Black History Month—100 years of progress in health…The Early Years

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Forward:

Few persons, perhaps, recall that among the opposing points of view held by Booker T. Washington and W.E.B. DuBois was an approach to the problem of the health of the Negro. Early in this century, while still at Atlanta University, Dr. DuBois made the first significant scientific approach to the health problems and biological study of the Negro. He found a Negro public unprepared for it, and White public hostile to it. In 1915, Washington approached the problem of health from a different viewpoint by crystallizing sentiment for a National Negro Health Week.

This is but part of the story which Dr. Montague Cobb, professor of anatomy in the Howard University School of Medicine, tells as he points out how the difference in the life expectancy of Whites and Negroes has been reduced fifty percent in the last fifty years.

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The handicaps from which Negroes suffered years 50 years ago are frankly acknowledged. The practitioners were poorly trained. The medical schools lacked standards and facilities. We were in a bad way and didn’t know it.

All is not well, too well; even today (1950). But significant progress has been made in the improvement of the health of Negroes, in the training of men in the allied medical professions and in health facilities.

At the beginning of the century, there was a feeling that the Negro was biologically inferior. His high incidence of disease and mortality seemed to prove that. Fifty years later, it is recognized that the Negroes of those days became sick and died all too often because of conditions which can be and are being eliminated today.

by W. Montague Cobb

Copyright, 1950 by the Pittsburgh Courier Publishing Co.

Reproduction in whole or in part expressly forbidden

cobb_montague
THE AUTHOR—William Montague Cobb, A.B., M.D., Ph.D, (1903-1990) was a physician, scholar, teacher, and civil rights activist.

(April 22, 1950)—Scientific and technological progress in medicine during the first half of the Twentieth Century has been phenomenal. The X-ray discovered in 1895, has been developed into a tool which, with accessory techniques, can explore and treat the inner condition of nearly every tissue and organ in the body, hard and soft alike. Clinical laboratory tests have so advanced that not only can we detect many specific diseases, but also determine how most of the organs are functioning and what is wrong with them. We are beginning to learn how to tag, with radioactive isotopes, atoms of food or drugs taken into the body and follow them from their moment of entry until they are excreted or thrown out.

One by one the active principles of the endocrine glands have been isolated, so that replacement therapy or supply of deficient elements is commonplace. The layman is quite familiar with the use of thyroxin in thyroid disease, insulin for the diabetic, sex hormone treatments, et cetera. Ever increasing knowledge of food and body chemistry is making nutrition approach an exact science. No region is too remote for the surgeon’s scalpel. Since blood groups were discovered in 1900, transfusion of blood and blood substitutes has saved countless lives. Understanding gained of the principles of fluid balance is decreasing, more and more, the risks of operations and emaciated states.

Population is living longer

The sulfa drugs and the antibiotics (penicillin, streptomycin, aureomycin, etc.) have proved means of cure beyond the wildest dreams of the practitioner of 1900. For those diseases for which cures have not been found, programs of control have been developed. As a result the infectious diseases are being stamped out, the population is living longer and research centers on the viruses, cancer and the degenerative diseases (heart disease, kidney disease, hardening of the arteries, etc.).

With this knowledge and these tools has come great progress in the construction and organization of facilities for applying them to those who need. Huge medical centers have appeared all over the country, and, as this is written, plans go forward for the erection of hospitals and health centers in every part of the land, so arranged that in terms of distance at least, the very latest means for treatment of any condition will be within reach of every citizen.

Measures for the general welfare such as sanitation, water purification, vaccination, mass diagnostic chest surveys, and clinics for eradication of communicable diseases have won universal approval in contrast to the hostility and taboos which greeted even the proposal of such measures at the turn of the century.

Notable contributions

In the swift and thrilling mainstream of this progress few Negroes have been able to participate. They have been occupied chiefly as shock troops and the trainers of shock troops in the healing professions who ministered as best they could under generally trying conditions, to millions of underprivileged with a crying need for their services. Yet some Negroes have been able to make notable contributions.

