Volume 305, Issue 4 p. 772-787
SPECIAL ISSUE ARTICLE
Free Access

Racism, structural racism, and the American Association for Anatomy: Initial report from a task force

Dale R. Sumner

Corresponding Author

Dale R. Sumner

Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, Illinois, USA

Correspondence

Dale R. Sumner, Department of Anatomy & Cell Biology, Rush University Medical Center, 600 S. Paulina St, Rm 507, Chicago, IL 60612, USA.

Email: [email protected]

Contribution: Conceptualization (equal), ​Investigation (equal), Project administration (lead), Writing - original draft (lead), Writing - review & editing (equal)

Search for more papers by this author
Sabine Hildebrandt

Sabine Hildebrandt

Department of Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Massachusetts, USA

Contribution: Conceptualization (equal), ​Investigation (equal), Writing - original draft (equal), Writing - review & editing (equal)

Search for more papers by this author
Allison Nesbitt

Allison Nesbitt

Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA

Contribution: Conceptualization (equal), ​Investigation (equal), Writing - original draft (equal), Writing - review & editing (equal)

Search for more papers by this author
Melissa A. Carroll

Melissa A. Carroll

Department of Anatomy & Cell Biology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA

Contribution: Conceptualization (equal), ​Investigation (equal), Writing - original draft (equal), Writing - review & editing (equal)

Search for more papers by this author
Vassiliki B. Smocovitis

Vassiliki B. Smocovitis

Departments of Biology and History, University of Florida, Gainesville, Florida, USA

Contribution: Conceptualization (equal), ​Investigation (equal), Writing - original draft (equal), Writing - review & editing (equal)

Search for more papers by this author
Jeffrey T. Laitman

Jeffrey T. Laitman

Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

Contribution: Conceptualization (equal), ​Investigation (equal), Writing - original draft (equal), Writing - review & editing (equal)

Search for more papers by this author
Amy C. Beresheim

Amy C. Beresheim

Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, Illinois, USA

Contribution: Conceptualization (equal), ​Investigation (equal), Writing - original draft (equal), Writing - review & editing (equal)

Search for more papers by this author
Christopher J. Ramnanan

Christopher J. Ramnanan

Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada

Contribution: Conceptualization (equal), ​Investigation (equal), Writing - original draft (equal), Writing - review & editing (equal)

Search for more papers by this author
Michael L. Blakey

Michael L. Blakey

Institute for Historical Biology, College of William & Mary, Williamsburg, Virginia, USA

Contribution: Conceptualization (equal), ​Investigation (equal), Writing - original draft (equal), Writing - review & editing (equal)

Search for more papers by this author
First published: 28 February 2022
Citations: 5

Abstract

In 2021, the American Association for Anatomy (AAA) Board of Directors appointed a Task Force on Structural Racism to understand how the laws, rules, and practices in which the Association formed, developed and continues to exist affect membership and participation. This commentary is the first public report from the Task Force. We focus on African Americans with some comments on Jews and women, noting that all marginalized groups deserve study. Through much of its 130 year history, some members were an essential part of perpetuating racist ideas, the Association largely ignored racism and had some practices that prevented participation. The Task Force concluded that individual and structural racism within the AAA, combined with the broader social context in which the Association developed, contributed to the current underrepresentation of African Americans who constitute 4.1% of the membership even though 13.4% of the U.S. population is Black. Intentional efforts within the AAA to reckon with racism and other forms of bias have only begun in the last 10–20 years. These actions have led to more diverse leadership within the Association, and it is hoped that these changes will positively affect the recruitment and retention of marginalized people to science in general and anatomy in particular. The Task Force recommends that the AAA Board issue a statement of responsibility to acknowledge its history. Furthermore, the Task Force advocates that the Board commit to (a) sustaining ongoing projects to improve diversity, equity, and inclusion and (b) dedicating additional resources to facilitate novel initiatives.

1 INTRODUCTION

The academic world is increasingly becoming aware that it can no longer ignore the lack of diversity, equity, and inclusivity (DEI) in its ranks, as well as a sensitivity to all questions surrounding this situation. The impact for anatomists recently struck close to home following the public protests of our anthropology colleagues' objectifying possession and use of the bones of a young African American girl who died at the hands of police in Philadelphia in 1985 (Tucker Law Group, 2021). This awareness has been heightened by the increased public attention being paid to the killing of many Black, Indigenous, and Latino people at the hands of authorities. Compounding the concern is the growing number of hate crimes in the United States, with the most common victims being Black and Asian people with increasing reported incidents of anti-Jewish as well as continuing significant levels of anti-Muslim violence (see analyses in ADL, 2022; Carrega & Krishnakumar, 2021 based on hate crime statistics compiled by the United States Federal Bureau of Investigation). These facts bring to the forefront the need to reckon with racism and other forms of bias.

Over the last 10 years or so, many universities and scientific associations have formed DEI offices or committees, including the American Association for Anatomy (AAA). The value to scientific societies of being proactive and not just reactive has recently been emphasized as an important mechanism to change the face of academia (Carroll et al., 2022). The AAA's DEI Committee has focused on developing new programs to address multiple issues (Carroll et al., 2022). However, many AAA members poorly understand the historical effects of racism and structural racism on the Association's DEI. Thus, the AAA Board of Directors appointed a task force in the spring of 2021 to examine structural racism within the AAA and to make recommendations to the AAA Board on the way forward. This commentary is the first public report from the Task Force.

It is useful to first define terms. “Racism” refers to the belief that human groups (races) can be ranked from superior to inferior as well as to prejudice groups of people (races) toward each other (e.g., see Dennis, 2004). These differences are often ascribed to heredity. The Aspen Institute defines structural racism as

“A system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity. It identifies dimensions of our history and culture that have allowed privileges associated with ‘whiteness’ and disadvantages associated with ‘color’ to endure and adapt over time. Structural racism is not something that a few people or institutions choose to practice. Instead it has been a feature of the social, economic and political systems in which we all exist” (Aspen Institute, 2021).

A related concept is “institutional racism,” in which

“the policies and practices within and across institutions that, intentionally or not, produce outcomes that chronically favor, or put a racial group at a disadvantage” (Aspen Institute, 2021).

The destructiveness of structural and institutional racism in science and medicine cannot be overestimated (Bailey et al., 2021). The structural effects of racism are not simply the cumulative effects of individual prejudice, but are influenced by “laws, rules, and practices, sanctioned and even implemented by various levels of government, and embedded in the economic system as well as in cultural and societal norms” (p. 768). Thus, to address the effects of structural racism, we need to understand the underlying policies and institutions.

Throughout the manuscript we use upper case in reference to racial or ethnic groups. The Task Force recognizes that there is considerable debate on this subject (APA, 2022; Appiah, 2020; CSSP, 2022), and we have chosen to capitalize these terms because we are using them as proper nouns of social identity.

2 STATEMENT OF PROBLEM AND SCOPE

Given the definitions outlined above, the goal of the AAA Task Force on Structural Racism was formulated as follows: to understand the role of African Americans in the AAA in the context of the laws, rules, and practices in which the Association formed, developed and continues to exist. The Task Force recognized that structural bias affects other ethnic and religious groups, sexual orientation, gender identity, those with disabilities, and other marginalized groups, but lacked the time or expertise to evaluate them in detail. All of these populations merit attention, and will require significant additional research efforts. Thus, while our focus is on Black participation in the AAA (Figure 1), we do make some comments about women, Jews and Indigenous peoples. Some areas have received considerable attention and other areas are relatively unexplored. Thus, this commentary is admittedly selective in terms of topics covered, but strives to provide an initial glimpse into AAA's history in the context of structural racism, motivate future research and guide development of new policies and programs. Part of the motivation was the perception that many members of the AAA may be ignorant about this history. Finally, we make several references to physical anthropology (biological anthropology) because of the close connection between this discipline and anatomy and that field's recent self-examination (Antón et al., 2018).

Details are in the caption following the image
Timelines demarking selected events relevant to the history of African Americans in the AAA. Please note the different time scales in the three panels, in which the “X” on the horizontal axis indicates the year that the AAA was founded. Panel a focuses on societal history, beginning with the first permanent European settlement in the New World. Panel b focuses on some aspects of the history of science, beginning with early efforts at classifying the natural world and Panel c focuses on some aspects of the history of the AAA, beginning with its founding. See text for details on the flagged items. AAA, American Association for Anatomy

3 CURRENT AAA DEMOGRAPHICS

Currently, the ethnic distribution of AAA members from the United States for whom the Association has self-identified ethnic group information is 75.2% White, 11.3% Asian, 5.7% Hispanic, 4.1% Black, 1.6% Middle Eastern, 1.4% other, and 0.8% American Indian (Table 1). These proportions do not compare favorably with recent United States census data as there are about one-third as many Hispanic and Black AAA members as one would expect. Nevertheless, the proportion of Black members in the AAA is closer to the U.S. population than for some other life science associations for which there are publically available data (Table 1). The proportion of AAA membership that is Black is approximately the same as the proportion of medical students who are Black (Morris et al., 2021) and the proportion of full-time faculty in academic medicine who are Black (Jeffe et al., 2019; Kaplan et al., 2019) and underrepresented minority students receiving postsecondary degrees in the biological or biomedical sciences (Meyer & Cui, 2019). It will not be easy to understand how the Association's demographics have changed since its founding because data of this type have only recently started to be collected. This is in keeping with most other scientific societies, including the American Association for the Advancement of Science (AAAS). However, using National Science Foundation, AAAS and other data, Ashley Smart found that over the last 40 years, African American graduates in science, technology, engineering, and mathematics (STEM) fields began at 4.1% of United States graduates in 1980, reached a peak of 7.4% in 2004, but had declined to 6.2% in 2010 (Smart, 2020). These trends suggest influences of two legal cases, Bakke (1979) and Grutter v. Bollinger (2003), each of which left institutions uncertain about the implementation of race-based affirmative action. Smart interpreted these findings to suggest that the ambiguity around affirmative action stunted the growth of African American college graduates in STEM fields (Smart, 2020). It is possible that the Black membership in the AAA followed the same trends. Nevertheless Black membership in the AAA may be at or near its historical peak, which means it has taken over 130 years to “advance” from 0% to 4% of the members being Black.

