First, Do No Harm

C. A. Asbrey

Although the phrase, “First, do no harm,” is attributed to Hippocrates, it doesn’t actually form part of The Hippocratic Oath. It’s from his work, Of the Epidemics. It’s also a commonly held opinion that all doctors take the oath when they graduate. They don’t. And those who do, take various versions of it around the world. One thing we can all agree on is that we all want doctors to do as much as they can to mitigate suffering, and not to increase it.

The various criminal trials and medical scandals that litter history show us that has not always been the case, not to mention the number of doctors and nurses who have been found to be serial killers. The most vulnerable are always the victims of such predators, and we thank those who have the courage to stand up and speak out against them. These whistle-blowers often have to deal with the powerful to do so.

The first doctor to do so was a remarkable man in so many ways, and spent his whole life confronting discrimination and abuse. He was also the first African American to get a medical degree, an ex-slave, and a member of the American Anti-Slavery Society along with Frederick Douglass. Douglass called him, “the single most important influence in his life.”

He was born in 1814, a slave in Manhattan. Set free in 1827, his maternal grandfather was the man who owned his mother. He stated often that he had relatives who were both slaves and slave owners. He attended The African Free School at 2 Mulberry Street in Manhattan. Smith was taught by an English immigrant, Charles C. Andrews, who frequently stated that his pupils were every bit as smart as white children, if not brighter. James McCune Smith stood out as exceptional, but despite being showing obvious intellect, he was refused admission to numerous universities and colleges due to racial discrimination. He was encouraged to go to Scotland where no such bars existed, and he attended Glasgow University, gaining a medical degree in 1837. In the interim he received a licence from The Royal College of Surgeons in Edinburgh in 1831, and served with the British Military as a surgeon in Sierra Leone. Glasgow University was on a par with Oxford or Cambridge at that time, and was a seat of The Scottish Enlightenment a few decades earlier. It had strong links with the abolitionist movement, and was far better than any American University of the time. In fact, it was one of the best in Europe. A fluent French speaker, Smith finished his residency in Paris.

Smith was offered a position in the Glasgow Lock Hospital for Unfortunate Females. Many cities had these in the nineteenth century, places where women suspected of having a venereal disease were incarcerated until they were considered ‘cured.’ Low class women were seen as responsible for the contamination of the men they tempted into sexual liaisons, even if they were children as young as seven. The origins of its name are believed to have stemmed from the French word ‘loques’, meaning rags and bandages, or from the old English ‘loke’, meaning a house for lepers. Europe’s first Lock Hospital had previously been a Lepper Hospital. The Glasgow building was constructed to look like the surrounding tenements in an act of Victorian discretion, and the conditions were dreadful. Women arrested for vagrancy, prostitution, or even having given birth outside wedlock were kept in reformatory conditions. The place was feared for good reason. Very few survived the treatments there.

On admission, their heads were shaved and they were thoroughly disinfected. The average stay was twenty-nine days, and they were given a number of treatments ranging from pills, ointments, salves, and eye-watering poultices and vapour baths. Most were ineffective at best, at worst they were fatal, and the women were given no say whatsoever on anything done to them. Smith’s background and understanding of the powerlessness of the marginalised led him to publish a series of articles in The London Medical Gazette, in which he openly questioned the use of experimental treatments on patients without their consent. It was not only the first time this had been done, but he also published the testimony of two poor women and the impact of unethical misapplication of medical experimentation on them, making it triply unique: The first time an African American Doctor had been published, the first time medical ethics on experimentation were questioned in medical publications, and the first time poor women were given a voice and taken seriously. To understand how little these women were considered worthy of consideration, reports from the same hospital blame girls up to the age of eight for their own venereal infections.

As well as being a doctor, Smith was also a talented statistician. He compiled figures to prove that one doctor in particular was administering experimental, and fatal, treatments to bolster his own medical reputation. The easiest thing would have been to say nothing, but his own life experience informed his courage in not only speaking up, but in publishing it in papers read throughout Europe. It’s especially telling that the doctor concerned knew what he was doing and tried to cover up the deaths and miscarriages by mis-attributing them to other causes. Smith was having none of it. He wrote:

“By this novel and ingenious mode of recording the Hospital transactions for 1836, [Prof Hannay’s team] keeps out of view the evidence of the severity of the treatment, and the amount of mortality, while, at the same time, the residence of the patients in the house seems shorted, the cost of each diminished, and the treatment made to appear more than usually successful.”

Professor Hannay’s aim was that effective treatments could be found so they could used on men and the wealthy.

It’s worth nothing that while at Glasgow University, James McCune Smith took philosophy classes from James Mylne, the theistic empiricist, who taught that the use of statistics could be an effective way to judge what is moral and ethical, based on the greater good. Smith not only used this approach in Scotland, but challenged the US Government on many occasions using the same method. He used statistics to prove that free black people were as intelligent, employable, and orderly as white people, that slavery shortened lives, and that the figures in the census showing that free black people died younger and had higher rates of insanity were corruptly added by those with vested interests in slavery. He was able to show that the census showed more black people in insane asylums in the north than the actual number of black people living in the states. John Quincy Adams called for an investigation based on his work.

James McCune Smith returned to the USA, and married in the 1840s. He had eleven children and never stopped fighting for the poor and the voiceless. He was a prolific writer, submitting articles to multiple scientific and political organisations and publications, and was the first black member of the American Geographical Society. He taught and practiced medicine, and in 1863 was appointed as professor of anthropology at Wilberforce College, the first African American-owned and operated college in the United States, but he was too ill to take up the position.

He died of congestive heart failure at the young age of fifty-two, a mere nineteen days before the abolition of slavery was ratified in the constitution. His children all married white partners, and the records show that his descendents gradually disappeared into white society, no doubt to escape discrimination.

Greta Blau, a white woman who wrote a paper on The Colored Orphan Asylum for a class at Hunter College in the 1990s, and recognised his name in the family tree in her grandmother’s Bible. She had only ever known of him as ‘the Scottish doctor’, and had no idea he was black, or of his incredible contribution to the world. She arranged for a new headstone and found that many of the extended family were buried in the same graveyard without even realising they were related.

Sadly, some of those contacted by her to be told that they were descended by this clever, humane, and educated man were not happy at the news that they had a black ancestor. That tells us that his work is not yet over.

James McCune Smith was the first African American doctor, but not the first black doctor. In 1809 Jamaican, William Fergusson, became the first black medical student at Edinburgh University, and he went on to become the president of Sierra Leone.