Black Women in White

Darlene Clark Hine, Darlene Clark Hine, John McCluskey, David Barry Gaspar

• Publisher: Indiana University Press
• Year: 2024
• Print ISBN: 9780253205292
• eBook ISBN: 9780253056955
• Topic: Social Sciences
• Subtopic: African American Studies
• Index: Social Sciences

" . . . pioneering. . . . This history, as Hine vividly depicts it, sheds light on the development of African-American professionals and offers as well the opportunity to analyze the intersection of race and gender." —The Nation

" . . . well-researched and innovative . . . Highly recommended." —Library Journal

"The book is full of poignant and sympathetic portraits of black nurses in their dedication and idealism, in their pain and anger at the relentless contempt of white nurses and in their deep concern for their community's health needs. . . . Hine has brilliantly fulfilled an aim other historians have neglected . . . " —The Women's Review of Books

"This well-researched book adds breadth and depth to the existing literature on the educational and professional history of black nurses, including the development of black hospitals and training schools in the US. . . . Highly recommended." —Choice

" . . . an important book not only because it is a serious effort to analyze nursing history in the context of American racism but also because it offers a vantage point on the experiences of black women at work." —Medical Humanities Review

"Darlene Clark Hine has written a thoughtful analysis of the struggles of African Americans striving for professional status and recognition. . . . an illuminating study of the interaction of race and gender in the construction of a professional identity." —The Journal of American History

This pathbreaking study analyzes the impact of racism on the development of the nursing profession, particularly on black women in the profession, during the first half of this century. Hine uncovers shameful episodes in nursing history and probes the nature and extent of racial conflict and cooperation in the profession.

PART ONE

The Institutional Infrastructure of Black Nursing

Origins of the Black Hospital and Nurse Training School Movement: An Overview

The movement to create a national network of black hospitals and nurse training schools began in the 1890s and peaked during the 1920s. Entrenched racial antipathy characterized the late nineteenth century. Its closing decades witnessed the complete subordination of black Americans. Political and educational institutions in both the North and South adopted and perpetuated the dogmas of racial segregation and white supremacy. The racial fortress that imprisoned blacks in a separate world of poverty, powerlessness, disease, and despair seemed increasingly invulnerable to attack.

The discrepancies in the status and treatment of the two races were most apparent in the area of health-care delivery and in the virtual absence of educational and career opportunities for black women and men in the nursing and medical professions. Left with little recourse, the first generation of post-slavery black physicians, educators, and community leaders developed within their enclosed world a number of health-care institutions. Through them they launched a nationwide movement to provide educational opportunities for black women who desired to become nurses. Moreover, these new hospitals aimed to improve the health care available to black citizens while facilitating the professional development of physicians and nurses.

Since their arrival in the Americas, black women had always provided health care. They were nurturers of the sick, both black and white, on slave plantations. As granny midwives they helped to deliver most of the babies born during slavery and in the early years of freedom, especially in the rural South. Indeed, some black women even in the antebellum era achieved widespread recognition for their nursing and curative skills. As early as the 1820s, Jensey Snow, for example, became a living legend in her native Petersburg, Virginia. After earning her freedom, Snow opened a hospital and continued for over thirty years to provide healthcare services for the community. Black abolitionist and women’s-rights activist Sojourner Truth (1797–1881) served as an unpaid nurse to wounded civilians and soldiers during the Civil War in Washington, D.C., while Harriet Tubman (1820–1913) performed in a similar capacity in the Sea Islands off the coast of South Carolina. During the Civil War, Susie King Taylor (1848–1912), an ex-slave who possessed an extensive knowledge of the curative properties of various flora, provided treatment for dysentery and other ailments for black soldiers in Camp Saxton, South Carolina. Taylor, in commenting on her nursing activities, wrote: “I gave my services willingly for four years and three months without receiving a dollar. I was glad, however, to be allowed to go with the regiment, to care for the sick and afflicted.”¹

The Civil War left many impressions upon Americans, one of which was the importance of effective medical care. In response to the lack of trained nurses, women in the North and South formed voluntary associations, erected makeshift hospitals, and scrounged for supplies and medicines to alleviate some of the misery and pain of the wounded soldiers. The shockingly high morbidity and mortality rates during the war demonstrated the critical shortage of medical personnel and treatment.²

