The Hill-Burton act and civil rights: Expanding hospital care for black southerners, 1939-1960

Journal of Southern History

Volumn 72, Issue 4, 2006, Pages 823-870

  Thomas, Karen Kruse ^a,b  

^a Reichelt Oral History Program

^b FLORIDA STATE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 67649528603     PISSN: 00224642     EISSN: None     Source Type: Journal    
DOI: 10.2307/27649234     Document Type: Review

References (204)

1. Paul Starr, The Social Transformation of American Medicine (New York, 1982), 350
2. U.S. Senate, Committee on Labor and Public Welfare, Subcommittee on Health, 93 Cong., 1 Sess., Hill-Burton Hospital Survey and Construction Act: History of the Program and Current Problems and Issues (Comm. Print; Washington, D.C., 1973), 11-13, hereinafter cited as History of the Program
3. Edward H. Beardsley, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South (Knoxville, 1987), 247. Support for research for this article was generously provided by a visiting scholar research grant from the Claude Pepper Library at Florida State University and by a Reynolds Research Fellowship at the University of Alabama at Birmingham Archives. The author wishes to acknowledge the assistance of Burt Airman and John Nemmers at the Pepper Library, Tim Pennycuff at the UAB Archives, and the staffs at the Florida State Archives, the North Carolina State Archives, and the North Carolina Collection and the Southern Historical Collection at the University of North Carolina at Chapel Hill. She also wishes to thank James Leloudis, Jacquelyn Hall, Clarence Mohr, and the anonymous Journal of Southern History reviewers for their valuable criticisms of previous drafts of this article
4. Scholars who have evaluated mid-century federal health programs, particularly Hill-Burton, primarily as racially discriminatory, include Paul B. Cornely, "Segregation and Discrimination in Medical Care in the United States," American Journal of Public Health, 46 (September 1956), 1074-81
5. Herbert M. Morais, The History of the Afro-American in Medicine (Cornwallis Heights, Pa., 1976), 140-53
6. Colin Gordon, Dead on Arrival: The Politics of Health Care in Twentieth-Century America (Princeton, 2003), chap. 5
7. P. Preston Reynolds, "Professional and Hospital Discrimination and the U.S. Court of Appeals Fourth Circuit 1956-1967," American Journal of Public Health, 94 (May 2004), 710-20
8. Mitchell F. Rice and Woodrow Jones Jr., Public Policy and the Black Hospital: From Slavery to Segregation to Integration (Westport, Conn., 1994), chap. 4
9. David Barton Smith, Health Care Divided: Race and Healing a Nation (Ann Arbor, 1999), chaps. 2 and 3
10. Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York, 1995), 185-90
11. Jill Quadagno and Steve McDonald, "Racial Segregation in Southern Hospitals: How Medicare 'Broke the Back of Segregated Health Services,'" in Elna C. Green, ed., The New Deal and Beyond: Social Welfare in the South since 1930 (Athens, Ga., 2003)
12. and David McBride, From TB to AIDS: Epidemics Among Urban Blacks Since 1900 (Albany, N.Y., 1991), 140, 153
13. for a critique of historical determinism in race and medicine scholarship, see Barbara Rosenkrantz, "Non-Random Events," in Susan M. Reverby, ed., Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study (Chapel Hill, 2000), 244-47
14. Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880 (expanded ed.; New York, 1987), 4
15. Jacquelyn Dowd Hall, "The Long Civil Rights Movement and the Political Uses of the Past," Journal of American History, 91 (March 2005), 1233-63
16. P. Preston Reynolds, "Hospitals and Civil Rights, 1945-1963: The Case of Simkins v. Moses H. Cone Memorial Hospital," Annals of Internal Medicine, 126 (June 1, 1997), 898-906
17. and P. Preston Reynolds, "The Federal Government's Use of Title VI and Medicare to Racially Integrate Hospitals in the United States, 1963-67," American Journal of Public Health, 87 (November 1997), 1850-58
18. Lawrence J. Clark et al., "The Impact of Hill-Burton: An Analysis of Hospital Bed and Physician Distribution in the United States, 1950-1970," Medical Care, 18 (May 1980), 532
19. History of the Program, 13