Dr. William Augustus Hinton, clinical professor of bacteriology and immunology in Harvard University, has become a distinguished serologist, internationally known for his development of the Hinton test for syphilis.

Dr. Louis T. Wright, director of the Department of Surgery of Harlem Hospital, New York, attained an outstanding reputation in several fields of surgery, and with his associates, was the first to use the miracle drug, Aureomycin, in human patients.

Dr. Charles R. Drew, late and deeply lamented professor of surgery in Howard University, did a superlative job in organization of blood banks and shipment of blood to Britain in her hour of need after Dunkirk, and subsequently as medical director of the project which became the pattern for blood bank development over the nation.

Achievement and disparities

Average length of life is the best single measure of the general health of large populations. The advances just described, together with elevation of the general standard of living, produced in 1948 the highest American longevity in history, 67.2 years. White men reached 65.5 years and White women 71 years. Life expectation for Colored males was 7.22 years less than that for White males, and of Colored females 8.68 years less than that for White females.

This disparity is due to preventable causes. It has been reduced from fifteen years in 1900 to eight years today. Affections like tuberculosis, pneumonia, venereal disease and maternal and infant mortality, which take higher toll in the Negro, are associated with poverty, exposure, ignorance and overcrowding. Programs for prevention and/or cure have been developed for each of these scourges. The remedies involve not only medical tools such as the antibiotics, sulfa drugs, and hospital facilities, but non-medical matters like good housing and the right to employment.

At the beginning of the century and for long thereafter, the high incidence of these diseases was held as evidence of biological inferiority of the Negro and as reason for constricting him even further in the segregated ghettos so contributory to his condition. Today public sentiment is largely permitting health programs to be directed at diseases and not their victims.

Early corrective efforts

In view of the wretched conditions striking the health of the Negro, the aura of insidious myths indicting his biological capacities, and the post bellum repressions which afflicted him as the century began, it would be expected that he himself would propose some rational, scientific approaches to the problems. The National Medical Association had been formed in Atlanta in 1895 as a result of the exclusion practices of White physicians and their organizations. The early days of the NMA were difficult and most of the physicians of the day were not well trained even according to the standards of the time. Consequently, when the first significant scientific approach to the health problems and biological study of the Negro appeared, neither the profession nor the Negro educational world were ready for it.

This work was, “The Health and Physique of the Negro American,” by Dr. W. E. B. DuBois, published in 1906 as Atlanta University Publication No. 11. That its author and editor was not a physician occasions no surprise. Many major contributors to the conquest of health hazards have not been members of the medical fraternity and their number grows yearly.

The potential usefulness of the DuBois work was not to be realized, not alone because of lack of a Negro public attuned to its values and prepared to carry on, but also because the White majority of the time was hostile to such a study. The 109-page document included a comprehensive bibliography and chapters on the Races of Men, the Negro Race, the Negro Brain, the Negro American, Physical Measurements, Psychological Considerations, the increase of the Negro American, the Sick and Defective, Mortality, Insurance, Hospitals, Medical Schools, Physicians, and Dentists and Pharmacists. This exemplary survey was DuBois single excursion into the health field. It was an extraordinary forward pass, heaved the length of the field, but there were no receivers.

Negro Health Week

Two men who were shortly to be in strategic position to have enhanced developments along the lines broadly indicated by the DuBois study were Dr. Charles V. Roman of Meharry Medical College and Dr. John A. Kenney of Tuskegee Institute. Each was prevented by background and circumstance from doing so. The Journal of the National Medical Association was established in 1909 with Roman as editor and Kenney as associate. Kenney succeeded to the editorship in 1916 and retained the post until 1948. During this thirty-nine year period the Journal was the principal medium for medical expression of Negro authors, publishing some 1,100 articles or about half of the total additions to medical literature by such authors.