TABLE 1. Demographic composition comparison
Comparator population
Group U.S. population Life science PhD's AAAS AAA AABA Average of three evolutionary biology societies
White 76.3% 67.8% 81.4% 75.2% 86.9% 74%
Hispanic 18.5% 9.6% 3.5% 5.7% 3.6% 12%
Black or African American 13.4% 4.3% 2.4% 4.1% 0.9% 1.7%
South/East Asian 5.9% 12.7% 8.5% 12.9% 3.4% 7%
Multiracial 2.8% 3.6% 3.8% n/a n/a 3.3%
Indigenous 1.5% <1.5% 0.4% 0.8% 1.6% <1.5%
  • Note: U.S. population, life science PhD's, and average of three evolutionary biology societies are from Rushworth et al. (2021). AAAS Membership data are for U.S. members as of December 31, 2021. Full AAAS membership data were available for only 44% of U.S. members (direct communication with AAAS, February 4, 2022). AAA membership data are for U.S. members of the AAA for 2021 and American Association of Biological Anthropology (AABA) membership data are for 2014 (Antón et al., 2018). Ethnic/racial groups are not consistent across reports, so for the AAAS the Indigenous category includes American Indian/Alaska Native and the South/East Asian category includes Asian/Pacific Islander, for the AAA the Asian and Middle Eastern data were grouped together as South/East Asian and for the AABA data Native American and Native Hawaiian and/or Pacific Islander were lumped as Indigenous, and the Asian category is reported as South/East Asian.

4 BROADER SOCIAL CONTEXT IN WHICH THE AAA FORMED AND DEVELOPED

The history of the AAA emerged in and unfolded against a wider social context that undoubtedly shaped its values and its policies, affecting who was included and who was excluded, both intentionally and tacitly (Figure 1a). The first European permanent settlement in North America was established in St. Augustine, Florida in 1565 and the first enslaved Africans were brought to the Virginia colony in 1619. The United States declared independence in 1776 and from the very beginning of the country, slavery was controversial. In 1807, the United States adopted a law prohibiting importation of enslaved people, leading to increased domestic trading of enslaved people. In 1857, the United States Supreme Court ruled that African Americans could not be citizens of the United States even if they had state citizenship (Dred Scott decision). The split over slavery caused the United States Civil War (1861–1865) when Southerners defended slavery by seceding from the Union. Northerners' defense of national Union led as a consequence to freeing the enslaved, first as a military necessity (the Emancipation Proclamation in 1863) and ultimately by the adoption of the 13th Amendment banning slavery and involuntary servitude (1865), the 14th Amendment, granting citizenship, civil and legal rights to African Americans and formerly enslaved peoples (1868) and the 15th Amendment, granting voting rights irrespective of race, color or previous condition of servitude (1870). However, Whites claimed control of the material inheritance of slavery's labor and the social disenfranchisement of African Americans as Jim Crow laws overturned the brief 12-year period of Reconstruction (1865–1877) at the end of the Civil War. In 1896, the United States Supreme Court upheld the legality of segregation (Plessy v. Ferguson). In this context, approximately 6 million African Americans uprooted themselves, moving from the South to the North and West during the Great Migration (~1916–1970). Segregation was ruled unconstitutional by the United States Supreme Court in 1954 (Brown v. Board of Education). Nevertheless, Jim Crow laws persisted until the early 1960's with the adoption of the 24th Amendment banning poll taxes (1964) and the implementation of the Civil Rights Act (1964) and the Voting Rights Act (1965).

One consistent theme in United States history is that access to education for Black people has been unequal. Indeed, many universities did not admit Black students, motivating the development of historically Black colleges and universities and Black medical schools. U.S. educational and medical institutions, with rare exceptions, were segregated by race, marginalizing the resources of “non-Whites” and “non-native [White] Americans” of the United States census. It was not until the Brown v. Board of Education Supreme Court decision in 1954 that the legal process of school desegregation began, continuously pressured by the Civil Rights movement. By the 1960s nearly exclusive White suburban communities proceeded to resegregate the schools. Intercommunity busing and affirmative action as remedies, rose as solutions and were subsequently attenuated.

While the Task Force lacked the expertise and time to explore other groups in detail, we would like to bring to attention some events negatively affecting Indigenous peoples in the United States. In 1830, the U.S. Congress passed the Indian Removal Act, forcing Native American tribes with land east of the Mississippi River to relocate to federal land in what is now Oklahoma. In 1879, the Carlisle Indian Industrial School was established by the Bureau of Indian Affairs in Carlisle, Pennsylvania (Child, 2016). Children were removed from their homes, separated from families, denied their names, culture, language and customs and forced to assimilate in a militarized environment. In other such boarding schools, children were physically or sexually abused, malnourished and had harsh living conditions, leading to high levels of morbidity and mortality (Bassett et al., 2014; Davis, 2001). By the turn of the 20th century, most of the lands of Indigenous peoples in the United States had been appropriated by Whites, for example, as facilitated by the Dawes Allotment Act (1887) which allowed the President to separate Native American tribal lands with Indians accepting the land granted U.S. citizenship while many individuals lost their land or were underpaid. Asians were not exempt from discrimination, as evidenced by the Chinese Exclusion Act (1882), which deprived Chinese immigrants of rights of United States citizenship and the forced incarceration of Japanese Americans during World War II following the signing of the notorious Executive Order 9066 by President Roosevelt in 1942.

Thus, through most if not all of its history, the United States has been dominated by a White Eurocentric discourse, leading many contemporary scholars to view it as a fundamentally racist country whose institutions and indeed its very structures of power worked to both create and exclude minorities (Kendy, 2019; Saini, 2019; Wilder, 2013; Wilkerson, 2020).

5 BROADER SCIENTIFIC CONTEXT IN WHICH THE AAA FORMED AND DEVELOPED

We briefly review the use of the term “race” and demonstrate that scientists, including early members of the AAA, were integral to developing and perpetuating racism. The concept of race and its use in science has been extensively examined (e.g., see Barkan, 1991; Smedley, 1993; Stepan, 1983). The concept has been the subject of deep scholarly interest, and is generally thought to date to the late middle ages, targeting Jewish communities, and followed European expansion and the African slave trade (Frederickson, 2002). The term “race” did not always infer biological determinism. It was used in English interchangeably with terms such as “people,” “nation,” “kind,” “type,” “variety,” and “stock,” from the 15th to 18th centuries (Smedley & Smedley, 2012). According to the American Anthropological Association (see Race, 2022 for many useful resources), “race” is now commonly

“used to refer to groups of people according to common origin or background and (is) associated with perceived biological makers… Ideas about race are culturally and socially transmitted and form the basis for racism, racial classification, and often complex racial identities” (Race, 2022).

Racism uses

“race to establish and justify a social hierarchy and system of power that privileges, preferences or advances certain individuals of groups of people usually at the expense of others. Racism is perpetuated through both interpersonal and institutional practices” (Race-website, 2022).

Racial categorization in European contexts became prominent during the Enlightenment (17th and 18th centuries) starting with Carolus Linnaeus (Hudson, 1996; Liscum & Garcia, 2022; Figure 1b). He inscribed upon the natural world the notions Europeans held at the time, launching the system that led to the “biologicalization” of race. Embodying Eurocentric values, these taxonomic categories with accompanying descriptors elevated the category of “Europaeus” above all others by implication (Blakey, 1994). Following closely upon Linnaeus' initial racial classification, the German J. F. Blumenbach (Blumenbach, 1781 and see Pointer, 2010) created another classification system that synthesized Christian with Enlightenment ideologies. He invented the term “Caucasian,” to replace the term “Europaeus,” which he considered to be the standard and Adamic human being. Adjacent to the Caucasian on either side he placed African and Asian races, adjacent to which he placed American Indians and Malay. These adjacent races, though not explicitly ranked above or below the Caucasian, were described as having degenerated from the original, Adamic race. The “soft-line racism” of Blumenbach's monogenesis was followed in the slave-holding United States with the “American School's” polygenesis. Thus, beginning with Samuel Morton's work in Philadelphia, races came to be defined as separate species (Gould, 1981). Many comparative works from the 19th and 20th centuries highlighted anatomical differences between groups of people, specifically between “Europeans” or “Whites” and “others,” as a means to justify a racial hierarchy. In this vein, physical characteristics were linked to perceived behavioral attributes such as intelligence, industriousness, and criminal propensity. In the United States, the concept of race, with inherent differences in ability, began as a moral justification of slavery (Gould, 1981; Smedley & Smedley, 2012). Thus, some anatomists and physical anthropologists, as described in more detail below, were key in creating the distinction of the naturalization of social status on the assumption of biodeterminism.
As early as 1834, the concept of racial superiority was challenged in a Royal Society of London article (Tiedemann, 1837), which rejected the existence of racial differences in brain size and intelligence between White and Black people. Based on a quantitative study of brain size, the author attributed perceived differences in intellectual ability to slavery:

“Many of the results… are at variance with the received opinions relative to the presumed inferiority of the Negro structure, both in the conformation and relative dimensions of the brain; … The author denies that there is any innate difference in the intellectual faculties of these two varieties of the human race; and maintains that the apparent inferiority of the Negro is altogether the result of the demoralizing influence of slavery, and of the long-continued oppression and cruelty which have been exercised towards this unhappy portion of mankind…” (pp. 398–399).

Not long after Tiedemann published his study, the first Black person to earn a MD from a U.S. Medical School, David Jones Peck, graduated from Rush Medical College in 1847. The fallacy of diverse human species was fully refuted by the original nurture argument in a pamphlet published by African American abolitionist Frederick Douglass in 1854 (Douglass, 1950). Douglass' broadly disseminated pamphlet (originally a commencement speech at Western Reserve University) was published in response to the publication of the most broadly disseminated polygenic tome, Types of Mankind (Nott & Giddon, 1854). The introduction in Types of Mankind admits to being a deliberate counter to abolitionist arguments, for example, of the English monogenist, James Cowles Prichard. Douglass began a rational and empirical refusal to allow the polygenists to remove ancient Egypt from Africa by racializing its people to somehow resemble the Norse. At about this time, Darwin published his landmark work on evolution, On the Origin of Species (Darwin, 1859). In Europe, Haitian diplomat, Antenor Firmin, refuted polygeny within the Anthropological Society of Paris in The Equality of Races, originally published in 1885, urging European scientists to embrace the positivism they defied (Firmin, 2002; Fluehr-Lobban, 2000). Interestingly, African American anatomist and anthropologist, William Montague Cobb erected an antiracist anatomical and anthropological program at Howard University in a tradition of thought similar to that of Douglass and Firmin (Blakey & Watkins, 2021). Cobb's White mentor, T. Wingate Todd, professed a similar nurture-side view which he made available to the National Association for the Advancement of Colored People (Rankin-Hill & Blakey, 1994). Contemporary refutations of the value of race as a scientific concept continue to be published (e.g., Blakey, 2021; Sussman, 2014).