20. University of Virginia Geospatial and Statistical Data Center, United States Historical Census Data Browser, 1940 census data, http://fisher.lib. virginia.edu/collections/stats/histcensus/ php/start.php?year = V1940. Unless otherwise specified, for statistics throughout the text South is defined, following the U.S. Census Bureau's standard, as including the eleven former Confederate states, West Virginia, Delaware, Oklahoma, Kentucky, and Maryland. In the years leading up to the passage of Hill-Burton, the Journal of Negro Education, the Journal of the National Medical Association, the American Journal of Public Health, Hospital Management, the Southern Conference for Human Welfare's Southern Patriot, the U.S. Public Health Service, southern state boards of health, and rural sociology departments of southern universities such as Louisiana State and North Carolina State were among the principal documenters of black and rural health. See Alva W. Taylor, "Health Deficit Limits Southern Manpower," Southern Patriot, 1 (August 1943), 3 (first quotation)
21. and Howard N. Rabinowitz, "From Exclusion to Segregation: Southern Race Relations, 1865-1890," Journal of American History, 63 (September 1976), 325-50
22. for a comparison of school and hospital facilities for southern blacks versus whites, see Gunnar Myrdal, An American Dilemma: The Negro Problem and American Democracy (New York, 1944), 337-46
23. Commission on Hospital Care, Hospital Care in the United States (New York, 1947), 163-67
24. Thomas J. Ward Jr., Black Physicians in the Jim Crow South (Fayetteville, Ark., 2003), 153-70
25. Morais, History of the Afro-American in Medicine, 127, 140-41
26. Gamble, Making a Place for Ourselves, 183
27. and Rice and Jones, Public Policy and the Black Hospital, 21 (second quotation), 34
28. figure for black midwives is from Beardsley, History of Neglect, 167
29. figures for black physicians (1948) and dentists (1940) are from Jessie Parkhurst Guzman, ed., 1952 Negro Year Book (New York, 1952), 164
30. (a higher figure of 2,018 black southern physicians as of 1942 was published in Paul B. Cornely, "Distribution of Negro Physicians in the United States in 1942," Journal of the American Medical Association, 124 [March 25, 1944], 827)
31. Selz C. Mayo, "Progress Report No. RS-5, 'Negro Hospital and Medical Care Facilities in North Carolina'" (hereinafer cited as Mayo, "Negro Hospital and Medical Care Facilities"), April 1945, TMs p. 8, Box 1, Series 94.2, Executive Secretary's Office, Hospital and Medical Care Study Commission, North Carolina Medical Care Commission Record Group (State Records, North Carolina State Archives, Raleigh; collection hereinafter cited as MCC)
32. 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 (Spring 2000), 107-37
33. and William J. Collins and Melissa A. Thomasson, "The Declining Contribution of Socioeconomic Disparities to the Racial Gap in Infant Mortality Rates, 1920-1970," Southern Economic Journal, 70 (April 2004), 746-76
34. Harvard Sitkoff, "The Impact of the New Deal on Black Southerners," in James C. Cobb and Michael V. Namorato, eds., The New Deal and the South (Jackson, Miss., 1984), 119
35. Gordon, Dead on Arrival, 185 (first quotation)
36. Michael R. Grey, New Deal Medicine: The Rural Health Programs of the Farm Security Administration (Baltimore, 1999), 41
37. Brenda J. Taylor, "The Farm Security Administration and Rural Families in the South: Home Economists, Nurses, and Farmers, 1933-1946," in Green, ed., New Deal and Beyond, 30-46
38. James H. Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York, 1993), 162-64
39. Elizabeth Temkin, "Driving Through: Postpartum Care During World War II," American Journal of Public Health, 89 (April 1999), 587-95
40. William H. Richardson, "Maternity-Child Care for Service Men's Families," Health Bulletin [published by the North Carolina State Board of Health], 60 (May 1945), 5-7
41. Karen Kruse Thomas, "'Law Unto Themselves': Black Women as Patients and Practitioners in North Carolina's Campaign to Reduce Maternal and Infant Mortality," Nursing History Review, 12 (2004), 47-66
42. "Southern Infant and Maternity Mortality Rates Drop Sharply," Southern Patriot, 2 (August 1944), 8
43. Milton Roemer, "Special Health Problems of Negroes in Rural Areas," Journal of Negro Education, 18 (Summer 1949), 321-22 (second quotation)
44. See also Lee J. Alston and Joseph P. Ferrie, Southern Paternalism and the American Welfare State: Economics, Politics, and Institutions in the South, 1865-1965 (Cambridge, Eng., 1999)
45. Robert C. Lieberman, Shifting the Color Line: Race and the American Welfare State (Cambridge, Mass., 1998)
46. Jill Quadagno, The Transformation of Old Age Security: Class and Politics in the American Welfare State (Chicago, 1988)
