Clinical Medicine in Harlem
When Blacks began to settle in Harlem in the early 1900s, they found a newly constructed, well staffed municipal hospital capable of providing up-to-date clinical treatment. That hospital, however, declined to welcome the new arrivals and remained insensitive to their needs and concerns. Only the sustained efforts of a black community growing in pride and political consciousness forced Harlem Hospital and its staff over time to provide equal opportunity for black medical professionals and to reorient itself to the needs of its black constituency.
The Growth of Harlem Hospital
The first Harlem Hospital, a twenty bed municipal institution, opened at the junction of 120th Street and the East River in 1887. By 1903, construction had begun on a new Harlem Hospital on the east side of Lenox Avenue between 136th and 137th streets. The new facilities resulted from a rapid increase in the area's population due mainly to a massive influx of Negro migrants from the South. In 1907 the new Harlem Hospital opened under the jurisdiction of Bellevue and Allied Hospitals, the central authority for all municipal hospitals in New York. The facility contained 150 beds, but by 1909 it was already overcrowded and extra patient beds clogged the aisles in the wards.
By 1910 the hospital was totally encircled by the growing black community and its patient load was over fifty percent black. In 1915 it increased its capacity to 390 beds, but from then until 1936 its size remained the same while its constituency grew by leaps and bounds. Over time it evolved into a first class hospital, but its growth could not keep pace with rising demand, and overcrowding provided a constant source of scandal.
The patient census at Harlem Hospital registered seventy-five percent black by 1920, yet in 1919 the staff registered one hundred percent white. "Evidence was accumulating that Negroes were often treated with indifference or scant efficiency at Harlem Hospital. Tragic incidents had come to light from time to time, revealing a pervasive racial prejudice and abuse and exploitation of the black patient. The hospital was becoming known as a place 'to go and die,' a reputation seriously affecting the psyche of a community unable to do without its ministrations. The situation had to be corrected."
Black Staff Physicians for Harlem Hospital
By 1919, Harlem had become a proud, well-knit community, conscious of its growing political power. Its leadership was determined to make Harlem Hospital respond to the needs of its constituency. Their opportunity to be heard materialized when the hospital, in dire need of medical personnel for the outpatient clinics, condescended to hire Dr. Louis T. Wright, a highly qualified black surgeon with a degree from Harvard Medical School. Though he was appointed to the lowest position in the clinic, his presence on the staff caused such an uproar that the superintendent was forced to transfer elsewhere. Outraged at the racism shown by the hospital staff, the Harlem news media and community leaders mounted a campaign to remedy the situation and to gain staff access for other black medical personnel. Almost immediately the hospital hired five more black physicians.
Over the next five years, unrelenting pressure by Dr. Wright, the North Harlem Medical Association, and the N.A.A.C.P brought change after change, until on November 23, 1925, the secretary of the Harlem Hospital medical board received official instructions that "as far as possible, all of the appointments to the house staff at the next examination should be colored men."
As Dr. Aubré Maynard relates in his autobiographical chronicle, Surgeons to the Poor, the first black physicians at Harlem Hospital faced daunting obstacles on the road to equal treatment, but a combination of stoicism and skilled political infighting carried them through until the unprecedented dissolution and reorganization of the hospital staff in 1930 resulted in an irrevocable policy of genuine racial integration.
A School of Nursing for Harlem Hospital
At the same time that black physicians were fighting for equal opportunity at Harlem Hospital, black women engaged in a struggle for access to the nursing profession. Until 1923, the only school in New York accepting black women for nurse training was the Lincoln Hospital School for Nurses in the Bronx, and as private school, it proved too costly for most. An alternative school was vitally needed.
The establishment of the Harlem Hospital School of Nursing in 1923 represented a triumph by and for Harlem's black community. Though many civic leaders played a role in its creation, primary credit belongs to Mr. William Vassalls and his daughter, Lurline Vassals DeShields. When Lurline was denied access to the Bellevue Hospital School of Nursing because of her color, they spearheaded the drive for a school of equal quality at Harlem Hospital for black women. The first class of twenty students graduated in 1925, and all passed the New York State Board examination, qualifying as registered, licensed nurses.