6 IDEAS ABOUT RACE AND EUGENICS

Drawing on the work of British biometricians like Francis Galton, who coined the term “eugenics,” for a then new science of the “well-born,” anthropologists in the United States, most notably Aleś Hrdlička, measured the heads and bodies of southern and eastern European immigrants, Black people, Native Americans, and “Old American Whites” at the Smithsonian Institution from 1904 until the Second World War (Hrdlička, 1925, 1927, 1928). Eugenics was based on the assumption that heredity was the main determinant of anatomical, physiological, and behavioral phenotypes (Kevles, 1995; Turda, 2022). Thus, eugenics attempted to improve future generations by controlling heredity, which for most of its history meant controlling the ability to reproduce (Paul, 1995). Hrdlička explicitly sought to know racial biological capacities, which a “eugenical” program of the Federal Government might use to manipulate the evolutionary “progress” of the nation. He defined eugenics as simply applied physical anthropological and evolutionary science (Hrdlička, 1918). He was part of a cluster of Galtonians, members of the Galton Society, that included eugenicist and Social Darwinist Madison Grant and American Museum of Natural History President and paleontologist H. F. Osborn, whose displays replicated the hierarchy of human types (Barkan, 1991; Clark, 2008; Rainger, 1991; Spiro, 2002). Osborn, himself, was an active member of the AAA as was Columbia University anatomist and medical doctor George Sumner Huntington, who served as President of the AAA from 1899 to 1903, and whose extensive private skeleton collection served as a resource of Hrdlička's studies (Columbia University, 2022). Likewise, the geneticist Charles Davenport instituted an extreme hereditarian view with White supremacist expectations at his Eugenics Records Office at Cold Spring Harbor. The Immigration Act of 1924 and racial segregation (including the reign of terror required to implement it) were justified in the highest and lowest quarters of White America by the science of eugenics: the manipulation of the organic evolution of society (Allen, 1975; Blakey, 1987, 1996; Gould, 1981; Ludmerer, 1972; Patterson, 1951). In opposition to this form of scientific racism, German–American Jewish anthropologist, Franz Boas at Columbia University advocated biological “plasticity” of European American somatotypes and crania to exemplify the “environmental” mutability of races (Boas, 1912; Stocking, 1966, 1989).

Eugenics itself swept through the international community which, as Hrdlička and others noted, made the incessant measurements of differences, the dicing and splitting of peoples by every possible biological characteristic appear to be of great social value (Kevles, 1995). Eugenic policies were instituted to frightful ends not only in the United States and Britain, but also in France, Sweden, Brazil, Japan, and Germany, where it reached its most extreme (and destructive) conclusion, leading to the deaths of 6 million Jews and others deemed inferior. Despite the rejection of Nazi philosophy, the presumptive legitimacy of biological determinism has not been eradicated, if no longer securely under the newly tainted label of “race.”

7 DEBUNKING OF RACE AS A USEFUL BIOLOGICAL CONCEPT

In the early 1940s, Theodosius Dobzhansky, a Soviet émigré to the United States, and evolutionary geneticist working with anthropologists Ashley Montagu and later Sherwood Washburn, began to undercut the notion of race, by substituting it with the population concept of the gene pool (Dobzhansky, 1941; Dunn & Dobzhansky, 1947; Farber, 2009; Smocovitis, 2012). The observed complexity of clinal variation and the noncovariance of traits debunked the notion of simple Linnaean categories of race.

After the Second World War, scholars of the newly formed United Nations brought evidence to debunk racial inequality and questioned the validity of the concept of race (see Montagu, 1951; Statement on Race Barkan, 1991; Brattain, 2007). The UNESCO Statement on Race allowed the idea of Caucasoid, Mongoloid, and Negroid “Divisions” to remain intact. On the one hand, previously racialized groups (especially Jews and other non-Western Europeans) were restored to ethnicity. On the other hand, those Europeans whom the brush of racialization had begun to paint with genetic explanations of their existence (and right to exist) were relieved of the threat of non-White racialization, and returned to the Caucasoid Division. This nominal relief set the stage for the socioeconomic reintegration of Jews to American “whiteness” (Sacks, 1998). Thus, by the early 1960s, the “nonexistence of race” had become a biological fact (Livingstone & Dobzhansky, 1962). Still, most textbooks continued to use the term race until near the end of the 20th century and biological anthropology texts were equivocal (Lieberman et al., 1989; Lieberman & Reynolds, 1978). As an unfortunate outcome, the concept of race persisted and indeed use of the term had become more a matter of choice, despite the efforts of population geneticists and anthropologists (see Birdsell, 1981 as an example). Others—Black people, Native peoples, and Asians in the United States—would require a Civil Rights Movement after the War to end the legal structures of racial inequity. But the imprimatur of antiracism had been set as a new Western moral standard (Barkan, 1991; Farber & Cravens, 2009).

8 BRIEF HISTORY OF THE AAA

In the late 19th century, scientists in the United States began forming discipline-specific scientific societies, including the Association of American Anatomists which was founded on September 17, 1888, at Georgetown University (Bruce, 1987; Daniels, 1967; Oleson & Voss, 1979; Figure 1c). Many of the scientific societies formed at this time in the United States began as sections within the AAAS (Kohlstedt et al., 1999). The Association's name changed to the American Association of Anatomists in 1908 and then to the AAA in 2019. Anatomical societies were also founded in this era in a number of international contexts, usually along nationalist lines, including the German Anatomische Gesellschaft (founded in 1886), the Anatomical Society UK (founded in 1887), the Japanese Association of Anatomists (founded in 1893), The Nederlandse Anatomen Vereniging (founded in 1893), the Association des Anatomistes (founded in 1899), the Unione Zoologica Italiana (founded in 1900), and the International Federation of Associations of Anatomy (founded in 1903).

The AAA was formed for “the advancement of the anatomical sciences” (Basmajian, 1987). Joseph Leidy, the first president was a keen institution builder, and promoter of science with wide-ranging polymathic interests (Warren, 1988). He was a skilled microscopist, paleontologist and comparative anatomist. Although he did not attend the meeting at which the Association was formed, Leidy was elected as first president by the founders, most of whom were not full-time anatomists, but were physicians or surgeons attending the Congress of American Physicians and Surgeons in Washington, D.C.

The organization reflected scientific developments in anatomy that were transforming anatomical practice. Novel techniques stemming from developments in 19th century microscopy as well as the application of experimental methods moved anatomical study into modern research laboratories, as new sciences such as cell biology, histology, and experimental embryology were added to gross anatomy. At the same time, museum collections began to undergo explosive development in a period that saw the institutionalization and comingling of both natural history and nationalist history in private as well as state and national contexts (Barrow, 2009; Redman, 2016); medical schools of instruction also began to flourish in the United States (Starr, 1982).

The first 100 years of the AAA were covered in a series of essays published in an edited volume (Pauly, 1987). Interestingly, of the 20 authors in this collection, all were White and two were women. The first two chapters describe the early history of the Association, including the beginnings of two of its journals (The American Journal of Anatomy in 1901 [renamed Developmental Dynamics in 1992] and The Anatomical Record in 1906). Thirteen chapters focus on how anatomists led or significantly contributed to many advances in laboratory science, such as cell biology, electron microscopy, histochemistry, radioautography, developmental biology, and neuroanatomy. Three chapters focused on gross and cross-sectional anatomy. Except for the first two chapters on the early history, the development of the Association after the early 1900's received little attention. However, there is an extensive appendix that includes demographic information broken down by sex, a history of meeting sites, pictures of the association presidents, and information on officers and members of the executive committee. Another potential source of information, which the Task Force has not explored, is AAA archival material housed in the Albin O. Kuhn Library & Gallery at the University of Maryland, Baltimore County. The archive contains records dating from 1900 to 2011, including institutional papers, publications, photographs, awards, committee files, planning files for Experimental Biology, financial documents, membership lists, and AAA publications.

Based on documentation in the published AAA proceedings and papers on the history of African American scientists, Roscoe L. McKinney seems to be the first Black anatomist with a PhD (Epps et al., 1993) and the first Black AAA member (Evans et al., 1931). He joined the association in 1931, 43 years after its founding. William Montague Cobb, who earned an MD in 1929, was also an early Black scientist to earn an anatomy PhD (1932) and was also trained in the then nascent field of physical anthropology (Rankin-Hill & Blakey, 1994). He joined the Association in 1934 (Anonymous, 1934). Cobb went on to a distinguished career, including establishing a named laboratory in the Department of Anatomy at Howard University and earning many professional achievements and honors. In fact, Cobb was honored with the 1980 AAA Henry Gray Scientific Award and is the namesake of the AAA W.M. Cobb Award in Morphological Sciences. The first Black member of the Board of Directors appears to have been Lee V. Leak, who served on the AAA Executive Committee from 1980 to 1984. It seems that there was a nearly 40 year hiatus until the next Black person and first Black woman, Shaun Logan in 2018, was elected to the Board, well over a century after the founding of the AAA and ~50 years following the height of the Civil Rights movement in the United States. The AAA went from a volunteer-led organization to being professionally run in 1997, and hired its first Black Executive Director, Shawn Boynes, in 2013.

The presentations at AAA meetings early in its history often espoused ideas of racial hierarchies. In fact, a preliminary study of proceedings of AAA meetings reveals many publications in the late 19th and early 20th centuries that embody the pervasive scientific racism shared by anatomists and anthropologists, not only in the United States but worldwide. Scientific racism generally refers to the application—or misapplication—of science to justify racism or racist practices (Barkan, 1991; Gould, 1981; Hammonds & Herzig, 2008; Smedley, 1993; Stepan, 1983). At the 1895 meeting, the presidential address of Thomas Dwight (1896) noted the following (p. 77):

“We are to hear also from the committee appointed to consider the anatomical peculiarities of the negro. I am not informed what success has been reached in the difficult task of collecting statistics. It is a work of such anthropological importance that it would be doubly to be regretted should it come to naught. As has already been said at our meetings, it is most proper that this Society should collect all possible information as to the anatomy not only of the negro, but of such savage races as still survive in North America, and of the extinct ones, whose bones can still be procured in large numbers.”