47. and Alan Dawley, Struggles for Justice: Social Responsibility and the Liberal State (Cambridge, Mass., 1991), 391-93
48. Myrdal concluded that there was "less discrimination against Negroes - and in some cases no discrimination at all - in respect to the so-called 'out-patient' services of public health institutions" and that "tremendous improvements [in public health] have been achieved in recent years, and . . . Negroes have shared in the benefits." American Dilemma, 345-46
49. Carl V. Reynolds, "Annual Report [of the] North Carolina State Board of Health To Conjoint Session State Medical Society," Health Bulletin, 61 (June 1946), 3 (quotations)
50. Robert R. Wyeneth, "The Architecture of Racial Segregation: The Challenges of Preserving the Problematical Past," Public Historian, 27 (Fall 2005), 15-17, 28-33
51. For more information on the efforts of southern state governments to equalize social welfare spending for blacks, see Charles C. Bolton, "Mississippi's School Equalization Program, 1945-1954: A Last Gasp to Maintain a Segregated Education System," Journal of Southern History, 66 (November 2000), 781-814; and the files on the Southern Governors Conference and Southern Regional Education Board (SREB) in the papers of Florida governors Millard F. Caldwell, Fuller Warren, LeRoy Collins, and Farris Bryant in the State Archives of Florida in Tallahassee
52. "Federal Works Agency - P.W.A., Office of Advisor on Negro Affairs," Journal of the National Medical Association, 32 (May 1940), 136
53. Douglas L. Smith, The New Deal in the Urban South (Baton Rouge, 1988), 114 (second and third quotations), 122 (first quotation)
54. figure for total black beds in PWA hospitals is from Charles S. Johnson, "The Negro," American Journal of Sociology, 47 (May 1942), 857
55. Federal Works Agency, Second Annual Report (Washington, D.C., 1941), 189, 315, 460
56. Federal Works Agency, Fourth Annual Report (Washington, D.C., 1943), 61
57. William Ivy Hair, The Kingfish and His Realm: The Life and Times of Huey P. Long (Baton Rouge, 1991), 230-31
58. John E. Salvaggio, New Orleans' Charity Hospital: A Story of Physicians, Politics, and Poverty (Baton Rouge, 1992)
59. T. R. Ponton, "Hospital Service for Negroes," Hospital Management, 51 (March 1941), 14-15
60. T. Carr McFall, "Needs for Hospital Facilities and Physicians in Thirteen Southern States," Journal of the National Medical Association, 42 (July 1950), 236. (McFall's article, the source for the number of beds in 1946, refers to non-whites, rather than specifying blacks.)
61. Both Louisiana and North Carolina demonstrate the efforts of southern state governments, even before the passage of Hill-Burton, to remedy the worst aspects of the prewar racially separate hospital system by devoting new resources and attention to black health care access within biracial institutions. Louisiana constructed five additional state charity hospitals around the state to supplement those already in operation at New Orleans and Shreveport. On the eve of Hill-Burton, out of 7,110 acceptable general hospital beds in Louisiana, 3,113 were in the seven charity hospitals, whose physical plants according to a 1948 report were "better than is generally found in the private institutions in the state." Despite this expansion, the charity hospitals still experienced overcrowding so that at four of the seven institutions, "the physical facilities . . . are not adequate to support the number of beds they are now required to provide." Half the charity hospital beds were allocated for blacks, who composed just under 30 percent of Louisiana's population. The state charity hospitals admitted 22,324 more black than white patients in 1946-1947, due to shorter average hospitalizations for blacks than whites. Charles Mitchell and Jesse H. Bankston, Hospital and Health Facilities in Louisiana (Baton Rouge, 1948), 29-31
62. A 1947 study of hospital admissions of children in six southern states conducted by the American Academy of Pediatrics ranked Louisiana first in rates of both black and white admissions. Louisiana's rate of 47.2 admissions per 1,000 black children was nearly equal to the white rate for the six states as a whole (47.8) but was still inferior to the rate of 70.2 for white Louisiana children. Goldstein, "Longevity and Health Status of Whites and Nonwhites," 94-95
63. "North Carolina's Draft Rejection Figures," North Carolina Medical Journal, 6 (January 1945), 39-40
64. "Current Good Health Crusade Is Deep Rooted," Alumni Review [published by the University of North Carolina], 35 (October 1946), 36-37
