The Story of CC 312

Christine Okaro, Department of Global Health Studies, Mercer University '17

Christopher Wilson, Department of Psychology, Washington University in St. Louis, '17


Editor’s Note     

This series of biographical sketches were authored by the 2015 class of the Howard University branch of AAMC’s Summer Medical Dental Enrichment Program at the W. Montague Cobb Research Laboratory. The students were assigned a Cobb Collection Individual and conducted research about that individual. The papers were reviwed by The Backbone Editorial Team and the name of the CC individual was redacted.

The death certificate of a fifty-nine year old woman from Arlington, Virginia, was examined to discover the relationship between her cause of death and the social, economic and healthcare disparities. The death certificate revealed that she died from lung abscess at the Gallinger Hospital, an inadequate public hospital largely serving minority populations, in Washington DC in 1943. Factors including her level of education, race and treatment options were analyzed to interpret the influence of ethnic and economic disparities on her health and access to adequate care. Due to the impact of segregation, minorities were limited regarding the type of treatment received and often died from preventable illnesses.

CC 312 was born in 1884 and lived in Arlington, Virginia until her death on April 11, 1943 (1920 United States Federal Census). Though CC 312 resided in post-slavery Virginia, it is expected that she experienced racial tensions and division in her lifetime. The effects of the Civil War and the Reconstruction era greatly impacted Virginians. Atrocities faced by African Americans, such as the public whipping post, were abolished during the “Readjuster” government of the early 1880’s (Virginia Historical Society).

Historical and Societal Impacts

During this “Readjuster” government, Virginia worked to enfranchise Blacks by promoting voting rights. This opportunity was short-lived. The election of Governor Fitzhugh Lee in 1885 and the rise of the Confederacy stifled the progress of African Americans until the momentum of the Civil Rights Movement (Virginia Historical Society). Although slavery was abolished in 1863 by mandate of Abraham Lincoln’s Emancipation Proclamation, Virginian governance enacted laws and regulations that greatly oppressed the civil rights of all African Americans through rigid segregation.

 Due to the economic and educational restrictions on Black Americans living in Virginia, it is probable that CC 312 and her husband did not receive an adequate education, which limits economic mobility. African Americans were largely treated as second-class citizens; this sentiment is reflected in the standard jobs available to them. African Americans generally worked as sharecroppers in rural areas, and menial or domestic service jobs in urban locations of Virginia (Virginia Historical Society). All aspects of life, including education, career options and living conditions were inferior to Whites.

 By the 1910’s and 1920’s, Virginia underwent a revival of the Klu Klux Klan and enacted the Racial Integrity Act in 1924 passed by the Virginia General Assembly (Sherman). This Act labeled all non-white individuals as “colored,” sanctioned the one-drop rule, which labels all individuals with any trace of African ancestry as “Black,” and banned interracial marriage as a mechanism for preserving the privilege and status of Whites in Virginia (Sherman). CC 312 likely experienced the outcome of racial insensitivity and violence. Constant exposure to segregation and taunting is classified as a stressor, which can negatively affect health and contribute to the manifestation of predispositions.   

 CC 312 lived through pivotal moments in history that have shaped the lives of post-slavery African Americans, which ushered in legislations towards justice for all. Monumental moments, such as the ending of the Civil War, and the start of the Reconstruction era, which struggled to tackle the need for black freedom. Plessy v. Ferguson (1896), a case which sanctioned the notion that Blacks remaining “separate, but equal” from Whites was constitutional. Along with experiencing racial segregation, CC 312 may have later experienced the rise of prominent Black institutions and voices.

 The National Association for the Advancement of Colored People (NAACP) was established in 1909. From its founding the NAACP, “the nation’s largest and oldest civil rights organization,” has worked to “fight for social justice for all Americans,” especially minorities and underrepresented populations (NAACP). The outbreak of World War I in 1914 was a pivotal moment in African American history, as events such as The Great Depression (1929-1939), The New Deal (1933-1938), and The Great Migration directly affected the economic aspects of African American communities. The birth of the NAACP and a movement towards the advancement of Black and minority Americans likely influenced and empowered CC 312, despite the fear induced by living in lawful segregation.

