1919: Segregated Medical Care & The Homer G. Phillips Hospital
Racism, fueled by the pseudoscience of eugenics, led to negative the health outcomes for African Americans in the St. Louis region.
Due to the increasing African American population within the city of St. Louis (doubling in number between 1910 and 1920), the city decided to start a second “City Hospital” expressly for the treatment of African Americans (Berg, 2003, p. 194).
Oral History bout City Hospital #2
The segregated and under-resourced facility demonstrated the racism at work in St. Louis public policy.
“City Hospital #2” operated from 1919-1937, and the stories from that short tenure demonstrate an intentional and systematic lack of resources given to the hospital to treat the African American patients (p. 194-195). The city spent less than 48% per African American patient at City Hospital #2 than it did per white patient at City Hospital #1 (Berg, 2003, p. 194).
The care patients received at the hospital was also significantly less than the care received by white patients at City #1.
One striking example related to the treatment of tuberculosis.
In the early twentieth century, tuberculosis was a particularly insidious danger to St. Louis–and the African American community in particular–as the close quarters of the poor tenement housing (in which many St. Louis African Americans were forced to live) were effectively the perfect petri dish for the disease to spread.
City hospital #2 was too small and underfunded to quarantine tuberculosis patients from the general hospital population, which increased the spread of tuberculosis. Further, because of poor care received at the hospital, the fatality rate from tuberculosis was over three times higher for Black residents than white residents in St. Louis in the first decades of the century (p. 193).
City Hospital #2 at 2945 Lawton Boulevard in 1920. The building was adjoined to Centenary Hospital, built in 1902; eventually, this building would be the Midtown Hotel which housed Peacock Alley.
Source: Wikipedia
Another example, related to infant care within the hospital.
Conditions within neonatal treatment were significantly lacking when compared to the white hospital leading to a Black infant mortality rate more than 1.5 times that of the city as a whole.
Other horror stories of the horrific hospital conditions circulated within the press–though these were often relegated to African American press outlets, The St. Louis Argus and The St. Louis American (Berg, 2003, p. 194; Villaire & Adris, 2017). They circulated stories such as: beds being tied together so that three patients rather than two could be accommodated and the death of a doctor due to faulty wiring in an X-ray machine. These along with numerous other anecdotes revealed what The St. Louis Argus rightly called the “intolerable conditions” of the “crowded firetrap” (Berg, 2003, p. 194-195, quoting The St. Louis Argus). Soon after the founding of City Hospital #2, it was clear to the African American community that not only was a new hospital needed to serve their community but also a way to improve the training of Black physicians.
The conditions and stories from the African American City Hospital in St. Louis led to an intense public outcry from the African American community.
In 1923, Mayor Henry Kiel used that underlying desire for a new hospital to garner support from African American voters as part of his larger 87 million bond project–of which he promised to dedicate one million to build a new hospital in North St. Louis specifically for the treatment of Black patients and the training of Black physicians (Berg, 2003, p. 195). Upon the bond measure’s passage, Mayor Kiel instead announced a plan to build the new hospital next door to the already existing white hospital, claiming this would save the city money in operational costs related to physician salaries (p. 195). This was unacceptable to leaders within the Black community who had specifically intended for an African American hospital in North St. Louis to provide for the training and professionalization of Black physicians–typically barred at this time from residencies and the “vast majority of training hospitals” within the United States (p. 195). The plans for the new hospital would be debated by the St. Louis Board of Alderpersons for the next decade. One of the outspoken advocates for the project, Homer G. Phillips,
argued that St. Louis needed a separate African-American hospital where black doctors could professionally develop, and while an addition to City Hospital #1 may have provided enough beds, black physicians would still have been shut out from higher medical training. [He and his allies] further argued that the city ought to build the hospital in the neighborhood of its clientele in north St. Louis (Berg, 2003, p. 195-196).
Eventually, their advocacy and hard work would prevail and a new hospital was built.
Sadly, Homer G. Phillips would not see the project through to fruition due to his untimely death by assassignation in 1931 (p. 196). When the hospital would eventually open in North St. Louis, it bore his name.
The Homer G. Phillips Hospital (HGPH) remained open from 1937-1979 serving the African American community of St. Louis and training Black physicians who would eventually practice medicine locally and across the country (p. 196-199). After Brown v. Board of Education (1954) ended the legal doctrine of “separate but equal” both Homer G. Phillips in St. Louis City Hospital #1 officially integrated, though the integration had little practical effect upon the patient demographics of Homer G. Phillips, “because it was located in an almost exclusively African-American neighborhood” (p. 199).
Aerial view of Homer G. Phillips Hospital complex, St. Louis, Missouri, 1936
Source: Missouri Historical Society, St. Louis
The hospital was under constant pressure to close and became an issue of intense political debate.
From 1965 onward, the hospital would be “a political hot potato. City administrators constantly talked of closing the hospital, but they risked alienating voters in north St. Louis” (Berg, 2003, p. 201). When Homer. G. Phillips Hospital did eventually close in 1979, there were protests and community outrage from African American residents in both the city and the county. The outrage was so intense that besides the protests, conflicts with police, and arrests, the issue of reopening actually paved the way for the 1981 mayoral race by Vincent Schoemehl to topple the incumbent Mayor James Conway (p. 202). Schoemehl campaigned on a promise to reopen Homer G. Phillips and as a result swept North St. Louis and the African American vote; unfortunately, Mayor Schoemehl could not deliver on his promise:
In order to reopen HGPH, the hospital had to comply with all modern accrediting standards, unlike City Hospital #1, which was grandfathered in because of its continuous operation. The city would need about $60 million to meet the new standards. Schoemehl orchestrated a bond issue vote that would have required a two-thirds majority to pass. Only between fifty-seven to fifty-eight percent of the voters voted in favor of the bond, and the issue was defeated. (Berg, 2003, p. 202).
The loss of Homer G. Phillips hospital cut deeper than just the immediate loss of medical care.
As Daniel Berg describes, the hospital represented “‘A source of pride to the community’… Among the African-American community, HGPH achieved a reverential devotion from the people who felt it was ‘their’ hospital” (p. 196). Though there was a slight admission bump, the medical statistics after HGPH’s closure reveal that it did not lead to a corresponding “bulge” in the admissions at City Hospital #1: “When the hospital closed, many patients simply disappeared from the system” (p. 202). The loss of a separate hospital specifically serving the African American community of St. Louis effectively reinforced the systemic racial inequalities in access to social programs and governmental services designed to serve all citizens.