This month we celebrate Black History Month and we are focusing on: Black Hospitals History.
The history of African America and health has always been a precarious one. A people descended from the medical genius, Imhotep, known as the “father of medicine” who performed the earliest known surgery to the inspiring story of Dr. Ben Carson in present times. Healing sanctuaries and temples to the goddess Sekhmet are known to be the earliest “hospitals” to date.
Fast forward a few thousand years to America and African Americans. From colonial times to present time, as noted in Medical Apartheid by Harriet Washington, when African Americans went outside of their own medical ecosystem we were and are subject to some of the most brutal medical experiments and abuses known in medical history. In an interview with Democracy Now, Ms. Washington is quoted giving examples of these abuses from past to present, “James Marion Sims was a very important surgeon from Alabama, and all of his medical experimentation took place with slaves. He took the skulls of young children, young black children — only black children — and he opened their heads and moved around the bones of the skull to see what would happen. He bought, or otherwise acquired, a group of black women who he housed in a laboratory, and over the period of five years and approximately forty surgeries on one slave alone, he sought to cure a devastating complication of childbirth called vesicovaginal fistula.”Ironically, as it were, Dr. Sims would go on to become president of the American Medical Association.
Ms. Washington then goes on to present times stating “It’s black boys who have been singled out for these very dangerous experiments, such as a fenfluramine experiment that took place right here in New York City between 1992 and 1997. A lot of the abuse in African Americans has dissipated, but that kind of research is being conducted in Africa, where the people are in the same situation. They don’t have rights. They don’t have access to medical care otherwise, and Africa is being treated as a laboratory for the West by Western researchers.” Despite this obvious and consistent pattern of behavior we continue to seek to dismantle our own medical ecosystem.
It is no secret that the health of the African American community has always been in peril. Today, more so than it has ever been in our history in this country. To some, the issues of medicine are a one size fits all prescription for any human anywhere. It is true we all have the same anatomy but historical diet from our ancestry, environment, stress from the Middle Passage, slavery, and socioeconomic burdens that culminated after desegregation have taken its toll and many other factors create unique issues in the African American health dynamic.
In fact, every group based on their historical geography and diet has unique health features in their present health makeup. So what is conducive to one group will not necessarily work for another. These variables mean that there is no blanket medical solutions or care for everyone. Biological diversity exist in every species be it cats (lions, cheetahs, tigers) or humans. Yet, our desire to ignore these realities for the sake of creating a racial or ancestral Utopia has created a boom in our health risk with no seemingly end in sight.
The numbers bear out a bleak picture of African American health today. African American life expectancy is 4.3 years less than the average American and 4.8 years less than European Americans. We currently have the highest age-adjusted death rate among all populations. The infant mortality rate in America for all is 6.8 per 1000 births yet for African America it is 13.2 per 1000 births. We are going extinct and do not even realize it.
Black hospitals have existed in three broad types: segregated, black-controlled, and demographically determined.
Segregated Black hospitals included facilities created by Whites to serve African-Americans exclusively and they operated predominantly in the South. Black physicians, fraternal organizations, and churches founded Black- controlled facilities. Changes in population led to the development of demographically determined hospitals which came about because of a rise in Black population surrounding the hospitals
Until the rise of the Civil Rights Movement, hospitals in the South and in the North either denied African-Americans admission, or accommodated them exclusively in segregated wards, usually in undesirable locations such as unheated attics and damp basements.
The Georgia Infirmary, 1832, was the first segregated Black hospital. By the end of the nineteenth century, others had been founded, including Raleigh’s St. Agnes Hospital in 1896 and Atlanta’s Mac Vicar Infirmary in 1900. Some of their White founders expressed genuine desire and interest to supply health care to Black people.
Soon Blacks founded hospitals to meet the specific needs of the African-American communities. Provident Hospital in Chicago, the first Black-controlled hospital in America, opened in 1891. Racism in Chicago had prevented Black nurses and doctors from practicing thus eliminating health care for any Black patients.
Other facilities opened up, including Tuskegee Institute and Nurse Training School in Alabama, 1892, Provident Hospital at Baltimore, 1894, and Frederick Douglass Memorial Hospital and Training School at Philadelphia in 1895. These hubs of medical assistance for African-Americans represented in part the institutionalization of Booker T. Washington’s political ideology, advancing racial uplift by improving the health status of Black people and by contributing to the Black professional class.