Shortly after the Civil War, in 1869, an American Medical Association committee evaluated and made recommendations concerning the training of nurses. Following a lengthy enumeration of the preferred qualifications of a good nurse and discussion of the duties she should be required to perform in hospitals and in private duty, the committee suggested that the nurse should be a woman who possessed so many positive traits that she was virtually perfect. She should be “of sound constitution, of good muscular strength, and of great power of endurance, capable of bearing up manfully under fatigue and loss of sleep.” In addition, she should be “literate, courageous, patient, temperate, punctual, cheerful, discreet, honest, sympathetic, refined, selfless, and devoted.” She should not be younger than twenty-two or older than thirty-five. The nurse should be able to notice the “character of the secretions and excretions, and the changes in the patient’s physical countenance.” She should be adept in the application of “leeches, blisters, bandages and other dressings.” Finally, the committee asserted that the nurse should be “proficient in making up beds, changing sheets, and handling patients exhausted by disease and injury.” The report included the suggestion that each state medical association work to establish schools for the training of such nurses for work in hospitals and with private families.³

The connection between the Crimean War and Florence Nightingale’s movement in the 1850s in Great Britain to establish an organized system of rigorous training of female nurses and exacting standards of recruitment is a familiar tale in need of little elaboration here. It is worthwhile to note, however, that one black West Indian nurse, Mary Grant Seacole of Jamaica, did provide, at her own expense, some nursing service during the Crimean War, though she was never accepted or given an official position by Florence Nightingale. The first three American nursing schools were founded in 1873: Massachusetts General Hospital in Boston, Bellevue Hospital in New York, and the New Haven Hospital in Connecticut. Each adhered to the “Nightingale Tradition,” emphasizing uniforms and military discipline. Each evidenced an overriding concern for attracting middle-class students into the program. There were 15 nursing training schools in 1880; by 1900 there were 432. (See Appendix, table 1.) Some of these early schools were quasi-independent, with separate sources of funding enabling faculty to enjoy some measure of autonomy. Actually, even these very early institutions were surrounded by hospitals, and the power of the women administrators was not as absolute as they preferred.⁴

Within a remarkably short time, hospitals acquired dominance in nursing education and soon eclipsed the seemingly autonomous nurse training schools. Two factors among many others aided hospital administrators in gaining complete hegemony in nursing training: insufficient capital and lack of endowment of the fledgling schools, and the increased demand for more scientifically based instruction. Additional factors included unchecked urbanization, revolutionary scientific discoveries, and steady improvements in medicine and surgery. Moreover, the increasing demand of patients for treatment away from the home dramatically fueled the expansion of hospitals.⁵ The history of the growth and development of the nursing profession is inextricably tied to the emergence and maturation of the modern American hospital. Nursing history is therefore as much a study of the evolution of hospitals as health-care institutions as it is an examination of the experiences, deeds, and struggles of the trained nurse.

Beginning in the last decade of the nineteenth century, hospitals gradually acquired more respectability, prestige, and acceptance as the previously skeptical, indeed hostile, public came to perceive them as places of effective care as opposed to dens of death. This transformation in public attitudes did not occur overnight. Throughout much of American medical history, the general hospital, using untrained nurses, provided treatment almost exclusively to the rootless poor. White middle-class Americans did not consider hospitalization a viable alternative to home care. Most often they were treated in their homes by an attending physician and female family members.

The growing urbanization of the American population and advances in late-nineteenth-century medicine, including the discovery of germicides and the development of more appropriate therapeutics, spurred the modernization of hospitals. This modernization dictated that administrators not only rationalize services but also cease to rely on poverty-stricken patients and the unrefined, uneducated nurses who provided the necessary hospital services and performed all of the domestic and maintenance chores. Instead of requiring the ambulatory patients to care for one another, hospital administrators recognized the need for a constant, obedient, and efficient supply of cheap labor. The best solution was to use student nurses. The rise of nursing as a profession stimulated the growth of the late-nineteenth-century hospital movement.

In 1873 there had been 178 hospitals in the United States; in 1909 there were 4,359. By the close of the first decade of the twentieth century, therefore, “not only had the hospital become more evenly distributed throughout the United States, it had become a potential recourse for a much larger proportion of Americans; the respectable and prosperous as well as the indigent might be treated in hospitals, frequently by their regular physicians.”⁶ By 1923 there were 6,830 hospitals, and fully one-quarter of them included a nursing school. By the mid-1920s these schools had graduated 17,000 trained nurses. (See Appendix, table 1.) As white physician Alfred Worcester observed in 1909, “Hospitals are everywhere springing up, not merely because their advantages were made so apparent in war times, nor only because the germs that formerly killed have themselves met their destroyer. An even greater cause is to be found in the development of the art of nursing.”⁷ In some schools the students received a modest stipend, but most simply received rudimentary nursing instruction, room and board, and a bolt of cloth with which to make their uniforms. In return they pledged to serve the hospital for a period of from eighteen months to three years.

