Reprinted from Memphis Medical Monthly, December, 1905.

* H. L. SUTHERLAND, M. D.ROSEDALE, MISS.

The destiny of the American negro is a question fraught with great interest to all citizens of the United States. His place among the races has not been definitely fixed. While his advancement socially is a perpetual cause of hysteria to Northern philanthropists, his physical preservation is exciting the gravest apprehension of those who, from daily observation of his environments, habits and diseases, know him best.

Notwithstanding the assertion that "all men are created equal," those who have been associated with the negro for many years are slow to accept this fiat, or to believe that he can ever be raised to our level, no matter how wide the door of opportunity may be open, but that race and heredity have been and are yet the determining factors in his struggle for a place among civilized peoples.

After forty years of freedom, with the paternalism of our government to uphold and sustain him against the dominancy of the superior race, his emancipators must confess to a measure of disappointment in his progress. For the millions which have been spent on his education by state and by charitable individuals, there has been a fair return in a lessened degree of illiteracy, but, paradoxical as it may seem his moral and physical conditions have notably deteriorated.

The negro has neither moral conception nor religion, yet he is an emotional religion of the loudest type and dies like a martyr. He is a fatalist without understanding it. He respects no law except through fear. He knows no country, and possesses an inborn hatred for the white race, without whose care and control he would revert to barbarism in less than a score of years. He has no co-operative faculty, except in politics--being a born republican--and when he deserts his party, he is a marked man with his race, and has become a renegade for personal gain. In his native state he had neither religion nor tradition. Now his religion is purely imitative, and his only tradition is an exaggerated picture of hardships and cruelties imposed on him while a slave.

Physically the negro was at his highest state of development as a slave. From a dwarf he was bred up to the full stature of manhood. He was well fed and clad, and his labor in the fields in sunshine and fresh air and the good sanitary condition of his quarters with plenty of plain but wholesome food, tended to growth and development and the power to repel disease. As a result chronic disease, especially syphilis and its congener, tuberculosis, both of extrinsie origin, were extremely uncommon affections in the negro. Their lives were ordered then exactly as we would order them now to combat those diseases.

After the close of the Civil War the picture completely changed. There was a steady movement of negro population to cities and towns, which has increased with the years until now they equal or exceed the whites in a majority of our towns. By reason of their improvidence they are crowded into insanitary abodes in the most undesirable parts of towns, and have not a sufficiency of wholesome food. Marriage is the exception and their children are brought up in shame. From long observation I think not more than 2 per cent. of negro girls preserve their virginity to the age of 12. The race has entered upon a "descending developmental progress," as Humphrey has expressed it as to old age. Poverty, ignorance, immorality and disease is the condition of the masses of the negro of the South today.

Hoffman, the impartial observer and accurate statistician of a strong life insurance company, remarks: "Instead of making the race more independent, modern educational and philanthropic efforts have succeeded in making it even more dependent upon the whites than it was before emancipation. It remains to be seen how far a knowledge of the facts about its own diminishing vitality, low state of morality and economic inefficiency will stimulate the race in adopting a higher standard. Unless a change takes place, a change that will strike at the fundamental errors that underlie the conduct of the higher races toward the lower, gradual extinction is only a question of time."

In the near future this tendency of the negro population to towns, instead of being voluntary, as heretofore, will be compulsory. Labor on farms has become inefficient and insufficient, and the labor problem of the South will be solved by the introduction of white labor. The negro will become the supernumerary labor on farms, and used for domestic purposes in cities and towns, thus creating hotbeds of disease at our very doors. Another discouraging feature to those who would "save him from himself" is his propensity to conceal his diseases and allow epidemics to attain headway before discovery, which, taken in connection with his presence in our households as a servant, renders him an important factor in the transmission of disease to the whites. Dr. McHatton, of Georgia, is the author of a paper, "Our House and our Servant," which should be read by the head of every white family, as it points out the dangers to which we are daily exposed.

Not long after the close of the civil war it became evident that the negro was not immune to tuberculosis, or even partially so, was thought by many, but on the contrary it was of precocious type. Syphilis also became almost epidemic, and while we have not for the past two decades seen it in its earlier stages as frequently as in the years just succeeding the close of the civil war, it is because of the immunity acquired. The race has become "syphilized", but at the cost of its constitutional vigor. Dr. Frank Jones, of Memphis, a clinician of wide experience, asserts that 75 per cent. of negroes have 00044a syphilitic history which must be taken into account in the treatment of all their diseases.

There can be no more favorable background for rapid progress of tuberculosis than a syphilitic heredity. As Meigs expresses it, we have "an inherited disposition to premature decay", and this explains the unanimous observation of Southern practitioners of the rapid progress of tuberculosis in the negro--the duration being from sixty days to six months.