65. Clarence Poe, Final Report of the North Carolina Hospital and Medical Care Commission (Raleigh, 1945), 16 (first quotation; this document is cataloged as part of the larger North Carolina Hospital and Medical Care Commission, To the Good Health of All North Carolina [8 vols. in 1; Raleigh, 1944-1945])
66. J. Melville Broughton to Claude Pepper, May 10, 1943, Folder 3, Box 12, Series 203B, "Southern Governors Conference" (Claude Pepper Library, Florida State University, Tallahassee)
67. William M. Coppridge, "Suggestions from the Committee on Hospitals of the Governor's Commission," North Carolina Medical Journal, 5 (November 1944), 546-47
68. Edson E. Blackman, "Negro Hospital and Medical Needs in North Carolina," in Poe, Final Report, 5-11. Broughton, along with the black educator Dr. Albert W. Dent, president of Dillard University and former director of Flint-Goodridge Hospital in New Orleans, went on to serve on the Federal Hospital Council, which formulated regulations barring racial and religious discrimination in Hill-Burton
69. "Current Good Health Crusade Is Deep Rooted," 34 (first quotation)
70. Thomas Parran, "Parran Evaluates N. C. Good Health Program," Alumni Review, 35 (April 1947), 219 (second quotation)
71. Mayo, "Negro Hospital and Medical Care Facilities," 19-20 (first, second, and third quotations)
72. Morais, History of the Afro-American in Medicine, 130
73. W. D. Carmichael to David S. Coltrane, November 3, 1949, Desegregation: Medical Care, 1949-1951 Folder, Subgroup 1, General Administration: Controller and Vice President for Finance (University Archives, Wilson Library, University of North Carolina at Chapel Hill; hereinafter cited as UNC Archives) (fourth and fifth quotations)
74. Myrdal, American Dilemma, 172; figure on southern rural outmigration is from Numan V. Bartley, "The Era of the New Deal as a Turning Point in Southern History," in Cobb and Namorato, eds., New Deal and the South, 139
75. Congressional Record, 75 Cong., 3 Sess., 3008 (March 8, 1938)
76. Starr, Social Transformation of American Medicine, 348
77. John Egerton, Speak Now Against the Day: The Generation Before the Civil Rights Movement in the South (New York, 1994), 177-81
78. entries for Claude Denson Pepper and Joseph Lister Hill, http:// bioguide.congress.gov (accessed June 22, 2004)
79. Virginia Van der Veer Hamilton, Lister Hill: Statesman from the South (Chapel Hill, 1987)
80. Claude Denson Pepper with Hays Gorey, Pepper: Eyewitness to a Century (New York, 1987)
81. William E. Leuchtenburg, Franklin D. Roosevelt and the New Deal, 1932-1940 (New York, 1963), 266
82. "Pepper and Hill," New Republic, 110 (April 24, 1944), 551
83. "How Sick is the South?" ibid., 3 (May 1945), 2
84. "North Carolina's Draft Rejection Figures," 39-40
85. "Current Good Health Crusade Is Deep Rooted," 36-37
86. U.S. Senate, Committee on Education and Labor, Subcommittee on Wartime Health and Education, 78 Cong., 2 Sess., Wartime Health and Education: Interim Report . . . (Comm. Print; Washington, D.C., 1945), i (first quotation), 1-2, 5-6, 22
87. Pepper, Senate speech, Cong. Record, 81 Cong., 1 Sess., 2134 (March 10, 1949)
88. Bruce J. Schulman, From Cotton Belt to Sunbelt: Federal Policy, Economic Development, and the Transformation of the South, 1938-1980 (New York, 1991), 47-51, 61 (second quotation), 208 (third quotation)
89. Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (New York, 1989), 219 (second quotation), 254
90. Ward, Black Physicians in the Jim Crow South, 176 (first quotation)
91. Quadagno and McDonald, "Racial Segregation in Southern Hospitals," 119-21
92. David Barton Smith, Health Care Divided, 46-47
93. P. Preston Reynolds, "Professional and Hospital Discrimination, " 710-11
94. Gordon, Dead on Arrival, 193-94
95. P. Preston Reynolds, "Federal Government's Use of Title VI and Medicare." On the role of antidiscrimination clauses in defeating federal aid to medical education, see the remarks of Sen. Elbert Thomas (D-Utah) and President M. Don Clawson of Meharry Medical College, Cong. Record, 80 Cong., 2 Sess., 5659-68 (May 12, 1948), as well as "The Federal Aid and Regional Plan Chimerae," Journal of the National Medical Association, 43 (September 1951), 339
96. Michael M. Davis and Hugh H. Smythe, Providing Adequate Health Service to Negroes (New York, 1949), 8 (first quotation)
97. To Establish a National Health Program, 237-43, 285-90, 891-98