By 1919, roughly 118 segregated and Black controlled hospitals existed, three-fourths of them in the South. Most of them were small and not full-service units, and were not prepared to survive sweeping changes in scientific medicine, hospital technology, and standardization that had begun to take place at the time. This was the most critical condition of survival of historically Black hospitals between 1920 and 1945.
In the early 1920s, a group of physicians associated with the National Medical Association (NMA), a Black medical society, and the National Hospital Association (NHA), a Black hospital organization, launched a reform movement to ensure the survival of these hospitals and the maintenance of professions for Blacks. Their activities, with added financial help from White philanthropists, produced some improvements and preservation by World War II.
However this “Negro Hospital Renaissance” showed that by 1923, out of 200 Black hospitals, only six provided internships and none of them had residency programs. In 1944 the number of hospitals increased to 124. The American Medical Association (AMA) approved nine of the facilities for internships and seven for residencies with the quality of some being suspect. The AMA admitted that their decision was based in part on the need to have some internship opportunities for Black doctors.
This attitude spotlights the then-accepted practice of treating Black people in separate but not equal facilities. During the Civil Rights Movement, the energies of the NMA, the NHA, and the NAACP focused on dismantling the “Negro medical ghetto” of which Black hospitals were a component. The protest between 1945 and 1965, poised toward integration in medicine, challenged the existence of the historically Black hospital. Legal action was a key weapon in desegregation of hospitals. With the Brown v Kansas Board of Education precedent, Simkins v. Moses H. Cone Hospital proved to be the pivotal case in 1963. The Civil Rights Act of 1964 further prohibited racial discrimination in any program receiving federal assistance.
Because of these changes in health care considerations, Black hospitals now faced an ironic dilemma. They now competed with hospitals that had once discriminated against Black patients and staff. Since 1965, African-American physicians have gained access to the mainstream medical profession and Black hospitals have become less and less important to their careers; this has also affected their importance to the Black middle-class patient. Consequently, the vulnerability of the Black hospital has increased dramatically.
Historically Black hospitals have had a significant impact on the lives of African-Americans. They evolved not only out of critical need but as a symbol of pride and achievement within the Black community. They supplied medical care and professional opportunities for countless African-Americans. They have now become non-essential to the lives of most Americans and are on the verge of extinction.
Nathaniel Wesley Jr.’s book Black Hospitals in America: History, Contributions and Demise points out that at our apex there were 500 African American owned and controlled hospitals. Today, Howard University in Washington D.C. is the last one standing.
During an interview Wesley was quoted, citing a few facts that came from his book. “A significant number of Black hospitals were founded to provide opportunities for clinical training for Black nursing students. Segregated White hospitals did not allow Black nursing students to receive clinical training at those hospitals.
In some locations, Black physicians were not given admitting privileges to Black hospitals. Only White physicians could admit consistent with the policies of the local medical society. Black physicians could then provide medical care to those patients”.
Black hospitals were true “community” hospitals. Individuals and institutions throughout a community would support the hospital socially, politically, economically and financially”.
In many communities, White physicians played a key role in securing critical medical resources from White hospitals for the care of Black patients. These physicians were also creative enough to provide surgical and medical services when such services were “off limits” at the White hospital
In 1983 as Dillard University was selling its hospital Flint-Goodridge their president at the time, Dr. Samuel Dubois Cook stated that its demise was a result of “tragic mismanagement, social change that desegregated hospitals, financial irregularities, the fact that 90 percent of the patients were on Medicare or Medicaid and the loss of broad community support”. It would be hard not to assume that these were the underlying cause of the majority of most African American owned hospitals.