After the school was established, the hospital's white nursing staff was gradually phased out. As soon as the black students proved capable, they assumed patient care responsibilities as part of a work/study routine, and after graduation many returned to Harlem Hospital because they could find employment in only four municipal hospitals, Lincoln and Harlem and two special hospitals for tuberculosis patients.
For the Harlem community, the discriminatory hiring practices of New York's hospitals proved a blessing in disguise because the Harlem Hospital School of Nursing graduates represented a valuable community health resource. Within the hospital, they provided the backbone of a competent nursing staff and a reassuring presence for community clients who might otherwise have been intimidated by the institution. They understood their patients' values and traditions, health habits and home environments, so they could respond to their needs with sensitivity. Many of the graduates found a vocation in public health nursing within the Harlem community, and their prior experience at the hospital gave them a unique ability to record, interpret, and implement homegoing instructions for discharged patients. They linked the medical establishment and the community as no others could.
Private Patient Alternatives
While Dr. Wright and other pioneering black physicians worked from within Harlem Hospital to gain broader access for black health care professionals, other black physicians, notably the members of the North Harlem Medical Association, established alternative community based treatment facilities and health care consortiums. These arrangements allowed them to perform surgery and to care for their private patients in a clinical setting at a time when they were denied access to staff positions in voluntary hospitals or privileges at the large, well equipped private hospitals. Community practitioners who had no such arrangements sometimes continued home or office treatment of patients whose condition warranted immediate hospitalization, either because the doctor wanted to retain control of the case or because the patient did not want to be treated by strangers.
Those community members who could afford private-patient status understandably preferred the intimacy of small sanitoria or private clinics and the convenience of house calls to the overcrowded and impersonal setting of Harlem Hospital. They were well served by the Edgecombe Sanitarium, built by Dr. Wiley Wilson with the proceeds of his divorce from cosmetics heiress A'Lelia Walker, the Vincent, creation of brilliant urological surgeon Dr. U. Conrad Vincent, Mount Morris hospital, established by a consortium of black West Indian physicians in a huge mansion facing Mount Morris park, and a few smaller institutions of limited duration. A wealthy black patient could also arrange to be hospitalized in a white institution, with a white physician in attendance, though he might not be accorded the same level of treatment as his white counterpart. A cursory survey of the Amsterdam News from the mid-twenties reveals news of prominent Harlemites recuperating in City Hospital, Presbyterian Hospital, St. Josephs Hospital, Bellevue, and other New York facilities.
The doctors who practiced in Harlem's small private hospitals served as some of the community's finest. The busiest among them were Dr. Vincent and Dr. Godfrey Nurse, who, with the possible exception of Dr. Wright, ranks as the Harlem community's most revered medical professional.
Past and Future
Over the past eighty years the Harlem community has been blessed with a succession of fine black physicians and nurses operating both within and outside of the Harlem Hospital complex. It has not been blessed with equally fine public hospital facilities. Harlem Hospital for most of its history has been the financial and political stepchild of New York's municipal hospital system, forced to make do with an overcrowded and poorly laid out physical plant. A series of five weekly "exposes" written by James L. Hicks and published in successive issues of the July 1956 Amsterdam News bemoans the lack of decent facilities at the Hospital while praising the staff that works wonders in spite of it all. He asks, "what could they do if they really had some equipment to work with?" Sadly, the April 15, 1998 Village Voice tells of sizable staff cuts announced for the hospital and rumors of its possible closing.
Despite major obstacles, Harlem's black medical professionals have served their community admirably. Theirs is not the only approach to health care, however; traditional folk medical practices have stood the test of time for many in the community, and sensitive intermediary agents must continue to negotiate the balance between the two.