Gentlemen of the Class of 1878
Gentlemen of the Class of 1878
Minority Medical Education
By: James Summerville
Source: James Summerville. Educating Black Doctors: A History of Meharry Medical College. Tuscaloosa, Ala.: University of Alabama Press, 1983.
About the Author: The Nashville, Tennessee, author James Summerville was born in 1947. He has written a number of nonfiction and young adult books, many concerning the American South and Southern history. Throughout his career, in addition to writing, he has held several public and private business-related positions.
Prior to the reforms catalyzed by Abraham Flexner (1886–1959), there was virtually no uniformity in American medical education. One aspect, however, was quite standard—African Americans were not admitted to the vast majority of United States medical schools. There were a small number of medical schools in the northern regions of the country that allowed entrance to free African American men before the American Civil War (1861–1865). Some Southern medical schools did not graduate their first African American until the second half of the twentieth century, after the enactment of desegregation laws. Even if they were permitted to gain entrance to university-affiliated medical schools, few (if any) African Americans had enough formal education to be able to succeed in a university setting.
Both enslaved and free African Americans had very limited access medical care, since most white physicians preferred not to treat African Americans. On the whole, African Americans lived in conditions of poverty and squalor, and their mortality rates, as well as their susceptibility to communicable diseases, were high. Because they had little ability to obtain traditional medical care, folk remedies were prevalent in African American communities.
African Americans were considered inferior in every way to whites, and were consistently treated as such in many parts of the United States, particularly before the advent of the Civil Rights Movement in the mid-twentieth century. A significant body of historical data indicates that African Americans were used as uninformed subjects in medical and experimental scientific research, and that their bodies were often used as dissection cadavers after death. The Emancipation Proclamation, followed by the conclusion of the Civil War, guaranteed some rudimentary rights to African Americans, but did nothing to prohibit segregation and institutionalized racism.
James Derham was the first African American to be trained as a physician, using the apprenticeship model. He was born a slave in Philadelphia, Pennsylvania, in 1757 and was owned by a series of physicians, whose work he was permitted to observe. After working to save enough money to purchase his freedom, Derham opened an independent medical practice.
James McCune Smith was the first African American to graduate from a medical school. He completed his medical degree at Scotland's University of Glasgow in 1837. He returned to America after completing his education and opened a medical practice. He was well-known, not only for his medical acumen, but for his work as a writer and an outspoken abolitionist. He also owned two pharmacies during the course of his medical career.
The first African American to graduate from a U.S. university-affiliated medical school was David Jones Peck, who graduated from Rush Medical College in 1847. Prior to gaining entrance to medical school, Peck apprenticed and studied under Dr. Joseph Gazzam—a white physician who was opposed to slavery. He practiced medicine in the United States for a brief time before moving to Central America.
During the last half of the nineteenth century and into the beginning of the twentieth century, there was a brief proliferation of medical schools for African Americans. By the end of the first quarter of the twentieth century, two remained (and they are still in existence): Meharry Medical College in Nashville, Tennessee, and Howard University School of Medicine in Washington, D.C. A third, Morehouse School of Medicine in Atlanta, Georgia, opened in 1975. The following speech was delivered at the graduation of the Meharry Medical College class of 1878.
Gentlemen of the Class of 1878:
I congratulate you tonight, first, because you are recognized as men. You were born slaves, the recognized property of others…. Tonight you are on your own; no fetters bind your limbs, no human manacles your intellect, no earthly master has the keeping of your conscience…. I hail you as men.
Your position here tonight is the trumpet voice of encouragement to the poor young men who have a desire to secure a thorough education. Your example tells them that they need not wait for others if they will use the powers God has given….
Your school days are about to end, but not your student life…. Know what is in your books; as soon as possible, get the best and dated works on medicine; read the best medical journals you can find. Be married to your books and dare allow to think for yourselves. Study your patients, notice carefully the various forms of disease, the effects of every prescription, the surroundings of the sick…. Remember that internal remedies will not remove dirt on the skin, or tonics overcome the destructive influences of bad ventilation, dampness, and filthiness. Get your mind filled with the idea of healthy surroundings for your patients, and labor to secure everywhere observance of the laws that will prevent disease as well as heal the sick….
You cannot go to Africa as a people, and it is doubtful if that would be best. Your home is here, and you are no carpetbagger. Generations in the future will find your people here. Cultivate for these generations the friendliest relations with your professional brethren; and others of the Anglo-Saxon race, and by your diligence in study, modesty in deportment, fidelity, and kindness to your patients, and your earnest efforts to promote the highest welfare of your people, demand the respect of the entire community….
Prior to publication of the Flexner Report in 1910, there were three distinct forms of medical education: the apprenticeship, the proprietary school, and the university-affiliated medical school. The American Medical Association sought to standardize educational programs and shift to a solely university-affiliated model. This plan met with limited success until the research that became the Flexner Report was undertaken. At the start of the twentieth century, there were nearly 150 medical schools in the United States. At the end of the medical school reform movement, ninety-five remained, two of which were the aforementioned African American medical schools.
African American physicians faced a number of challenges. White hospitals were not typically open to them as training institutions, nor as work places. In addition, white patients did not wish to be treated by African American doctors. Most white hospitals did not admit African American patients—although some hospitals did have segregated colored wards. The rare African American patients in white-run hospitals could not be treated by African American physicians. Eventually, this system led to the development of hospitals owned and administered by African Americans. The first large-scale hospital dedicated to the provision of medical care for African Americans was the Freedman's Hospital in Washington, D.C. It was designed to offer care to freed slaves. The facility still exists and is now called Howard University Hospital. Provident Hospital, the first medical facility owned and managed by African Americans, was opened by a physician named Daniel Hale Williams in 1891 in Chicago, Illinois. It was also a nurse's training school.