It is important to point out that Dwight truly believed in 1895 that this endeavor, which from today's point of view was clearly racist, was “most proper.” Similar arguments can be traced through the history of anatomy. Indeed, this idea of what is the “proper” duty of science resonates nearly word for word with some of the reflections by anatomists active in Nazi Germany, who used legally available bodies of Nazi victims for their research (Hildebrandt, 2016). At the 1897 AAA meeting, secretary D. S. Lamb mentioned the following: “The circular and blanks in reference to the anatomical peculiarities of the negro race were ordered to be modified and copies sent out for report of cases” (Lamb, 1897, p. 311). There is more of the same in the annual address that Aleś Hrdlička gave in 1908, as President of the Anthropological Society of Washington (Hrdlička, 1908) and again more at the 1906 AAA meeting, when embryologist Franklin P. Mall gave the president's address “On some points of importance to anatomists.” Herein, he argued for the European idea of academic freedom in the following manner: “The teachers and students in an anatomical department should be given a free hand […] they may study the arm of a human embryo or the negro brain” (Mall, 1907). In the same proceedings, an abstract on the frontal lobe of monkeys (Millus, 1907, p. 56) was directly followed by the abstract on Robert Bennett Bean's work on “The racial peculiarity in the temporal lobe of the negro” (Bean, 1907, p. 57). Similar articles such as Some racial peculiarities of the negro brain published from Johns Hopkins, and in the American Journal of Anatomy (volume 5) in 1906 by Bean (1906), still correlated “negro” brain size with the amount of White blood mixed in. Furthermore, Bean concluded that “the negro has the lower mental faculties (smell, sight, handicraftsmanship [sic], body-sense, melody) well developed, the Caucasian the higher (self-control, will power, ethical and Esthetic senses and reason)” (p. 412). Bean also authored the Racial Anatomy of the Philippine Islanders (1910) and The Races of Man: Differentiation and Dispersal of Man (1932) (Bean, 1910, 1932).

Studies such as these were not solely isolating Black Africans or Americans, but all “others.” This is evident in articles such as A study of a plains Indian brain in 1916 (Keegan, 1916) that was supposedly “filling a gap” in the racialized cerebral anatomy data (published in the Journal of Comparative Neurology). These articles demonstrate a long history of scientific racism in anatomical sciences in the United States, and would have been part of the training environment of Leidy et al. in the AAA at the time. A further detailed look at the early proceedings of the AAA is likely to reveal similar reflections of the pervasive racism of anthropological and anatomical science at the time.

Partially to support emerging theories of human evolution and racial differences, human remains became highly sought-after objects in scientific research, medical education, and even in public exhibitions (Appendix I for more details). Resultant anatomical collections thus have multifaceted and complex origins. Means of collection included archeological fieldwork, the opportunistic procurement of war dead, bodysnatching, and international purchase. Sometimes, collections first existed as bodies used for anatomical instruction. Importantly, the acquisition of human remains was often illegal and largely involved the exploitation of non-White groups. Although the remains of White individuals did make their way into museum and university or medical school repositories (e.g., the Hamann-Todd and Terry collections), the remains were most likely to be from criminals or the destitute living on the fringes of society.

Black physicians attempted to found an integrated medical society during legal segregation, but the Medico-Chirurgical Society was unable to sustain White membership under the law (Cobb, 1939). In 1895, partly in response to the American Medical Association (AMA) denying, segregating members or refusing local delegations entry (AMA, 2022), a group of physicians formed the National Association of Colored Physicians, Dentists, and Pharmacists, which was later named the National Medical Association (Cobb, 1981; Mitchell, 2020). It was this organization and not the AMA or AAA that provided for normal collegiality among African American physicians and scientists in the days of legal and customary Jim Crow racial segregation in the United States.

The formative years of the AAA occurred during the time of a wholescale effort to reform medical education in North America, an era that facilitated discriminatory barriers in medicine (Appendix II). Organizations such as the AMA insisted in advocating for higher standards across medical schools, ultimately leading to standardizing curricular structure, licensing requirements for medical practice, and publicizing board exam failure rates (Markowitz & Rosner, 1973; Miller & Weiss, 2012; Savitt, 2006). This era culminated in the influential 1910 Flexner Report, which emphasized admission and curricular standards (including laboratory-based and hospital-based training), and the closure of any school that could not meet these expectations (Harley, 2006; Miller & Weiss, 2012). Prior to this era of reform, only a handful of Black students were admitted to large, established medical schools in North America (Harley, 2006). Prospective Black medical students therefore had limited options, including a small number of medical schools dedicated to Black individuals and small proprietary schools that were limited in terms of faculty, infrastructure, and financial resources (Miller & Weiss, 2012; Savitt, 2006). These institutions were poorly equipped to meet the new standards for medical training and most ultimately had to close, with only two (out of seven) Black medical schools surviving, further constricting already scarce education opportunities for prospective Black doctors (Harley, 2006; Savitt, 2006). Flexner also articulated a narrow, limited role for the Black physician in society (Sullivan & Suez, 2010). Undoubtedly influenced by Flexner's characterization, many large, established medical programs formally instituted decades-long bans or restrictions on admitting Black students, motivated by the perception that Black students would hurt the school's standing with the AMA (Glauser, 2020). The sum of the AMA's actions in the late 1800s and early 1900s clearly contributed to structural discrimination that excluded Black individuals in medicine, and the consequences are still apparent today with respect to the persistent underrepresentation of Black individuals in the medical field (Campbell et al., 2020).

While historic demographic data are quite limited with respect to race or ethnicity, there are some data on women as members and officers in the AAA. Within 6 years after its founding, the AAA accepted its first female member, Mary Blair Moody. By the end of WWII, the AAA had 11% female members and 18% female members by 1987. Today, the female: male ratio is 1:1. Of the 212 elected officers through 1987, 18 (8.5%) were women (Pauly, 1987). The first female president of the AAA was Florence R Sabin (1924–1926), followed by Berta Scharrer (1978–1979), and Elizabeth D. Hay (1981–1982). The current AAA board of directors includes 10 women and four men. Of the 10 most recent presidents, five are women. Sufficient data for comparison were found for the German Anatomische Gesellschaft, which was explicitly conceived as an international organization. The first female member mentioned in its historiography is Wera Dantschakoff in 1908. Of the 453 members registered between 1933 and 1945, 15 (3.3%) were women (Winkelmann, 2012). Until 1965 there were no female honorary members or copresidents (Herrlinger, 1965). The first documented woman copresident was Christine Heym in 1990, the next Eveline Baumgart Vogt in 2006 (Anatomische Gesellschaft, 2021). Thus, the AAA had earlier female association officers and a higher percentage of female members by 1945 than the German Anatomische Gesellschaft, 11% versus ~3%.

Among other marginalized groups in society, the participation of Jews in medicine, anatomy and the AAA deserves mention. Jewish involvement in American medicine during the latter part of the 19th century through the first half of the 20th century was substantial (see Appendix III). This growth was due in large part to the immigration of sizable numbers of Jews, first from central Europe, and subsequently from eastern Europe to the United States. Many of the central European Jews, particularly from Germany, were highly educated, often trained as physicians, lawyers or businessmen; those from Russia, Poland and other areas in the east were frequently impoverished and less well educated (see Aufses & Niss, 2002; Birmingham, 1967). Particularly stemming from the foundation of The Mount Sinai Hospital in New York in 1852, Jewish physicians started to become integral in American medicine, especially in “newer” fields such as pediatrics, psychiatry, or neurology that did not have limits or barriers as the more established and economically more competitive surgical fields. While Jews rose to prominence in clinical medicine, they seemed to not have entered anatomy or cognate fields with the same numbers, possibly related to the linkage of anatomy with the less-welcoming surgical fields. Jewish prominence in the Association seems to have been limited as compared to other medical fields. In Germany, it is important to mention that during the time of the Nazi regime all Jewish and politically persecuted members of the Anatomische Gesellschaft were “lost” from the association's roster. The Anatomische Gesellschaft did not, as it still claimed in the 1980s (Schierhorn, 1986), “protect” its members; it simply did not actively remove them. However, anyone who did not pay their dues was struck from the membership lists, including those who could no longer afford the fees or were forced to emigrate due to persecution by the Nazi regime (Winkelmann, 2012). Whether there was any active antisemitism within the AAA is unclear and needs further study. The AAA apparently never commented on the practices of German National Socialism and the Holocaust and has also not accepted proposals for symposia or special studies on antisemitism and racism until recently. This brief accounting emphasizes that detailed and systematic historical investigations are limited for some groups and currently missing for nearly all marginalized groups within the AAA.

9 AAA POLICIES, PROCEDURES, AND GOVERNANCE STRUCTURE

Based on our limited review, the AAA never had rules forbidding membership by gender or race, but a much more careful examination of the historical records merits attention. The AAA did maintain norms (or upheld policies) that prevented the full participation of members and reinforced inequality. For instance, by 1902, candidates for membership needed to be persons engaged in the investigation of anatomical or cognate sciences and had to be nominated in writing to the executive committee by two members, who had to accompany the recommendation by a list of the candidate's publications, together with references. This requirement would certainly have limited access to the Association for many underrepresented individuals who were lacking the necessary networks within the profession. This policy was not changed until 2002, when the bylaws were amended, removing the nomination requirement. Another example of a structural barrier that limited Black members of the association was the geographic location and venue for the annual conference. Prior to the passing of the Civil Rights Act of 1964, outlawing discrimination in public accommodations, the choice of meeting location adversely affected Black members of the AAA. State laws or local ordinances often mandated segregation of transportation, restaurants, restrooms, hotels and other public spaces and venues. These laws restricted where Black members could move, eat, sleep, and travel, and thus limited full participation of Black members in AAA events. Black members Drs William Montague Cobb and M. Young Wharton, for example, boycotted the 1957 (70th) AAA meeting held in Baltimore, Maryland because of discrimination at the conference hotel (Heywood, 2018). According to the Proceedings of the Seventieth Annual Meeting held in 1957, the membership voted to study a resolution about the location of future meetings of the association (Anonymous, 1957). A year later at the 71th annual meeting held in 1958 in Buffalo, New York, the “Resolution on Sites of Future Meetings” prepared by the Executive Committee was approved (Anonymous, 1958). The resolution states,

“In selecting the place for the annual meeting of the Association the Executive Committee will be guided by the desire of the members of this Association to provide the same facilities for all its members and for their full participation in all its activities.”

10 DISCUSSION

The goal of the Task Force was to understand the history of African Americans within the AAA in the context of the laws, rules and practices in which the Association formed, developed and continues to exist. At the time of the Association's founding, the United States was a highly segregated country with many people, including scientists, openly expressing racist attitudes and presenting papers that were both fueled by, and in turn fed, scientific racism. In addition, Black people lacked educational opportunities, including those in STEM. Those factors certainly contributed directly and indirectly to creating barriers that led to low participation in the AAA by African Americans.

While there may have been no explicit policies prohibiting participation by people of color, Jews, Indigenous peoples and other societally marginalized groups such as lesbian, gay, bisexual, transgender, and queer or questioning, additional research needs to determine how practices within the AAA (i.e., behaviors of members and society officers) affected participation. Thus, while we have focused on the participation of Black people, with some comments on Indigenous people, women and Jews, other histories need to be explored. It is to be suspected that this more detailed knowledge may reveal patterns of overt as well as structural and institutional bias that, once fully rectified, may help the Association more rapidly bend the arc of the diversity trajectory.