 Analysis of Personal Life

Exploring the aspects of CC 312’s personal life reveals the lifestyle and living conditions that may have led to her death. According to the 1920 Census Record, CC 312 lived in Richmond Madison Ward, Richmond (Independent City), Virginia at the age of thirty-six. CC 312 was married and identified as the head of household’s wife. Her husband was also born in Virginia in 1877. CC 312 could both read and write, which suggests CC 312 had, at the least, a basic level of education. The parents of both CC 312 and her husband were born in Virginia. This establishes CC 312 as a generational dweller of Virginia.

Due to segregation, CC 312’s access to quality health care was limited. On April 11, 1943, CC 312 died at the Gallinger Municipal Hospital. This hospital, established in 1806, was the first public hospital in Washington, D.C. From its inception, resources at this hospital were inadequate. Only the poor and minorities utilized Gallinger for treatment, which often suffered from overcrowding, low supplies of medicine, and inefficient laboratory and x-ray services (Fenston).

 CC 312 lived approximately twenty-seven miles away from this hospital, suggesting that this institution, based on her economic and racial background, was her primary source for medical care. At the time, receiving medical care at public institutions was exclusively for poor or minority citizens. Private physicians largely treated affluent White individuals. Consequently, segregation led to inadequate medical attention and little effort directed towards improving the services rendered by public hospitals, such as Gallinger Municipal Hospital.

 Illness and Resistance to Treatment

The death certificate of CC 312 lists her cause of death as “abscesses of the lungs”. Abscess of the lung is a bacterial infection in the lung resulting from bacterial growth in the mouth. This illness causes tissue to die, and results in pus accumulating in that space (Bartlett). The symptoms of this disease appear gradually over time and may not be diagnosed until the disease is well advanced. Common symptoms include coughing, fever, shivering, and night sweats. Chest pain and shortness of breath can also be present in some cases. In many cases, symptoms are mistaken for a common cold, which may have influenced the severity of her illness. CC 312 died from this disease because she either did not receive timely, adequate medical treatment. Instead of immediately seeking medical attention, CC 312 may have sought the aid of home remedies, until the illness became life threatening.

 Apart from the probability of CC 312 neglecting the progression of her illness, it is possible that her care at Gallinger Hospital was subpar and ineffective -- leading to a worsened state of health.  In the early stages of public health care, patients were not afforded advanced medical exams, equipment and treatments. The worsening the disease plaguing CC312 likely led to a complicated medical case that Gallinger Hospital was not equipped to treat. Furthermore, the severity of her disease coupled with the second-class treatment of minorities, especially African Americans during segregation, directly affects the quality of medical attention received.

 Another factor contributing to CC 312’s lack of treatment was the attitude of minorities and poor individuals towards hospital-based medical treatment. While it is true that minorities and African Americans used public hospitals as medical resources, the marginalization of African American lives in medicine resulted in a culture of distrust. Due to events such as The Tuskegee Syphilis Experiment (1932-1972), which infected African American patients with the syphilis virus, African Americans largely lost trust in America’s healthcare system. The fear of unwarranted medical exploitation often outweighed the need for hospital visits.  

 

Early Treatment Methods

Between 1935 and 1945, the most recognized treatment for abscess of the lung involved the use of sulfonamides (Willis). Prior to this treatment, the disease was managed through the draining, posturing, conducting a bronchoscopy, or surgery. The mortality rate of abscess to the lung before 1930 was 32-34% (Willis). Although this treatment was widely accepted, the introduction of sulfonamides as a form of treatment did not significantly alter the mortality rate. However, in the late 1940’s penicillin was introduced as a method to alleviate the effects of this disease, which lead to a lower death rates and a 90-95% patient recovery rate.