98. U.S. Senate, Committee on Education and Labor, 76 Cong., 3 Sess., Construction of Hospitals: Hearings on S. 3230, March 18-19, 1940 (Washington, D.C., 1940), 78-91
99. McBride, From TB to AIDS, 142 (second and third quotations)
100. Ward, Black Physicians in the Jim Crow South, 177-82
101. Ann Short Chirhart, "Gender, Jim Crow, and Eugene Talmadge: The Politics of Social Policy in Georgia," in Green, ed., New Deal and Beyond, 86-88
102. Richard Kluger, Simple Justice: The History of Brown v. Board of Education and Black America's Struggle for Equality (new ed., New York, 2004), 201-3, 211-12 (quotation), 259, 268-69
103. Egerton, Speak Now Against the Day, 152-53
104. On Wright's outspoken advocacy of health care integration in other contexts, see P. Preston Reynolds, "Dr. Louis T. Wright and the NAACP: Pioneers in Hospital Racial Integration," American Journal of Public Health, 90 (June 2000), 883-92
105. "Colleges: Fewer But Better?" U.S. News and World Report, June 20, 1952, p. 35
106. SREB minutes, June 23, 1950, Folder 1, Box 79, Governor Fuller Warren Papers, Record Group 102, Series S235, Florida State Archives
107. Winfred L. Godwin, "Report on SREB Regional Contract Program, 1959-60," Exhibit J in SREB minutes, June 12-14, 1960, "Corresp. Southern Regional Education Board, 1959-61," Box 55, Series P 14a, President Wayne J. Reitz Papers (University Archives, Department of Special and Area Studies Collections, George A. Smathers Libraries, University of Florida, Gainesville)
108. "Recommendations of a Special Committee of the National Medical Association to the Technical Committee on Medical Care, in conference, U.S. Public Health Service Building, Washington, D.C., November 22, 1938," Journal of the National Medical Association, 31 (January 1939), 35-36
109. North Carolina Advisory Committee to the U.S. Commission on Civil Rights, "Equal Protection of the Laws Concerning Medical Care in North Carolina," November 9, 1961, p. 4, Series 94.8, Director's Office, Agencies and Organizations Correspondence, 1947-1974 (hereinafter cited as Agencies and Organizations), MCC (second quotation)
110. Preston Reynolds, "Dr. Louis T. Wright and the NAACP," 883-92
111. Bolton, "Mississippi's School Equalization Program," 782 (first quotation)
112. Cong. Record, 78 Cong., 1 Sess., 8559-65 (October 20, 1943)
113. Chirhart, "Gender, Jim Crow, and Eugene Talmadge," 86-88
114. Amos H. Carnegie, "The Hospital Situation in Miami, Florida," Journal of the National Medical Association, 42 (January 1950), 58-59
115. "N.C. Cities to Fight Jimcrow Hospitals," Raleigh Carolinian, June 13, 1953
116. "Negro Voters Defeat Hospital Bond Issue," Journal of the National Medical Association, 45 (November 1953), 438
117. "Hospital Discrimination Must End!" ibid., 45 (July 1953), 284-86
118. W. Montague Cobb, "The Crushing Irony of De Luxe Jim Crow," ibid., 44 (September 1952), 386-87 (second quotation on p. 386)
119. Cobb, "The National Health Program of the N.A.A.C.P.," ibid., 45 (1953), 333-39 (third quotation on p. 334)
120. quoted in David Barton Smith, Health Care Divided, 49
121. Brandt, No Magic Bullet, 4, 161
122. "Memphis NAACP Branch Rescinds Endorsement of Negro Hospital," Journal of the National Medical Association, 44 (July 1952), 314-15
123. David Barton Smith, Health Care Divided, 40, 41-49
124. "Florida A. and M. College Hospital, Tallahassee, Fla.," Journal of the National Medical Association, 42 (May 1950), 186-87
125. "Professional News," ibid., 24 (May 1937), 71
126. Beardsley, History of Neglect, 99, 245-51, 255-59
127. Rice and Jones, Public Policy and the Black Hospital, 109-10
128. W. Montague Cobb, "Medical Care and the Plight of the Negro," Crisis, 54 (July 1947), 201-11 (first quotation on p. 208)
129. Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill, 2001), 94-103 (third quotation on p. 103), 111-14 (second quotation on p. 111)
130. AMA Council on Medical Education and Hospitals, "Hospitalization of Negro Patients," Journal of the American Medical Association, 115 (October 26, 1940), 1461 (quotation)
131. Alan P. Smith, "The Institutional Care of Negroes with Mental Diseases in the United States," Journal of the National Medical Association, 24 (November 1937), 146 (Va., W.Va., Md., and Okla. also had separate state mental hospitals for blacks, and S.C. and Fla. had separate black divisions within their state mental hospitals. Smith spoke highly of care for mentally ill black veterans within the Veterans Administration hospital system, particularly in the facility at Tuskegee.)
