Hospitals and African Americans in the Mid 20th Century

“They called it Not Doctor Street, and they were inclined to call the charity hospital at its northern end No Mercy Hospital since it was 1931, on the day following Mr. Smith’s leap from its cupola, before the first colored expectant mother was allowed to give birth inside its wards and not on its steps. The reason for the hospital’s generosity to that particular woman was not the fact that she was the only child of this Negro doctor, for during his entire professional life he had never been granted hospital privileges and only two of his patients were ever admitted to Mercy, both white. Besides, the doctor had been dead a long time by 1931. It must have been Mr. Smith’s leap from the roof over their heads that made them admit her. In any case, whether or not the little insurance agent’s conviction that he could fly contributed to the place of her delivery, it certainly contributed to its time.” -pp. 4-5

In the early twentieth century, African-Americans had limited access to professionally provided health care. One factor was the inability of many blacks to meet the financial demand of services provided in facilities owned and run by whites. Lower class African-Americans were often dependent on employers to finance their medical needs. Some employers would directly front this cost, while others deducted the cost of medical care from their workers’ wages (Beito, “Fraternal Hospitals”). Some charity hospitals existed to meet these needs, including six that existed in southern Mississippi by the middle of the century (Beito, “Fraternal Hospitals”). Many African-Americans relied upon midwives for medical advice as an alternative to the costly services offered elsewhere (Beito). In addition to these financial restrictions, African-Americans received less than adequate care at many medical facilities during this time period. Most medical institutions required blacks to enter through the back of the building, and they received care in quarters separate from their white patients, if they were admitted at all. These patients were often seen last, after any white patients’ needs had been met, and actual services offered to African-Americans were limited. Obstetrical services were not provided for black women (Paulshock), and in some cases patients had to provide their own eating utensils, bed linens, and hire their own black nurse if none was on staff (Beito). African American doctors also experienced the effects of racial segregation. Many black practitioners had limited access to clinical training and internships, which in turn limited the services they were able to provide to their patients. Even when they were able to provide services, supervision of a white doctor was often required. Overall, the experience of African-Americans in the early twentieth century hospital was one of “humiliating, second-class treatment” (Beito, “Fraternal Hospitals”, 112).

As a result, African- Americans felt the urge to form their own institutions for medical treatment. Fraternal organizations were integral in achieving this goal. Initially these societies provided outlets through which a general practitioner could administer medical treatment to its members, in return for a salary based on the number of members in the organization (Beito, “Fraternal Hospitals”). In the New Orleans area alone, about 600 of these fraternal societies offered medical services by the 1920’s (Beito). After World War I, fraternal societies began founding hospitals for their communities. Often members would be charged an annual fee which would be pooled for construction costs of a hospital. Some white bankers and planters would facilitate the process either through direct financial support or through the provision of loans as a “means for them to escape paying medical costs for poor blacks” (Beito, “Fraternal Hospitals”, 116). In Mississippi, Thomas J. Huddleston was able to raise enough funds to take out a loan from a white bank in Yazoo City for the construction of the Afro-American Hospital by collecting an annual fee of $1.50 from each new member of Afro-American Sons and Daughters. As a whole, fraternal societies offered “self help and mutual aid” as a solution to the problems caused by Jim Crow laws (Beito, “Fraternal Hospitals, 113).

A major turning point in the desegregation of medical institutions was brought about by the government’s involvement. At first, state government had a hands off approach that was believed to free white taxpayers and white doctors from additional charity-care obligations in supporting black medical institutions and care. However, the Hill-Burton Hospital Construction Act of 1946 offered states grants and required that a portion go toward providing care for those living in poverty, and that all services be offered “without discrimination”. This act allowed southern states to maintain hospital segregation as long as the care was “of like quality”. This act made free and paid hospital care more available for African Americans, but hospital segregation was still not overcome (Beito, “Let Down”, 567). Greater black access to mainstream health care institutions was fought for during the New Deal Period. The first improvement was to integrate white medical institutions. Black practitioners could then admit and treat patients in white hospitals without supervision. During this period, accredited hospital training for African American doctors was also expanded. Many African Americans welcomed the intervention by the government due to the discrimination they experienced in private and local public health facilities (Nelson, 604). By the 1950’s, although segregation still existed in hospitals, one medical intern at the Delaware Hospital observed “that all patients received the same careful, caring treatment, regardless of race. A bed was always found for any patient, any color, who needed admission” (Paulshock, 73-74). The expense of segregation was outweighed by the economic practicality of combined restrooms and dining halls, which enabled the expansion of available services through the redesign of hospital facilities (Paulshock). This led to the straight forward and almost instantaneous desegregation of wards, semi-private rooms, and services in this hospital, “without fanfare... before any public demand” (Paulshock, 79).

It is in this historical context that Toni Morrison sets the scene of her novel Song of Solomon. The opening pages are set outside of a charity hospital in Michigan in the early 1930’s, with a pregnant black woman threatening to give birth on the very stoop of the building. The hospital is the backdrop for acts of intense racial discrimination, and up until this point, no black woman has been allowed to deliver a child inside, evidence of the limited health care available for African-Americans in this time period. The passage also illuminates the discrimination against black doctors. The accreditation of Dr. Foster, a respected man in his community, is not acknowledged by the town’s white hospital and he and his patients are refused care, with the exception of two of his white patients. The very mission of Mercy Hospital is called into question, as the so-called “charity hospital” denies African-Americans access to its services. Compounding the contradiction is the hospital’s location in a black neighborhood, where the dire need for such services surrounds it. This passage provides insight into the hospital’s role as a vehicle of racial discrimination against African Americans in the beginning of the twentieth century.

Works Cited

Beito, David T. "Black Fraternal Hospitals in the Mississippi Delta, 1942-1967." The Journal of Southern History 65.1 (1999): 109-40. Print.

Beito, David T. “Let Down Your Bucket Where You Are. The Afro-American Hospital and Black Healthcare in Mississippi 1924-1966.” Social Science History 30.4 (2006): 551-569. Print.

Nelson, Jennifer. “Healthcare Reconsidered: Forging Community Wellness Among African Americans in the South”. Bulletin of the History of Medicine 80.3 (2007): 594-623). Print.

Paulshock, Bernadine Z. "Desegregating the Delaware Hospital: Why, How and When Did It Happen." Delaware History 30.2 (2002): 71-84. Print.