The Black Hospital Movement (1865 – 1960’s)
A place for Negro physicians to treat patients and improve skills through lectures, workshops, and training sessions
Negroes (doctors and patients) were excluded from most hospitals
To offset the inequities with respect to health care facilities and practices
The lack of Negro hospitals contributed to the poor health status of the colored community
Black physicians saw black hospitals as a larger part of a general movement to improve the social standing of colored society
Establishment of the Freedmen’s Bureau and it’s medical division
Hospitals, dispensaries, and other health care facilities were established in the larger cities, especially in the south
Self-help and philanthropic support
The move from exclusion to segregation in hospital care
The establishment of separate (but not equal) asylums, poorhouses, homes for children, institutions for the deaf and dumb, and adjuncts to city and county hospitals and infirmaries
The emergence of the black hospital
Freedmen’s Hospital (Washington, DC)
Freedmen’s Hospital was established 1862 in Washington, DC by the Medical Division of the Freedmen’s Bureau to provide the much needed medical care to slaves, especially those freed following the aftermath of the Civil War. The hospital was located on the grounds belonging to Howard University and was the only Federally-funded health care facility for Negroes in the nation.
It still exists today as Howard University Hospital, one of only three remaining traditional Black hospitals. The Freedmen’s Bureau existed for only four years, but during that time a movement was started that paved the way for some ninety new Negro hospitals and other health care facilities. Each state acquired some type of health care facility around 1865 through the turn of the century. By 1900, there were about forty Negro hospitals.
Lincoln Hospital (Durham, NC)
Lincoln Hospital was founded by Dr. Aaron McDuffie Moore (1863-1923) in 1901 when he convinced Washington Duke that a hospital would be a more valuable investment than Duke’s idea of building a monument on the Trinity campus to honor Negroes who had fought for the confederacy.
Dr. Moore, who received his medical degree from Leonard Medical College (Shaw University), was Durham’s only Negro doctor during this time.
Provident Hospital (Chicago, IL)
Provident Hospital and Training School for Nurses, the first African American owned and operated hospital in America, and founded in 1891 by Dr. Daniel Hale Williams. Negro patients were denied admission to White hospitals; therefore, Negro physicians could not treat their patients. The hospital was opened because a young black woman who was aspiring to become a nurse was turned down for admission to all Chicago’s nursing schools because of her race. After seeing what was happening, her brother, the Rev. Louis Reynolds, approached a respected black surgeon during that time, Dr. Daniel Hale Williams for assistance. The two decided to start a new nursing school for black women. Here are five other facts you might not know about the hospital.
1. The school opened on the south side of Chicago on April 5, 1891. Provident Hospital became an Illinois corporation, the training school for nurses opened and Dr. Williams was appointed hospital chief-of-staff. He attracted national attention when he sewed up the lining of a human heart following a stab wound; it was a procedure that was deemed as impossible.
2. By 1892, seven women, including Emma Reynolds, had enrolled in the first nursing class. Provident was established to serve all races, and its patients and physicians were black and white during early years. It is estimated that by 1897, the Hospital had over 180 inpatients, and the outpatient clinic, the Armour Dispensary, treated approximately 6,000 patients.
3. By 1915, Provident had become a predominantly African American institution. It had become a renown a medical center, graduating 118 women from twenty-four states through its nursing program.
4. Credit is given to black residents, workers, employers, public officials, church leaders, and civic leaders to opening and sustaining the facility. The hospital was dependent on wealthy donors, and the generosity of community residents.
5. Provident began to have problems with their finances in the 1940s. However, they overcame those obstacles only to go through the same situation in the late 1980s. The hospital attempted a series of efforts to keep their doors open to no avail. Provident Hospital closed its doors in September 1987.
Saint Agnes Hospital (Raleigh, NC)
Saint Agnes Hospital established (1886) in Raleigh, North Carolina on the grounds of St. Augustine’s College. Despite obvious handicaps, it was referred to in 1922 as the “only well equipped hospital for Negroes between Washington and New Orleans, serving not only North Carolina, but adjacent Virginia and South Carolina.” The hospital closed in April 1961 after nearly 65 years of service.
Health, Hospitals and the Negro
(The Modern Hospital, Eugene H. Bradley, August, 1945)
In 1944, there were 124 Negro hospitals in the United States catering exclusively to colored patients. Of these 124 hospitals, 23 were fully approved by the American College of Surgeons and three were provisionally approved. These institutions were located in 23 states and the District of Columbia.
Today’s Remaining Traditional Black Hospitals (Source: 1996 AHA Guide to the Health Care Field)
Howard University Hospital
Riverside General Hospital
Medical schools were closed to Negroes in the South and to a lesser degree in the North. Because of the color line in medicine, the first Negro physicians received their medical degrees abroad. A few older medical schools in the East admitted some Negroes; namely, Harvard, Yale, and Pennsylvania. In the Midwest, Indiana, Northwestern, and Michigan accepted some Negro medical students.