Had Roman and Kenney been able to use the Journal to spearhead the scientific approach DuBois so brilliantly indicated, the National Medical Association would have performed a great service for the nation as well as for the Negro. Roman however, became submerged in the difficulties of clinical pioneering. Kenney, as a young man had gone fresh from his internship to Tuskegee as school physician and personal physician to Booker T. Washington. As the controversy over the ideologies of DuBois and Washington declined, it was natural that Washington would come forth with a different program, as National Negro Health Week in 1915, and that Kenney would follow this line.

Both the scientific and the lay educational approaches are essential and the idea of a special “Negro Health Week” has become outmoded even as the coordinated scientific study method lay unused.

Professional education

When the century began seven medical schools were engaged in the training of Negro physicians. The schools and the dates of their establishment were as follows: Howard, 1868: Meharry, 1876; Shaw, 1882; Louisville National, 1887; Flint, 1889; Knoxville, 1895; and West Tennessee, 1900. There was a short-lived Chattanooga National Medical College established in about 1902. Record indicates it’s having had nine students and one graduate. Lincoln University, Pa., established a medical school in 1870 but discontinued it in 1876. It is known to have had six students at one time but no graduates.

In 1900 medical education as a whole was in unsatisfactory condition. A total of about 200 schools were in operation, many of which were proprietary “diploma mills,” turning out thousands of poorly trained practitioners upon a helpless population. As a result of the Flexner report of 1910, sponsored by the Carnegie Foundation, standards were raised, the number of schools gradually reduced to seventy-seven (now seventy-nine) and affiliation with universities made almost mandatory. All of the Negro schools were substandard and closed successively until only Howard and Meharry remained. At the end of World War I, the conditions of these, too, was so perilous, that only the essential service they were performing in the training of Negro health personnel prevented them from being closed. Both received by unwritten courtesy a period of time in which to conform to the ever rising standards.

Obtained new plants

In the 29’s, toward the end of the period of which health had been the most fashionable field for philanthropic work, Howard and Meharry obtained new plants. The Howard funds were supplied half by the General Education Board and half by alumni and friends of the university. The Meharry funds came from the General Education Board, the Rosenwald Fund, Mrs. George Eastman, Edward Harkness and alumni and friends.

Fellowships for the graduate training of young men who would serve as nuclei for modern well-trained faculties at Howard and Meharry were furnished by the General Education Board. Sixty-two individuals, twenty-eight for Howard and 34 from Meharry were trained for faculty service under these fellowships. The schools were not able to hold these men well, however, Howard losing five and Meharry 14, chiefly because of low salaries.

The outstanding figure in this faculty rebuilding program at both Howard and Meharry was the late Dr. Numa P. G. (Pompilius Garfield) Adams of Howard, the first Negro medical dean. Adams fought and won many unsung battles for Negro professionals. He encouraged his students to qualify for advanced degrees while taking their training, and eleven of them did so, mostly in the pre-clinical fields. Adams died prematurely, a martyr to his job.

Shots in the Arm

This material and human rebuilding proved but shots in the arm. Rising costs of medical education made new financial support of our medical schools as a whole a public problem and Federal aid came to be proposed and finally recognized as a necessity. This sentiment resulted in S. 1453, a bill providing Federal aid to medical education which passed the Senate Sept. 23, 1949, and is due soon to come before the House of Representatives.

The overall planning for new financial aid to medical education from both public and private sources has been formally in progress since 1946. Yet for the first school to face financial crisis, Meharry Medical College, a plan different from that for any other medical school was worked out. This was the now notorious regional educational plan which in effect is a device to perpetuate segregation. It was foisted on Negro leadership as the only possible way to save the school. A significant segment of Negro opinion believed and put up no fight against the plan. Elsewhere this writer has set down all the facts in true perspective.