132. Maurice H. Greenhill, "The Present Status of Mental Health in North Carolina," North Carolina Medical Journal, 5 (January 1945), 10, 12 (first quotation)
133. William R. Johnson, "Report of Visit to State Hospital, Goldsboro," Cherry Hospital, Goldsboro, N.C., Folder, Box 241, Bureau of Work Among Negroes Series, MCC
134. "Federal Works Agency-P.WA., Office of Advisor on Negro Affairs," 136
135. Michael A. Dowell, "Hill-Burton: The Unfulfilled Promise," Journal of Health Politics, Policy and Law, 12 (Spring 1987), 154
136. Stevens, In Sickness and in Wealth, 269-70; "Saint Agnes Hospital Condemned," Raleigh Carolinian, May 14, 1955 (quotation)
137. "Ford Grant Brings New Hope to St. Agnes Hospital," ibid., October 27, 1956
138. See Pohl, "Long Waits," 113
139. Pohl, "Long Waits," 111-31; Duke Endowment Hospital Section, "North Carolina General Hospitals Caring for Negro Patients in 1944," MCC
140. Department of Rural Sociology, North Carolina Agricultural Experiment Station, Medical Care Services in North Carolina: A Statistical and Graphic Summary . . . (Raleigh, 1945), 34-35
141. Poe, Final Report; Rice and Jones, Public Policy and the Black Hospital, 21, 34
142. David T. Beito, "Black Fraternal Hospitals in the Mississippi Delta, 1942-1967," Journal of Southern History, 65 (February 1999), 134-40
143. Salter Cochran and Doris Cochran, interview by author, Weldon, N.C., April 12, 1997, Interview R-14, Southern Oral History Program Collection #4007 (Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill)
144. Spencie Love, One Blood: The Death and Resurrection of Charles R. Drew (Chapel Hill, 1996), 1, 21-31, 217-27
145. Anslee Willett, "Technology Brings Comfort to Patients," Burlington (N.C.) Times-News, November 11, 1999
146. N.C. Medical Care Commission, "One Hundred Ninety-Two Projects," UNC Archives; beds for blacks are calculated by multiplying total beds by percentages of Negro patients from Duke Endowment, 1961 Miscellaneous Hospital Statistics (n.p., 1961), A-1, A-5, Box HCCD 16, Hospital Division Subseries, Duke Endowment Archives (Duke University Rare Book, Manuscript and Special Collections Library, Durham, N.C.)
