- The Washington Times - Saturday, December 20, 2003

BLACK PHYSICIANS IN THE JIM CROW SOUTH

By Thomas J. Ward

University of Arkansas Press, $34.95, 300 pages

REVIEWED BY CATHERINE JONES

In the preface to “Black Physicians in the Jim Crow South,” Thomas J. Ward describes being admonished by Dr. Matthew Page, a physician from Greenville, Miss. When asked what it was like to be a black physician in Mississippi in the 1950s, Dr. Page answered, “I don’t know, but I can tell you what it was like to be Matthew Page.”

Although Dr. Page’s caution against generalization is well taken, after reading Mr. Ward’s book, it is difficult to escape a sense of wonder that Dr. Page had managed to work as a physician in the Jim Crow South, and indeed, that he had so much company in his chosen profession. In his book, Mr. Ward reveals the persistence and resourcefulness of the black men and women who overcame enormous legal, social, and cultural barriers to pursue professions as doctors in a period in the nation’s history profoundly hostile to their efforts.

Sharing the stories of these remarkable people is a goal of Mr. Ward’s book, but not the only one. He also explores the tensions between an educated professional class and the larger racial community, largely denied educational and economic opportunity, of which it was a part. In broad strokes, the fortunes of black physicians followed the same contours as those of the larger black population, waxing in the immediate aftermath of the Civil War, facing constricting opportunities at the turn of the century, and then slowly pushing against legal and social strictures, crescendoing to the mid-century civil rights movement.

Nevertheless, aspiring doctors confronted particular challenges, which Mr. Ward lays out in three large sections in his book. The first step to becoming a physician in the postbellum United States was gaining access to medical education. Simply reaching the doors of such institutions represented no small feat for much of the Southern black population, for whom access to elementary education was severely limited by law and economic opportunity. Aspiring doctors faced an even greater challenge in the early 20th century as attempts to improve medicine’s professional stature led to the closure of many medical schools.

Mr. Ward demonstrates that the seemingly objective calls for standards effectively limited black opportunity by essentially leaving only Meharry Medical College in Tennessee and Howard University in Washington to serve black medical students. Having obtained academic medical training, black physicians’ professional opportunities were further circumscribed by exclusion from hospital internships and residencies, a serious deficit as such training became increasingly central to medical education.

Despite these limitations, black medical students made opportunities, for example, by establishing a cooperative relationship between Meharry and Taborian Hospital, a facility established by a black fraternal organization in the Mississippi Delta. This relationship served the needs of the former for clinical training, and of the latter for medical service.

Having overcome the hurdle of medical education, would-be physicians faced additional challenges in their efforts to establish medical practices. Seeking to practice in the Jim Crow South, physicians confronted legal and cultural barriers, as simple tasks like obtaining space for a medical office were transformed into herculean feats by racial discrimination. White professional organizations also joined to deny black physicians important memberships in professional organizations, as well as denying them indispensable hospital privileges.

Cultural patterns also worked against black doctors, as even potential black clients often rejected their claims to being “real” doctors. Again, Mr. Ward reveals the persistence of black physicians, making a place for themselves in the interstices between racial exclusions, competing professionally by charging lower fees, serving marginal patients, developing private black hospitals, and pursuing contract medicine (serving groups, often members of black fraternal organizations or benevolent societies, for a fixed price).

The last section of the book, “Community Life,” is the most interesting, but also the most problematic. The author recounts fascinating episodes of community uplift, such as the Mississippi Health Project, sponsored by the Alpha Kappa Alpha sorority, an organization of elite black women with a deep commitment to community service. Under the flexible leadership of Dorothy Ferebee, of Howard and Tufts medical schools, a group of volunteers sought to bring basic care, particularly child immunizations, to desperately underserved Mississippians.

Mr. Ward contrasts such examples of racial solidarity to the reluctance of many black physicians to become involved in the civil rights movement. He seems to be somewhat perplexed by the variety of political, and apparently apolitical, expression of black physicians, asserting in one instance, that his subjects were natural community leaders by virtue of their education and wealth, and in another, that they struggled to cultivate black patients and shunned political involvement that might imperil their delicate social and economic position.

His internally contradictory interpretations of physicians’ roles in the community seem rooted in a limiting framework of assimilation versus resistance. Mr. Ward might have built a more flexible context for interpreting the politics of his subjects if he had attempted to make fuller use of their own representations of their political objectives. This would have further increased the interest and accessibility of the book itself. The work of historians such as Glenda Gilmore, who have made an important case for the progressive political implications of apparently accommodationist organizations, might have helped him push his interpretation further.

While Mr. Ward must be congratulated for bringing an important story to light, the work raises as many questions as it answers. One wonders how his narrative might have looked if, rather than breaking his book into discreet discussions of education, practice, and community life, he had employed a different approach, more attentive to the mutual influence of these dimensions. Such a strategy might have enabled him better to explain the changes in opportunity that shaped the professional progress of black physicians.

For example, the author repeatedly uses the formulation, “by x date,” sufficient scholarships, or sufficient internships, had become available. This obscures the process by which such changes occurred. Simply including more statistics to track these changes would have also clarified the contours of his narrative.

Similarly, by limiting his story to physicians, he may ignore the important connections between their work and other patterns of health care delivery within the black community. By extension, building the context of black medicine might have also helped explain the degree to which the experiences of black and white physicians were shaped by the same pressures of professionalization.

Ultimately, Mr. Ward’s book does important work detailing the diverse ways the Jim Crow South both limited and made possible the rise of black physicians. While acknowledging that a small number of black professionals were able to carve out opportunities, he demonstrates the corrosive character of the racism that undergirded much of the legal and professional order of this moment, and by extension, the enormity of the challenge of undoing it.

Catherine Jones is a doctoral candidate in history at Johns Hopkins University.


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