 As the benefits of penicillin were recognized, it became the primary treatment method. It is likely that CC 312 did not receive penicillin as a form of treatment, which contributed to her death from an avoidable and treatable disease. Because CC 312 died after the discovery of penicillin method of treatment, it is unlikely that she received penicillin. This may be one of the reasons why she succumbed to the disease. CC 312’ case reiterates the disparities many African Americans were faced, due to the lack of public hospitals that provided quality medical care.

 Treating CC 312 Today

Since CC 312’s death in 1943, the medical field has undergone several changes physically and technologically. As of now, patients have choices when selecting a hospital or health care provider. Despite this, health care disparities still exist, as the best medical service is available to those who can afford it. Although health insurance is meant to alleviate these disparities, these policies equate better medical care to higher premiums. Generally, poorer and minority neighborhoods are still served by hospitals that provide comparatively substandard service.

 

Martin Luther King, Jr. Hospital in Los Angeles California is an example of an inner-city medical facility, with mainly minority patients living in close proximity. In 2007, this hospital’s poor patient care made headlines as staff ignored a minority patient who lay dying on the floor without offering assistance (Los Angeles Hospital to Close). This egregious conduct led to its closure. Similarly, reports of neglect and medical incidents lead to the recent closing of Gallinger Hospital in 2001 (Fenston).

 

To withstand rising healthcare costs, The Affordable Healthcare Act (2010) extends the coverage of medical care and lowers the intended cost of services (U.S. Department of Health and Human Services). Through this health care law, disparities in the availability of health care can be eliminated. This means more individuals are able to obtain preventative treatment to manage illnesses early, which avoids unnecessary deaths from treatable diseases. Regular doctor visits, made possible by the availability of health insurance, can lead to longer, healthier lives for all patients, regardless of race, financial ability, or social class.        

As healthcare services have improved overtime, so has the treatment of abscess of the lungs. At present, the mortality rate for abscess of the lung is less than 10% (Bartlett). This is due to new antibiotic drug discoveries. Current treatment consists of clindamycin antibiotic therapy for four to six weeks, followed by an x-ray to assess the progress of treatment (Kamangar). This advancement is acknowledged as a more effective treatment than penicillin, the previous treatment of lung abscess. Although laws are now enacted to ensure equality in medical care, health disparities are still prevalent in minority populations.

 The Story of CC 312

From the research provided, the circumstances of CC 312’s life, which led to her premature death, can be asserted. CC 312, a Black woman, lived in Arlington, Virginia during World War II and the confederacy. CC 312 dismissed the early symptoms of the disease, due to the benign signs of abscess lungs: cough and fever. As the symptoms worsened, she weighed the inconvenience of leaving her home and work to travel to Washington D.C. for treatment. Due to the progression and severity of her illness, including chest pain and shortness of breath, she was eventually forced to travel a great distance to twenty-seven miles to Gallinger Hospital. Closer to her death, CC 312 experienced intensified coughing accompanied by putrid smelling mucus.

She had to part with her husband for the journey, due to their inability to afford transportation for the two of them. Upon arriving at Gallinger Hospital, CC 312 waited for several hours to receive services, due to the overcrowding patients and under-resourcing of staff. After being admitted, CC 312 was placed in a crowded, under-furnished, unsanitary examination room, in which she did not receive an adequate examination. By this time, CC 312 experienced intense pain and discomfort while still unsure of her illness or potential treatment methods. Because of the progression of her illness, the lack of medical supplies at Gallinger Hospital, and the misdiagnosing of her disease, CC 312 did not receive adequate care. This medical oversight led to her death.

If CC 312 suffered from abscess lungs today, she would be prescribed the antibiotic clindamycin (Kamangar). This would have increased her chances of survival and decreased her probability of death to 1/8th of the previous treatment (Kamangar). Additionally, CC 312 would have the resources to seek treatment earlier, as Medicare or the Affordable Care Act would likely cover her medical costs.