Although black women for generations had borne primary responsibility for providing nursing care in their communities, few were admitted to the new training schools. Most of the hospital nursing schools in the North imposed racial quotas, while institutions in the South excluded black women. Mary E. Mahoney was the first black woman to graduate from a nursing school. In August 1879 she received her diploma from the New England Hospital for Women and Children in Boston. The charter of this pioneering nursing school stipulated that only one Negro and one Jewish student be accepted each year. By 1899 only five other black women had been graduated: Lavinia Holloway, Josephine Braxton, Kittie Toliver, Ann Dillit, and Roxie Dentz Smith.⁸

Southern black women possessed scant opportunity to become “trained” nurses. The patterns and practices of racial segregation received the highest sanction when in 1896 the United States Supreme Court delivered a decision destined to have profound implications for all black Americans. In Plessy v. Ferguson the Court promulgated the doctrine of “separate but equal,” which provided the legal basis for the whole system of segregation. This decision and the one delivered in the 1899 case Joseph W. Cumming, James Harper, and John C. Ladevez v. School Board of Richmond County, Georgia became the cornerstone for segregated education, housing, and health care.⁹ Although the Court insisted that equal facilities be provided for blacks, none of the southern states deigned to do so. Black patients were either excluded from or segregated within publicly supported municipal hospitals, while racial discrimination denied black physicians access to internships, residencies, and hospital staff appointments.

Mary Eliza Mahoney (1845–1926), the first black professional nurse in America. She earned her diploma from the New England Hospital for Women and Children on August 1, 1879. Courtesy of the Schomburg Center for Research in Black Culture, New York Public Library.

By the turn of the century, many contemporary observers linked the general deterioration in the health of black Americans to the absence of adequate health care-delivery systems, the lack of trained black medical practitioners, and the increased migration of black people from rural South to urban North. A brief examination of the black morbidity and mortality rates of one southern city, New Orleans, is illustrative of prevailing conditions in cities across the nation. Severe food shortages and unsanitary and overcrowded living arrangements repeatedly contributed to the spread of contagious diseases in urban America. During the Civil War the United States government had established the Freedmen’s Bureau, which in turn had constructed approximately fifty makeshift hospitals to treat illnesses born of poverty and racial oppression. Three of these hospitals were located in Louisiana. By the collapse of Reconstruction in 1877, however, all of the Louisiana facilities were closed.¹⁰ Only the Freedmen’s Hospital in Washington, D.C., would survive into the twentieth century.

The morbidity and mortality rates of New Orleans blacks and whites diverged sharply as thousands more blacks contracted tuberculosis, pneumonia, influenza, typhoid fever, whooping cough, malaria, syphilis, and pellagra. Among black women, puerperal (or childbirth) fever and complications associated with premature births took a deadly toll. Between 1890 and 1900 the death rate in New Orleans dropped modestly from 25.4 to 23.8 per thousand among whites. For blacks, however, the rate increased significantly from 36.6 to 42.4 per thousand. Infant mortality throughout the South remained high for both races, but blacks registered greater losses. In 1920 in South Carolina, 159 babies out of every 1,000 died before they reached one year of age, as compared to 86 white infants per 1,000.

Unsanitary water supplies and inadequate sewage systems contributed to the excessively high black mortality not only in New Orleans but throughout the urban South. Black urbanites in Chicago, Cleveland, Philadelphia, Detroit, and New York, like their counterparts in southern cities, lived in overcrowded, poorly ventilated, vermin-infested housing. Their children suffered from malnutrition, and whole families relied far too heavily on diets of fat pork, grits, and molasses. Yet even had blacks known (and many did not have sufficient knowledge of nutrition) what to eat, procuring adequate fare on meager, often nonexistent, earnings proved difficult, if not impossible.¹¹

A convergence of critical forces including the high incidence of black morbidity and mortality gave impetus to the creation of a separate network of black hospitals and nursing schools. A major factor shaping their development was the simultaneous emergence of private philanthropic foundations organized by John D. Rockefeller, Andrew Carnegie, and particularly Julius Rosenwald, the president of Sears, Roebuck and Company. Through the Julius Rosenwald Fund, Rosenwald distributed a small fortune to “his chief philanthropic interest,” the Negro.¹² Before blacks could enjoy adequate health care and before black women could have access to formal nursing training, black leaders and these white philanthropists had to replicate the health-care system then developing within the white communities. John D. Rockefeller and his wife, Laura Spelman Rockefeller, financed the establishment of the nation’s first black nursing training scho...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgments
• Introduction
• Part One: The Institutional Infrastructure of Black Nursing
• Part Two: More Than Angels of Mercy
• Conclusion
• Appendix
• Notes
• Bibliography
• Index