By the middle of the twentieth century, there were nearly 125 hospitals across the United States dedicated specifically to the provision of medical care for African Americans. However, less than one-fifth of those hospitals were fully approved by the American College of Surgeons. By the start of the twenty-first century, only three African American hospitals remained open: Howard University Hospital in Washington, D.C., Norfolk Community Hospital in Norfolk, Virginia, and Riverside General Hospital in Houston, Texas.
The 1960s and early 1970s witnessed another significant change in American medical education, but this shift was initiated by the student populations themselves. The country was awash with student activism and protests throughout most of the 1960s. By the end of the decade, some of those activists entered medical school, and the student mindset shifted (however briefly) away from quiet conservatism to more vocal activism and liberalism. Students made their feelings publicly known on a variety of political issues. They protested the lack of resources available in local economically disadvantaged communities, as well as to traditionally underserved groups. In addition, they organized to promote reform of admissions and academic policies that were discriminatory toward women and racial minorities (particularly African Americans and Hispanic Americans), who were statistically under-represented in the medical student populations.
After World War II, more students than ever before entered medical school. However, the increased student population did not reflect the demographics of the American population, particularly in terms of the numbers of racial and ethnic minorities and women gaining admission. For African Americans, the statistics were particularly discouraging—although roughly 10 percent of the U.S. population identified as African American, less than 3 percent of students entering medical school were African American. Of those that matriculated, many were unable to obtain residencies, fellowships, hospital staff positions, or faculty appointments upon graduation from medical schools that were not predominantly African American (and affiliated with African American hospitals). Several medical schools, particularly those in the southern or south-eastern United States, remained segregated until the end of the 1960s when they were legally required to change their policies.
In response to both student activism and growing political pressure to eliminate racism in medical schools, the Association of American Medical Colleges (AAMC) created an Office of Minority Affairs in 1969, and organized a task force to address the issue of under-representation of minorities in medicine the following year. The task force stated that the percentage of minority group members practicing as physicians should approximate their percentages in the overall population. As a result, American medical schools were charged with the responsibility of increasing their minority student admissions from less than 3 percent in 1970 to 12 percent by 1976.
Affirmative action programs were created at nearly all post-secondary institutions, beginning in the late 1960s. Affirmative action ensured not only a more favorable admissions process for minority students, but it afforded ongoing support and enrichment programs throughout the educational process. Students in the affirmative action programs might be offered supplementary or remedial tutoring programs, ongoing academic counseling, longer academic terms and summer programs, peer support groups, and a variety of supportive and supplemental activities, all aimed at increasing the likelihood of academic success and eventual graduation or program completion.
Financial aid was a central part of the most successful affirmative action programs; scholarship funds were increased considerably through funding from several major philanthropic and grant foundations. The National Medical Foundation, which was at that time the primary source for minority student private scholarships, increased from $195,000 in 1968 to $2,280,000 in 1974.
Another paradox was created as a result of affirmative action programs. The better funded schools were able to offer highly competitive financial aid and funding packages to the top African American scholars, and were, therefore, able to outcompete the smaller, less richly funded, traditionally African American schools. As a result, African American and smaller medical schools had a very difficult time attracting a sufficient number of appropriately qualified students. These schools either left places unfilled or were forced to admit less qualified students in order to meet admissions percentages (smaller, racially diverse schools) or to stay financially solvent (traditionally African American schools).
Uneven admission standards presented another conundrum. Less qualified students were admitted to medical schools whose graduation standards had not been relaxed to match their entrance standards. As a result, students were admitted who had very low probability of either academic success or probable program completion and graduation. In an effort to increase the likelihood of academic success, some medical schools provided significant academic support, intensive tutoring, course repetition as needed, or allowed students to spread coursework out over a longer time period (six years rather than four, for example). Although a significant proportion of minority students or students from disadvantaged academic or socioeconomic backgrounds required academic assistance or support during the first half of medical school, they were found to be essentially on par with their peers during the clinical years.
African American hospitals were hit very hard by the effects of affirmative action. Although African American students had difficulty obtaining internships and residencies in prior decades, this was much less likely to occur after the inception of affirmative action. As a result, many African American physicians were able to secure positions at larger (integrated) and better funded teaching hospitals, leaving positions unfilled at African American hospitals. As a consequence of affirmative action, many African American hospitals were forced to close due to insufficient staffing and financial resources.
By the end of the first phase of affirmative action in 1974, minority student enrollments had increased to approximately 10 percent. Overall, the greatest increases were shown by Native Americans, students from the mainland of Puerto Rico, and Mexican Americans. The percentage of African American students rose from just under 3 percent to roughly 7.5 percent. Over the next decade, these enrollment percentages remained relatively static, while the minority percentages in the overall American population rose significantly. In effect, by remaining stable, the minority enrollment percentages dropped significantly (because they did not keep up with changes in the larger population). Because the enrichment and affirmative action programs took place at and above the post-secondary school, and no nationwide programs were created to increase the overall quality of academic instruction and preparation at the lower levels (elementary, middle school, and high school), the qualified applicant pool effectively shrank or, at least, failed to grow.
In recognition of the continuing difficulty in obtaining qualified applicants from all sectors of the American population, the AAMC created a program entitled "Project 3000 in 2000," in 1990. The centerpiece of the program was the development of partnerships between medical schools and elementary, middle, and high schools, as well as colleges, in their local communities. It was hoped that this program would lead to global improvement in the quality of education delivered, resulting in an enlarged pool of well qualified minority applicants. Although some viable and ongoing partnerships were created, the program fell far short of its stated goal—having 3,000 minority students enrolled in American medical schools in the year 2000. In 2000, although minority group members comprised more than 21 percent of the overall population, the enrolled medical student population included less than eleven percent minority students.
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