First Negro medical student graduated from a Northern medical school – David J. Peck (Rush Medical School, Chicago).
Bowdoin Medical School in Maine awarded medical degrees to John V. De Grasse and Thomas J. White.
Berkshire Medical School in Massachusetts awarded two medical degrees to Negroes.
By 1860, at least nine Northern medical schools admitted Negroes: Bowdoin in Maine, the Medical School of the University of New York, Caselton Medical School in Vermont, Berkshire Medical School in Pittsfield, Massachusetts, Rush Medical School in Chicago, the Eclectic Medical School of Philadelphia, the Homeopathic College of Cleveland, the American Medical College, and the Medical School of Harvard University.
Seven medical schools for blacks were established between 1868 and 1904. In 1895, there were 385 Negro doctors, only 7 percent from white medical schools. In 1905, there were 1,465 Negro doctors, only 14.5 percent from white medical schools. Almost 2,400 physicians were graduated from Howard and Meharry medical schools from 1890 to the end of WWI.
Medical Schools For Blacks Established 1868 to 1904
Howard University Medical School, est. 1868
Meharry Medical College, est. 1876
Leonard Medical School (Shaw University), 1882-1914
New Orleans University Medical College, 1887-1911
New Orleans, LA
(Renamed Flint Medical College)
Knoxville College Medical Department, 1895-1900
(Became Knoxville Medical College in 1900 and closed in 1910)
Chattanooga National Medical College, 1902-1908
University of West Tennessee College of Physicians and Surgeons, 1904-1923
By 1923, only Howard University Medical School and Meharry Medical School remained.
The first North American insurance enterprise for the care of the sick and poor of the black community was, as far as is known, founded in Philadelphia by free blacks in 1787. The preamble of the “Free African Society” set out the principles of the society and its insurance practices. While white insurance companies actively competed for black clients during the mid-to-late 19th century, they chose to reduce the size of the policies they wrote for them and significantly increased their premiums.
This fueled the growth of black-owned insurance companies including, starting in October 1898, the North Carolina Mutual Life Insurance Company in Durham, which ultimately became and remains the largest black-owned insurance company in the U.S. The moving forces behind N.C. Mutual were Dr. Aaron McDuffie Moore, physician , John Merrick, barber and local businessman, and C.C. Spaulding, salesman and office manager. Dr. Clyde Henry Donnell became its medical director following Dr. Moore’s death in 1923.
The idea that someone else will care for you, your family, or your community better than you seems to be the purveying attitude of African America in almost every facet of our strategy today. This is of course assuming you believe we have an institutional strategy of our own to begin with. Instead of building and competing for power and control we seem content on waiting for others to share their spoils with us because it is the “right” thing to do only to be “shocked” when others idea of right and our idea of right do not acquiesce.
Rethinking the role of hospitals in general is needed given the rapid rise of healthcare cost but especially so in the African American community where the ability to afford private healthcare is almost impossible given our lack of wealth. While Asian and European America’s median net worth both approach $100,000 the African American median net worth is close to $2,000 and dropping according to the Economic Policy institute.
Hospitals in our communities should be fashioned as health and wellness focused on preventive care, nutrition, and alternative medicines more unique to our biology. HBCUs themselves while not all needing to build hospitals should all be investing in community clinics that are connected regionally with an African American owned hospital. The pre-med and business programs should create more courses on the development of these facilities. Its impact on both wealth creation and health improvement would do wonders for African America as a whole.
It could be said that for all the benefits of the Affordable Healthcare Act proposed by President Obama, our longer term interest in building a medical ecosystem focused on the needs and issues that face the African American and African Diaspora community would go much farther in improving our health as a people. After all if health is wealth and wealth is created by ownership then we must once again build and own the ecosystem that is the DNA of our blood, sweat, and tears.
Quote: The health of nations is more important than the wealth of nations.– Will Durant
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The Encyclopedia of African-American Heritage
by Susan Altman Copyright 1997, Facts on File, Inc. New York. ISBN 0-8160-3289-0
Journal of the National Medical Association, 53(5):439-446; Sept. 1961.
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