“The Medical Realm of Southern Desegregation of Medicine, Post Reconstruction”

The medical realm's exacting combination of concern for the well-being of both the individual and the community, its focus on the majority, and the stress of sickness and death makes it a fascinating and important setting for the assessment of race relations. Few places other than hospitals and doctors' offices necessitate such a high degree of intimacy characterized by such powerful feelings, ranging from pain and anxiety to delight and conquest. The hospital has been a symbol of kindness, professionalism, and scientific and technological novelty, while at the same time maintaining racial, ethnic, gender, and class discrimination. Treatment in post-World War II hospitals in the southern part of the United States advanced on its improvements in medical knowledge and technology and on a code of ethics, yet southern hospitals controlled by whites almost always either excluded African Americans or provided them with separate and inferior facilities. The primary reason to look at the process of medical desegregation and integration of schools and hospitals is to grasp an understanding of why it took so long for it to occur, and why it occurred, surprisingly, without much objection from outside agitators as other public facilities had.

After World War II, there were a multitude of conferences, seminars, and high-level commissions on the race question. From the health and medical field came reports detailing the burden of discrimination, and for the first time medical segregation itself began to come under attack from well respected individuals and groups. Many high officials believed that the only way that black Americans could get adequate and equal access to healthcare, was to get it from equally qualified black doctors and nurses providing it. Apparently, in the minds of many white people, only black people could more accurately take care of other black people medically. In order to that, there had to be equal and adequate education for black medical doctors and nurses to be able to become equally qualified to practice good medicine.¹

Many poverty-stricken blacks and whites waited until they knew that something was seriously wrong before seeking treatment from a physician. There were many reasons for this aversion to doctors. Chalmers Archer, Jr., in his autobiography, Growing Up Black in Rural Mississippi, stated that blacks could not always afford to go to a physician and did not want to go to white physicians who "frequently did not want to treat black patients and showed it through their demeanor." Archer, who was born in 1928 and grew up in Holmes County, on the border of the Delta and the surrounding hill country, spent a chapter of his book on health-care conditions for blacks in the 1930s and 1940s. There was one white physician "who was a friend to all, black and white alike," Archer wrote; he was a "recent immigrant; he did not exhibit the prejudices common to local whites." When Archer was a young boy, another white physician came to his neighbor's house to help with a black woman's difficult labor. The physician informed the husband that neither his wife nor his child would survive unless they went to the hospital. The husband asked the physician to take his wife to the hospital, since the family had no car and the nearest hospital was eight miles away. Archer wrote that the physician ignored the request and left; still, the mother and child survived without his help. White people mainly visited black physicians for venereal diseases and other embarrassing problems, so people in their community would not learn of it. ^{2, 6}

Hospital desegregation was a long process, just like the desegregation of other facilities. The process involved people of all races to come together and become one voice. It also involved lots of fighting in the courts to gain more strength in the public’s eye to gain even more supporters. The civil rights movement for the medical field that started in the late 1940’s put southern doctors and hospitals on the defensive for the first time. The northern hospitals started to voice their opinion that the southern hospitals were inferior to them because they were not using the most advanced or state of the art practices of medicine due the ignorant and closed eyes of practicing segregation and discrimination. The northern doctors also believed that the biggest obstacle for improving the African American’s health was segregation and must be eliminated immediately. ^{1, 3}

The desegregation of medical schools was even slower to change due to white alumni personal sentiment. The insufficient number of black doctors was so bad that the surgeon general estimated in 1949 that five thousand additional black doctors would be needed just to get the ratio down to 1500:1 for patients to black doctors. It was very important to open up more schools in the south since that was where 75 percent of blacks lived and as of 1948 not one school in the south had accepted a black applicant. ¹

One of the first steps in gaining access to all-white medical schools in the South was to first survey all of the schools. Montague Cobb was the leading activist who pressured the schools, the AANC and the AMA in hopes to gain admittance. With the help of black physicians groups and the willingness of many school administrators, fourteen of the twenty-six Southern schools by 1957, started to admit black students. There were two deciding factors that led to their decision to comply with the black activists which were the fear of litigation but mostly the growing appreciation by the white medical community of the handicaps facing the black profession. ¹

When comparing medical societies and schools to hospitals, hospitals presented a far more difficult and complex problem. It was very hard to change traditional relationships in institutions that served a massive amount of patrons. It was also very hard to change patient’s imbedded racial attitudes about sharing the same room with black people in the hospital. Gradual change has shown to be the best way of introducing the new policies and the large acceptance of the integration of hospital facilities just emphasized the fact that the public was ready for the changes. Not all facilities were met with such acceptance. Wake Memorial hospital nearly collapsed financially in its first year because white patients were unwilling to go to what was popularly derided as a colored hospital. The continued

low number of patients almost shut it down, but eventually many of the surrounding hospitals started to get overcrowded and white patients were almost forced to go to the colored hospital. As more people got used to going to integrated hospitals, the acceptance of the new policies seemed to grow exponentially.