Tuberculosis is a house disease. It is practically settled that it is "a disease of environmental only." In Marburg, Germany, it was found that from one-third of the houses occupied by the poorer classes there occurred 59 per cent. of all cases of tuberculosis. We are so accustomed to the presence of consumption, and its "onward march is so silent and insidious", that it does not alarm us like and epidemic of yellow fever or smallpox which occasionally visits our country, yet its victims are many times greater, and it is incumbent on us to take some steps toward controlling the dissemination of this dread disease, this greatest plague of the negro race.

The prophecy of the extinction of the negro race by Hoffman, made nine years ago, seems more probable of fulfillment now than then, not only because of its high morality rate, but also of its lessening fecundity. The small number of negro children on plantations is a matter of common remark by men who farm with negro labor, yet his greatest increase comes from the rural families. The decreasing fecundity is die in a great measure to venereal disease in the females. I think I am not overestimating when I say that 50 per cent. of negro women are suffering from the results of venereal disease, which practically sterilizes them. They are also adepts in the art of abortion, preferring this to the usual preventive means.

The combined population of New Orleans, Charleston, Atlanta and Memphis for the year 1904 was, whites, 394, 238, and blacks, 221, 569. The average mortality from all causes was, while the blacks was 27.7, nearly double. The number of deaths from consumption of the lungs was 14 per cent. of the deaths from all causes. Even Memphis, the reputed cleanest city of the South, with a negro population 00055of 59,000 during the year 1904, lost 197 from consumption, which was one-seventh of the deaths from all causes in the negro. Yet the morality from tuberculosis, as complied from health board reports, does not give a correct idea of the ravages of this disease in the negro, as there is no way of finding out in how many diseases, such as meningitis, pneumonia, chronic bronchitis and enteritis it was real or contributory cause of death. Hoffman, referring to consumption in the negro, says "a volume could easily be written on this one disease and its influence on the destiny of the colored race. Few writers on negro mortality have failed to discourse upon the excessive mortality due to this cause, and but few have failed to recognize the fact that this most dreaded of all diseases is constantly on the increase among the colored population of this country."

The greatest glory, the most enduring fame, which can be attained by medical men of today, is achieved in the field of preventive medicine. One hundred years have not dimmed the luster shed on our profession by Edward Jenner. The work of Pasteur, Koch and others will shine resplendent as long as time lasts. It is estimated that in the fourteenth century twenty-five millions of human beings lost their lives in Europe alone from plague, and even today in India, among the ignorant people, over two hundred thousand lives are lost every year from that disease. Haffkine's inoculations have diminished the susceptibility of the people by 75 per cent. The treatment of yellow fever in the recent epidemic was scarcely mentioned, but the world held its breath while the great battle was fought and victory won by sanitary science-preventive medicine applied.

It is a stupendous task to undertake to save a race of people from extinction whose characteristics are ignorance, immorality and superstition, and which regards our efforts as inimical to its welfare, but we owe it to posterity, and we owe it to ourselves as a Christian obligation, for "he has been laid at our gate."

In making suggestions along this line I wish to say, first, that any attempt at the treatment of consumption in the negro with a view of cure is worse than useless, as every case is 00066practically hopeless from the time [?] made. I would not suggest any measures other than those [?] to the segregation of the infected, and care for those who are likely to become infected. The radical treatment of [?] trouble would be the separation of the races. It is another question as to how this could be accomplished, and where the negro could be colonized, so as to give him the best opportunity to enjoy "life, liberty and the pursuit of happiness".

McHatton tells us of a colony of ten families of Spanish nobility who had become so intensely tuberculous about the close of the eighteenth century that they saw something must be done or extinction would soon follow. They settled on the western slope of a Central American State in the interior, and are today a healthy and hardy race of people, without having intermarried with the natives, and no signs of tuberculosis can be found in them.

There are other reasons why the separation of the races should be made, and perhaps paramount to the consideration of the extinction of the inferior race. One of these is the preservation of the higher ideals of the Anglo-Saxon race, by discontinuing association in the same territory and under the same laws with a race whose traits and tendencies are all bad. No race of people who continually require "an unwarranted extension of the principles of government" to enable them to hold their own among races can ever be raised to the level of the higher. I think it impossible for two peoples with such marked racial difference to dwell in one country and be governed by the same laws. This very fact has led to the enactment of laws which were never intended to be impartially administered--the peonage and vagrancy laws of Mississippi, for example. We have been guilty of attaining an end by false pretenses.

Association with an inferior race whom we remember as our slaves, and whose personal and political rights we do not respect, has had a brutalizing effect on us and has led to much bloodshed, which was not justified by the offenses committed. We know there is scarcely a place in the South to-day where a respectable white man can be convicted of murder, or even 00077sentenced to prison for a short term, for killing a negro under any circumstances. This is one of our "unwritten laws" inspired by our contact with the negro.

Upon the assumption that our negro laborer is robbing us, both by what he steals, and by not giving a fair return in labor for the wage he is paid, we practice extortion on him, both for the necessaries of life which he can get only from us, and in not giving him a fair price for the product of his labor, and our standard of honesty is lowered by a feeling that we must resort to such practices to hold our own in transacting business with him.