Specialists and colleges

Specialty boards were established in 1916, the first being that for diseases of the eye. The first Negro specialist to become certified was the late Dr. W. Harry Barnes of Philadelphia who became a diplomat of the American Board of Otolaryngology in 1927. At present 116 Negro physicians have became certified specialists, as follows: internal medicine, 12; surgery, 21; otolaryngology, 9: orthopedic surgery, 1; obstetrics and gynecology, 10; pediatrics, 13; radiology, 17; ophthalmology, 12; pathology, 3; preventive medicine and public health, Of these six have died and one man, Dr. Chester Chinn of New York is a diplomate of two boards, leaving a total of 109 living Negro specialists.

The several “Colleges” of specialists within the past decade have practically dropped racial bars. Dr. Daniel Hale Williams of Chicago was inducted into the American College of Surgeons at its organization in 1913. Dr. Louis T. Wright was admitted in 1934. Color bars remained definitely up until 1945, but relaxation since that time has resulted in the induction of a total of twenty-nine Negro surgeons. The late Dr. Algernon B. Jackson of Philadelphia was admitted to the American College of Physicians at the time of its formation. Two Negro physicians are now qualifying for this body through associate membership. The International College of Surgeons, American College of Radiology, American College of Chest Physicians, American Academy of Pediatrics and American Academy of Dermatology and Syphilology all admit Negroes upon qualification.

Pre-professional education

Many indicia such as state-board failures, national medical aptitude tests and surveys by the U. S. Office of Education have shown repeatedly that over the period of the record the average Negro pre-professional student is not of the caliber he should be. This derives from the poor preparation the majority receives. While there have certainly been improvements in the Negro schools which furnish the majority of professional applicants, these have not been adequate to keep pace with the speed of the general advance.

As a result, many medical, dental and nursing schools which do not accept Negro students truthfully state they would gladly take more if applicants meeting their standards applied. There are 354 accredited nursing schools, exclusive of twenty-nine segregated schools, which accept Negro students. In 1949 only sixty-three of these schools had Negro nurses registered. Such is the pervasive extent to which professional preparation has fallen behind existing opportunities and modern demands.

Remaining segregative bars

While we do not now have personnel to fill potential openings for medical, dental, nursing and pharmaceutical students, that is but one problem. It is also true that 25 or an approximate third of 79 approved medical schools; 16 or nearly half of 40 dental schools; 20 or about a third of 65 pharmaceutical schools; and 832 or 68 percent of 1,215 state-accredited nursing schools will not admit Negro students. Most of these are located in the South. As tax-supported or tax-exempt institutions, in view of their public service, their doors must be opened. That is strictly a separate matter.

From a scraggly dozen Negro hospitals around the turn of the century, the number has increased to about 124 today, good, bad and indifferent. Throughout the South the basement ward in white institutions may still be found and everywhere virtual segregation of patients in public and private institutions may be spotted. The segregation of patients and the right of Negro doctors to staff appointments have recently became live issues nationally and all over the country some advances can be pointed out.

‘Old Clothes to Sam’

An old custom which we called the “Old clothes to Sam” pattern, of turning over outmoded or about to be discarded white hospitals to Negroes, always at considerable financial burden to the recipient, burgeoned into grand proportions in the Thirties and Forties will transfer, in the name of progress, of such large buildings as Provident Hospital in Chicago and Sydenham Hospital in New York to essentially Negro clientele. This glorification of the “hand-me-down” still has subsided, but it is likely to reappear anywhere at any time.

The Julius Rosenwald Fund closed in 1942 a fifteen-year program of development of demonstration hospitals and health centers and various public health projects.

Climaxing many years of study and effort the Hill-Burton Hospital Survey and Construction Act was passed Aug. 13, 1946. This authorizes Federal funds in varying proportions as grants-in-aid for the construction of hospitals all over the country according to predetermined actual need. Already plans for 1,000 new hospitals have been approved. The act contains a weak non-discrimination clause which in effect is a “separate but equal” affair. The total effect of the act will mean gains to the Negro, but how much is problematical?