White professionals generally had the willingness to do the right thing. White physicians and hospital administrators sometimes were so open, that it startled the black professionals. Many of the white physicians generally believed in practicing medicine colorblind because that is the only way to morally practice medicine. When the laws were passed to desegregate the hospitals, the hospital administrators had a scapegoat to refer to if certain patients protested. One of the biggest factors that kept the hospitals segregated was the financial gamble and once finances were not an issue; hospitals were generally happy to comply. ¹ Between 1964 and 1970, the large majority of southern hospitals accepted desegregation of patients and physician staffs without the application of federal sanctions. Hospitals compliance with the laws that were passed was attributed to the primary goal of hospitals which is to provide quality of care without regards to the color of the patient’s skin color.

The Civil Rights legislation was not solely responsible for the progress made in desegregation and integration of medical facilities and schools. The federal courts played a huge influential and deciding role. The most famous of the hospital cases was the 1963 judgment of the Fourth United States Circuit Court of Appeals, which began to register its impact just as Congress passed the 1964 law. The case was Simkins v. Moses H. Cone Memorial Hospital, and according to former United States attorney Terrill Glenn of Columbia it was the “granddaddy of hospital desegregation suits.” for it did what black medical reformers had been unable to do for fifteen years: eliminate segregation form the province of the Separate but Equal act.^1,4

Another factor that played in the role for the smooth transition to the integration of hospitals was the fact that black Americans had been working together in close proximity in intimate settings before, during, and after World War II which influenced how the hospital administrators and staff responded to the equal care for the black patients and staff. Unfortunately, other people did not experience the closeness that the medical people experienced, so it took having laws passed to gain an agreement across the board to set better moral standards for healthcare in the United States. This was a major step in the

direction of gaining the respect of foreign countries and becoming even more of a trend setter for the world. ^{1, 4}

Labors culminated in the case of Simkins v Moses H. Cone Memorial Hospital; this case became the breakthrough decision by the U.S. Supreme Court and ultimately led to the abolition of segregated health care. Three months after the case, President Johnson ratified the Civil Rights Act of 1964, which included Title VI, thus extending the policy of equality to all federal programs. Laying a foundation for universal access to health care in the United States depended on a victory in the courts, in national health legislation, and in public opinion. All were achieved through strategic efforts to accumulate extensive support for the removal of discrimination in medicine. ⁵

Medical desegregation and integration is both fascinating and hard to understand if the person who is trying to understand is an outsider. Many of the people of this generation have no idea what hardships and hard work their ancestors had to go through in order for their children to gain the fruit of their efforts. The desegregation of Southern Hospitals and Schools was both a strategic plan and a paradoxal process. It was strategic in how the process began. The process started with surveying all

of the Southern Medical schools, followed by gaining public interest, followed by using the federal court system, and finished by legislation. It was paradoxal because in some ways the process was long and in other ways it was a very short process when comparing it to the desegregation of other federal institutions. The process was long in terms of the amount of years it took for all of the hospitals in the south to be completely desegregated. In Contrast, the process was very short in the acceptance of desegregation in the hospitals. There are many points of view in the desegregation of the hospital system and medical schools; however, most of the opinions agree that hospital and medical school desegregation in the south was surprisingly smooth. ^{1, 4, 6}

End Notes

1-Edward Beardsley, Desegregating Southern Medicine 1945-1970 (North Carolina: International Social Science Review, 2001)

2- Chalmers Archer, Jr., Growing Up Black in Rural Mississippi: Memories of a Family, Heritage of a Place (New York: Walker, 1992), p. 89.

3- Charles E. Rosenberg, The Care of Strangers: The Rise of America's Hospital System (New York: Basic Books, 1987); Rosemary Stevens, In Sickness and In Wealth: American Hospitals in the Twentieth Century (New York: Basic Books, 1989).

4-Montague Cobb, “The Crushing Irony of Deluxe Jim Crow,” JNMA 44 (1952):387; Cobb, “Medical Care and the Plight of the Negro.” 201-11.

5-Lynn Marie Pohl, “Long Waits, Small Spaces, and Compassionate Care: Memories of Race and Medicine in a Mid-Twentieth-Century Southern Community, Bulletin of the History of Medicine 74.1 (2000) 107-137.

6-Reynolds, Preston P. Hospitals and Civil Rights: 1945-1963. Annals of Internal Medicine. (1997) 910-912.