Another urgent reason why the races should be separated is the illicit relations too frequently existing between white males and negro females. The negro woman, both in her own estimation and that of her race, is elevated by concubinage with a white man--it is the zenith of her expectations in life, and many otherwise estimable and well-bred white men become bound as in a shirt of Nessus by these sirens whose song is always ruin, and death to character. By frequent observation of such vicious practices our sensibilities become obtunded and our ideals lowered. As evidence that I have not exaggerated the immoral tendency from the dwelling together of the two races, we have but to note the increasing number of mulattoes in our country. Statistics show that the mulatto, of whatever shade in color, is morally and physically the inferior of the pure black--that he is a more dangerous criminal, is comparatively worthless as a laborer and more subject to tuberculous affections.

There is another danger which is yearly increasing, the very thought of which thrills us with horror, and even the attempted preparation of which makes fiends of us all.

I admit that I believe our association with the negro has dragged us down more than it has uplifted him. Our necessary relations with him are such that he is a menace to us from any viewpoint we may take, but not least of all is the danger from his disease.

Consumption in the white man being now recognized as a curable disease, effective work is being done to lessen the annual loss by death from this cause. Organized effort by 00088anti-tuberculosis societies is yielding good results by educating the white masses, not only to a sense of danger, but in the judicious use of simple means to avoid infection and effect a cure. Every magazine and newspaper has become a teacher of sanitary science, and is doing an immense amount of good in an educational way, not only against the spread of consumption, but of all other infectious diseases. An unusual impetus has been given this work during the present year, and as a demonstration of what science can do in control of disease, the recent epidemic of yellow fever has been an object lesson which has carried conviction to the minds of the people.

This is an army of sanitarians, composed of men and women of every profession, working for and believing in, "the great brotherhood of man," but any improvement in the negro's condition, based on educational methods, is chimerical and will never be realized. The negro does not make practical application of his education; it is "of his life a thing apart;" he uses it as he does his Sunday clothes. Being a fatalist he takes no precautions against, and makes no long resistance to encroachment of disease, but resigns himself to his fate and really welcomes death; likewise do his friends, as they tire of long waiting and prefer to speed the parting friend. Even parental affection wanes when disease is long drawn out, and "shuts out all heed for the worn and weary--for the feeble and decaying." Selfishness dominates all their impulses.

I think no measures can be applied to check the rapid spread of consumption in the negro except through the strong arm of the Federal Government. For reasons already assigned the entire race, both for it's own benefit and the benefit of the white race, should be colonized and kept under government supervision. This being scarcely probable, consumptive negro families should be segregated in some suitable climate, and taken care of by the government. If leprosy can be controlled in this manner, why not consumption, which threatens so many more lives, is so much greater public burden, and is the only hope of the negro consumptive?

Legislators are not usually sanitarians and view askance legislation asked for by our craft, but occasionally they pass a 00099law without comprehending all the benefits it may bestow, and upon whom. In 1904 the legislature of Mississippi enacted what is known as the law against vagrancy, the pith of which is in this language: Persons leading an idle and immoral, or profligate life, who have no property to support them and who are able to work and do not work, shall be declared vagrants. The purpose of this law was primarily to drive the negroes from the towns to the farms and relieve the stringency of the labor problem, but they "builded better than they knew," and the law is one of the best which could have been enacted for the good of the health of the negro, if properly enforced.

The State of Mississippi has provided schools for the higher education of her negroes, where they can be trained in industrial pursuits, which have been a blessing to the race from a health point of view. Until recent years those able to acquire a higher education than was offered by the common schools were sent North and many of them returned home to die of consumption and infect their families. I have in mind an old black man who sent, at different times, two daughters to Ohio. In three years both had died of consumption, and in less than ten years the entire family of six or seven persons had died of this disease.

The public schools should be looked after both as to teachers and pupils. Not two years ago I examined a colored female teacher who had just given up her work on account of her health, and in two months she was dead from consumption.

That tuberculosis is rapidly spreading among the negroes, there can be no doubt, for statistics of the cities show it, and the universal observation of physicians in the negro belt confirms it.

I believe that we of the South are now confronted with the most serious problem which we have had since the reconstruction period. If slavery was a sin, forty years of freedmen is an all-sufficient atonement. No doubt the transition period in a change of labor from the negro to white would be a trying one and would bring financial disaster to many, but for the incalculable good it would bring to our sons and their sons to be forever separated from this inferior and corrupt 001010race, that they may maintain a high standard of honor, that they may not imbrue their hands in his blood, that they may not draw the bar sinister across our escutcheons by mixing our blood with the negroes, the loss would be repaid to us in a re-civilization, and then in truth woulyd we have our "New South," and for this we should ever pray " Who shall deliver us from the body of this death?"