Clinical Medicine in the Low Country

The White Establishment

At the end of the nineteenth century, black residents of the Charleston area received only limited access to the benefits of established clinical medicine. The city of Charleston provided medical service to blacks only if they lived within the city limits, and that service was provided by a uniformly white staff that treated them with indifference, if not outright hostility. According to a 1905 document, "only those (black residents) too poor entirely to escape, go to the city hospital owing to the nature of the treatment they receive there. All must be in the ward; the nurses are all white; and the family physician may not practice there." In addition to inpatient treatment at City Hospital, Charleston offered treatment to the poor of both races through dispensary clinics.

In 1898, when Charleston's population was listed as 28,870 whites and 36,295 blacks, City Hospital treated 643 white and 889 black patients. Nine percent of the white patients and nineteen percent of the black patients died. In the same year, dispensary physicians treated 6,096 whites and 22,464 blacks. The death rate for black dispensary patients was four times higher than for white. The provider of these figures commented, "We see from these figures that hospital and dispensary treatment are as usual much more fatal to colored than to white patients."

While maltreatment undoubtedly contributed to the higher fatality rates cited, other factors played a part as well. Faith in traditional folk medicine and habitual self-reliance, combined with marginalization due to race and economic factors, often caused members of the black community to seek treatment by the "white establishment" only as a last resort, when their condition was already terminal. Unhealthy living conditions within the home and failure to understand, trust, and follow the regimen prescribed by the white dispensary physicians also contributed to the patients' lack of recovery. Mental and spiritual belief in the power of a healing regimen are critical to that regimen's success.

Black Physicians

Within the city of Charleston there were only seven practicing black physicians. They were graduates of black medical schools and included a woman, a dentist, and one, the legendary Alonzo C. McClennan, who was also a degreed pharmacist. Before 1896, when six of the seven succeeded in founding the Hospital and Training School for Nurses, these physicians, loved and respected by the black community, provided all treatment, even surgery, either in their offices or in their patients' own homes because they were not permitted to perform surgery in the City Hospital or even to attend patients there. These same seven physicians were the only source of clinical medical treatment for area blacks who lived outside Charleston's city limits.

From its inception in 1896, the Hospital and Training School for Nurses provided for the black community what the city of Charleston would not--competent and compassionate treatment rendered in a comfortable, supportive environment. Highly visible within the community, especially Dr. William H. Johnson, the staff physicians and their families provided leadership in both civic and religious organizations, and two McClennans and three McFalls made service at the hospital a family tradition. The Hospital's six founding physicians attended at the Hospital not only their private patients but also a large number of the community's indigent members and all sick or injured people, black or white, brought in from the countryside beyond Charleston's city limits where they had no doctors. Despite their large case loads, they also served, without charge, as the faculty of the Training School.

ãA Modern Hospitalä

The facilities of The Hospital and Training School for Nurses, located in a handsome three-story brick house built in 1800, were modest but satisfactory. It boasted room for twenty-four patient beds (some in private rooms), nurses' quarters, an operating room, a dining hall, a reception room, and an office. The rooms were high ceilinged, well lighted, and immaculate. In addition to the brick hospital building, the generously sized property at 135 Cannon Street contained a frame annex used as a lying-in ward, a laundry, and a barn that housed an ambulance and the horse that drew it.

Because the Hospital received no financial aid from the city, it depended entirely on charitable contributions and the small fees paid by nursing students and patients. Its financial state was always precarious. The lack of adequate funds was evident in the scarcity of medical equipment. In 1905, their operating room had no sterilizers, and all the surgical instruments on hand were the private property of Dr. McClennan. Yet, to the black community of Charleston, the Hospital was a source of great pride--the product of their generosity and leadership--and, at that time, the model of a modern hospital.

A School of Nursing

Because space in the Hospital was limited, the training school for nurses accommodated only ten students. It required applicants to be between the ages of twenty and forty, to possess a good "common school" education, and to be certified mentally, morally and physically sound. Additionally, in the opinion of faculty member Dr. Lucy H. Brown, "clean hands, well-kept nails, carefully brushed hair, sweet breath, gentle voice, are some of the essentials of good nursing." The students' role model was Anna DeCosta Banks, R.N., who served the Hospital from 1898 to 1930, and their course of study lasted two years. Graduates of the school were well regarded in Charleston and beyond. A number found employment with white physicians and one, who attended the mayor of Rock Hill, South Carolina, received in reward a position as the only black nurse in that town's city hospital.

Service in the Community

Until its closing in 1930, the training school provided an invaluable service to the hospital and the community beyond. In addition to providing free staffing to the hospital as students, the nurses served as good will ambassadors and educators when they took their place in the community. Through them knowledge of good nutrition, hygiene, and the positive accomplishments of clinical medicine passed to their clients, neighbors and families, and by giving clinical medicine a friendly and familiar face they helped to dispel the fears that kept many community members from seeking medical help.

Constantly plagued by lack of funds, the Hospital and Training School for Nurses continued to serve Charleston's black community until 1959. In the last decades of its existence it operated in violation of numerous fire and health codes, but because it was Charleston's only "Negro hospital", the city granted it exceptions. From the mid-forties on, Medical Director Thomas Carr McFall, MD, campaigned tirelessly to acquire new funding for the hospital and for the possible return of a school of nursing. He argued that the black community was best served from within, with concern for "the racial affiliation of the physician, the nurse, and the patient,...for where they are all of the same race, there will be a more intimate knowledge of the patient, his living conditions, his activities, his field of contacts, and his possibility of spreading communicable disease, all of which may be reflected in the health status of the community."

As racial segregation was then a fact of life in Charleston, his argument bore fruit, and in 1959 the hospital at 135 Cannon Street was replaced by the new McClennan Banks Memorial Hospital, named for Alonzo C. McClennan and Anna DeCosta Banks. The medical pioneers of the black community at last received the honor owed them by the city of Charleston.