To understand AAA's history, we briefly traced scientific racism and its implications for the Association. We encourage future studies that compare publications of the AAA with the development of anatomical sciences at the same time. One question to answer will be the extent to which all branches of research carried out by members of the AAA were shaped by scientific racism or contributed to its existence. For example, developments in cell and molecular biology that took place in the 20th century (Pauly, 1987) may not have contributed to scientific racism at least overtly, but this is a supposition deserving further attention, given recent work in the history of cytology (Skloot, 2010). A more thorough understanding of the history of the AAA is needed before a comprehensive awareness can be achieved of how barriers to inclusivity emerged and were promulgated.

Through much of its history and with rare exception, the AAA ignored racism, and some of its members were an essential part of promulgating scientific racism. Despite these barriers, some people who were members of underrepresented groups did become part of the AAA. We suspect that progress has been glacially slow, but may have accelerated in the last 10–20 years when the AAA made a strong and deliberate commitment to increasing diversity. With respect to intentional efforts to improve participation by Black anatomists, serious effort only began in the last 10 years, ~4–5 decades after the landmark passing of the Civil Rights Act (1964) and the Voting Rights Act (1965) in the United States. With respect to women in the Association, the intentional effort did not really start until ~8 decades after passing of the 19th Amendment to the United States constitution (1920), which in practice only granted voting rights to White women. Recognizing that these efforts have only occurred during the most recent 10% of the Association's history, it is not surprising that so few individuals from marginalized groups are members of, or have held leadership roles in the AAA. It is fair to ask why these changes took so long to initiate.

A candid look at the history of the AAA reveals clear patterns of racism, which reach into the present. A critical reflection on the history of the Association has started in recent years, motivated in part by member initiatives (e.g., Black in Anatomy and member-initiated project proposals to the Board), encouragement of purposeful action by the Board with respect to Committee appointments and nominations (consistent with the Association's recently articulated values and strategic plan), and the active political discourse of groups such as Black Lives Matter. In addition, discussions of ethics in anatomy, closely related to any critical reflection, have been supported by the AAA as well as the International Federation of Associations of Anatomy in the last few years through symposia at meetings, special issues of the journals Anatomical Sciences Education (“Ethics in Anatomy Education,” July/August 2019, volume 12, number 4) and The Anatomical Record (“History and Ethics of Anatomy,” of which this paper is a part), and other publications. Recognizing that the present essay is limited in scope, it is clear that a thorough and comprehensive historical analysis of the AAA as well as the history of anatomy in the United States is still missing, and needs to happen because it may guide us through the present and in the future.

The relationship between racism and structural racism itself merits comment. The Task Force originally sought to focus on structural racism, but it is nearly impossible to ignore personal bias. In fact, it is worth asking if a focus on structural racism sweeps the importance of personal racism under the rug; that is, can structural racism exist in the absence of personal racism? “Racism” is institutional, interpersonal, and internalized. We have been misguided to think that it is only the uncivil act of bad persons, but it does not preclude these. Robin DiAngelo seeks to disregard the interpersonal or personal responsibilities in order to get past “White fragility” long enough to have reasonable discussions between White and Black people about racism (DiAngelo, 2018). However, if individuals never take personal responsibility, the structural problems will not likely change.

While there may not have been explicit policies causing lack of diversity in the AAA, the benign interpretation of the AAA's behavior as an association is that there were numerous acts of complicity to structural and institutional racism by omission and inattention, lack of critical questioning of practices and lack of reflection. For instance, it was not until the late 1950's, after criticism by two prominent African American members, that the AAA pledged to hold its annual meetings in cities where African Americans could attend. Furthermore, throughout its history, the AAA has remained largely mute on the topic of body procurement for anatomical dissection although the topic's importance was recognized early in the Association's history (see Dwight, 1896). Its first body donation policy was not adopted by the Board of Directors until 2009, and later revised in 2019, despite the fact that the first United States Uniform Anatomical Gift Act was passed in 1968. The AAA has recently taken significant steps to redress this issue. The Body Donation Task Force, which was formalized in 2020, seeks to increase awareness about whole body donation for education and research, advocate for body donor best interests, and develop and contribute to best practices. Recognizing the questionable origins of many of skeletal collections, and following discussion among anatomists as well as in the wider community, the AAA has created a Task Force on Legacy Anatomical Collections. Its aim is to formulate recommendations that address ethical and practical concerns surrounding such collections. These include the need for anatomists to inventory and report on human remains in their care (ethical stewardship, duty of care); perspectives on anatomical museum and teaching collections; dealing with known remains and remains with unknown provenance, including from contexts of colonialism, slavery, and marginalized populations in general. An emphasis lies on inventory and understanding the source and identity of remains. We do note that the United States Native American Graves Protection and Repatriation Act, which took effect in 1990, may be the only such law world-wide that mandates the return of human remains and cultural objects to the descendant community.

With respect to the society in which it exists, it appears that the AAA, as an organization, was often silent with respect to multiple instances of racism in the United States or the racist assault upon Jews during the Holocaust, not to mention the long history of discrimination against other minority populations, leading ultimately to a limited pool of talent for society as a whole. It is worth understanding why this occurred; why was the AAA silent? This understanding might be helpful today and going forward in recognizing and combating racism and other forms of bias. We suspect that current members are poorly informed on these issues and recommend that the Association include an educational component in its programming. In addition, the Task Force recommends that academic departments of biology, anatomy, and medicine have substantial curricular components in the history of these sciences and to explore the existence of racism in their past and present practices. College students need this long before they become professionals.

From the perspective of today it seems obvious that the AAA could have done better in the past, and an important question is whether or not the Association is less biased today. We would like to think so, but this question can only be answered 10 or 20 years from now when a future AAA task force reexamines questions related to structural racism. However, we believe a better understanding of our past may help guide future behavior and hope that the present Task Force's efforts will inspire new research. The paucity of persons from historically underrepresented groups in the AAA is consistent with their underrepresentation in academia in general. It is likely that improving diversity within the AAA will not occur by looking only within the AAA or competing with other disciplines for recruitment and retention of underrepresented groups, but will take an academy-wide effort.

The AAA has a DEI Committee, which is charged with creating strategies to increase representation and engagement of the membership, work with the other AAA committees to ensure and assess DEI throughout the association. Many of these initiatives have recently been described (Carroll et al., 2022), as has a toolkit for making anatomy curricula more inclusive (Finn et al., 2022). Two major new programs being funded by the AAA include the Anatomy Scholars Program (a professional development, mentorship and networking program) and POP AART (Portfolios of People: Advancing Anatomical Representation), a project to create a representative library of anatomical images across categories of race, ethnicity, gender, body habitus, age, physical ability, and accessibility. It might be worth scrutinizing the history of DEI initiatives in the AAA to determine if any significant efforts were made prior to the establishment of the DEI Committee.

The Task Force believes that this recounting of the AAA history in the broader context of science and society clearly supports the hypothesis that personal racism and structural racism are fundamental reasons explaining why there are few people from marginalized groups in the AAA. While overt individual racism may be less prevalent today than in the past, it would be naïve to think it does not exist. The importance of individual bias, unconscious bias, microaggressions and other acts of discrimination should not be ignored. Even worse, the long-term sequelae, which manifest today as structural racism, still play a major role. Thus, the Task Force recommends that the AAA craft a Statement of Responsibility acknowledging its history and provide resources to facilitate further study of that history to better understand the continuing implications. In addition, the Association should support new and existing initiatives to improve DEI and encourage and support people from currently marginalized populations to become scientists, whether or not they eventually become anatomists or members of the Association.

ACKNOWLEDGMENTS

The authors thank Dominic Hall, curator of the Warren Anatomical Museum at Harvard Medical School, for pointing to Lamb (1897). The authors also thank Keli Hughes, Administrative Coordinator for the AAA, for providing logistical support for the task force and Liz Phares, Senior Membership Services Manager for the AAA for providing current demographic data, and Shawn Boynes, Executive Director for the AAA for his overall guidance. The opinions expressed in this commentary are solely those of the authors.

    AUTHOR CONTRIBUTIONS

    Dale R. Sumner: Conceptualization (equal); investigation (equal); project administration (lead); writing – original draft (lead); writing – review and editing (equal). Sabine Hildebrandt: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Allison Nesbitt: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Melissa Carroll: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Vassiliki B. Smocovitis: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Jeffrey T. Laitman: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Amy Beresheim: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Christopher Ramnanan: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Michael L. Blakey: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal).

    Appendix I: Structural Racism and Laws Governing Body Procurement for Anatomical Study in the United States

    Amy C. Beresheim

    Although body donor population demographics in the United States have changed substantially over the past few decades, the bodies of the poor, the marginalized, and the transient were historically overrepresented in medical education and anatomical research. The low socioeconomic status of these groups made the use of their bodies less noticeable and less objectionable to the middle and upper classes, and it greatly inhibited their ability to resist exploitation even in death (Savitt, 1982; Nystrom, 2014). This blatant social discrimination was embraced by the medical community for many decades, wherein professional organizations, such as the American Association for Anatomy (AAA), were either complicit or remained silent (Carroll et al., 2022, this issue).

    In 1831, Massachusetts became the first state to pass an Anatomy Act, which permitted the use of unclaimed bodies for dissection, and predated the Anatomy Act in the United Kingdom by one year. Although several other states created legal channels for procuring bodies by the 1850s, these were often limited to the bodies of executed criminals and were insufficient for meeting the demands of the growing medical establishment (Blake, 1955). With the proliferation of medical schools throughout the 19th century (increasing from four to approximately 160 by 1900), there were chronic body shortages, leading to a burgeoning industry of bodysnatching (Hildebrandt, 2010). Bodysnatching refers to the theft of a dead body, typically from either a morgue or the site of interment. Although they are often used interchangeably, the term bodysnatching is distinct from grave-robbing, which refers to the plundering of burials for personal effects and artifacts rather than for the body itself.

    The ability to secure the sanctity of the grave was most reliably determined by the socioeconomic status of the individual in life. Potter's fields, municipal cemeteries in which individuals were buried at public expense, constituted another major source for the illicit body trade. These graves were easy targets as they were often superficially buried, and the coffins were simple pine boxes. Graves without markers were especially vulnerable (Highet, 2005). The rich were further protected as they could afford physical measures to safeguard their graves. These included burying bodies in iron coffins, installing mortsafes, hiring guards to look after gravesites, and temporarily storing bodies in vaults until they decomposed beyond medical usefulness (Highet, 2005). By the mid-19th century, an estimated 600-700 graves were emptied annually to supply New York City medical schools alone (Heaton, 1943). Nationwide, this number is closely approximated to be 5,000 (Humphrey, 1973).

