Hektoen International

A Journal of Medical Humanities

Dr. Rebecca Cole and racial health disparities in nineteenth-century Philadelphia

Meg Vigil-Fowler
Grand Junction, Colorado


The anatomy lecture room at the Woman’s Medical College of New York Infirmary. Published in Frank Leslie’s Illustrated Newspaper.  April 16, 1870. Library of Congress.

From the beginning of black women’s professional involvement in medicine, public health marked a central component of the scope of their practice. Rebecca Cole, the second black woman physician in the United States, began her career as the “sanitary visitor” in the late 1860s for the New York Infirmary for Women and Children run by two of the first women physicians, famous sisters Elizabeth and Emily Blackwell. Elizabeth recalled that: “With tact and care,” Cole provided “simple, practical instruction to poor mothers on the management of infants and the preservation of the health of their families.”1 After spending much of the rest of the Reconstruction era practicing in South Carolina, Cole returned to her native Philadelphia and opened the Women’s Directory with white woman physician and fellow WMCP alumna, Charlotte Abby. In this work, Cole likely continued to hone an interest in public health while still treating individual patients, a balance that would become common among African American women physicians engaged in public health work.

Cole exhibited her longstanding interest and expertise in public health in a response she gave to W.E.B. DuBois, at that time an assistant instructor in sociology at the University of Pennsylvania, at the first meeting of the Women’s Missionary Society of Philadelphia in 1896.2 This society was not specifically medical, but DuBois seems to have taken an interest in black women physicians. Here he interacted with Cole, one of the earliest African American women physicians. Ten years later, he wrote to the WMCP to inquire whether any black students had attended or were attending there. The Crisis, which DuBois edited, featured information about black women medical school graduates and their difficulty securing clinical internships. He likely wrote the profile on Dr. Virginia Alexander, with whom he had an extra-marital relationship.3 In addition to DuBois himself, his presence in these women’s lives provides a proxy for the standing African American women held in their communities in general. Many of their lives intersect with the “great men” of African American history in this period: Frederick Douglass, Booker T. Washington, and W.E.B. DuBois.

At the time of this meeting, DuBois was just about to begin work on what would become his groundbreaking first book, The Philadelphia Negro: A Social Study, which surveys the city’s Seventh Ward, predominantly inhabited by impoverished African Americans. Despite his professional and scholarly prominence, Cole openly criticized DuBois’ use of the statistics he presented on African Americans’ disproportionately high incarceration and tuberculosis mortality rates. She questioned the very motives of the creators of these statistics:

Now who made these figures but men of a class who are so warped by that strange American disorder, colorphobia, that before accepting their verdict we must be excused for saying we are not ready for the question…And who makes up the police records? To what class do most of the men in this department belong but to Irish democracy? Who can tell how many white offenders go free, either by bribery or by their own aptitude to escape the consequence of their actions?4

Cole blamed the “young, inexperienced white physicians,” who she claimed treated the vast majority of the poor, for the reported higher incidence of tuberculosis among African Americans: “They have inherited the traditions of their elders, and let a black patient cough, they immediately have visions of tubercles. Let him die, and though in the case there may be good reason for a difference of opinion, he writes, ‘tuberculosis,’ and heaves a great sigh of relief that one more source of contagion is removed.”5

While she denied any “implicit faith in these statistics,” Cole agreed that African American residents of poorer neighborhoods suffered higher incidence of disease: “We must teach these people the laws of health; we must preach this new gospel, that the respectability of a household ought to be measured by the condition of the cellar; that to prolong the hours of toil or study or pleasure habitually into the night, when we must be up betimes in the morning, is to rob our offspring of vitality, and invite epilepsy, consumption, and a train of other evils.”6 She advocated addressing what we would now term “structural inequality” through improved sanitation and housing and displayed her expertise in demanding “cubic air space laws,” which would regulate the number of people who could live in one dwelling, “that people may not be crowded together like cattle while soulless landlords collect fifty per cent on their investments.”7

Addressing contemporary racial theories, such as whether African American mortality rates reflected the “fate of all exotics,” Cole repeatedly emphasized that to the degree that a higher incidence of disease and death truly existed, this phenomenon demonstrated only poor living conditions based on racial and class discrimination and a lack of education rather than any form of inherent biological inferiority that predisposed African Americans to be more likely to contract disease. Cole denied that high rates of vice, disease, and crime could be attributed to racial causes, stating instead that they “have no complexion.” These problems could only be met with improved sanitation and hygiene practices.

Strikingly, Cole questioned the very epistemology upon which public health statistics were based. If structural inequality became reified in the statistics without questioning how the data was collected or accurately ascribing possible causes, the “data” itself could not be trusted. While it is impossible to know if Cole’s response to his presentation in any way influenced DuBois’ findings in The Philadelphia Negro, many of his conclusions about the true causes of inequality echo hers, especially in the role white perception of black residents played in misidentifying inequality as biological rather than social. Black women physicians of the next generation would become some of the first doctors to earn Masters of Public Health degrees. Through her initial foray into addressing what we now term “health disparities” and “social determinants of health,” Cole paved the way for them.



  1. Blackwell, Pioneer Work In Opening the Medical Profession, (London: Longman), 227-228.
  2. Despite DuBois’ title, he actually had no contact with students and did not teach. He was hired specifically to do the research for what became The Philadelphia Negro.  See Greg Johnson, “W.E.B. DuBois at Penn,” accessed February 20, 2018, https://www.upenn.edu/spotlights/web-dubois-penn
  3. My evidence for this comes from the director of the University of Pennsylvania Archives, Mark Frazier Lloyd, who stays in touch with two of Alexander’s nieces. They have discussed their family history with him.
  4. Rebecca J. Cole, “First Meeting of the Women’s Missionary Society of Philadelphia, The Womans Era, Volume III No. 4 (October and November 1896), Rebecca Cole BWPP Folder, Drexel University College of Medicine, Legacy Center Archives and Special Collections, Philadelphia, Pennsylvania.
  5. Ibid.
  6. Ibid.
  7. Ibid.



MEG VIGIL-FOWLER, PhD, is an award-winning historian currently writing a book on the history of early African American women physicians. She received her doctorate in the history of health sciences from the University of California San Francisco in 2018.


Spring 2019 |  Sections  |  Women in Medicine

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