Race proved not merely a disadvantage in securing access to prompt and appropriate medical care, but often became a life and death issue for blacks in the American South during the early decades of the twentieth century. This article investigates the impact some of the new academic disciplines such as anthropology, evolutionary biology, racially based pathology and genetics had in promoting scientific racism. The disproportionately high morbidity and mortality rates among blacks were seen as a consequence of inherent racial deficiencies that rendered any attempt to ameliorate their situation as futile. While the belief in a different pathology in blacks initially deterred most health officials from taking any action, advances in medicine and microbiology, in particular the germ theory, stirred a variety of responses out of sheer self preservation, as fears among whites at the first sign of an epidemic initiated sporadic and limited actions. Ironically, in an era of deepening scientific racism, public health initiatives based on a better understanding of disease causing microorganisms, gradually improved black health. However, some public health measures were hijacked by eugenicists and racists and, rather than addressing the ill health of blacks, public health policy complied with the new laws of heredity by promoting drastic measures such as involuntary sterilization or even abortion. This further complicated the strained relationship between southern blacks and health care professionals and effected ongoing distrust towards public healthcare services.