Black Women, Indigent Medical Care, and Academic Medical Politics, 1950–1965: The Case of Birmingham, Alabama

Abstract

Black Women, Indigent Medical Care, and Academic Medical Politics, 1950–1965:The Case of Birmingham, Alabama Charlotte G. Borst (bio) A "Negro child" had been born "'like an animal'" on the front lawn of the city's University Hospital, the Birmingham News reported on December 14, 1958, in a front-page story that seemed a modern reenactment of the biblical Christmas story. The paper explained that the mother, who was not named, but whom I shall refer to as Mary, had been turned away from the academic medical center's hospital because it had imposed "rigid charity regulations" that provided few maternity beds for poor Black mothers. Indeed, these regulations were so strictly enforced that the hospital's staff was even barred from offering Mary aid as she labored and delivered her baby on the lawn.1 Although Alabama and the city of Birmingham historically had supported what historian Sam Bass Warner Jr. has identified as "the [End Page 467] American tradition of privatism," where the quest for private gain prevented the establishment and support of public amenities, the very public display of such a failure of the welfare system, and the obvious nature of Mary's humiliation and degradation at the feet of an academic medical center, elicited significant coverage in the state's newspapers.2 Most people would not have been surprised—in 1951, a Black woman named Emma Dangerfield had died in the waiting room of Birmingham's Jefferson Hospital (part of the University Hospital complex) after being denied entrance.3 As the provider of 95 percent of the area's total indigent medical care in the 1950s, University Hospital was locked in a fierce debate with both local and state officials over the lack of sufficient public funds for the support of the sick poor. Long before becoming part of the university's medical school, this county-owned facility had served white poor and paying patients, as well as Black indigent-care patients, who were housed in segregated wards. Black middle-class patients who could pay mostly received their care in other private but segregated hospitals in Birmingham. Indigent care for all patients was reimbursed through [End Page 468] county funding. But when the county sold the hospital to the University of Alabama in 1945 (in exchange for county indigent-care subsidies), the hospital's mission changed from serving members of the community to providing medical education as well as charity care.4 The reasons Mary was left on the lawn to labor reflected three intertwining changes in the South—not just in Birmingham or Alabama—in the post–World War II era. One was the role that medical schools and their associated hospitals played in the South's postwar strategies for economic development. The rise of and resistance to the expanding civil rights movement and its link to the racialized and gendered history of southern welfare policy were two other key fundamentals. These elements help explain Mary's story, and she provides a human face for the larger argument in this article: that it is only when we braid multiple historiographies together—the economic development fostered by hospitals and medical centers that followed a particular trajectory unique to the South's economic history; the very particular gendered racialization of welfare that was tied to the history of segregation; and the complicated and evolving history of massive white resistance—that we can understand why modern medical facilities in the postwar South succeeded in economic ways for some people but failed to bring health-care equity to women like Mary and her children.5 Even in the twenty-first century throughout the South, Black neonatal mortality is twice that of white infants.6 This story is particularly evident in Birmingham. At the end of World War II, challenged by the economic, social, and political upheaval of the war years, local political, business, and social [End Page 469] leaders tried to set a new agenda for the South. They understood that their region lagged behind much of the rest of the country economically, and their political rhetoric echoed a determination to catch up and establish the South as a favorable place for new industry.7 Attracting industry...