147. N.C. Advisory Committee, "Equal Protection of the Laws," 17, 20, MCC
148. "Student Succumbs After Aid is Refused at Hospital," Raleigh Carolinian, December 9, 1950
149. "Seriously-Burned Woman Refused Admittance to Two NC Hospitals: White, Negro Hospitals Refuse Aid," ibid., February 16, 1952
150. Richard Meckel, Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850-1929 (Baltimore, 1990), 173-74
151. Collins and Thomasson, "Declining Contribution of Socioeconomic Disparities," 769-70 (quotation on p. 769). Collins and Thomasson note that "even as the colossal Hill-Burton program pumped federal funds into the health care system . . . the secular decline in infant mortality stagnated for nonwhites from 1950 to 1965 and for whites between 1955 and 1965" (p. 758). They conclude that the largest single factor contributing to the racial gap in infant mortality before 1970 was the gap in education levels of women between 20 and 40, followed by income, urban residence, and geographic distribution of physicians. Although the Great Migration of southern blacks from farms to southern and northern cities improved levels of income, education, and access to hospitals and physicians, these improvements were outweighed by the negative consequences of urbanization compounded by racial discrimination, resulting in increased costs of housing, food, and health care; increased rates of cigarette smoking; overcrowded and unhealthy living conditions in urban ghettos; increased exposure to communicable disease and environmental pollution; hazardous industrial employment; and separation from family support networks (pp. 752-61)
152. Helen Gahagan Douglas, "What Price Medicine: Current Legislation Dealing with Health Before the Present Congress," Journal of the National Medical Association, 40 (January 1948), 17
153. Vane M. Hoge, "The National Hospital Construction Program," ibid., 40 (May 1948), 102, 104 (quotations); "Federal Aid and Regional Plan Chimerae," 339
154. Oscar R. Ewing, "Facing the Facts on Negro Health," Journal of the National Medical Association, 44 (March 1952), 108-12 (first quotation on p. 108)
155. "The Honorable Oscar Ross Ewing," ibid., 43 (November 1951), 402-4 (second quotation on p. 403)
156. "'Let Not Thy Left Hand Know . . .,'" North Carolina Medical Journal, 9 (May 1948), 271 (third quotation)
157. Parran, "Abstract of 'Hospitals and the Health of the People,'" TMs, 600.1 Reference Material (USPHS) Folder, Box 4, Agencies and Organizations, MCC (fourth and fifth quotations; this abstract summarizes Thomas Parran, "Hospitals and the Health of the People," Journal of the American Medical Association, 133 [April 12, 1947], 1047-49)
158. Though Parran worked hard to extend public health initiatives to
159. U.S. Commission on Civil Rights, Report of the U.S. Commission on Civil Rights, 1963 (Washington, D.C., 1963), 131 (first quotation)
160. William A. Link, "'The Harvest Is Ripe, but the Laborers Are Few': The Hookworm Crusade in North Carolina, 1909-1915," North Carolina Historical Review, 67 (January 1990), 3-4
161. "Jimcrow Hospital Nixed, TB Hospital to Be Utilized By All the People" Raleigh Carolinian, September 22, 1951, pp. 1, 8
162. "Nix Hospital Plan," Raleigh Carolinian, May 1, 1954
163. Robert Fredrick Burk, The Eisenhower Administration and Black Civil Rights (Knoxville, 1984), 196
164. Cong. Record, 85 Cong., 1 Sess., 5024-25 (April 3, 1957)
165. Parran, "Parran Evaluates," 218-19
166. N.C. Medical Care Commission, The Expansion of Medical Facilities and Services in North Carolina - Two Decades of Progress (Raleigh, 1967), 11
167. William F. Henderson, "Remarks Before the North Carolina Legislative Research Commission," January 5, 1968, TMs, Legislative Research Commission Folder, Box 3, Agencies and Organizations, MCC; N.C. Advisory Committee, "Equal Protection of the Laws," 18, 23, 26 (quotation), MCC
168. For the percentage of blacks in North Carolina in 1940 see University of Virginia Geospatial and Statistical Data Center, United States Historical Census Data Browser, 1940 census data
169. Jill Quadagno, One Nation Uninsured: Why the U.S. Has No National Health Insurance (New York, 2005), 82 (quotation)
170. Stevens, In Sickness and in Wealth, 5
171. N.C. Medical Care Commission, Expansion of Medical Facilities and Services in North Carolina, 11
172. Karen Kruse Thomas, "The Wound of My People: Segregation and the Modernization of Health Care in North Carolina, 1935-1975" (Ph.D. dissertation, University of North Carolina at Chapel Hill, 1999), 175-88