Coupled with an increase in the number of hospitals, as well as affordable public transportation, CC 312 would have more opportunities to seek earlier treatment. Educational opportunities for women and minorities have improved over recent years, which would have provided CC 312 with economic and social advancement resulting in employment and access to company-provided health insurance. Due to the economic advancements, medical innovations, and civil rights movements The United States has become a nation better fit to address the medical needs of individuals. If born at this time, it is highly expected that CC 312 would live a healthier and longer life. ***

References    

1920 United States Federal Census. Official Enumeration Date: January 1, 1920. Enumeration District: 143. Place: Richmond Madison Ward, Richmond (Independent City), Virginia, United States. Household ID: 59. Publication Number: T625. Page: 3A. Line Number: 40. Microfilm Number: 1821911. Image number: 00417.
Willis, AT. “Anaerobic Bacteria: Role in disease.” Annals of Internal Medicine Ann Intern Med 82.6 (1975): 862. Web.
Bartlett, John G. "Clinical Infectious Diseases." Oxford Journal 40.7 (2004): 923-25. Print.
1877 Census. Richmond Madison Ward, Richmond (Independent City), Virginia, United States Richmond (Independent City) Virginia Male 43 1877 Head African American Black.
Fenston, Jacob. “From Public Hospital To Homeless Shelter: The Long History of D.C. General.” WAMU 88.5. Web. 01 July 2015. 
Kamangar, Nadar. "Lung Abscess Treatment & Management." Lung Abscess Treatment & Management: Medical Care, Antibiotic
Therapy, Surgical Care. Medscape, 18 Dec. 2014. Web. 08 July 2015. <http://emedicine.medscape.com/article/299425-treatment#d8>.
NAACP. “National Association for the Advancement of Colored People." NAACP. National Association for the Advancement of Colored People. Web. 04 July 2015.
Sherman, Richard B. “The Last Stand”: The Fight for Racial Integrity in Virginia in the 1920s.” The Journal of Southern History 54.1 (1988): 69, Web. 4 July 2015.
The Virginia Historical Society. “Virginia Historical Society”, New Southerners. The Virginia Historical Society,Web. 04 July 2015. <http://www.vahistorical.org/what-you-can-see/story-virginia/explore-story-virginia/1861-1900/new-southerners>.

Ms. Christine Okaro, a 2013 Gates Millennium Scholar, is a pre-medical student pursuing a Bachelor of Arts degree in Global Health Studies with a minor in Chemistry at Mercer University. She will be graduating in the spring of 2017. During the summer of 2015, Christine participated in the Summer Medical and Dental Education Program (SMDEP) at Howard University. While at Howard University, she shadowed physicians at Howard University Hospital, completed biochemistry and genetics courses, and conducted research with the W. Montague Cobb Research Lab. As a Mercer University undergraduate student, she has worked as a research assistant to Dr. C. Obidoa on two projects. In Exploring the Context of Sexual Risk-taking in African American Youth in Macon, Georgia, she formatted qualitative surveys and interviewed participants. In Globalization & Me: Exploring the Impact of Globalization through Social Media, she analyzed participant responses using SPSS and co-authored a research paper. She presented Globalization & Me research findings at Mercer’s BEAR Day Research Symposium and received a BEAR Day Outstanding Poster Presentation Award. In addition, she serves on the executive board of Mercer’s Minority Association of Pre-medical Students (SNMA-MAPS), volunteers as a local high school math tutor through the AVID Program, and assists first-year Mercer University students as a Peer Advisor. After graduation, Christine hopes to obtain her MD and pursue a career combining medical practice and research.

Mr. Christopher Wilson is a junior at Washington University in St. Louis where he is majoring in Psychology in the Department of Arts and Sciences. He participated in the Howard Hughes Medical Institute Dental Academy where he and his research partner conducted research on a protein known as grainyhead-like 2 to determine whether or not this protein would affect tumor sphere forming ability. The findings indicating that the deletion of this protein could possibly prevent cancer proliferation were later presented to the American Association for the Advancement of Science. During the summer of 2015 he participated in the Summer Medical and Dental Education Program at Howard University. Currently he serves as a member of Treasury in the Student Union at Washington University. He also mentors students from underprivileged elementary schools in the St. Louis area. During his spare time, he enjoys playing basketball and spending time with family.


Cobb Lab