    Only a small proportion of the illicit body trade was ever detailed in 18th and 19th century newspapers. While the media published sensationalist stories about the bodies of prominent Whites being used in medical school dissections (e.g. Congressman John Harrison) (Humphrey, 1973), they largely remained silent on the desecration of Black or Native American burial grounds (Highet, 2005; Nystrom, 2014). People tended only to be concerned about the dead within their own social stratum. Indeed, fear and public anxiety over bodysnatching came to a head on several occasions, with over 17 anatomy riots occurring between 1785 and 1855. Many of these riots were precipitated by the discovery of empty White graves and were subsequently followed by the closure of the local medical school (Edwards, 1951; Sappol, 2002). The 1788 Doctor's Mob in New York City is perhaps the most famous and is of particular interest. A year prior, a group of free Blacks petitioned the New York City Common Council to stop the removal of their dead from the Negro Burial Ground. Their request was ignored, and it was not until the body of a White woman was reported stolen from Trinity Church Cemetery that a riot ensued. The riot lasted three days and resulted in the deaths of six people (Swan, 2000).

    In order to circumvent inciting public outrage, “sack-’em-up men”, “night doctors”, or “resurrectionists” preferentially targeted Black bodies. Blacks lacked the political power to protect their dead, and thus their graves constituted a significant source of the illicit body traffic. Harriet Martineau, a British travel writer, is famously quoted as saying, “the bodies of coloured people exclusively are taken for dissection because the whites do not like it, and the coloured people cannot resist” after a trip to Baltimore in 1834 (Martineau, 1838) (p. 140). Some medical schools (e.g. South Carolina Medical College) even went so far as to advertise their proximity to large African-American populations. This allowed their students to benefit from the local supply of bodies so that they could “conduct proper dissections without offending any individuals in the community” (Halperin, 2007). Other schools kept their activities more clandestine, with evidence of anatomical dissection being later uncovered through bioarcheological investigations of human skeletal remains from either cemetery or institutional contexts (Blakely, 1997; Blakely & Harrington, 1997; Davidson, 2007; de la Cova, 2010, 2019; Doubek & Grauer, 2019; Lans, 2020; Nystrom, 2014; Stevens et al., 2018; Watkins, 2018).

    At the Medical College of Georgia, many bodies were illicitly obtained through the efforts of Grandison Harris, a slave who worked as both a janitor and body snatcher. During his 50 years of service, as many as 400 bodies were taken from the Cedar Grove Cemetery, an African American burial ground located just a short distance away from the school (Blakely and Harrington, 1997b). In some instances, the bodies of slaves were sold and delivered directly to anatomists by their owners (Humphrey, 1973; Savitt, 1982; Blakely and Harrington, 1997a). There have also been several documented cases where Northern medical schools were found to be importing Black bodies from the South in the advent of local shortages (Washington, 2006).

    The bodies of indigents who died in prisons, poorhouses, hospitals, or mental asylums were also predisposed to bodysnatching. Before burial, these bodies were surreptitiously transferred to medical schools for anatomical dissection. In addition, a disproportionate number of immigrants ended up in the illicit body trade. In 1880, one eighth of the US population was foreign born, but immigrants comprised almost a third of the paupers in almshouses (Humphrey, 1973). An early 20th century survey of US medical schools revealed that the majority used almshouses as either their primary or only source, but some schools also relied on local “charitable institutions” or tuberculosis hospitals for their supply of bodies for dissection (Jenkins, 1913).

    By 1913, most US states had passed some form of legislation regulating the use of bodies in anatomical dissection. However, these laws often did not stipulate rules governing the reception, transportation, treatment, preservation and disposal of the bodies, nor did they ensure that proper identification records were kept (Jenkins, 1913). In the US and elsewhere, the disposition of the dead for scientific purposes still raises ethical questions today. The Uniform Anatomical Gift Acts (1968, 1987, and 2006) deemphasize whole body donation in favor of organ donation (Dalley et al., 1993), and do not explicitly prohibit the use of unclaimed bodies in anatomical dissection, nor the commercial sale of human body parts for education and research. In fact, most state laws governing anatomical donation still permit the use of unclaimed bodies (Caplan and DeCamp, 2019), and several continue to use antiquated terminology (e.g. Illinois “Cadaver” Act of 1885). Although the use of unclaimed bodies in US anatomy programs has substantially decreased in the past few decades, an estimated 12.4% of the US supply is still derived from the bodies of individuals who have not given informed consent (Caplan and DeCamp, 2019). Unclaimed bodies remain the major or exclusive source in many other countries (Habicht et al., 2018). Similarly, most anatomical studies published do not indicate the sources of their specimens. According to a recent report, just over one quarter of anatomy articles published between 2011-2015 provided information on consent, and less than one-third reported some form of ethical approval for their study. The individuals or their families were only acknowledged in 17.7 % of the articles (Gurses et al., 2016). However, as a prerequisite for publication, a select few journals (e.g. Annals of Anatomy, Anatomical Science International) do require a statement of acknowledgement if human tissues are used.

    The commercialization of dead human bodies and their parts continues to be of concern. Over the past two decades, the United States has seen a significant increase in the number of for-profit non-transplant anatomical donation companies, or “body brokers” (Champney et al., 2019). While these businesses rely on willed body donations, their advertising is often manipulative, their handling practices lack respect and transparency, and their proceeds are not shared with grieving families. The sale of human skeletal remains throughout the 20th century represents another example of commercial exploitation. From the 1930s to 1985, Indian export suppliers contributed a significant proportion of the global bone trade, wherein an estimated 70% of their international sales were to individuals or institutions within the United States (Hefner et al., 2016). As many as 2 million skeletons total, and up to 65,000 annually, were shipped from India. These remains were largely derived from unclaimed bodies from hospitals and police morgues, but in other instances they were stolen from graves, procured from rivers after ceremonial water burials, or diverted from crematoriums without the permission from the next-of-kin (Stephan et al., 2017).

    The medical establishment and associated scientific societies have long defended the legitimacy of anatomical dissection, but we have only recently begun to consider our ethical obligations to the dead, and to scrutinize how bodies are obtained and used for study. The American Association of Clinical Anatomists (AACA) made their first public statement in disfavor of third-party brokers in 1991 (Cahill and Marks, 1991), and later published guidelines for body donation programs in 2008 (Champney, 2011) . The AAA followed suit in 2009 with less detailed recommendations. Respectively, these policies have most recently been revised in 2017 and 2019 (AACA-Website, 2017; AAA-Website, 2019).

    Voluntary donations now constitute the vast majority of the bodies used in US medical schools (Garment et al., 2007). However, Black bodies appear to be underrepresented in modern donor populations. Several studies have shown that Blacks are less likely than Whites to participate in either organ or full body donation programs because of medical mistrust and iatrophobia (Boulware et al., 2004; Siminoff et al., 2006). Similar body donation trends are observed for other historically marginalized groups in the United States (Collins et al., 2018), as well as abroad (Kramer and Hutchinson, 2015; Zhang et al., 2020). The reluctance of these groups to donate is at least in part a reflection of the historic burden of racism and socioeconomic inequality in science and medicine.

    Summary: Anatomical dissection has been practiced in the United States for nearly three centuries, but the laws regulating the obtainment and treatment of dead bodies are historically fraught. Legislation, or the lack thereof, has consistently failed to protect the most vulnerable people. This has led to the overrepresentation of poor and Black bodies in anatomical dissection, most often without any form of consent, and sometimes even in the face of direct protest. Over the years, legislative changes have been made and scientific societies such as the AAA have proposed guidelines for willful body donation. Nonetheless, channels for exploitation continue to exist. Because of this legacy and ongoing medical mistrust, Black people and individuals from other marginalized groups are less likely to participate in present day body donation programs.

    References Cited

    AAA-Website. 2019. The donation of bodies for education & biomedical research: guidelines suggested by the American Association for Anatomy. In. https://www.anatomy.org/AAA/About-AAA/What-Is-Anatomy/Body-Donation-Policy.aspx accessed 2 February 2022.

    AACA-Website. 2017. AACA best practices for donor programs. In. https://clinical-anatomy.org/images/downloads/draft_aaca_bp_asc_.pdf accessed 2 February 2022.

    Blake JB. 1955. The development of American anatomy acts. Journal of Medical Education 30:437-439.

    Blakely RL, Harrington JM, editors. 1997a. Bones in the basement: postmortem racism in nineteenth-century medical training. Washington, DC: Smithsonian Institution Press.

    Blakely RL, Harrington JM. 1997b. Grave consequences: The opportunistic procurement of cadavers at the Medical College of Georgia. In: Blakely RL, Harrington JM, editors. Bones in the basement: postmortem racism in 19th century medical training. Washington, DC: Smithsonian Institution Press. p 162–183.

    Boulware LE, Ratner LE, Cooper LA, LaVeist TA, Powe NR. 2004. Whole body donation for medical science: A population-based study. Clinical Anatomy 17:570-577.

    Cahill DR, Marks SC. 1991. Memorandum Adopted by the American Association of Clinical Anatomists-May 31, 1990. Clinical Anatomy 4:232.

    Caplan I, DeCamp M. 2019. Of Discomfort and Disagreement: Unclaimed Bodies in Anatomy Laboratories at United States Medical Schools. Anat Sci Educ 12:360-369.

    Carroll MA, Boynes S, Jerome-Majewska LA, Topp KS. 2022. The imperative for scientific societies to change the face of academia: Recommendations for immediate action. Anat Rec (Hoboken):1-13.

    Champney TH. 2011. A proposal for a policy on the ethical care and use of cadavers and their tissues. Anat Sci Educ 4:49-52.

    Champney TH, Hildebrandt S, Gareth Jones D, Winkelmann A. 2019. BODIES R US: Ethical Views on the Commercialization of the Dead in Medical Education and Research. Anat Sci Educ 12:317-325.

    Collins AJ, Smith W, Giannaris EL, Orvek E, Lazar P, Carney JK, Gilroy AM, Rosen MP. 2018. Population representation among anatomical donors and the implication for medical student education. Clinical Anatomy 31:250-258.

    Dalley AF, Driscoll RE, Settles HE. 1993. The Uniform Anatomical Gift Act: What Every Clinical Anatomist Should Know. Clinical Anatomy 6:247-254.

    Edwards LF. 1951. Resurrection Riots During the Heroic Age of Anatomy in America. Bulletin of the History of Medicine 25:178-184.

    Garment A, Lederer S, Rogers N, Boult L. 2007. Let the Dead Teach the Living: The Rise of Body Bequeathal in 20th-Century America. Academic Medicine 82:1000-1005.

    Gurses IA, Coskun O, Gurtekin B, Kale A. 2016. The amount of information provided in articles published in clinical anatomy and surgical and radiologic anatomy regarding human cadaveric materials and trends in acknowledging donors / cadavers. Surgical and Radiologic Anatomy 38:1225-1231.