Hospital attitudes toward Negro patients have shown substantial improvement. Places are still too numerous where Negro patients will be turned away to die, as was Dean Julia Derricotte in Chattanooga some years ago. On April 1, however, when Dr. Charles Drew and his companions were taken after their tragic accident to the Alamance General Hospital, Burlington, N.C., the staff gave immediate highly skilled attention before they knew identity of the patients. After this became known, however, the institution “turned itself out” in vain resuscitative efforts.

Segregative principles

Highly significant progress has been made on the elimination of the segregative plan in professional education. First came the declarations of the President’s Committee on Civil Rights in 1947.

In 1947 the Commission on Hospital Care of the American Hospital Association recommended adequate and competent hospital care for all without discrimination and that “qualified Negro physicians should be admitted to membership on the medical staffs of hospitals on the same basis as are other physicians.”

In 1948 the report of the President’s Commission on Higher Education stated that discrimination in education was harmful and should be abandoned. It urged educational institutions to act as “pioneering agents of leadership against discrimination.”

These actions at the pronouncement level do not, of course, carry enforcement powers, but are nevertheless important.

In November, 1949, the National Medical Association petitioned the Association of American Medical Colleges to declare against exclusions in medical schools as national policy, to urge repeal of state segregative laws and to urge elimination of pre-professional educational inequalities. The AAMC replied in effect, “No jurisdiction,” but did not feel too comfortable about the matter, and officials admitted the discussion provoked wrought much good.

National Membership

The American Nurses Association in 1948 created a category of “national membership’ through which nurses might join who were excluded only by race from their local and state associations.

The Baltimore County Medical Society and the St. Louis Medical Society, both constituent bodies of the American Medical Association, have recently admitted Negro physicians.

The medical school of the University of Arkansas has admitted a Negro student without mishap in two successive years.

Significant recognition has lately come to Negro scientists at Harlem Hospital and Howard and Meharry medical schools, particularly, in the awards of sizeable grants-in-aid of research.

In the last war one Negro, Dr. Midian O. Bousfield, became a colonel in the Army Medical Corps, a first. At the present time one of the most productive Negro physicians, Dr. Hildrus A. Poindexter, heads a U.S. Public Health Service Mission in Liberia. The American Medical Association will seat the first Negro in its House of Delegates in June. Dr. Peter Marshall Murray, director of Cynecology in Harlem Hospital.

Road ahead

still rocky

Things are looking up, but the road ahead is very rocky and everything needs to be done on all fronts. In his commencement address at Tulane University, June 1, 1949, Dr. Robert A. Lambert, retired associate medical director of the Rockefeller Foundation and the man who administered the advanced training fellowships for Negro physicians during the Twenties and Thirties, said, “I was for some years concerned with the problem of an adequate supply of Negro doctors so badly needed in providing medical service for the ten million colored people living in the South, a problem about which most of the Southern states have thus far done practically nothing.”

From the manifold experience in other areas, the Negro well knows that, “The race is not to the swift, nor the battle to the strong, but to him that endureth to the end.” So in health, the obstacles will be leveled if intelligently and without remission, we “keep a ‘pluggin away.”

About the author

Dr. William Montague Cobb heads the department of anatomy of the Howard University School of Medicine. He was born in Washington, D.C. October 12, 1904, attended the schools there, going later to Amherst College, Amherst, Mass., where he was graduated in 1926, a year ahead of the late Dr. Charles R. Drew.

He studied medicine at Howard University and got his Ph.D. degree from Western Reserve University. He gained athletic renown in his college days.

One of the world’s outstanding authorities on anatomy and anthropology, Dr. Cobb has authored ninety-seven books, pamphlets and articles, and done twelve top flight reviews of the works of other experts. He has been, at various times, editor of the Journal of the National Medical Association. He is a director of the NAACP and heads its national medical committee. He holds memberships in scientific societies in the United States and abroad. At 45, he is one of the best informed men in the world in his field.

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