Integrating the City of Medicine: Blacks in Philadelphia Health Care, 1910-1965 (review)

427 Review INTEGRATING THE CITY OF MEDICINE: BLACKS IN PHILADELPHIA HEALTH CARE, 1910-1965 By David McBride, Ph.D. 320 pp. Philadelphia, PA: Temple University Press, 1988. $39.95 (cloth). Integrating the City of Medicine documents in very graphic terms the medical politics of dealing with public health issues in the presence of institutional radal prejudice and the disparate availability of health care among Philadelphia's white and black residents. The first part of the book discusses the isolation of black health care providers from the larger health care community, and the adaptive measures that were used to provide services to the disadvantaged, who because of their race were not allowed access to traditional public and private health care institutions. With few exceptions, opportunities for black physidans for postgraduate training at predominantly white institutions were essentially nonexistent . Similarly, the training of black nurses was also severely restricted to "colored only" fadlities, which often lacked suffident funding from either the private or public sector to ensure continued growth and accreditation. In the early chapters, the book illustrates through graphs and tables the relative percentage of physicians and trained nurses by birthplace and race in Philadelphia between 1910 and 1920. With this historical background, the author portrays the medical career of Dr. Nathan Mossell, the first black graduate of uSeUniversityofPennsylvania,andMosseirseffortstoimprovethe health care of those denied access to race-restricted health care fadlities. Dr. Mossell's vision of an accredited hospital which would not only administer to the needs of the African-American community but also train physicians and nurses and provide a place for employment resulted in the formation of Douglass Hospital. Between 1910 and 1940, Douglass Hospital and later Mercy Hospital struggled valiantly to serve the black community. They were virtually the only two facilities in the state of Pennsylvania that sought to fulfill this need. The author uses Philadelphia's tuberculosis epidemic in the first quarter of the 20th century to illustrate how a health issue that transcended racial boundaries forced the medical establishment to recognize the importance of Journal of Health Care for the Poor and Underserved, Vol. 1, No. 4, Spring 1991 428__________________________________________________________ black physicians and nurses. At the time, most domestic and service workers who came in daily contact with the white community were black, making the risk of tuberculosis exposure a matter of general public health concern. Thus access to treatment to prevent the spread of the disease became a concern that crossed racial and ethnic barriers. The second half of the book concentrates on problems that limited the prosperity of Douglass and Mercy Hospitals, which merged in 1948. Although municipal and state governments heavily supported private and public hospitals through tax revenues, these monies were not equitably distributed. Douglass and Mercy Hospitals pressed repeatedly for their share of these funds, particularly since their patient populations were the most indigent and least able to pay for services. The Hill-Burton Hospital Construction Act of 1946, which provided government funds to privately controlled hospitals, clinics, and medical schools, revived optimism for the survival of these two black hospitals. The opportunity to receive expanded federal funds was particularly crudal because the cohesiveness of the black medical professional community was being eroded. Predominantly white hospitals in the city were opening their doors to black patients in increasing numbers, although black physicians still lacked staff privileges and in large measure were denied the chance to partidpate in the care of their patients once they entered a white hospital for treatment. With black patients increasingly admitted to white fadlities, the patient base for Mercy Douglass Hospital was being diminished at a time when its hospital facilities were becoming outdated and revenues were shrinking. The final chapters of the book cover the emergence of a struggling Mercy Douglass Hospital that was oftentimes ironically perceived by the black community as unnecessary and second rate in comparison to predominantly white institutions. Mounting debt, coupled with shrinking occupancy rates and the reaffiliation of its medical staff with the hospitals that had previously denied them staff privileges, signaled the inevitable collapse of Mercy Douglass. The radal discrimination which created the need for the hospital, and was a central issue in battles waged by its founders...