173. P. Preston Reynolds, "Hospitals and Civil Rights, 1945-1963."
174. N.C. Medical Care Commission, "One Hundred Ninety-Two Projects," UNC Archives
175. James E. Rohrer, "The Political Development of the Hill-Burton Program: A Case Study in Distributive Policy," Journal of Health Politics, Policy and Law, 12 (Spring 1987), 142-43 (quotation)
176. Jacquelyn Hochban et al., "The Hill-Burton Program and Changes in Health Services Delivery," Inquiry, 18 (Spring 1981), 61
177. Duke Endowment, 1964 Miscellaneous Hospital Statistics (n.p., 1964), A-1, Box HCCD 16, Hospital Division Subseries, Duke Endowment Archives; Walter Reece Berryhill to Henry Clark, April 11, 1953, Black Student Admissions Folder, Series 3, Student Affairs, Office of Minority Students, Subgroup 1, Health Affairs: Dean of the School of Medicine, UNC Archives; N.C. Advisory Committee, "Equal Protection of the Laws," 17-18, MCC. Another high-cost project, a 107-bed expansion to the all-white Watts Hospital in Durham, was paired with a 35-bed addition to the all-black Lincoln Hospital, with federal and local funding allocated based on racial population ratios. P. Preston Reynolds, "Watts Hospital, 1895-1976: Paternalism and Race in the Evolution of a Southern Institution in Durham, North Carolina" (Ph.D. dissertation, Duke University, 1986)
178. P. Preston Reynolds, "Hospitals and Civil Rights, 1945-1963."
179. Peter F. Drucker, "The Age of Social Transformation," Atlantic Monthly, November 1994, pp. 53-72
180. Carolanne H. Hoffman, "Health Insurance Coverage," Series 10, Number 11, National Center for Health Statistics (Washington, D.C., 1964)
181. N.C. Advisory Committee, "Equal Protection of the Laws," 20, MCC; Stevens, In Sickness and in Wealth, 268-75
182. "Current Good Health Crusade Is Deep Rooted," 35
183. Roy Parker Jr., "Welfare Officials See Progress For NC Hospitalization Program," Raleigh News and Observer, August 23, 1959
184. Duke Endowment, Annual Reports of the Hospital and Orphan Sections, For the Fiscal Year October 1, 1961-September 30, 1962, pp. 22-25
185. Beito, "Black Fraternal Hospitals in the Mississippi Delta," 136, 140 (quotation)
186. Robert Coles, Farewell to the South (Boston, 1972), 170-77
187. Numan V. Bartley, The New South, 1945-1980 (Baton Rouge, 1995), 156 (second quotation and third quotation, quoting Hamilton)
188. Two examples of criticism of Hill-Burton's failure to fulfill its pledge that participant hospitals would provide substantial care to indigent patients are Lawrence A. Schneider, "Comments: Provision of Free Medical Services By Hill-Burton Hospitals," Harvard Civil Rights-Civil Liberties Law Review, 8 (1973), 351-83 (fourth quotation on p. 352)
189. Schulman, From Cotton Belt to Sunbelt, 120-33, 280-81n9
190. Hill, "The Growth of Hospitals and Voluntary Health Insurance," address to the American Hospital Association, September 26, 1949, Cong. Record, 81 Cong., 1 Sess., A6373 (October 17, 1949) (quotation)
191. Pepper, speech, July 30, 1947, p. 4., Folder 2, Box 5, Subseries U.S Senate - Speeches, Series 203B, Pepper Library; Lewis E. Weeks and Howard J. Berman, Shapers of American Health Care Policy: An Oral History (Ann Arbor, 1985), 39
192. "The Republican Welfare States," Atlantic Monthly, March 2004, p. 48
193. "A Decade of Hill-Burton," American Journal of Public Health, 47 (November 1957), 1446-47 (states that half of the Hill-Burton hospitals in the program's first decade were built in the South but does not define South)
194. Clark et al., "Impact of Hill-Burton," 538-42 (first quotation on p. 542), 548-50
195. Starr, Social Transformation of American Medicine, 350, 373
196. Beardsley, History of Neglect, 184, 342n88 (second quotation; Beardsley cites the Southern Regional Council's hospital study and "A Decade of Hill-Burton")
197. Bolton, "Mississippi's School Equalization Program," 783-84
198. Ponton, "Hospital Service for Negroes," 15
199. Michael M. Davis, How a National Health Program Would Serve the South (New York, 1949), 5
200. McFall, "Needs for Hospital Facilities and Physicians," 236
201. Beito, "Black Fraternal Hospitals in the Mississippi Delta," 136-37 (quotation)
202. Kenneth M. Ludmerer, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (New York, 1999), 163-65
203. Cornely, "Segregation and Discrimination in Medical Care in the United States," 1079-80
204. History of the Program, 17 (second and third quotations)