Do No Harm: Critical Race Theory and Medicine

In the winter of 1848, an epidemic of typhus ravaged Upper Silesia, a largely Polish mining and agricultural enclave in the Prussian Empire. Months earlier, heavy floods had destroyed large swaths of cropland, leaving the peasants to subsist on a paltry diet of clover, grass, and rotten potatoes. Weakened by starvation, they readily succumbed to infection. The Prussian authorities tapped a precocious twenty-six-year-old junior physician named Rudolf Ludwig Karl Virchow, at Berlin’s Charité Hospital, to perform the routine task of surveying the outbreak. For three weeks, Virchow travelled from town to town, observing that families of six or more often shared single room dwellings, turning homes into hotbeds of contagion. He noted the stigmata of the typhus rash — angry red spots that mysteriously spared the face and soles of the hands and feet — documented the nature of fevers, coughs, and diarrhea, and performed a few autopsies.  Virchow’s report to the Prussian Minister for Religion, Education, and Medicine contained mortality statistics and clinical descriptions. He also dispensed predictable recommendations for flood control and drainage systems. But what exercised Virchow the most — and what his sponsors least wanted to confront — were the deeper causes of the epidemic. “The nouveaux riches” who extracted wealth in metals and minerals from the mines treated their Silesian workers “not as human beings but as machines,” he wrote. He blamed the Catholic Church for keeping “the people bigoted, stupid and dependent.” “If these conditions were removed,” the bold young doctor offered the minister, “I am sure that epidemic typhus would not recur.”  Even before he left for Upper Silesia, Virchow was primed to see the threads between social conditions and disease. In Friedrich Engels’ treatise on the working class in Manchester and the deathtrap factories in which they toiled, which appeared in 1845,

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