable traits such as being liars, malingerers, hypersexual, etc. or that nature made them more fit for hard labor in the hot sun, or that they were incapable of being free.  Thus the science coupled with the medical establishment  evolved in the interest of  slaveowners 

“This science also served a critical political purpose, for it provided a biological and ethical rationale for enslavement. Historical documents reveal that African Americans recognized this hazardous medical agenda and resisted when they could.”    Pg. 33 

The book progresses chronologically into the post civil war period through to modern times. Most of the more flagrant abuses of the slave period begin to subside in the 20th century, however other forms of exploitation evolved and many of the myths and stereotypes persist today. Whereas blacks were once specifically targeted for abuse during slavery, in the modern era, in addition to race, their economic and educational weaknesses left them vulnerable to exploitation. This leads Washington to devote some time to questioning the whole notion of legal consent. She goes on to chronicle the widespread theft of cadavers from mostly black cemeteries to be used for research in medical schools, and the use of eugenics and sterilization to control the black birth rate, the disproportionate use of blacks in radiation experiments in the 1940’ and 50s, and on to the exploitive use of prisoners for medical research.

Medical Apartheid is rich in detail, almost encyclopedic in character and very meticulously documented, an empirical tour de force. And yet Washington is such a wonderful writer.  There is an uncommon flow to her prose style for someone whose subject requires precision and unavoidable reference to technical medical terminology which she explains with clarity and ease.  Written remarkably without rancor the author makes very clear why she wrote the book.

She sees in many African Americans an inherent distrust of the medical establishment which only works to their detriment as they understandably shy away from participating in medical research projects that could be beneficial when conducted ethically. By educating them she hopes to empower them to protect themselves. 

 Apart from that enormously important goal the author also achieves another. The national discussion of race in America today has degenerated into sporadic outbursts of indignation triggered by some foolish or offensive remark by a public personality. (Don Imus, William Bennett, Trent Lott, Ann Coulter etc.). We are losing the all important and much deeper understanding of what racism is both historically and in the present. Without that depth of perspective one would think that racism has been just a war of insults to be corrected by better manners. The real value for all of us is to understand what is meant by institutional racism and how it functions, sometimes openly and intentionally, other times indirectly or covertly.  Whatever, it continues to shape us from childhood through adulthood. When we understand that, we can understand how Medical Apartheid could easily have companion volumes; Judicial Apartheid,  Economic Apartheid,  Educational Apartheid etc.  


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Ilan Pappe has been called  “…Israel’s bravest, most principled, most incisive historian.”  by John Pilger   and  “a traitor”,  “an advocate of Israel’s destruction”,  and “the most hated Israeli in Israel”  by Front Page Magazine.  It all reflects once again how difficult it is to approach the subject of the Israeli/Palestinian conflict without stirring the most extreme polarizing emotions. 

In his book “The Ethnic Cleansing Of Palestine” Israeli born Professor Pappe, who until recently was a senior lecturer of Political Science at Haifa University in Israel and is now a professor at the University of Exeter in Great Britain,  focuses his attention primarily on events in the critical period from December 1947 to May of 1948 and then from May 1948 to 1949.  This was the birth of the modern state of Israel and the genesis of the some 1,000,000 Palestinian refugees, whose demand of the right of return is perhaps the core of one of the most intractable social/political conflicts of our time.  Israelis refer to these events as the War Of Independence while Palestinians call it “Al Nakba” The Catastrophe. The principle argument of the book, and what has made it controversial, is the claim that the refugee problem was the direct result of a deliberate plan of ethnic cleansing finalized at a meeting on March 10, 1948 by the Israeli leadership and would come to be referred to as Plan D, or Plan Dalet.    Or as he states at the very beginning:

“…. I want to make the case for the paradigm of ethnic cleansing and use it to replace the paradigm of war as the basis for the scholarly research of, and the public debate about, 1948.”   Pg. xvi 

A brief historical summary is useful here.  In the period 1947-48 as the British Mandate over Palestine was coming to an end, the newly formed United Nations had devised the partition of Palestine into a Jewish state and a Palestinian state.  This division was rejected by the Palestinians and the surrounding Arab states thereby setting the stage for conflict resulting in nearly a million Palestinian refugees.

The official Israeli version was that the overwhelming majority of Palestinians left Israel voluntarily, either because they did not wish to live in a Jewish state or because the Arab leaders urged them to do so as they prepared for an invasion of Israel.  This of course was vehemently denied by the Palestinians but inside Israel it would take a generation or so before the official version was challenged. These were the “new”  or revisionist historians that emerged in the late 1970s and 1980s led by Benny Morris. Ilan Pappe was part of this group. Having access to heretofore unavailable state archives, papers and documents , these historians demonstrated that in fact the Palestinians were forcibly expelled by violence and the threat of violence as fighting between Israelis and Arabs raged around them. While this would confirm much of the testimony of Palestinians themselves, it does not go so far as to suggest premeditation at the upper levels of the Israeli leadership necessary to fit the definition of ethnic cleansing the author takes from the Hutchinson Encyclopedia: 

“… the expulsion by force in order to homogenize the ethnically mixed population of a particular region or territory….”   Pg 2.