    Halperin EC. 2007. The poor, the black, and the marginalized as the source of cadavers in United States anatomical education. Clinical Anatomy 20:489-495.

    Heaton C. 1943. Body snatching in New York City. New York Journal of Medicine 43:1864.

    Hefner JT, Spatola BF, Passalacqua NV, Gocha TP. 2016. Beyond taphonomy: Exploring craniometric variation among anatomical material. Journal of Forensic Sciences 61:1440-1449.

    Highet MJ. 2005. Body Snatching & Grave Robbing : Bodies for Science. History and Anthropology 16:415-440.

    Hildebrandt S. 2010. Lessons to be Learned From the History of Anatomical Teaching in the United States: The Example of the University of Michigan. Anatomical Sciences Education 3:202-212.

    Humphrey DC. 1973. Dissection and Discrimination: The Social Origins of Cadavers in America, 1760-1915. Bulletin of the New York Academy of Medicine 49:819-827.

    Jenkins GB. 1913. The legal status of dissecting. The Anatomical Record 7:387-399.

    Kramer B, Hutchinson EF. 2015. Transformation of a Cadaver Population: Analysis of a South African Cadaver Program, 1921 – 2013. Anat Sci Educ 8:445-451.

    Martineau H. 1838. Retrospect of Western Travel, Vol. 1: Sanders & Otley.

    Nystrom KC. 2014. The Bioarchaeology of Structural Violence and Dissection in the 19th-Century United States. American Anthropologist 116:765-779.

    Sappol M. 2002. A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America. Princeton, NJ: Princeton University Press.

    Savitt TL. 1982. The Use of Blacks for Medical Experimentation and Demonstration in the Old South. The Journal of Southern History 48:331-348.

    Siminoff LA, Burant CJ, Ibrahim SA. 2006. Racial Disparities in Preferences and Perceptions Regarding Organ Donation. Journal of General Internal Medicine 21:995-1000.

    Stephan CN, Caple JM, Veprek A, Sievwright E, Kippers V, Moss S, Fisk W. 2017. Complexities and remedies of unknown-provenance osteology. In: Strkalj G, Pather N, editors. Commemorations and memorials: exploring the human face of anatomy. Singapore: World Scientific Publishing Company. p 65-95.

    Swan RJ. 2000. Prelude and Aftermath of the Doctors ' Riot of 1788 : A Religious Interpretation of White and Black Reaction to Grave Robbing Prelude and Aftermath of the Doctors ' Riot of 1788 : A Religious Interpretation of White and Black Reaction to Grave Robbing. New York History 81:417-456.

    Washington H. 2006. Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. New York: Doubleday Books.

    Zhang X, Peng L, Li Lj, Fan W, Deng J, Wei X, Liu X, Li Z. 2020. Knowledge, attitude and willingness of different ethnicities to participate in cadaver donation programs. PLoS ONE 15:1-11.

    Appendix II: Early 20th Century Medical Education Reform, the Flexner Report, and Consequences for Training Black Doctors

    Chris J. Ramnanan

    One of the precipitating factors influencing systemic discrimination in the field of medical education (including foundational medical science disciplines like anatomy) was undoubtedly the movement to reform medical training and practice standards in the late 19th and early 20th centuries. During the late 1800’s, options for Black individuals who wanted to pursue medical training were already severely limited, even prior to the age of medical education reformation. Only a handful of Black students were admitted to select, predominately White medical schools in Canada and in the northeastern United States (Harley, 2006). Medical school options for Black students were therefore scarce, and the only recourse available to most individuals were small operations operated by either religious (missionary) groups or individuals that ran for-profit (proprietary) schools specifically dedicated to Black individuals. Small proprietary ventures were created by graduates from missionary institutions. Whether created by Black proprietors or White missionaries, these schools were extremely limited in terms of teaching space, equipment and resources, faculty, and student enrolment, all of which contributed to, and were influenced by, precarious and limited financial resources (Harley, 2006; Savitt, 2006; Miller and Weiss, 2012).

    In the late 1800s, organizations such as the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA) were persistent and vocal in promoting the notion that there were too many poorly trained physicians and an excess of medical schools of questionable quality, both of which the AMA perceived to have negative consequences on the integrity and stature of the profession (Markowitz and Rosner, 1973; Miller and Weiss, 2012). The AAMC and AMA were therefore tireless in advocating for increasing standards of medical training and practice, encouraging standardization of admission requirements, improving the structure and delivery of medical school, and advocating for licensing requirements (Markowitz and Rosner, 1973; Savitt, 2006).

    This advocacy led to the swift transformation of the medical education landscape in North America. In the 1890s, the AAMC's recommendation for lengthening medical school training to a standard three-year medical curriculum (and a subsequent recommendation for a four-year curriculum, for the 1896-1897 academic year) was widely adopted by many medical schools in the United States. By 1900, the AAMC's designated formal prerequisites for medical training (Miller and Weiss, 2012). The AMA also founded the Council of Medical Education (CME) in 1904, which placed particular emphasis on licensing exam results of trainees in the evaluation of medical programs (Miller and Weiss, 2012). By 1907, the AMA's official Journal (Journal of the American Medical Association [JAMA]) was publishing licensing board failure rates and the CME was implementing site visits with individual medical schools, providing confidential feedback. Both the site visit feedback and the publication of board exam failure rates were presumably done to encourage institutions to reform to prescribed guidelines (Savitt, 2006).

    The Flexner Report, authored by Abraham Flexner and commissioned by the CME and the Carnegie Foundation for the Advancement for Teaching, further served the agenda of the AMA and AAMC, thereby hastening the demise of medical schools deemed to be substandard. Based on site visits to each of the 155 North American medical schools at the time, Flexner's report included recommendations for consistent prerequisites for medical school admission, placing emphasis on laboratory science- and research-based training during preclinical years of medical school, and facilitating hospital-based instruction during the clinical years (Harley, 2006). Flexner ultimately recommended that only 31 of the existing 155 medical schools were worthy of investing in and maintaining, and that the other schools should be eliminated, including propriety medical schools that provided training for Black students (Miller and Weiss, 2012).

    It was predictable that certain schools would tolerate the financially-intensive requirements for change to meet medical education standards. For example, in an editorial letter in JAMA in 1905, it was proclaimed that there was ‘little reason to fear any undesirable falling off in the supply of undergraduates in the really high class institution of the country’, because these institutions (and medical students, who were almost all if not entirely Caucasian) could afford these changes (Markowitz and Rosner, 1973). Large, established medical schools with large endowments and wealthy alumni had the resources to adapt in this era of reform, investing in teaching space, laboratory infrastructure, and developing affiliations with hospitals and universities to provide the necessary clinical training and faculty (Markowitz and Rosner, 1973).

    In contrast, medical education reform had a disproportionally negative effect on the medical schools dedicated to the training of Black physicians of the era, as they were financially ill-equipped to navigate the new standards (Harley, 2006; Savitt, 2006). There was also a negative impact on Black individuals aspiring to become doctors, as they were more likely to come from families with limited financial means, preventing equitable access to completing prerequisites that were now formally required (Miller and Weiss, 2012). This led to decreases in enrollment in Black medical schools, exacerbating the financial problems these schools were experiencing in trying to adapt to new standards. In fact, in his 1910 report, Flexner indicated that only two (Meharry Medical College, Nashville, TN; the Medical Department at Howard University, Washington, DC) of the seven Black medical schools at the time had any merit worth investing in, stating that the other five medical schools were ‘in no position to make any contribution of value’ with regards to these new expectations (Savitt, 2006). Within a decade of the Flexner Report, the five Black medical schools he deemed unworthy of survival in the modern era of medical education became extinct, further compressing the already limited opportunities available to Black individuals for medical training (Harley, 2006). To this day, there is a marked lack of Black physicians in the United States, relative to the overall population, and the closure of these schools have unquestionably played some part in this underrepresentation (Campbell et al., 2020).

    It must be noted that Flexner utilized brutal and unforgiving language throughout his report, and was also damning in his description of medical schools dedicated to training Black doctors (Savitt, 2006). Flexner's criticisms did not come with any suggestions for investment, development or support to help schools deemed to be sub-standard. Further, the language utilized in Flexner's article also belied a particularly narrow, limited, view for the Black physician in society. Namely, he stated that Black physicians should be dedicated to treating Black communities, reduced to promoting health and hygiene as ‘sanitarians’ rather than full-fledged medical practitioners (Sullivan and Suez Mittman, 2010). One of Flexner's prevailing rationales for having Black doctors treat Black patients, focusing on hygiene, was to limit the spread of disease in Black communities to White communities (Savitt, 2006). There was no acknowledgment that Black medical graduates could or should contribute to healthcare broadly in a similar fashion to Caucasian graduates who were deemed capable of serving diverse communities, contributing to the teaching and research missions of their academic institutions, and serving in leadership roles. This limited opportunities for Black physicians for decades, which in turn restricted the modelling of potential career paths for future generations of Black individuals (Sullivan and Suez Mittman, 2010; Campbell et al., 2020).

    The sum of the AMA's initiatives dedicated to medical education reform, including the Flexner Report's articulation of a very narrow role for the Black physician in society, permitted or encouraged some schools to create further systemic barriers of discrimination in medical education targeting Black individuals. For example, shortly after the dissemination of the Flexner Report in 2010, the Senate at Queen's University (Kingston, Ontario, Canada) voted to ban Black individuals from medical school in 1918 (Vogel, 2019). At the time there were about 15 Black men enrolled in Queen's medical school, who all felt pressure from administrators to leave before completing their studies. It was reported that the motivation of the administrators driving this decision was the perception that the school's reputation and ranking by the AMA would be improved with the dismissal of their Black trainees. The ban at Queen's University was representative of formal bans or restrictions in place at other Canadian medical schools that existed for decades (Vogel, 2019). In fact, it wasn't until the mid-1960s that there was at least one Black student admitted into every U.S.-based medical school (Sullivan and Suez Mittman, 2010), and as a consequence, significant under-representation of Black individuals in medical training persists to this day (Campbell et al., 2020).

    Summary: This era of medical education reform did create mechanisms for standardization, oversight, and quality control for medical schools that were needed. However, the events that contributed to medical education reform (including the release of the Flexner Report) also created lasting, discriminatory barriers that restricted opportunities for generations of prospective Black medical students. This systemic discrimination in medical training was essentially endorsed by professional medical organizations (such as the AMA), and may have also influenced professional scientific societies (such as the American Association of Anatomists) that were developing during that era.

    References Cited

    Campbell KM, Corral I, Infante Linares JL, Tumin D. 2020. Projected Estimates of African American Medical Graduates of Closed Historically Black Medical Schools. JAMA Netw Open 3:e2015220.

