Deluxe Jim Crow: Civil Rights and American Health Policy, 1935-1954

1. The Roots of Deluxe Jim Crow

|| 9 || n 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 historical origins of health disparities, how did they change during the course of the twentieth century, and what caused them to improve or worsen? When, why, and how did the federal government begin to address racial and regional disparities in health as a national problem? Until at least the Progressive Era, the South was a bastion of antifederalism where state investment in public services was minimal or nonexistent. After the Civil War, Reconstruction had “reinforced blacks’ identification with federal authority” and had the opposite effect on whites. Yet southern health was exceptional because public health and political leaders together pursued policies that not only sought to restrict federal oversight but also emphasized the national consequences of southern health problems and the need to apply federal resources to solve those problems. Two early examples of federally sponsored southern health facilities were the marine hospitals and the Government Free Bathhouse in Hot Springs, Arkansas. In the 1830s, the governors of Louisiana andMississippiaskedthenorthernstatesforaidinprovidinghospitalcareforthe large transient population aboard riverboats and barges traveling the Mississippi River.Thiseffortrepresentedanextensionofthefirstfederalhealthprogram,the U.S. Marine Hospital Service, established in 1798 to provide medical care to sailchapter 1 The Roots of Deluxe Jim Crow I || 10 || chapter one orsandmerchantmarinesinportsalongtheAtlanticcoastandlaterreorganized as the U.S. Public Health Service (phs) in 1912. As settlement spread westward and the cotton trade made New Orleans a major port during the antebellum era, cities and towns in the Mississippi Valley petitioned Congress to establish additional interior marine hospitals, and in 1837 the Marine Hospital Service was extended to include Lake Erie and the Ohio and Mississippi Rivers. By 1945, nine of the twenty-seven marine hospitals operated by the phs were located along the coastlines of the southeastern Atlantic seaboard, the Gulf Coast, and the lower Mississippi River Valley.1 PoormenandwomencamefrommilesaroundHotSpringstoseekhealingin the steamy waters located on a public federal reservation under the authority of the Department of the Interior. One of the hot springs was believed specifically to cure venereal diseases, particularly when accompanied by heavy oral doses of mercury. In 1878, Congress appropriated funds to provide free bathing facilities for indigent patients. Over the next thirty years, federal funds supported new construction and expansion, including a free dispensary opened in 1898 on the second floor of the bathhouse and staffed by volunteer physicians. In 1902, racially segregated facilities replaced open pool bathing with individual recessed porcelain tubs and a variety of other amenities, foreshadowing the simultaneous emergence of racial and medical segregation in twentieth-century hospitals. By 1911, more than 220,000 baths were administered each year, and a medical director was appointed for the first time to improve the quality of care for indigent patients.2 During the Progressive Era, Jim Crow was only one of many proliferating forms of segregation designed to protect society from corruption and expressed in geographical, temporal, spatial, and architectural forms for a variety of purposes including but not limited to racial separation. The Government Free Bathhouse met the specific medical needs of poor venereal disease patients but signifiedtheirexclusionfromothersourcesofcareonracial,financial,andmoral grounds. In 1921, surgeon general Hugh Cummings, National Parks Service director Stephen T. Mather, and Arkansas state health officer C. W. Garrison established a model venereal disease treatment clinic at Hot Springs, which became a major phs training and research center. The bathhouse, however, did not survive the end of segregation and closed in 1956.3 The scope of public health broadened during the early twentieth century, but important regional variations persisted. The federal role in public health grew through measures such as the U.S. Death Registration Area (begun in the roots of deluxe jim crow || 11 || 1900), the 1906 Pure Food and Drug Act, and the medical examination of arriving immigrants by phs officers. During the 1910s, the phs spearheaded the rural sanitation movement, helped establish county health departments, and initiated rural health education and prevention programs with the assistance of such organizations as the National Tuberculosis Association, the American Red Cross, and the federal Children’s Bureau. At the state and local levels, southern public health departments were established later, had weaker authority and less funding, and were far slower to hire full-time, professionally trained...