 “… the essence of ethnic cleansing is the eradication of a region’s history.”  Pg. 2     -   The U.S. State department

Pappe’s argument, or as he gladly admits, his “j’accuse”  rests on first demonstrating that Zionists from the very first days of Herzl in the 1890s recognized the demographic problem they faced if they were to realize a purely Jewish state in a land overwhelmingly non-Jewish.  Using various source materials he shows how the idea of forced expulsion had always been there but emerged openly in the 1930s. Two particulary stark quotes from David Ben Gurion stand out.

“I am for compulsory transfer; I do not see anything immoral in it”  Ben Gurion in 1938  pg. xi 

And here on the eve of achieving statehood:

“There are 40% non-Jews in the area allocated to the Jewish state. This composition is not a solid basis for a Jewish state. And we have to face this new reality with all its severity and distinctness. Such a demographic balance questions our ability to maintain Jewish sovereignty… only a state with at least 80% Jews is a viable and stable state”     Ben Gurion on December 3, 1947  pg. 48

In the next part of the book Pappe uses Israeli archives from the military, the IDF, minutes of political meetings, public statements, and also diaries of David Ben Gurion and other memoirs from the period.  What these documents show is that while the political leadership didn’t have to articulate a master plan of ethnic cleansing in its instructions, the overall objective was understood.

“…most of the troops engaged in ethnic cleansing do not need direct orders; they know what is expected of them.  Pg. 3

What follows is a most powerful, and riveting narrative.  It is the detailed account, almost day by day of the events from December 1947 through 1948, the period when the ethnic cleansing began. Pappe does not hold back in graphically recounting the systematic, brutally cruel expulsion of the Palestinians from over 500 tiny villages that dotted the landscape of old Palestine. Nothing less than acts of pure terrorism were employed,  mostly by the Irgun and the Stern gang operating under the auspices of the  Hagana which earlier was the militant Zionist underground dating back to the 1920s and officially designated a terrorist organization by the British. The campaign to “cleanse” Palestine of its indigenous population included bombings, assassinations, demolitions, arson, pillage, rape, and two cases of poisoning the water supply with typhoid; one succeeded the other failed. The most famous case is the massacre at Deir Yassin in which up to 100 men, women, and children were murdered in cold blood.  Because international reporters happened to be on the scene it aroused a round of international outrage at the time. But spreading fear in the Palestinians so that they would flee in terror was also part of the strategy of the Hagana. 

It should be noted that Pappe has been accused of fabricating massacres. He deals with this charge in the book in reference to a particular case of a libel suit in Israel against a University student. Most of the scholarship on this period has relied on Israeli sources and either ignores or gives little credence to oral histories by Palestinians or other Arab sources.  Pappe insists that a complete picture of what happened is not possible unless all testimonies are included for scholarly consideration.

The last part of the book deals with the “memoricide of the Nakba” and “Nakba Denial”.  The expulsion and dispossession of the Palestinians in 1948 constituted a gross physical abuse. What followed has been a profound psychological abuse far deeper and no less painful.  This has been the systematic bulldozing and destruction of almost all of the small Palestinian villages so that there remains no trace that they ever existed. Over these ruins are built Jewish homes, roads, recreation parks, Kibbutzim and even historic sites all renamed with Hebrew names, modern or ancient to reflect the resurrection of ancient Israel, destroy the memory of a Palestinian culture and community,  and support the myth of a “land without a people, for a people without a land”.    

Ilan Pappe has argued that the time for a two state solution has passed and that the only just solution to this conflict, and the only way that both Jews and Arabs can find the peace and security they yearn for, is in a one state democracy in which all Palestinian refugees are finally granted their right of return as expressed in UN Resolution 194. Of course, the demographics of such a solution would make Jews a minority and thus the exclusively Jewish character of the state, which has been the Zionist dream, would disappear.  But then again Pappe considers himself a “post Zionist” historian.  

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I have coupled the review of these two books together because of their mutual link to histories which are stark and painful, but whose consequences continue in the present.  It is a natural human tendency to try to bury and deny an ugly past. We all want rejuvenation. We all want to wipe the slate clean and get a fresh start. But when is it time to move on? Who decides?  We can neither live forever in guilt nor construct our lives on denial. But closure can be illusive. Somehow it seems to have its own stubborn, immutable timetable.   

Russell Branca

New York,

October, 2007