    Harley EH. 2006. The forgotten history of defunct black medical schools in the 19th and 20th centuries and the impact of the Flexner Report. J Natl Med Assoc 98:1425-1429.

    Markowitz GE, Rosner DK. 1973. Doctors in crisis: a study of the use of medical education reform to establish modern professional elitism in medicine. American Quarterly 25:83-107.

    Miller LE, Weiss RM. 2012. Revisiting black medical school extinctions in the Flexner era. J Hist Med Allied Sci 67:217-243.

    Savitt T. 2006. Abraham Flexner and the black medical schools. 1992. J Natl Med Assoc 98:1415-1424.

    Sullivan LW, Suez Mittman I. 2010. The state of diversity in the health professions a century after Flexner. Acad Med 85:246-253.

    Vogel L. 2019. Queen's to redress harms of historic ban on black medical students. CMAJ 191:E746.

    Appendix III: A Synopsis of the growth of Jewish Participation in American Medicine and Jewish Participation in the American Association for Anatomy

    Jeffrey T. Laitman

    By the mid-19th century, Jews were formally entering into the medical field in the United States. The first “Jewish” Hospital in the United States was established in Cincinnati in 1850 with important others, such as those in Philadelphia and Baltimore, opening in 1866 (Halperin, 2012). The most significant example was the establishment of The Mount Sinai Hospital in New York City - which was becoming a center of American Jewry - in 1852. Mount Sinai Hospital was initially called The Jews’ Hospital until the name was changed in 1866 to acknowledge its broader mission (Hirsh and Doherty, 1952; Aufses and Niss, 2002). People of all races and religions were admitted to Mount Sinai from the beginning, a practice codified some years later in The President's 1905 Message on the Hospital where it was eloquently re-stated that “All are welcome within this House of Noble Deeds.” This was a distinct departure from practices at many private hospitals in New York, and indeed most of the country, which were usually sectarian, restricted to specific religious orders. In fact, until the end of the Second World War many of the hospitals in New York City restricted admittance of both, Jews and Blacks. Jewish New Yorkers were well aware of which hospitals were “NJA” (No Jews Allowed), the common code at the time that also meant that no Blacks or frequently individuals whose names ending with a vowel – indicating immigrant origins – would be welcome. This type of blatant discrimination could be found throughout the city and environs with signs often reading “No Jews Allowed” or, at times, “No Dogs, No Jews, No Negros.”

    As the Jewish population of New York City grew (see Birmingham, 1984) so too did the need for Jewish physicians. Often trained in Europe, particularly Germany, German-Jewish physicians became a backbone for the care of Jews not seen by gentile physicians. The center for Jewish physicians and their training in the United States was, again, The Mount Sinai Hospital, which was founded, and financed, by New York's prominent German-Jewish immigrant families (see Birmingham, 1967; Aufses and Niss, 2002). Jews were attracted to this hospital for training and, indeed, many renowned physicians in American medicine – such as pediatrician Abraham Jacobi; gastroenterologist Burrill Crohn; neurologist Bernard Sachs; Bernard Oppenheimer, a pioneer in use of electrocardiography; or Jonas Salk, eventual polio vaccine developer – were physicians or trainees of the hospital.

    During the latter part of the 19th century and into the first half of the 20th century, Jews became more prominent in American Medicine sensu lato. Certain fields, however, were generally more “welcoming” than others, with Jews tending to join medicine-based disciplines such as general medicine, gastroenterology, pediatrics, neurology, and psychiatry, rather than the more surgically based specialties. Indeed, as in Europe, established surgical fields were often closed to Jews, thus leading those interested in medicine to move into newer, less entrenched areas such as psychiatry, neurology, immunology, and dermatology (Rabin, 2012). Some surgical fields were extraordinarily hostile, such as neurosurgery. Neurosurgery, as we know it today, was largely founded by Harvey Cushing (1869-1939) who spent most of his career at Harvard Medical School. He was undeniably one of the most creative minds in the history of American surgery and trained many of the leading neurosurgeons that followed. He was also an unabashed racist and antisemite, whose deep seated beliefs, and influence, likely played a part in restricting Jews from entering many neurosurgery programs of the era and beyond (see Bliss, 2005).

    It is interesting to note that while more and more Jews entered medicine in the latter half of the 19th century through the first half of the 20th century, there does not appear to have been a concomitant surge of Jews into the anatomical sciences, as best can be told as reflected by membership in the American Association for Anatomy (AAA). The AAA was founded in 1888 and Joseph Leidy, Professor of Anatomy at the University of Pennsylvania School of Medicine (the nation's first medical school), was elected in absentia as its first president (see Warren, 1988). While Jews on occasion did rise to positions of leadership in some medical school anatomy departments – particularly in New York City – in general, they do not appear to have paralleled the significant rise to prominence that many had in medicine. Similarly, while some Jews did achieve positions of prominence in the AAA, there appear (documents do not indicate the religion of AAA Board Directors or Presidents) to have only been three – all from New York - who were elected President of the association in its 134 year history (Michael Gerson, Columbia; Donald Fischman, Cornell; and Jeffrey Laitman, Mount Sinai).

    Why Jews apparently did not flock to anatomy departments is unclear, but it can be hypothesized that it may have been related to the historical ties of anatomy to surgery and its subdivisions. As noted, while medical fields were fertile training grounds for Jewish physicians who would often rise to prominence in those areas, the surgical fields were much less so. Due to the fact that many surgeons oft-times had roles in anatomical teaching, it is quite possible, that the prejudices from those such as Cushing carried over to make anatomy a less then welcoming home. It is also worthy to note that anatomy's sister discipline – physical anthropology – was largely focused upon the identification and promulgation of racial biology both in Europe and in the United States. Indeed, American craniologist Samuel George Morton in his Crania Americana (Morton, 1839) established a “scientific” basis that showed that skull size reflected brain size and intellectual capacity and could be used to distinguish the races, with Caucasians at the pinnacle and Negros at the base. This work was latter amplified by his followers, Nott and Giddon, in their extensive supporting work, The Types of Mankind (Nott and Giddon, 1854). Such research was very popular and well-received by the public and became disseminated throughout the United States and Europe (see Redman, 2016). (Much of this work, including methodologies, were challenged, and largely discredited, in more recent studies; see for example, Stephen Jay Gould's The Mismeasure of Man (Gould, 1981).

    Many Jews were particularly sensitive to such focus upon race. While some notable Jews (such as Franz Weidenreich originally from Germany and later at the American Museum of Natural History in New York, or his successor at the museum, Harry Shapiro) did enter into the field of Physical Anthropology in the 20th century, many other Jews likely did not embrace the discipline due to the racial focus. Indeed, well-known Jewish physical anthropologists, such as Milford Wolpoff of the University of Michigan or Robert Sussman of Washington University in Saint Louis, both wrote compelling treatises debunking the myth of race and the effect that it has had upon the public's view of human populations in general and the field of anthropology in particular (Wolpoff and Caspari, 1997; Sussman, 2014).

    It is unclear what, if any, positions were taken by the AAA in the face of the rise of Nazi Germany, the alienation of Jewish physicians, or of the atrocities of the Holocaust itself. Indeed, the AAA has not entertained formal discussions of the events of the topic in recent years. The Guest Editor of this Special issue, Jason Organ, had proposed Symposia on the Holocaust to acknowledge the 70th anniversary of the liberation of Auschwitz in 2015 (and, when not chosen, again in 2016). These proposed symposia had internationally recognized speakers, including participants from this Special Issue. Each time the planning committee, while acknowledging the importance of the issues, demurred, saying (for example in 2015) that the Professional Development Committee, wanted to have “…very practical sessions that help members deal with issues related to their careers” and thus did not see such sessions focusing on the Holocaust or racism as fitting (from the 2015 declination letter). Even three-fourths of a century after the Holocaust the AAA did not deem a discussion of the highest priority. Indeed, it was only over the last few years that the AAA Board - influenced by the general awakening in the United States of the realization of the continued influence of systemic racism – that this Task Force was initiated to explore the nexus of racism and the AAA. There will also finally be a Symposium at this year's (2022) Annual AAA Meeting, supported by The Anatomical Record and in recognition of this special issue that will discuss racism in the broad sense, including the Holocaust.

    Summary: Jewish participation in American Medicine has grown continuously since the middle of the 19th century, particularly through opportunities afforded by the establishment of Jewish Hospitals throughout the United States. While Jews rose to levels of prominence in many medical disciplines, particularly newer ones such as neurology or psychiatry, their involvement in the anatomical sciences has not been as equally robust. The latter may be due to initial prejudice against Jews in more-established surgical disciplines, which were often linked to aspects of anatomy. The American Association for Anatomy, the home and voice for anatomists in the United States, has been largely silent on issues of racism as it affects Jews, including not advancing positions or discussions of the Holocaust.

    References Cited

    Aufses AH, Niss BJ. 2002. This house of noble deeds: the Mount Sinai Hospital, 1852-2002. New York: New York University Press.

    Birmingham S. 1967. Our crowd: the great Jewish families of New Yorki. New York: Harper and Row.

    Birmingham S. 1984. The rest of us: The rise of America's eastern European Jews. New York: Little Brown and Company.

    Bliss M. 2005. Harvey Cushing: a life in surgery. Oxford: Oxford University Press.

    Gould SJ. 1981. The miusmeasure of man, 1st ed. New York City: Norton.

    Halperin EC. 2012. The rise and fall of the American Jewish hospital. Acad Med 87:610-614.

    Hirsh J, Doherty B. 1952. The first hundred years of the Mount Sinai Hospital. New York: Radom House.

    Morton SJ. 1839. Crania Americana. Philadelphia: John Penington.

    Nott JC, Giddon GR. 1854. Types of mankind: or ethnological researches based upon the ancient monuments, paintings, sculptures and crania of races, and upon their natural, geographical, philogical and biblical history; illustrated by selections from the inedited papers of Samuel George Morton and by additional contribuions from L. Agassiz, W. Usher, and HS Patterson. Philadelphia: J.B. Lippincott, Grambo and Co.

    Rabin RC. 2012. Tracing the path of Jewish medical pioneers. In: New York Times. https://www.nytimes.com/2012/05/15/health/exhibition-traces-the-emergence-of-jews-as-medical-innovators.html

    Redman SJ. 2016. Bone rooms: from scientific racism to human prehistory in museums. Cambridge, MA: Harvard University Press.

    Sussman RW. 2014. The myth of race. Cambridge, MA: Harvard University Press.

    Warren L. 1988. Joseph Leidy: the last man who knew everything. New Haven: Yale University Press.

    Wolpoff M, Caspari R. 1997. Race and human evolution. New York: Simon & Schuster.

    After publication, the appendices, which were originally included online as supporting information, were added to the article.