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Deluxe Jim Crow

Civil Rights and American Health Policy, 1935-1954

Karen Kruse Thomas

Publication Year: 2011

Plagued by geographic isolation, poverty, and acute shortages of health professionals and hospital beds, the South was dubbed by Surgeon General Thomas Parran “the nation’s number one health problem.” The improvement of southern, rural, and black health would become a top priority of the U.S. Public Health Service during the Roosevelt and Truman administrations.

Karen Kruse Thomas details how NAACP lawsuits pushed southern states to equalize public services and facilities for blacks just as wartime shortages of health personnel and high rates of draft rejections generated broad support for health reform. Southern Democrats leveraged their power in Congress and used the war effort to call for federal aid to uplift the South. The language of regional uplift, Thomas contends, allowed southern liberals to aid blacks while remaining silent on race. Reformers embraced, at least initially, the notion of “deluxe Jim Crow”—support for health care that maintained segregation. Thomas argues that this strategy was, in certain respects, a success, building much-needed hospitals and training more black doctors.

By the 1950s, deluxe Jim Crow policy had helped to weaken the legal basis for segregation. Thomas traces this transformation at the national level and in North Carolina, where “deluxe Jim Crow reached its fullest potential.” This dual focus allows her to examine the shifting alliances—between blacks and liberal whites, southerners and northerners, activists and doctors—that drove policy. Deluxe Jim Crow provides insight into a variety of historical debates, including the racial dimensions of state building, the nature of white southern liberalism, and the role of black professionals during the long civil rights movement.

Published by: University of Georgia Press


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p. vii

List of Tables

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p. ix

List of Figures

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p. xi

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p. xiii

Portions of the book have been previously published in somewhat different form as articles and appear with the permission of the following journals and their sponsors: “The Hill-Burton Act and Civil Rights: Expanding Hospital Care for Black Southerners, 1939–1960...

Deluxe Jim Crow Timeline

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pp. xv-xvii

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Introduction. The Devil’s Bargain of Deluxe Jim Crow Health Reform

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pp. 1-5

The phrase deluxe Jim Crow was first coined in the Baltimore Afro-American in 1927 to describe the first-class compartment for blacks on the Memphis Special, a train running through the heart of the segregated South. Thurgood Marshall later applied the phrase to the southern states’ attempts to shore up...


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1. The Roots of Deluxe Jim Crow

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pp. 9-44

In all regions of the United States, white American policy makers have historically neglected the health of minorities yet have used their high rates of death and disease to justify legalized segregation, immigration restriction, and other overt forms of racial and ethnic discrimination. What are the...

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2. The New Deal in Health

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pp. 45-75

Although the U.S. Public Health Service (PHS) had begun to make inroads into the infectious diseases of poverty that beleaguered the South’s growing urban population and its shifting rural areas, the farm crisis of the 1920s, the catastrophic Mississippi River flood of 1927, and the hardening of...

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3. New Deal Health in North Carolina

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pp. 76-100

North Carolina’s position as a regional and national leader in public health resulted from several unique resources, particularly the state’s visionary health reformers. The State Board of Health was led by some of the nation’s most progressive public health leaders, John A. Ferrell, Watson Smith Rankin...


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4. The South and National Health Reform

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pp. 103-137

Several watershed events in 1938 heralded the emergence of deluxe Jim Crow health policy. In July, the Roosevelt administration simultaneously released the Report on Economic Conditions of the South and the Technical Committee on Medical Care’s report on a national health program. In...

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5. State Reform and the Racial Divide over National Health Insurance (Images follow)

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pp. 138-153

At the same time that Thomas Parran, Lister Hill, Claude Pepper, Michael M. Davis, and Louis Wright pursued national health reform, southern state officials began to accept responsibility for equalizing public services for blacks with regard to health and welfare spending. Not only in the American...


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6. Hill-Burton and the Deluxe Jim Crow Hospital

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pp. 157-181

During World War II, progressive southern leaders such as Claude Pepper and Lister Hill at the national level and Governor J. Melville Broughton and state health officer Carl V. Reynolds in North Carolina elevated health reform, particularly hospital construction, to the top of the political agenda...

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7. Hill-Burton in North Carolina

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pp. 182-207

Until 1963, Hill-Burton remained the only federal program governed in the South by a legislative separate but equal clause, which did not, in its original context, preclude segregation within funded hospitals as long as patients were admitted on an equal basis. The clause allowed individual...

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8. Training Black Doctors as Public Policy

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pp. 208-228

Abraham Flexner and early black reformers such as John A. Kenney, Eugene Dibble, Numa P. Adams, Midian O. Bousfield, Louis Wright, and Paul Cornely led the early twentieth-century efforts to improve black and southern medical education. In 1942, after the Rosenwald, General Education...

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9. Training Black Doctors in North Carolina

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pp. 229-249

In February 1951, just before the controversy began to heat up over admitting the first African American student to the University of North Carolina School of Medicine, Dean Walter Reece Berryhill received a letter from J. Charles Jordan, president of the Old North State Medical Society. Jordan protested that...

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10. Racial Disparities and the Truman Health Plan

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pp. 150-265

When Harry S. Truman assumed the presidency in April 1945, Thomas Parran had been surgeon general for nearly a decade. Parran was the federal official who most advanced the cause of deluxe Jim Crow health policy as an integral part of the New Deal and helped to define its emphasis on southern...

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Conclusion. Deluxe Jim Crow in Education Versus Health Care

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pp. 266-279

The rise and fall of the ideology of equalization among both blacks and whites provided the backdrop for racial change during the era of deluxe Jim Crow. Beginning in the 1930s, the southern movement to equalize black and white schools was black-led (primarily by the National Association for the...

Appendix 1. Deluxe Jim Crow Organizations

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pp. 281-288

Appendix 2. Deluxe Jim Crow Individuals

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pp. 289-296

Appendix 3. U.S. and Southern Populations by Race and Rural-Urban Residence, 1900–2000

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p. 297


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pp. 299-346


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pp. 347-356


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pp. 357-372

E-ISBN-13: 9780820341781
E-ISBN-10: 0820341789
Print-ISBN-13: 9780820330167
Print-ISBN-10: 0820330167

Page Count: 328
Illustrations: 14 b&w photos, 17 tables, 4 charts
Publication Year: 2011

OCLC Number: 773176957
MUSE Marc Record: Download for Deluxe Jim Crow

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Subject Headings

  • African Americans -- Medical care -- United States -- 20th century.
  • Minorities -- Medical care -- United States -- History -- 20th century.
  • Equality -- Health aspects -- United States -- 20th century.
  • Discrimination in medical care -- United States -- 20th century.
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